Box 1 Summary of the PartoMa intervention at Mnazi Mmoja Hospital, Zanzibar

The PartoMa Project was initiated at Zanzibar’s tertiary hospital, Tanzania in January 2015. Its objective was to improve quality of care and perinatal outcomes. Skilled birth attendants were involved in focus groups discussions, adapting international labour management guidelines to better suit their local situation and participation in trainings. Prior to the PartoMa intervention, the stillbirth rate was 59 per 1000 total births (52% had positive foetal heart rate on admission) and the rate of Apgar score of ≤5 was 52 per 1000 live births.

At the 12th intervention month, stillbirth rate had decreased to 39 per 1000 total births (relative risk 0.66, 95% CI 0.53–0.82; intra-hospital singleton stillbirths reduced from 28 to 15 per 1000 total births) and Apgar score ≤ 5 fell to 28 per 1000 live births (relative risk 0.53, 95% CI 0.41–0.69). This was associated with improved quality of care, including improved foetal heart rate surveillance (a reduction in median time interval from last FHR to delivery from 120 (IQR 60–240) to 74 (IQR 30–130) minutes), more judicial use of oxytocin and improved management of women with severe hypertensive disorders.