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Sao SS, Kisigo GA, Osaki H, Coleman JN, Renju J, Mwamba RN, Ngocho JS, Mmbaga BT, Watt MH. Understanding male involvement in antenatal care in the Kilimanjaro region of Tanzania: Barriers, facilitators, and opportunities for engagement. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 39:100931. [PMID: 38039661 PMCID: PMC11129671 DOI: 10.1016/j.srhc.2023.100931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 11/07/2023] [Accepted: 11/23/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Male engagement in antenatal care (ANC) has been recommended by the World Health Organization to improve maternal and newborn health outcomes, but implementation challenges remain. This study explored barriers, facilitators, and opportunities to improve male attendance and engagement in ANC. METHODS In-depth interviews were conducted individually with pregnant women and male partners attending a first ANC visit at two public health facilities in Moshi, Tanzania. Interviews examined factors influencing male ANC attendance and male experiences during the clinic visit. Interviews were recorded, transcribed verbatim, and translated from Swahili into English. Transcripts were coded thematically in NVivo. MAIN FINDINGS Constructions of masculinity both positively and negatively influenced male involvement in ANC. Individual-level barriers included a fear of HIV testing, perceptions of pregnancy as the woman's responsibility, and discomfort with ANC as a predominantly female space. Structural barriers included inability to take time off from work and long clinic wait times. The primary facilitator to male involvement was the preferential care given in the ANC clinic to women who present with a male partner. Additionally, some men desired to learn about their family's health status and felt that attending ANC was a sign of respect and love for their partner. CONCLUSIONS Opportunities exist to improve male involvement in ANC, namely training providers to engage men beyond HIV testing and counseling. Peer programs that promote men's engagement in pregnancy could prove useful to reduce apprehension around HIV testing and dispel conceptions of ANC as only a women's healthcare space.
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Affiliation(s)
- Saumya S Sao
- Duke Global Health Institute, Duke University, Durham, NC, USA; Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
| | - Godfrey A Kisigo
- Duke Global Health Institute, Duke University, Durham, NC, USA; Kilimanjaro Clinical Research Institute, Moshi, Tanzania; London School of Hygiene and Tropical Medicine, London, UK; Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
| | - Haika Osaki
- University of Copenhagen, Copenhagen, Denmark; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
| | - Jessica N Coleman
- Duke Global Health Institute, Duke University, Durham, NC, USA; Duke Psychology and Neuroscience, Duke University, Durham, NC, USA; Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
| | - Jenny Renju
- London School of Hygiene and Tropical Medicine, London, UK; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
| | - Rimel N Mwamba
- Duke Global Health Institute, Duke University, Durham, NC, USA; University of Chicago Pritzker School of Medicine, Chicago, IL, USA; Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - James S Ngocho
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA; Kilimanjaro Christian Medical University College, Moshi, Tanzania.
| | - Blandina T Mmbaga
- Duke Global Health Institute, Duke University, Durham, NC, USA; Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA; Kilimanjaro Christian Medical University College, Moshi, Tanzania.
| | - Melissa H Watt
- Duke Global Health Institute, Duke University, Durham, NC, USA; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
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Mwita S, Mgaya E, Haule A. Awareness of the rational use of medicines and the medication counseling practice in community pharmacies in Nyamagana district, Mwanza: A cross-sectional study. THE JOURNAL OF MEDICINE ACCESS 2024; 8:27550834241261852. [PMID: 38887665 PMCID: PMC11181881 DOI: 10.1177/27550834241261852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 05/27/2024] [Indexed: 06/20/2024]
Abstract
Background Community pharmacies play a vital role in promoting the rational use of medicines by providing medication counseling to their clients to ensure the safe and appropriate use of medicines. Thus, this study aimed to assess awareness of the rational use of medicines and the medication counseling practice in community pharmacies. Methods A descriptive cross-sectional study was conducted from June to July 2021. The study was carried out in community pharmacies in Nyamagana district, Mwanza, Tanzania. Data were collected using a self-administered, semi-structured questionnaire. The data for descriptive statistics were entered in Microsoft Excel and analyzed using STATA version 15. Results A total of 68 pharmaceutical personnel participated in this study. Thirty-eight participants, that is, 55.9%, were aware of the rational use of medicines. The awareness was significantly influenced by the participant's age and profession. The majority of the dispensers practiced rational use of medicines by telling their clients the dose of the medicine (n = 63, 92.6%), frequency of administration (n = 61, 89.7%), and route of administration (n = 60, 88.2%). However, only 21 (30.9%) told clients about the need to comply with their medications. The information that was not regularly provided by dispensers to clients was the side effects of medicines (n = 6, 8.8%). Less than a quarter of participants frequently told their clients information regarding why the medicine is prescribed, drug interactions, storage conditions, and contraindications. Conclusion This study has shown that almost half of the participants were aware of the rational use of medicines. There was a low frequency at which information was given regarding medication compliance, side effects, storage conditions, drug interactions, and contraindications. These findings underscore the need for targeted interventions to enhance pharmaceutical personnel's understanding of rational use of medicine principles and improve their practice of patient medication counseling.
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Affiliation(s)
- Stanley Mwita
- Department of Pharmaceutics and Pharmacy Practice, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Ezra Mgaya
- Department of Pharmaceutics and Pharmacy Practice, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Ambrose Haule
- Department of Medicinal Chemistry and Pharmacognosy, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
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Tesha J, Fabian A, Mkuwa S, Misungwi G, Ngalesoni F. The role of gender inequities in women's access to reproductive health services: a population-level study of Simiyu Region Tanzania. BMC Public Health 2023; 23:1111. [PMID: 37296416 PMCID: PMC10251643 DOI: 10.1186/s12889-023-15839-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/06/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Amref Health Africa, with support from Global Affairs Canada, examines if women's access to reproductive health services in Tanzania is affected by Gender social norms, decision-making power, roles and responsibility, and access to resources in relation to the utilization of reproductive Health Services in Tanzania. A Gender Need Assessment (GNA) was conducted in five districts in ' 'Tanzania Simiyu Region to improve the infrastructure, supply, quality, and demand for integrated Reproductive, Maternal, Newborn, and Child and Adolescent Health (RMNCAH), Nutrition, and Water, Sanitation, and Hygiene (WASH) services. The analysis identifies gender as a fundamental maternal and child health driver through existing gender inequality at the household and community levels that dictates women's status. METHODS The qualitative assessment involved data collected from gender- and age-desegregated focus group discussions (FGDs) and in-depth interviews (IDIs) of key informants in three districts; Bariadi, Busega, and Meatu, in Simiyu region, Tanzania. Participants comprised 8-10 married women and men, unmarried women and men, and adolescent boys and girls. A total of 129 participants were involved in the FGDs. RESULTS This paper reports the critical drivers influencing gender inequality in Simiyu by detailing how Gender inequality affected women's access to reproductive health care in relation to; gender social norms, decision-making power, access to resources at the household and community level, roles and responsibilities, including men's and 'boys' roles are more valued than the roles and responsibilities of women and girls resulted to limited free time to do things for themselves, such as visiting the health facilities for RMNCAH. CONCLUSIONS This paper explored gender-based enablers and/or barriers influencing women and girls' realization of their sexual and reproductive health and rights. It was found that social norms, decision-making powers, and lack of access to and control over resources presented as key barriers. In contrast, continuous community sensitization and increased scope of women's participation in decision-making served as enabling environment to overcome gender inequities that influence woman's use of RMNCAH services in Tanzania. Such insights will shape interventions geared towards valuing differences in a manner that overcome gender inequities that influence woman's use of RMNCAH services in Tanzania.
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Affiliation(s)
- Jane Tesha
- Amref Health Africa, Tanzania. Ali Hassan Mwinyi Road Plot 1019 P O, Box 2773, Dar es Salaam, Tanzania
| | - Agatha Fabian
- Department of Public Health, College of Health Sciences, Dodoma University, P.O.Box 395, Dodoma, Tanzania
| | - Serafina Mkuwa
- Amref Health Africa, Tanzania. Ali Hassan Mwinyi Road Plot 1019 P O, Box 2773, Dar es Salaam, Tanzania
| | - Gaspery Misungwi
- Amref Health Africa, Tanzania. Ali Hassan Mwinyi Road Plot 1019 P O, Box 2773, Dar es Salaam, Tanzania
| | - Frida Ngalesoni
- Amref Health Africa, Tanzania. Ali Hassan Mwinyi Road Plot 1019 P O, Box 2773, Dar es Salaam, Tanzania
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Nkya S, Njiro BJ, Ngowi D, Solomon D, Kaywanger F, Nyangasa S, Ndoje G, Marco E, Moses M, Makani J. Building research capacity for sickle cell disease in Africa: Lessons and challenges from establishing a birth cohort in Tanzania. Front Pediatr 2022; 10:826199. [PMID: 36160767 PMCID: PMC9500343 DOI: 10.3389/fped.2022.826199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Sickle Cell Disease (SCD) is a known public health burden in sub-Saharan Africa (SSA). The manifestation of SCD starts in early childhood and if not well-managed may lead to early death (before the age of 5 years). Understanding the underlying mechanisms that influence early SCD manifestation is of great importance for early disease and intervention management which will in turn, reduce both morbidity and mortality rates in children. One approach of achieving this is by establishing SCD birth cohorts that can be followed for a period of time (3-5 years) whilst documenting necessary information related to early childhood illnesses. To date, there are few SCD birth cohorts in Africa. To address this gap, we have established a birth cohort of babies with and without SCD (with sickle cell trait and healthy babies). These babies are followed up for 3 years with their study visits synchronized to the immunization schedule. During enrollment and follow-up visits, information on demographic, clinical, and laboratory parameters are collected. To date, we have enrolled a total of 341 babies with and without SCD. Out of these, a total of 311, 186, 133, 81, 44, and 16 babies have returned for their 1st, 2nd, 3rd, 4th, 5th, and 6th visits, respectively. We have collected both demographic and clinical information for these babies at enrollment and during follow-up. We have also utilized this platform to learn on the best approaches of establishing and maintaining a research birth cohort in an African context. We have analyzed the practical issues pertaining to the integration of the birth cohort with the immunization platform which seems to be the most effective and sustainable strategy for maintaining a birth cohort in our context.
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Affiliation(s)
- Siana Nkya
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Biological Sciences, Dar es Salaam University College of Education, Dar es Salaam, Tanzania
- Tanzania Human Genetics Organization, Dar es Salaam, Tanzania
| | - Belinda J. Njiro
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Doreen Ngowi
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - David Solomon
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Frida Kaywanger
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Salama Nyangasa
- Biological Sciences, Dar es Salaam University College of Education, Dar es Salaam, Tanzania
| | - Godfrey Ndoje
- Biological Sciences, Dar es Salaam University College of Education, Dar es Salaam, Tanzania
| | - Emmanuela Marco
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mazoea Moses
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Julie Makani
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Mapunda B, August F, Mwakawanga D, Mhando I, Mgaya A. Prevalence and barriers to male involvement in antenatal care in Dar es Salaam, Tanzania: A facility-based mixed-methods study. PLoS One 2022; 17:e0273316. [PMID: 35984819 PMCID: PMC9390926 DOI: 10.1371/journal.pone.0273316] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 08/06/2022] [Indexed: 12/03/2022] Open
Abstract
Background Men have traditionally not been fully involved in reproductive health care of their partners, and yet, they play a crucial role in family decision-making and therefore crucial key players in preventing poor pregnancy outcomes. This study aimed to assess prevalence and determinants of male participation in maternal health care and explore male partners’ perspective of their involvement in antenatal care at an urban tertiary referral facility. Methods A mixed-methods study was conducted from October 2018 to January 2019 at Muhimbili National Hospital. A cross-sectional survey of 428 nursing mothers and two focus group discussions of male partners (n = 7 and n = 11) of women attending antenatal clinic and nursing mothers in the post-natal ward were performed. Using SPSS Ver. 23 (IBM, Chicago, IL), frequency distribution tables summarized demographic data and categories of male partners’ involvement in antenatal care. Focus group discussions included male partners of age from 24 to 55 years at their first to fifth experience of pregnancy and childbirth. Interviews were audio-recorded, and then transcribed and coded. Thematic analysis was applied. Results The prevalence of male involvement in antenatal care was 69%. More than two-thirds of nursing mothers received physical, psychological and financial support from partners (76%) and attended four or more antenatal visits (85%). Five themes of male perspective of their involvement in antenatal care were generated, including: a) cultural norms and gender roles, b) ignorance of reproductive health service, c) factors outside their control, d) couple interaction and conflicts, and e) institutional obstacles. Conclusion The prevalence of male partners’ involvement in antenatal care was relatively high. Men’s involvement in antenatal care depended on access to antenatal care education, standards of structure and process of antenatal service and how well their role was defined in the maternal health care system. Interactions and practice in society, employment sector and government health system should complement strategies to promote men’s involvement in maternal health.
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Affiliation(s)
- Bosco Mapunda
- Department of Obstetrics and Gynaecology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Furaha August
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Dorkas Mwakawanga
- Department of Nursing and Midwifery, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Isaya Mhando
- Department of Obstetrics and Gynaecology, St. Joseph College of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Andrew Mgaya
- Department of Obstetrics and Gynaecology, Muhimbili National Hospital, Dar es Salaam, Tanzania
- Department of Women’s and Children’s Health/International Maternal and Reproductive Health and Migration, Uppsala University, Uppsala, Sweden
- * E-mail:
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Shiferaw K, Mengistie B, Gobena T, Dheresa M, Seme A. Extent of Received Antenatal Care Components in Ethiopia: A Community-Based Panel Study. Int J Womens Health 2021; 13:803-813. [PMID: 34526826 PMCID: PMC8435480 DOI: 10.2147/ijwh.s327750] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/30/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study aimed to identify the extent of antenatal care content received and associated factors among Ethiopian women. METHODS A nationally representative Performance Monitoring for Action 2020 Ethiopian data were used. A multistage cluster sampling design was used to select 2855 pregnant or recently postpartum women nested within 217 enumeration areas. Female resident enumerators collected the data using a semi-structured questionnaire. Researchers dichotomized the number of ANC content received greater than or equal to 75 percentiles as adequate. Otherwise, it was considered inadequate. A multilevel Poisson regression was fitted. The result was reported using an incidence rate ratio with a 95% confidence interval and a p-value less than 0.05 was considered for statistical significance. RESULTS The study revealed more than a quarter of pregnant women received adequate ANC content (27.8%; 95% CI: 23.8%, 32.2%). Multivariable analysis revealed urban residence (IRR = 1.09, 95% CI: 1.01, 1.21), attending secondary and above formal education (IRR = 1.08, 95% CI: 1.01, 1.16), maternal age 20-24 years (IRR = 1.10, 95% CI: 1.02, 1.19), and partner's encouragement to attend clinic for antenatal care (IRR = 1.14, 95% CI: 1.05, 1.24) was significantly associated with receiving higher numbers of antenatal care content. CONCLUSION The proportion of women who received adequate antenatal care content in Ethiopia was low. Despite Ethiopia's effort to improve maternal health services utilization, disparities among regions and between rural and urban exist. This study highlights the importance of ensuring high received antenatal care content, which is crucial for reducing pregnancy-related morbidity and mortality. This implies prompt intersectoral collaboration to promote female education, target older aged women, and rural resident women, encourage partner involvements during the antenatal care process, minimize regional variation, and strengthen the implementation of received ANC content policies and programs with the active participation of the stakeholders are priority issues.
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Affiliation(s)
- Kasiye Shiferaw
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bezatu Mengistie
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tesfaye Gobena
- Department of Environmental Health Science, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Assefa Seme
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Namatovu HK, Oyana TJ, Sol HG. Barriers to eHealth adoption in routine antenatal care practices: Perspectives of expectant mothers in Uganda - A qualitative study using the unified theory of acceptance and use of technology model. Digit Health 2021; 7:20552076211064406. [PMID: 34900326 PMCID: PMC8664308 DOI: 10.1177/20552076211064406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Current empirical evidence suggests that successful adoption of eHealth systems improves maternal health outcomes, yet there are still existing gaps in adopting such systems in Uganda. Service delivery in maternal health is operating in a spectrum of inadequacy, hence eHealth adoption cannot ensue. This study set out to explore the challenges that impede eHealth adoption in women's routine antenatal care practices in Uganda. A qualitative approach using semi-structured interviews was employed to document challenges. These challenges were classified based on a unified theory of acceptance and use of technology constructs. One hundred and fifteen expectant mothers, aged between 18 and 49 years, who spoke either English or Luganda were included in the study that took place between January to May 2019. Thematic analysis using template analysis was adopted to analyse qualitative responses. Challenges were categorised based on five principal unified theories of acceptance and use of technology constructs namely: performance expectancy, effort expectancy, social influence, facilitating conditions and behavioural intention. Facilitating conditions had more influence on technology acceptance and adoption than the other four constructs. Specifically, the lack of training prior to using the system, technical support, computers and smart phones had a downhill effect on adoption. Subsequently, the cost of data services, internet intermittency, and the lack of systems that bridge the gap between mothers and health providers further hindered technology uptake. In conclusion, strategies such as co-development, training end-users, garnering support at the national and hospital levels should be advocated to improve user acceptance of technology.
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Affiliation(s)
- Hasifah Kasujja Namatovu
- Department of Information Systems, School of Computing and Informatics Technology, Makerere University Kampala, Uganda
| | - Tonny Justus Oyana
- Geospatial Data and Computational Intelligence Lab, School of Computing and Informatics Technology, Makerere University Kampala, Uganda
| | - Henk Gerard Sol
- Faculty of Economics and Business, University of Groningen, the Netherlands
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