Time of delivery and perinatal outcomes at Muhimbili national hospital Dar es salaam 2011. Tanzania.

Background: Adverse perinatal outcomes in terms of 5thminutes Agar score < 7, and perinatal death (still birth and early neonatal death) are not only related to maternal health but also are best indicators of the quality of health care services. Perinatal death is much higher in developing countries; it is 10 times higher than in developed countries. According to Millennium Development Goals progress report, December 2010, Infant mortality rate in Tanzania was estimated to be 51 per 1000 live births. In a study done in 2006 at Muhimbili National Hospital PMR was found to be 65/1000 singleton deliveries and 116/1000 multiple deliveries. Preterm birth, infection and birth asphyxia are thought to be the main causes of death in newborn babies worldwide5. Staffing also has been implicated on causes of adverse outcomes. Understanding the factors contributing to the increased perinatal mortality and morbidity is the key for reduction of adverse perinatal outcomes. At MNH there are three working shifts for nurses; the morning shift has eight hours, the evening shift has 6 hours and the night shift has 12hours. The purpose of this study was to determine the association between time of delivery (shifts) and perinatal outcomes in singleton deliveries at MNH. Methodology: This was a cross sectional study. All singletoned deliveries of gestation age > 28 weeks between 1st July 2011 to 31st October 2011, who met inclusion criteria and consented, were enrolled in the study. vii Results: During the study period there were 3193 deliveries. Five hundred and fifty seven (557) were excluded. The remaining 2636 singletoned deliveries were included in the analysis. There were 802(29.3%), 605(22.1%), and 1328 (48.6%) deliveries in the morning, evening and night shift respectively. Majority 2469(91.3%) of the deliveries were of term pregnancies. Sixty percent (59.7%) of the women had primary school education. Sixty three percent (63.4%) of mothers were admitted from home and, 35.2% were referrals. One thousand three hundred and twenty (50.0%) had spontaneous vertex delivery, 1236 (46.9%) had cesarean section, and 48(1.8%) had low cavity vacuum extraction and 32 (1.2%) had assisted breech delivery. Night time deliveries had more adverse perinatal outcomes as compared to morning and evening shifts. Ten percent (10.4%) had Apgar score less than 7 at 5minutes, 8.2% fresh stillbirth, 5.3% early neonatal death which was statistically significant difference (P-value=0.018, 0.001, and 0.026 respectively).Baseline characteristics of women, in terms of maternal education, referrals, prematurity and mode of delivery were equally distributed in all shifts. Conclusion: The night shift had significant adverse perinatal outcomes in terms of low Apgar score neonates, early neonatal death and fresh stillbirth as compared to morning and evening shifts. Recommendations; Staffing at night shift need to be improved since it is longer than other shifts and therefore it has more patients than morning and evening shifts. Shifting residents in 12hours shift instead of 24 hours shifts so as to reduce staff fatigue may improve perinatal viii outcomes. Early referrals might improve night shift outcomes. Further in-depth study is needed to be done in this aspect