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Article History

Received: 14 April 2017

Accepted: 22 April 2018

First Online: 9 May 2018

Authors’ information

: LL, MSPH, Program Officer II, Innovations, Jhpiego; CM, MPH, Monitoring and Evaluation Advisor, Jhpiego; AK, Zonal Program Manager - Zanzibar, Jhpiego Tanzania; CH, MHS, Senior Program Officer, Jhpiego; JZ, MS, Country Director, Jhpiego, Tanzania; KM, Zonal Public Health Nursing Officer, Ministry of Health Zanzibar, RN, RM, BsCN, MPH; MD, BSN, RN, MPH, Monitoring, Evaluation and Research Director, Jhpiego, Tanzania; MM, PDME, MSc, Senior Monitoring and Evaluation Officer, Jhpiego, Tanzania; MN, Monitoring, Evaluation and Learning Analyst, Jhpiego, Tanzania; SM, Director, Hospital Services, Ministry of Health, Zanzibar; YK, MSc, Senior Health Informatics Advisor, Jhpiego, Tanzania; PG, CNM, MPH, Senior Maternal and Newborn Health Technical Advisor, Jhpiego.

: The study protocol, study tools, and informed consent forms were approved by the MOH Zanzibar Medical Research and Ethics Committee (IRB00004514) and the Johns Hopkins School of Public Health Institutional Review Board (IRB00000758). Skilled birth attendants (SBAs) provided written informed consent and laboring clients provided oral informed consent to participate in the study. The study team determined that reading a consent form would be unduly burdensome for the laboring woman so oral consent was obtained from women in labor, as has been done in similar IRB approved studies. The oral informed consent script and process were approved by the Zanzibar Medical Research and Ethics Committee and the Johns Hopkins School of Public Health IRB. SBAs who obtained oral consent from laboring women were trained on how to obtain informed oral consent within the context of labor and delivery.

: The study protocol, which included details of data management to maintain confidentiality and anonymity of in-depth interviews, and informed consent forms were approved by both a US-based and the Zanzibar-based ethics committees. Quotes from in-depth interviews with SBAs were taken from anonymized, transcribed and translated audio files of the interviews. Names of skilled birth attendants (SBAs) were not asked during recording, included in digital files, nor written in the interview notes. The study team has reviewed the quotes several times to ensure that an individual participant’s identity could not be derived from the quotes, or from the context of the manuscript along with the quotes. Given these steps to protect study participants anonymity we rely on the IRB approved written informed consent forms obtained from SBAs to include these quotes.

: The authors declare that they have no competing interests.

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