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Bonaccorsi G, Milani C, Giorgetti D, Setola N, Naldi E, Manzi F, Del Riccio M, Dellisanti C, Lorini C. Impact of Built Environment and Neighborhood on Promoting Mental Health, Well-being, and Social Participation in Older People: an Umbrella Review. Ann Ig 2023; 35:213-239. [PMID: 35788248 DOI: 10.7416/ai.2022.2534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background The built environment, especially in the context of the neighborhood, affects older people's health. This umbrella review aims to summarize the associations between factors and interventions in the built environment as regards modifying or improving mental health, well-being, social inclusion and participation in the elderly. Methods We searched articles in the following databases: PubMed, Embase, Cochrane Library, Scopus, Avery Index, Sage, Web of Science, Health Evidence, and Google Scholar, without any time limits. The factors and interventions examined have been classified into three categories (urban infrastructure, green infrastructure, built environment), and we have assessed their relationships with each of the health outcomes. Results Eight reviews have been included. The results show a positive association between factors and interventions and health outcomes, even though this tends to differ with respect to some of the elements (study design, sample size, built environment and health outcome measurements, and the quality of the primary studies included in the reviews) in the selected studies. Conclusions In conclusion, the present study suggests and confirms that acting on the built environment has a positive impact on mental health and social inclusion.
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Affiliation(s)
- G Bonaccorsi
- Department of Health Sciences, University of Florence, Italy
| | - C Milani
- Department of Health Sciences, University of Florence, Italy
| | - D Giorgetti
- Postgraduate medical school in Hygiene and Preventive Medicine, University of Florence, Italy
| | - N Setola
- Department of Architecture, University of Florence, Italy
| | - E Naldi
- PhD student, Department of Architecture, University of Florence, Italy
| | - F Manzi
- Department of Health Sciences, University of Florence, Italy
| | - M Del Riccio
- Postgraduate medical school in Hygiene and Preventive Medicine, University of Florence, Italy
| | - C Dellisanti
- Department of Epidemiology, Regional Health Agency of Tuscany, Florence, Italy
| | - C Lorini
- Department of Health Sciences, University of Florence, Italy
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2
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Unkels R, Manzi F, Kapologwe NA, Baker U, Ahmad A, Nabiev R, Berndtsson M, Baraka J, Hanson C, Hirose A. Feasibility, usability and acceptability of a novel digital hybrid-system for reporting of routine maternal health information in Southern Tanzania: A mixed-methods study. PLOS Glob Public Health 2023; 3:e0000972. [PMID: 36962837 PMCID: PMC10021923 DOI: 10.1371/journal.pgph.0000972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/28/2022] [Indexed: 01/15/2023]
Abstract
Health information systems are important for health planning and progress monitoring. Still, data from health facilities are often of limited quality in Low-and-Middle-Income Countries. Quality deficits are partially rooted in the fact that paper-based documentation is still the norm at facility level, leading to mistakes in summarizing and manual copying. Digitization of data at facility level would allow automatization of these procedural steps. Here we aimed to evaluate the feasibility, usability and acceptability of a scanning innovation called Smart Paper Technology for digital data processing. We used a mixed-methods design to understand users' engagement with Smart Paper Technology and identify potential positive and negative effects of this innovation in three health facilities in Southern Tanzania. Eight focus group discussions and 11 in-depth interviews with users were conducted. We quantified time used by health care providers for documentation and patient care using time-motion methods. Thematic analysis was used to analyze qualitative data. Descriptive statistics and multivariable linear models were generated to compare the difference before and after introduction and adjust for confounders. Health care providers and health care managers appreciated the forms' simple design features and perceived Smart Paper Technology as time-saving and easy to use. The time-motion study with 273.3 and 224.0 hours of observations before and after introduction of Smart Paper Technology, respectively, confirmed that working time spent on documentation did not increase (27.0% at baseline and 26.4% post-introduction; adjusted p = 0.763). Time spent on patient care was not negatively impacted (26.9% at baseline and 37.1% at post-intervention; adjusted p = 0.001). Health care providers described positive effects on their accountability for data and service provision relating to the fact that individually signed forms were filled. Health care providers perceived Smart Paper Technology as feasible, easy to integrate and acceptable in their setting, particularly as it did not add time to documentation.
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Affiliation(s)
- Regine Unkels
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Health System, Policy and Economic Evaluations, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Fatuma Manzi
- Health System, Policy and Economic Evaluations, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Ntuli A Kapologwe
- Health, Social Welfare & Nutrition Services, President's Office - Regional Administration and Local Government, Dodoma, Tanzania
| | - Ulrika Baker
- UNICEF Tanzania Country Office, Dar es Salaam, Tanzania
| | - Aziz Ahmad
- Health System, Policy and Economic Evaluations, Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | | | - Jitihada Baraka
- Health System, Policy and Economic Evaluations, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Atsumi Hirose
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- School of Public Health, Imperial College, London, United Kingdom
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3
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Rodrigues E, Mordente C, Rodrigues L, Lima I, Miranda DA, Zenóbio E, Manzi F. Is the computed tomography exam important for planning mini-implant installation? J Clin Exp Dent 2023; 15:e298-e303. [PMID: 37152501 PMCID: PMC10155946 DOI: 10.4317/jced.60288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/30/2023] [Indexed: 04/03/2023] Open
Abstract
Background Mini-implants are devices used to provide absolute and temporary anchorage for tooth movement. Objectives: The present study was carried out to compare the use of periapical radiographs and computed tomography (CT) for planning mini-implants performed by orthodontists. Material and Methods Five radiographs and five CT scans of premolars and molars regions. These were analyzed by ten Orthodontists. Initially (T1), the evaluators indicated the preferred location for the insertion of a mini-implant, as well as the diameter and length of the device, using only a periapical radiograph. After 30 days (T2), the same evaluation was performed. Sixty days later (T3), the orthodontists reassessed the radiographs in association with the CT scans. Finally, after 90 days (T4), the evaluation was performed with the same exams. The comparison of the chosen diameter and length of the mini-implants was performed using the Student's t-test. The evaluation of the chosen insertion sites was analyzed by the Wilcoxon test. For both tests, the level of significance was 5%. The kappa concordance test was also performed for the intra- and inter-examiner evaluations. Results The results of the study showed substantial or perfect intra-examiner and reasonable to perfect inter-examiner agreement. Considering the length and diameter of the mini-implants, no statistical difference was found between the groups. Regarding the insertion site, more than 20% of the treatment plans were changed when the CT scan was associated. Conclusions The results showed that the association of a CT scan with radiography frequently leads the professional to change the insertion point for the installation of mini-implants. Key words:Orthodontic anchorage procedures. Mini Dental Implants. Bone Screws. Cone-beam computed tomography. Periapical radiography.
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4
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Kuwawenaruwa A, Makawia S, Binyaruka P, Manzi F. Assessment of Strategic Healthcare Purchasing Arrangements and Functions Towards Universal Coverage in Tanzania. Int J Health Policy Manag 2022; 11:3079-3089. [PMID: 35964163 PMCID: PMC10105173 DOI: 10.34172/ijhpm.2022.6234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/13/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Strategic health purchasing in low- and middle-income countries has received substantial attention as countries aim to achieve universal health coverage (UHC), by ensuring equitable access to quality health services without the risk of financial hardship. There is little evidence published from Tanzania on purchasing arrangements and what is required for strategic purchasing. This study analyses three purchasing arrangements in Tanzania and gives recommendations to strengthen strategic purchasing in Tanzania. METHODS We used the multi-case qualitative study drawing on the National Health Insurance Fund (NHIF), Social Health Insurance Benefit (SHIB), and improved Community Health Fund (iCHF) to explore the three purchasing arrangements with a purchaser-provider split. Data were drawn from document reviews and results were validated with nine key informant (KI) interviews with a range of actors involved in strategic purchasing. A deductive and inductive approach was used to develop the themes and framework analysis to summarize the data. RESULTS The findings show that benefit selection for all three schemes was based on the standard treatment guidelines issued by the Ministry of Health. Selection-contracting of the private healthcare providers are based on the location of the provider, the range of services available as stipulated in the scheme guideline, and the willingness of the provider to be contracted. NHF uses fee-for-service to reimburse providers. While SHIB and iCHF use capitation. NHIF has an electronic system to monitor registration, verification, claims processing, and referrals. While SHIB monitoring is done through routine supportive supervision and for the iCHF provider performance is monitored through utilization rates. CONCLUSION Enforcing compliance with the contractual agreement between providers-purchasers is crucial for the provision of quality services in an efficient manner. Investment in a routine monitoring system, such as the use of the district health information system which allows effective tracking of healthcare service delivery, and broader population healthcare outcomes.
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Kamala SR, Julius Z, Kosia EM, Manzi F. Availability and functionality of neonatal care units in healthcare facilities in Mtwara region, Tanzania: The quest for quality of in-patient care for small and sick newborns. PLoS One 2022; 17:e0269151. [PMID: 36409741 PMCID: PMC9678323 DOI: 10.1371/journal.pone.0269151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/03/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Evidence shows that delivery of prompt and appropriate in-patient newborn care (IPNC) through health facility (HF)-based neonatal care and stabilization units (NCU/NSUs) reduce preventable newborn mortalities (NMs). This study investigated the HFs for availability and performance of NCU/NSUs in providing quality IPNC, and explored factors influencing the observed performance outcomes in Mtwara region, Tanzania. METHODS A cross-sectional study was conducted using a follow-up explanatory mixed-methods approach. HF-based records and characteristics allowing for delivery of quality IPNC were reviewed first to establish the overall HF performance. The review findings were clarified by healthcare staff and managers through in-depth interviews (IDIs) and focus group discussions (FGDs). RESULTS About 70.6% (12/17) of surveyed HFs had at least one NCU/NSU room dedicated for delivery of IPNC but none had a fully established NCUs/NSU, and 74.7% (3,600/4,819) of needy newborns were admitted/transferred in for management. Essential medicines such as tetracycline eye ointment were unavailable in 75% (3/4) of the district hospitals (DHs). A disparity existed between the availability and functioning of equipment including infant radiant warmers (92% vs 73%). Governance, support from implementing patterns (IPs), and access to healthcare commodities were identified from qualitative inquiries as factors influencing the establishment and running of NCUs/NSUs at the HFs in Mtwara region, Tanzania. CONCLUSION Despite the positive progress, the establishment and performance of NCUs/NSUs in providing quality IPNC in HFs in Mtwara region is lagging behind the Tanzania neonatal care guideline requirements, particularly after the IPs of newborn health interventions completed their terms in 2016. This study suggests additional improvement plans for Mtwara region and other comparable settings to optimize the provision of quality IPNC and lower avoidable NMs.
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Affiliation(s)
- Serveus Ruyobya Kamala
- Department of Health Systems, Policy, Economic Evaluations, Ifakara Health Institute (IHI), Dar Es Salaam, Tanzania
- Department of Global Health and Bio-Medical Sciences (GHBM), School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology (NM-AIST), Arusha, Tanzania
- Department of Health, Mtwara Regional Secretariat, Mtwara, Tanzania
- * E-mail:
| | - Zamoyoni Julius
- Department of Health Systems, Policy, Economic Evaluations, Ifakara Health Institute (IHI), Dar Es Salaam, Tanzania
| | - Efraim M. Kosia
- Department of Global Health and Bio-Medical Sciences (GHBM), School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology (NM-AIST), Arusha, Tanzania
| | - Fatuma Manzi
- Department of Health Systems, Policy, Economic Evaluations, Ifakara Health Institute (IHI), Dar Es Salaam, Tanzania
- Department of Global Health and Bio-Medical Sciences (GHBM), School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology (NM-AIST), Arusha, Tanzania
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6
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Manzi F, Ishikawa M, Di Dio C, Itakura S, Kanda T, Ishiguro H, Massaro D, Marchetti A. Infants’ Prediction of Humanoid Robot’s Goal-Directed Action. Int J Soc Robot 2022. [DOI: 10.1007/s12369-022-00941-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AbstractSeveral studies have shown that infants anticipate human goal-directed actions, but not robot’s ones. However, the studies focusing on the robot goal-directed actions have mainly analyzed the effect of mechanical arms on infant’s attention. To date, the prediction of goal-directed actions in infants has not yet been studied when the agent is a humanoid robot. Given this lack of evidence in infancy research, the present study aims at analyzing infants’ action anticipation of both a human’s and a humanoid robot’s goal-directed action. Data were acquired on thirty 17-month-old infants, watching four video clips, where either a human or a humanoid robot performed a goal-directed action, i.e. reaching a target. Infants looking behavior was measured through the eye-tracking technique. The results showed that infants anticipated the goal-directed action of both the human and the robot and there were no differences in the anticipatory gaze behavior between the two agents. Furthermore, the findings indicated different attentional patterns for the human and the robot, showing a greater attention paid to the robot's face than the human’s face. Overall, the results suggest that 17-month-old infants may infer also humanoid robot’ underlying action goals.
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7
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Lewis TP, Ndiaye Y, Manzi F, Kruk ME. Associations between women’s empowerment, care seeking, and quality of malaria care for children: A cross-sectional analysis of demographic and health surveys in 16 sub-Saharan African countries. J Glob Health 2022; 12:04025. [PMID: 35356662 PMCID: PMC8932460 DOI: 10.7189/jogh.12.04025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Todd P Lewis
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, MA, USA
| | - Youssoupha Ndiaye
- Division of Planning, Research and Statistics, Ministry of Health and Social Action, Dakar, Senegal
| | - Fatuma Manzi
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, MA, USA
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8
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Ozaltin A, Vaughan K, Tani K, Manzi F, Mai VQ, Van Minh H, Kosen S, Shimp L, Brenzel L, Boonstoppel L. Key Factors Influencing Use of Immunization Cost Evidence in Country Planning and Budgeting Processes: Experiences From Indonesia, Tanzania, and Vietnam. Glob Health Sci Pract 2022; 10:GHSP-D-21-00264. [PMID: 35294377 PMCID: PMC8885341 DOI: 10.9745/ghsp-d-21-00264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/09/2021] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Kassimu Tani
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Vu Quynh Mai
- Hanoi University of Public Health, Hanoi, Vietnam
| | | | - Soewarta Kosen
- National Institute of Health Research and Development, Jakarta, Indonesia
| | | | - Logan Brenzel
- Bill & Melinda Gates Foundation, Washington, DC, USA
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9
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Tukay SM, Pasape L, Tani K, Manzi F. Evaluation of the Direct Health Facility Financing Program in Improving Maternal Health Services in Pangani District, Tanzania. Int J Womens Health 2021; 13:1227-1242. [PMID: 34916854 PMCID: PMC8669272 DOI: 10.2147/ijwh.s333900] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/13/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Maternal morbidity and mortality remain significant public health concerns globally, with Tanzania reporting 398 deaths per 100,000 live births annually. While national level data provide some insights into the issue, a focus on sub-national levels is required because of differences in contexts such as rural-urban disparities in maternal mortality. This study examined Direct Health Facility Financing (DHFF) and its effects on the quality of maternal health services in Pangani, a rural district in Tanzania. METHODS This study was conducted in Pangani district of Tanga region in Tanzania. The study used both qualitative and quantitative methods, including 16 in-depth interviews with the council health management teams, facility in charges, maternity nurse in charge, and 5 focus group discussions with community health governing committee members. The number of deliveries that occurred in health facilities, as well as medical supplies, equipment, and reagents purchased by the facilities, were compared using descriptive statistics before and after the DHFF implementation. RESULTS Direct disbursement of funds from the central government through the Ministry of Finance and Planning to the primary health facilities reduced delays in procurement, improved community outreach services, and improved community leaders' engagements. Deliveries occurring at health facilities increased by 33.6% (p < 0.001) one year after the HDFF implementation. Various medicines, delivery kits, and some reagents increased significantly (p < 0.05). However, the lack of computers and poor internet connectivity, an insufficient supply of medical equipment and unstable stock of the Medical Stores Department increased the difficulty of obtaining the missed items from the selected prime vendor. CONCLUSION Overall, this study shows a positive impact of the DHFF on maternal health service delivery in Pangani district. Specifically, an increase in the number of medical supplies, equipment, and reagents necessary to provide maternal health services contributed to the observed increase in facility deliveries by 33.6%. Moreover, the system minimizes unnecessary delays in the procurement processes of required drugs, supplies, and other facility reagents. To maximize the impact of the HDFF system, lack of computers, unstable internet, limited knowledge of the staff about the system, and inadequate health workforce should be addressed. Therefore, strengthening the DHFF system and staff training in-service and on the job is essential for smooth implementation.
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Affiliation(s)
- Samwel Marco Tukay
- The Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
- Pangani District Council, Tanga, Tanzania
- Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - Liliane Pasape
- The Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Kassimu Tani
- Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - Fatuma Manzi
- Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
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10
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Kakolwa MA, Woodd SL, Aiken AM, Manzi F, Gon G, Graham WJ, Kabanywanyi AM. Overuse of antibiotics in maternity and neonatal wards, a descriptive report from public hospitals in Dar es Salaam, Tanzania. Antimicrob Resist Infect Control 2021; 10:142. [PMID: 34627366 PMCID: PMC8502304 DOI: 10.1186/s13756-021-01014-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 09/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Overuse of antibiotics is a major challenge and undermines measures to control drug resistance worldwide. Postnatal women and newborns are at risk of infections and are often prescribed prophylactic antibiotics although there is no evidence to support their universal use in either group. METHODS We performed point prevalence surveys in three hospitals in Dar es Salaam, Tanzania, in 2018 to collect descriptive data on antibiotic use and infections, in maternity and neonatal wards. RESULTS Prescribing of antibiotics was high in all three hospitals ranging from 90% (43/48) to 100% (34/34) in women after cesarean section, from 1.4% (1/73) to 63% (30/48) in women after vaginal delivery, and from 89% (76/85) to 100% (77/77) in neonates. The most common reason for prescribing antibiotics was medical prophylaxis in both maternity and neonatal wards. CONCLUSIONS We observed substantial overuse of antibiotics in postnatal women and newborns. This calls for urgent antibiotic stewardship programs in Tanzanian hospitals to curb this inappropriate use and limit the spread of antimicrobial resistance.
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Affiliation(s)
- Mwaka A Kakolwa
- Ifakara Health Institute, PO Box 78373, Dar es Salaam, Tanzania.
| | - Susannah L Woodd
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, Keppel Street, London, UK
| | - Alexander M Aiken
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, Keppel Street, London, UK
| | - Fatuma Manzi
- Ifakara Health Institute, PO Box 78373, Dar es Salaam, Tanzania
| | - Giorgia Gon
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, Keppel Street, London, UK
| | - Wendy J Graham
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, Keppel Street, London, UK
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11
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Esposito F, Barni L, Manzi F, Braccio P, Latella L, Corvi A, Freddolini M. Does ankle Kinesio Taping® application improve static and dynamic balance in healthy trained semi-professional soccer male players? A single blinded randomized placebo controlled crossover study. Sci Sports 2021. [DOI: 10.1016/j.scispo.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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12
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Li AJ, Manzi F, Kyesi F, Makame Y, Mwengee W, Fleming M, Mkopi A, Mmbaga S, Lyimo D, Loharikar A. Tanzania's human papillomavirus (HPV) vaccination program: Community awareness, feasibility, and acceptability of a national HPV vaccination program, 2019. Vaccine 2021; 40 Suppl 1:A38-A48. [PMID: 34229889 PMCID: PMC9601816 DOI: 10.1016/j.vaccine.2021.06.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/31/2021] [Accepted: 06/19/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND In April 2018, Tanzania introduced the human papillomavirus (HPV) vaccine nationally to 14-year-old girls, utilizing routine delivery strategies (i.e. vaccinating girls at health facilities and community outreach, including schools). We sought to assess awareness, feasibility, and acceptability of the HPV vaccination program among health workers and community-level stakeholders. METHODS We conducted cross-sectional in-person surveys among health workers, school personnel, community leaders, and council leaders in 18 council areas across six regions of Tanzania in October-November 2019. Regions were purposively selected to provide demographic, geographic, and vaccination coverage variability; sub-regional levels used random or stratified random sampling. Surveys included questions on HPV vaccine training and knowledge, delivery strategy, target population, and vaccine and program acceptability. Descriptive analysis was completed for all variables stratified by respondent groups. RESULTS Across the 18 councils, there were 461 respondents, including health workers (165), school personnel (135), community leaders (143), and council leaders (18). Over half of each respondent group (50-78%) attended a training or orientation on HPV vaccine. Almost 75% of the health workers and school personnel respondent groups, and less than half (45%) of community leaders correctly identified the target age group for HPV vaccine. Most (80%) of the health workers indicated HPV vaccination was available at health facilities and schools; most (79%) indicated that the majority of girls receive HPV vaccine in school. Approximately half (52%) of all respondents reported hearing misinformation about HPV vaccine, but 97% of all respondents indicated that HPV vaccine was either "very accepted" or "somewhat accepted" in their community. CONCLUSION The HPV vaccination program in Tanzania was well accepted by community stakeholders in 18 councils; adequate knowledge of HPV vaccine and the HPV vaccination program was demonstrated by health workers and school personnel. However, continued technical support for integration of HPV vaccination as a routine immunization activity and reinforcement of basic knowledge about HPV vaccine in specific community groups is needed. The Tanzania experience provides an example of how this vaccine can be integrated into routine immunization delivery strategies and can be a useful resource for countries planning to introduce HPV vaccine as well as informing global partners on how to best support to countries in operationalizing their HPV vaccine introduction plans.
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Affiliation(s)
- Anyie J Li
- CDC Foundation, Atlanta, GA, USA; Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Furaha Kyesi
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dar es Salaam, Tanzania
| | | | - William Mwengee
- World Health Organization, Tanzania Country Office, Dar es Salaam, Tanzania
| | - Monica Fleming
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Dafrossa Lyimo
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dar es Salaam, Tanzania
| | - Anagha Loharikar
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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13
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Manzi F, Di Dio C, Di Lernia D, Rossignoli D, Maggioni MA, Massaro D, Marchetti A, Riva G. Can You Activate Me? From Robots to Human Brain. Front Robot AI 2021; 8:633514. [PMID: 33681301 PMCID: PMC7933445 DOI: 10.3389/frobt.2021.633514] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/15/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- F Manzi
- Research Unit on Theory of Mind, Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Humane Technology Lab, Università Cattolica del Sacro Cuore, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - C Di Dio
- Research Unit on Theory of Mind, Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Humane Technology Lab, Università Cattolica del Sacro Cuore, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - D Di Lernia
- Humane Technology Lab, Università Cattolica del Sacro Cuore, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - D Rossignoli
- Humane Technology Lab, Università Cattolica del Sacro Cuore, Milan, Italy.,DISEIS, Department of International Economics, Institutions and Development, Universitá Cattolica del Sacro Cuore, Milan, Italy.,CSCC, Cognitive Science and Communication research Center, Universitá Cattolica del Sacro Cuore, Milan, Italy
| | - M A Maggioni
- Humane Technology Lab, Università Cattolica del Sacro Cuore, Milan, Italy.,DISEIS, Department of International Economics, Institutions and Development, Universitá Cattolica del Sacro Cuore, Milan, Italy.,CSCC, Cognitive Science and Communication research Center, Universitá Cattolica del Sacro Cuore, Milan, Italy
| | - D Massaro
- Research Unit on Theory of Mind, Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Humane Technology Lab, Università Cattolica del Sacro Cuore, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - A Marchetti
- Research Unit on Theory of Mind, Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Humane Technology Lab, Università Cattolica del Sacro Cuore, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - G Riva
- Humane Technology Lab, Università Cattolica del Sacro Cuore, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Applied Technology for NeuroPsychology Laboratory, Istituto Auxologico Italiano, Milan, Italy
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14
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Gon G, Kabanywanyi AM, Blinkhoff P, Cousens S, Dancer SJ, Graham WJ, Hokororo J, Manzi F, Marchant T, Mkoka D, Morrison E, Mswata S, Oza S, Penn-Kekana L, Sedekia Y, Virgo S, Woodd S, Aiken AM. The Clean pilot study: evaluation of an environmental hygiene intervention bundle in three Tanzanian hospitals. Antimicrob Resist Infect Control 2021; 10:8. [PMID: 33413647 PMCID: PMC7789081 DOI: 10.1186/s13756-020-00866-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/25/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Healthcare associated infections (HAI) are estimated to affect up to 15% of hospital inpatients in low-income countries (LICs). A critical but often neglected aspect of HAI prevention is basic environmental hygiene, particularly surface cleaning and linen management. TEACH CLEAN is an educational intervention aimed at improving environmental hygiene. We evaluated the effectiveness of this intervention in a pilot study in three high-volume maternity and newborn units in Dar es Salaam, Tanzania. METHODS This study design prospectively evaluated the intervention as a whole, and offered a before-and-after comparison of the impact of the main training. We measured changes in microbiological cleanliness [Aerobic Colony Counts (ACC) and presence of Staphylococcus aureus] using dipslides, and physical cleaning action using gel dots. These were analysed with descriptive statistics and logistic regression models. We used qualitative (focus group discussions, in-depth interviews, and semi-structured observation) and quantitative (observation checklist) tools to measure why and how the intervention worked. We describe these findings across the themes of adaptation, fidelity, dose, reach and context. RESULTS Microbiological cleanliness improved during the study period (ACC pre-training: 19%; post-training: 41%). The odds of cleanliness increased on average by 1.33 weekly during the pre-training period (CI = 1.11-1.60), and by 1.08 (CI = 1.03-1.13) during the post-training period. Cleaning action improved only in the pre-training period. Detection of S. aureus on hospital surfaces did not change substantially. The intervention was well received and considered feasible in this context. The major pitfalls in the implementation were the limited number of training sessions at the hospital level and the lack of supportive supervision. A systems barrier to implementation was lack of regular cleaning supplies. CONCLUSIONS The evaluation suggests that improvements in microbiological cleanliness are possible using this intervention and can be sustained. Improved microbiological cleanliness is a key step on the pathway to infection prevention in hospitals. Future research should assess whether this bundle is cost-effective in reducing bacterial and viral transmission and infection using a rigorous study design.
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Affiliation(s)
- Giorgia Gon
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | | | - Petri Blinkhoff
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Simon Cousens
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Stephanie J Dancer
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
- Department of Microbiology, Hairmyres Hospital, Glasgow, UK
| | - Wendy J Graham
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Joseph Hokororo
- Ministry of Health Community Development Gender Elderly and Children, Dar es Salaam, Tanzania
| | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Tanya Marchant
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Dar es Salaam, Tanzania
| | - Dickson Mkoka
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Sarah Mswata
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Shefali Oza
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Loveday Penn-Kekana
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Susannah Woodd
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Alexander M Aiken
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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15
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Vaughan K, Clarke-Deelder E, Tani K, Lyimo D, Mphuru A, Manzi F, Schütte C, Ozaltin A. Immunization costs, from evidence to policy: Findings from a nationally representative costing study and policy translation effort in Tanzania. Vaccine 2020; 38:7659-7667. [PMID: 33077300 PMCID: PMC7604567 DOI: 10.1016/j.vaccine.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 12/02/2022]
Abstract
Delivery costs represent 33% of total immunization program costs in Tanzania. Costs are higher for outreach than for facility-based delivery. We used calibration methods to estimate unit and total costs. This work will inform domestic resource advocacy and planning.
Introduction Information on the costs of routine immunization programs is needed for budgeting, planning, and domestic resource mobilization. This information is particularly important for countries such as Tanzania that are preparing to transition out of support from Gavi, the Vaccine Alliance. This study aimed to estimate the total and unit costs for of child immunization in Tanzania from July 2016 to June 2017 and make this evidence available to key stakeholders. Methods We used an ingredients-based approach to collect routine immunization cost data from the facility, district, regional, and national levels. We collected data on the cost of vaccines as well as non-vaccine delivery costs. We estimated total and unit costs from a provider perspective for each level and overall, and examined how costs varied by delivery strategy, geographic area, and facility-level service delivery volume. An evidence-to-policy plan identified key opportunities and stakeholders to target to facilitate the use of results. Results The total annual economic cost of the immunization program, inclusive of vaccines, was estimated to be US$138 million (95% CI: 133, 144), or $4.32 ($3.72, $4.98) per dose. The delivery costs made up $45 million (38, 52), or $1.38 (1.06, 1.70) per dose. The costs of facility-based delivery were similar in urban and rural areas, but the costs of outreach delivery were higher in rural areas than in urban areas. The facility-level delivery cost per dose decreased with the facility service delivery volume. Discussion We estimated the costs of the routine immunization program in Tanzania, where no immunization costing study had been conducted for five years. These estimates can inform the program’s budgeting and planning as Tanzania prepares to transition out of Gavi support. Next steps for evidence-to-policy translation have been identified, including technical support requirements for policy advocacy and planning.
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Affiliation(s)
| | - Emma Clarke-Deelder
- Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, MA, USA.
| | - Kassimu Tani
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Dafrossa Lyimo
- Immunization and Vaccines Development (IVD), Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Alex Mphuru
- Immunization and Vaccines Development (IVD), Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, Tanzania
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16
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Manzi F, Marchant T, Hanson C, Schellenberg J, Mkumbo E, Mlaguzi M, Tancred T. Harnessing the health systems strengthening potential of quality improvement using realist evaluation: an example from southern Tanzania. Health Policy Plan 2020; 35:ii9-ii21. [PMID: 33156943 PMCID: PMC7646731 DOI: 10.1093/heapol/czaa128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 11/13/2022] Open
Abstract
Quality improvement (QI) is a problem-solving approach in which stakeholders identify context-specific problems and create and implement strategies to address these. It is an approach that is increasingly used to support health system strengthening, which is widely promoted in Sub-Saharan Africa. However, few QI initiatives are sustained and implementation is poorly understood. Here, we propose realist evaluation to fill this gap, sharing an example from southern Tanzania. We use realist evaluation to generate insights around the mechanisms driving QI implementation. These insights can be harnessed to maximize capacity strengthening in QI and to support its operationalization, thus contributing to health systems strengthening. Realist evaluation begins by establishing an initial programme theory, which is presented here. We generated this through an elicitation approach, in which multiple sources (theoretical literature, a document review and previous project reports) were collated and analysed retroductively to generate hypotheses about how the QI intervention is expected to produce specific outcomes linked to implementation. These were organized by health systems building blocks to show how each block may be strengthened through QI processes. Our initial programme theory draws from empowerment theory and emphasizes the self-reinforcing nature of QI: the more it is implemented, the more improvements result, further empowering people to use it. We identified that opportunities that support skill- and confidence-strengthening are essential to optimizing QI, and thus, to maximizing health systems strengthening through QI. Realist evaluation can be used to generate rich implementation data for QI, showcasing how it can be supported in ‘real-world’ conditions for health systems strengthening.
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Affiliation(s)
- Fatuma Manzi
- Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Tanya Marchant
- Department of Disease Control, London School of Hygiene and Tropical Medicine, UK
| | - Claudia Hanson
- Department of Public Health Sciences, Karolinska Institutet, Sweden
| | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene and Tropical Medicine, UK
| | - Elibariki Mkumbo
- Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Mwanaidi Mlaguzi
- Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Tara Tancred
- Department of Disease Control, London School of Hygiene and Tropical Medicine, UK
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17
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Manzi F, Del Riccio M, Naldi E, Setola N, Dellisanti C, Lorini C, Bonaccorsi G. Elements of the built environment that can promote physical activity in elderly: an umbrella review. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
All healthy adults aged 65 years and above, unless specific medical conditions, benefit from physical activity. The built environment can support and encourage physical activity. The aim of this study is to establish which specific elements of the built environment can contribute to improve the physical activity of self-sufficient, non-institutionalized and living in the city adults > 65 years.
Methods
An extensive literature search was conducted in several database. Umbrella review methodology was used to include the systematic reviews that presented a sufficient methodological quality. Data from reviews were undergone to critical appraisal, data extraction and synthesis.
Results
Eleven reviews were included. The elements positively associated with physical activity in the elderly resulted: walkability; residential density/urbanisation; street connectivity; access/availability of services and destinations (land-use mix destination diversity and access, public transit, recreational facilities, parks and open spaces); pedestrian/cycling infrastructures and streetscapes (footpaths presence and quality, infrastructures for walking or cycling, easy access to building entrance, benches and sitting facilities, street lights); greenery and aesthetically pleasing scenery; safety and traffic (crime, personal and general safety, traffic and pedestrian safety, human or motorised traffic volume). The elements that resulted as negatively associated with physical activity were: the presence of slopes or hilliness; presence of barriers to walking/cycling; littering/vandalism/decay/vacant buildings; pollution (air, noise, sewer).
Conclusions
Evidences show that specific elements of the built environment can contribute to promoting elderly people's physical activity. The city restructuring plans should take into consideration these evidences in order to implement the design of interventions aimed at promoting physical activity of elderly people.
Key messages
Evidences show that specific elements of the built environment can contribute to promoting elderly people’s physical activity. The city restructuring plans should take into consideration these evidences in order to implement the design of interventions aimed at promoting physical activity of elderly people.
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Affiliation(s)
- F Manzi
- Postgraduate School in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - M Del Riccio
- Postgraduate School in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - E Naldi
- Department of Architectural Technology, University of Florence, Florence, Italy
| | - N Setola
- Department of Architectural Technology, University of Florence, Florence, Italy
| | - C Dellisanti
- Operating Unit of Epidemiology, Local Health Unit Tuscany Center, Florence, Italy
| | - C Lorini
- Postgraduate School in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - G Bonaccorsi
- Postgraduate School in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
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18
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Manzi F, Ishikawa M, Di Dio C, Itakura S, Kanda T, Ishiguro H, Massaro D, Marchetti A. The understanding of congruent and incongruent referential gaze in 17-month-old infants: an eye-tracking study comparing human and robot. Sci Rep 2020; 10:11918. [PMID: 32681110 PMCID: PMC7368080 DOI: 10.1038/s41598-020-69140-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/06/2020] [Indexed: 11/09/2022] Open
Abstract
Several studies have shown that the human gaze, but not the robot gaze, has significant effects on infant social cognition and facilitate social engagement. The present study investigates early understanding of the referential nature of gaze by comparing-through the eye-tracking technique-infants' response to human and robot's gaze. Data were acquired on thirty-two 17-month-old infants, watching four video clips, where either a human or a humanoid robot performed an action on a target. The agent's gaze was either turned to the target (congruent) or opposite to it (incongruent). The results generally showed that, independent of the agent, the infants attended longer at the face area compared to the hand and target. Additionally, the effect of referential gaze on infants' attention to the target was greater when infants watched the human compared to the robot's action. These results suggest the presence, in infants, of two distinct levels of gaze-following mechanisms: one recognizing the other as a potential interactive partner, the second recognizing partner's agency. In this study, infants recognized the robot as a potential interactive partner, whereas ascribed agency more readily to the human, thus suggesting that the process of generalizability of gazing behaviour to non-humans is not immediate.
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Affiliation(s)
- F Manzi
- Research Unit on Theory of Mind, Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.
| | - M Ishikawa
- School of Graduated Letter, Department of Psychology, Kyoto University, Kyoto, Japan
| | - C Di Dio
- Research Unit on Theory of Mind, Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - S Itakura
- Centre for Baby Science, Doshisha University, Kyoto, Japan
| | - T Kanda
- Human-Robot Interaction Laboratory, Department of Computer Science, Kyoto University, Kyoto, Japan.,Advanced Telecommunications Research Institute International, IRC/HIL, Keihanna Science City, Kyoto, Japan
| | - H Ishiguro
- Advanced Telecommunications Research Institute International, IRC/HIL, Keihanna Science City, Kyoto, Japan.,Department of Systems Innovation, Osaka University, Toyonaka, Japan
| | - D Massaro
- Research Unit on Theory of Mind, Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - A Marchetti
- Research Unit on Theory of Mind, Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
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Gandra T, Tavares I, Carlos A, Rodrigues L, Lima IA, Manzi F. Patient with McCune albright syndrome: Case report and 10 Years of follow-up imaging examination. J Clin Exp Dent 2020; 15:e264-e268. [PMID: 37008242 PMCID: PMC10062463 DOI: 10.4317/jced.60161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/07/2022] [Indexed: 02/20/2023] Open
Abstract
The McCune Albright syndrome (MAS) is a rare, multi-system disease composed of the triad of polyostotic fibrous dysplasia of bone (PFDB), café-au-lait skin hyperpigmentation, and endocrine disorders. The diagnosis involves clinical, biochemical and imaging findings, with dentistry playing an important role in MAS, since many patients present DFPO in the craniofacial bones, including the maxilla and mandible, and in view of their dental needs, the correct management of these patients is not only an essential but important area to be investigated. This report presents a case of a patient with McCune Albright Syndrome, the behavior of the disease over a period of 10 years and how imaging exams such as scintigraphy and tomography were important for planning the dental treatment of this patient, since they are fundamental allies for identification and evaluation of the progression and/or stability of the disease. Key words:Craniofacial fibrous dysplasia, cone-beam computed tomography, scintigraphy, imaging diagnosis.
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20
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D'Amata G, Del Papa M, Palmieri I, Florio G, Musmeci L, Manzi F, Del Vecchio C, Carnì P, Crovaro M, Buonocore V. Amyand's hernia with acute phlegmonous appendicitis: case report. G Chir 2019; 40:587-589. [PMID: 32007124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Any inguinal hernia containing the vermiform appendix is called Amyand's hernia. Amyand hernias are very rare and even rarer is the association of Amyand hernia with acute appendicitis. Due to the rarity of this entity, it constitutes a challenging case in terms of diagnosis and treatment. The surgical management is not yet standardized and there are no clear guidelines. There are some controversies regarding whether to perform an appendectomy if appendix appears normal or whether mesh can be used for the hernia repair if appendectomy is performed. We describe a case of Amyand hernia in a 90-year old man with acute appendicitis and we review current literature regarding surgical strategy.
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21
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Florio G, D'Amata G, Crovaro M, Musmeci L, Manzi F, Carnì P, Del Papa M. Can Longo stapled haemorrhoidopexy for haemorroids be a day-case procedure? G Chir 2019; 40:556-558. [PMID: 32007120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We retrospectively collected data of 100 consecutives elective Longo's procedures for third- and fourth-degree simptomatic haemorroids, classified ASA grade I and II. All patients stayed overnight, because discharge was scheduled the day after the operation. 98 were discharged the day after the operation. Two patients were not discharged the day after because mild and severe bleeding respectively occurred during the first night after the operation which settled conservatively. All the patients were discharged on oral NSAID and stool softeners. None required rehospitalisation. Our retrospective study, pointing out that, in general patients did not require active intervention on the first postoperative night, represents an encouragement to introduce day-case stapled procedure for haemorroids.
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22
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Florio G, D'Amata G, Crovaro M, Musmeci L, Manzi F, Carnì P, Del Papa M. Utility of continuous intraoperative neural monitoring in thyroid surgery in a low volume centre. G Chir 2019; 40:455-458. [PMID: 32003730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This retrospective study, of a single surgeon's experience, evaluates the role of intraoperative neuromonitoring (IONM) for total thyroidectomy, in a low-volume district general hospital. 128 patients with normal preoperative vocal fold function underwent thyroid surgery with routine use of nerve monitoring. Patients were followed for 6 months after surgery, and postoperative Romanerve function was determined by fiberoptic laryngoscopy. One (0,8%) patient was found to have a unilateral vocal fold paralysis, but after 6 months this patient had regained vocal fold motion. The technique of intraoperative neuromonitoring in thyroid surgery is safe and reliable in excluding postoperative recurrent laryngeal nerve palsy; it has high accuracy, specificity, sensitivity and negative predictive value. Neuromonitoring is useful to identify the recurrent laryngeal nerve and it can be a useful adjunctive technique for reassuring surgeons of the functional integrity of the nerve. Its application can be particularly recommended for low-volume thyroid operation centres.
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23
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Day LT, Ruysen H, Gordeev VS, Gore-Langton GR, Boggs D, Cousens S, Moxon SG, Blencowe H, Baschieri A, Rahman AE, Tahsina T, Zaman SB, Hossain T, Rahman QSU, Ameen S, El Arifeen S, KC A, Shrestha SK, KC NP, Singh D, Jha AK, Jha B, Rana N, Basnet O, Joshi E, Paudel A, Shrestha PR, Jha D, Bastola RC, Ghimire JJ, Paudel R, Salim N, Shamb D, Manji K, Shabani J, Shirima K, Mkopi N, Mrisho M, Manzi F, Jaribu J, Kija E, Assenga E, Kisenge R, Pembe A, Hanson C, Mbaruku G, Masanja H, Amouzou A, Azim T, Jackson D, Kabuteni TJ, Mathai M, Monet JP, Moran A, Ram P, Rawlins B, Sæbø JI, Serbanescu F, Vaz L, Zaka N, Lawn JE. “Every Newborn-BIRTH” protocol: observational study validating indicators for coverage and quality of maternal and newborn health care in Bangladesh, Nepal and Tanzania. J Glob Health 2019; 9:010902. [DOI: 10.7189/jogh.09.010902] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Shamba D, Tancred T, Hanson C, Wachira J, Manzi F. Delayed illness recognition and multiple referrals: a qualitative study exploring care-seeking trajectories contributing to maternal and newborn illnesses and death in southern Tanzania. BMC Health Serv Res 2019; 19:225. [PMID: 30975142 PMCID: PMC6460539 DOI: 10.1186/s12913-019-4019-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 03/18/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Maternal and neonatal mortality remain high in southern Tanzania despite an increasing number of births occurring in health facilities. In search for reasons for the persistently high mortality rates, we explored illness recognition, decision-making and care-seeking for cases of maternal and neonatal illness and death. METHODS We conducted 48 in-depth interviews (16 participants who experienced maternal illnesses, 16 mothers whose newborns experienced illness, eight mothers whose newborns died, and eight family members of a household with a maternal death), and five focus group discussions with community leaders in two districts of Mtwara region. Thematic analysis was used for interpretation of findings. RESULTS Our data indicated relatively timely illness recognition and decision-making for maternal complications. In contrast, families reported difficulties interpreting newborn illnesses. Decisions on care-seeking involved both the mother and her partner or other family members. Delays in care-seeking were therefore also reported in absence of the husband, or at night. Primary-level facilities were first consulted. Most respondents had to consult more than one facility and described difficulties accessing and receiving appropriate care. Definitive treatment for maternal and newborn complications was largely only available in hospitals. CONCLUSIONS Delays in reaching a facility that can provide appropriate care is influenced by multiple referrals from one facility to another. Referral and care-seeking advice should include direct care-seeking at hospitals in case of severe complications and primary facilities should facilitate prompt referral.
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Affiliation(s)
- Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania.
| | - Tara Tancred
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Claudia Hanson
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.,Department of Public Health Sciences-Global Health, Karolinska Institute, Stockholm, Sweden
| | - Juddy Wachira
- School of Medicine/AMPATH, Moi University, Nairobi, Kenya
| | - Fatuma Manzi
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
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25
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Arsenault C, Jordan K, Lee D, Dinsa G, Manzi F, Marchant T, Kruk ME. Equity in antenatal care quality: an analysis of 91 national household surveys. Lancet Glob Health 2019; 6:e1186-e1195. [PMID: 30322649 PMCID: PMC6187112 DOI: 10.1016/s2214-109x(18)30389-9] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/31/2018] [Accepted: 08/10/2018] [Indexed: 12/17/2022]
Abstract
Background Emerging data show that many low-income and middle-income country (LMIC) health systems struggle to consistently provide good-quality care. Although monitoring of inequalities in access to health services has been the focus of major international efforts, inequalities in health-care quality have not been systematically examined. Methods Using the most recent (2007–16) Demographic and Health Surveys and Multiple Indicator Cluster Surveys in 91 LMICs, we described antenatal care quality based on receipt of three essential services (blood pressure monitoring and urine and blood testing) among women who had at least one visit with a skilled antenatal-care provider. We compared quality across country income groups and quantified within-country wealth-related inequalities using the slope and relative indices of inequality. We summarised inequalities using random-effects meta-analyses and assessed the extent to which other geographical and sociodemographic factors could explain these inequalities. Findings Globally, 72·9% (95% CI 69·1–76·8) of women who used antenatal care reported blood pressure monitoring and urine and blood testing; this number ranged from 6·3% in Burundi to 100·0% in Belarus. Antenatal care quality lagged behind antenatal care coverage the most in low-income countries, where 86·6% (83·4–89·7) of women accessed care but only 53·8% (44·3–63·3) reported receiving the three services. Receipt of the three services was correlated with gross domestic product per capita and was 40 percentage points higher in upper-middle-income countries compared with low-income countries. Within countries, the wealthiest women were on average four times more likely to report good quality care than the poorest (relative index of inequality 4·01, 95% CI 3·90–4·13). Substantial inequality remained after adjustment for subnational region, urban residence, maternal age, education, and number of antenatal care visits (3·20, 3·11–3·30). Interpretation Many LMICs that have reached high levels of antenatal care coverage had much lower and inequitable levels of quality. Achieving ambitious maternal, newborn, and child health goals will require greater focus on the quality of health services and their equitable distribution. Equity in effective coverage should be used as the new metric to monitor progress towards universal health coverage. Funding Bill & Melinda Gates Foundation.
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Affiliation(s)
- Catherine Arsenault
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | - Keely Jordan
- Department of Public Health Policy and Management, NYU College of Global Public Health, New York University, New York, NY, USA
| | - Dennis Lee
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Girmaye Dinsa
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Public Health and Health Policy, College of Health Sciences, Haramaya University, Harar, Ethiopia
| | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Tanya Marchant
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
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Day LT, Ruysen H, Gordeev VS, Gore-Langton GR, Boggs D, Cousens S, Moxon SG, Blencowe H, Baschieri A, Rahman AE, Tahsina T, Zaman SB, Hossain T, Rahman QSU, Ameen S, El Arifeen S, Kc A, Shrestha SK, Kc NP, Singh D, Jha AK, Jha B, Rana N, Basnet O, Joshi E, Paudel A, Shrestha PR, Jha D, Bastola RC, Ghimire JJ, Paudel R, Salim N, Shamb D, Manji K, Shabani J, Shirima K, Mkopi N, Mrisho M, Manzi F, Jaribu J, Kija E, Assenga E, Kisenge R, Pembe A, Hanson C, Mbaruku G, Masanja H, Amouzou A, Azim T, Jackson D, Kabuteni TJ, Mathai M, Monet JP, Moran A, Ram P, Rawlins B, Sæbø JI, Serbanescu F, Vaz L, Zaka N, Lawn JE. " Every Newborn-BIRTH" protocol: observational study validating indicators for coverage and quality of maternal and newborn health care in Bangladesh, Nepal and Tanzania. J Glob Health 2019. [PMID: 30863542 PMCID: PMC6406050 DOI: 10.7189/jogh.09.01902] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background To achieve Sustainable Development Goals and Universal Health Coverage, programmatic data are essential. The Every Newborn Action Plan, agreed by all United Nations member states and >80 development partners, includes an ambitious Measurement Improvement Roadmap. Quality of care at birth is prioritised by both Every Newborn and Ending Preventable Maternal Mortality strategies, hence metrics need to advance from health service contact alone, to content of care. As facility births increase, monitoring using routine facility data in DHIS2 has potential, yet validation research has mainly focussed on maternal recall surveys. The Every Newborn – Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study aims to validate selected newborn and maternal indicators for routine tracking of coverage and quality of facility-based care for use at district, national and global levels. Methods EN-BIRTH is an observational study including >20 000 facility births in three countries (Tanzania, Bangladesh and Nepal) to validate selected indicators. Direct clinical observation will be compared with facility register data and a pre-discharge maternal recall survey for indicators including: uterotonic administration, immediate newborn care, neonatal resuscitation and Kangaroo mother care. Indicators including neonatal infection management and antenatal corticosteroid administration, which cannot be easily observed, will be validated using inpatient records. Trained clinical observers in Labour/Delivery ward, Operation theatre, and Kangaroo mother care ward/areas will collect data using a tablet-based customised data capturing application. Sensitivity will be calculated for numerators of all indicators and specificity for those numerators with adequate information. Other objectives include comparison of denominator options (ie, true target population or surrogates) and quality of care analyses, especially regarding intervention timing. Barriers and enablers to routine recording and data usage will be assessed by data flow assessments, quantitative and qualitative analyses. Conclusions To our knowledge, this is the first large, multi-country study validating facility-based routine data compared to direct observation for maternal and newborn care, designed to provide evidence to inform selection of a core list of indicators recommended for inclusion in national DHIS2. Availability and use of such data are fundamental to drive progress towards ending the annual 5.5 million preventable stillbirths, maternal and newborn deaths.
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Affiliation(s)
- Louise T Day
- Joint first authors.,Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK
| | - Harriet Ruysen
- Joint first authors.,Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK
| | - Vladimir S Gordeev
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK
| | - Georgia R Gore-Langton
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK
| | - Dorothy Boggs
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK
| | - Simon Cousens
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK
| | - Sarah G Moxon
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK
| | - Hannah Blencowe
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK
| | - Angela Baschieri
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Tanvir Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Ashish Kc
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Naresh P Kc
- Department of Health Services, Ministry of Health, Kathmandu, Nepal
| | - Dela Singh
- Pokhara Academy of Health Science, Pokhara Ranipauwa, Nepal
| | | | - Bijay Jha
- Nepal Health Research Council, Kathmandu, Nepal
| | - Nisha Rana
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | | | | | | | - Deepak Jha
- Department of Health Services, Ministry of Health, Kathmandu, Nepal
| | | | | | | | - Nahya Salim
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Donat Shamb
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Karim Manji
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Josephine Shabani
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Kizito Shirima
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Namala Mkopi
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Mwifadhi Mrisho
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Fatuma Manzi
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Jennie Jaribu
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Edward Kija
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Evelyne Assenga
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Rodrick Kisenge
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Andrea Pembe
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Claudia Hanson
- Public Health Sciences - Global Health - Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden
| | - Godfrey Mbaruku
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania.,Deceased 2 September 2018
| | - Honorati Masanja
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Agbessi Amouzou
- Institute for International Programs, Department of International Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tariq Azim
- MEAUSRE Evaluation, University of North Carolina, North Carolina, USA
| | - Debra Jackson
- Knowledge Management & Implementation Research Unit, Health Section, UNICEF, New York, USA
| | | | - Matthews Mathai
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Allisyn Moran
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Pavani Ram
- Office of Health, Infectious Disease and Nutrition, Bureau for Global Health, United States Agency for International Development, Washington, DC, USA
| | | | - Johan Ivar Sæbø
- Department for Informatics, University of Oslo, Oslo, Norway
| | - Florina Serbanescu
- Division of Reproductive Health, Centres for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Lara Vaz
- Save the Children, Washington, DC, USA
| | - Nabila Zaka
- Knowledge Management & Implementation Research Unit, Health Section, UNICEF, New York, USA
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK
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27
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Kuwawenaruwa A, Ramsey K, Binyaruka P, Baraka J, Manzi F, Borghi J. Implementation and effectiveness of free health insurance for the poor pregnant women in Tanzania: A mixed methods evaluation. Soc Sci Med 2019; 225:17-25. [DOI: 10.1016/j.socscimed.2019.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 01/24/2019] [Accepted: 02/03/2019] [Indexed: 11/25/2022]
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Del Papa M, D'Amata G, Manzi F, Carnì P, Florio G, Crovaro M, Musmeci L, Buonocore C. Open inguinal hernia repair with self-gripping Parietex ProGrip mesh: a retrospective study of 204 cases. G Chir 2019; 40:26-31. [PMID: 30771795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Chronic pain and recurrence rates are the main challenge in modern inguinal hernia surgery. Several trials have investigated the role of self-adhesive mesh repair for inguinal hernia, with special attention to the incidence of chronic postoperative inguinal pain and recurrence. The purpose of our study was to retrospectively evaluate the early and long-term results using a self-gripping mesh (Parietex Progrip® , Covidien) in our institution. A total of 204 patients, mean age 50.3 standard deviation (SD) 15.3, was included in the study. The repair was performed under local anaesthesia in 159 (78%) cases and locoregional anaesthesia in remaining 45 (22%). Mean operative time was 39 ± 20 minutes. The time for self-gripping mesh placement ranged from 5 to 9 minutes (mean 7 ± 2 minutes). There were no intraoperative complications. Clinical follow-up was performed at 1 month, 1 year and 2 years and consisted in the evaluation of complications, discomfort/pain and recurrence. One case of cutaneous infection and three cases of seroma were observed at one-month follow-up and were all treated conservatively. 8 patients were lost at one year follow-up, and another 4 were lost at 2 years. 3 patients died for other causes during follow-up. At 1 year and 2 years follow-up no cases of seroma, testicular complications or mesh infection were observed. Two cases of recurrence were recorded at 2 years follow up. No patient reported VAS score > 2 at one month, 1 year and 2 years follow-up. There were no readmissions, systemic complications or death during 2 years follow-up. Lichtenstein open repair using Parietex Progrip® mesh is a simple, rapid, effective and safe method for inguinal hernia repair. The main advantage of self-fixing mesh is the reduced operative time. A suturless fixation seems to prevent the development of postoperative chronic pain, without increasing recurrence rate in the majority of the trials.
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29
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Baker U, Petro A, Marchant T, Peterson S, Manzi F, Bergström A, Hanson C. Health workers' experiences of collaborative quality improvement for maternal and newborn care in rural Tanzanian health facilities: A process evaluation using the integrated 'Promoting Action on Research Implementation in Health Services' framework. PLoS One 2018; 13:e0209092. [PMID: 30566511 PMCID: PMC6300247 DOI: 10.1371/journal.pone.0209092] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 11/28/2018] [Indexed: 12/13/2022] Open
Abstract
Background Quality Improvement (QI) approaches are increasingly used to bridge the quality gap in maternal and newborn care (MNC) in Sub Saharan Africa. Health workers typically serve as both recipients and implementers of QI activities; their understanding, motivation, and level of involvement largely determining the potential effect. In support of efforts to harmonise and integrate the various QI approaches implemented in parallel in Tanzanian health facilities, our objective was to investigate how different components of a collaborative QI intervention were understood and experienced by health workers, and therefore contributed positively to its mechanisms of effect. Materials and methods A qualitative process evaluation of a collaborative QI intervention for MNC in rural Tanzania was carried out. Semi-structured interviews were conducted with 16 health workers in 13 purposively sampled health facilities. A deductive theory-driven qualitative content analysis was employed using the integrated Promoting Action on Research Implementation in Health services (i-PARIHS) framework as a lens with its four constructs innovation, recipients, facilitation, and context as guiding themes. Results Health workers valued the high degree of fit between QI topics and their everyday practice and appreciated the intervention’s comprehensive approach. The use of run-charts to monitor progress was well understood and experienced as motivating. The importance and positive experience of on-site mentoring and coaching visits to individual health facilities was expressed by the majority of health workers. Many described the parallel implementation of various health programs as a challenge. Conclusion Components of QI approaches that are well understood and experienced as supportive by health workers in everyday practice may enhance mechanisms of effect and result in more significant change. A focus on such components may also guide harmonisation, to avoid duplication and the implementation of parallel programs, and country ownership of QI approaches in resource limited settings.
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Affiliation(s)
- Ulrika Baker
- Department of Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
- Department of Public Health Sciences, Global Health—Health Systems and Policy Research, Karolinska Institutet, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institutet, Huddinge, Sweden
- * E-mail: ,
| | - Arafumin Petro
- Ifakara Health Institute, Health Systems, Impact Evaluation and Policy (HSIEP), Dar es Salaam, Tanzania
| | - Tanya Marchant
- Department of Disease Control, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Stefan Peterson
- Department of Public Health Sciences, Global Health—Health Systems and Policy Research, Karolinska Institutet, Stockholm, Sweden
- Department of Women’s and Children’s Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden
- Makerere School of Public Health, Kampala, Uganda
- UNICEF, Health Section, Programme Division, New York, United States of America
| | - Fatuma Manzi
- Ifakara Health Institute, Health Systems, Impact Evaluation and Policy (HSIEP), Dar es Salaam, Tanzania
| | - Anna Bergström
- Department of Women’s and Children’s Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden
- Institute for Global Health, University College London, London, United Kingdom
| | - Claudia Hanson
- Department of Public Health Sciences, Global Health—Health Systems and Policy Research, Karolinska Institutet, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
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30
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Hanson C, Betrán AP, Opondo C, Mkumbo E, Manzi F, Mbaruku G, Schellenberg J. Trends in caesarean section rates between 2007 and 2013 in obstetric risk groups inspired by the Robson classification: results from population‐based surveys in a low‐resource setting. BJOG 2018; 126:690-700. [DOI: 10.1111/1471-0528.15534] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2018] [Indexed: 11/28/2022]
Affiliation(s)
- C Hanson
- Department of Public Health Sciences Karolinska Institutet Stockholm Sweden
- Department of Disease Control London School of Hygiene and Tropical Medicine London UK
| | - AP Betrán
- Department of Reproductive Health and Research UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction World Health Organization Geneva Switzerland
| | - C Opondo
- Department of Disease Control London School of Hygiene and Tropical Medicine London UK
| | - E Mkumbo
- Ifakara Health Institute Dar‐es‐Salaam Tanzania
| | - F Manzi
- Ifakara Health Institute Dar‐es‐Salaam Tanzania
| | - G Mbaruku
- Ifakara Health Institute Dar‐es‐Salaam Tanzania
| | - J Schellenberg
- Department of Disease Control London School of Hygiene and Tropical Medicine London UK
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31
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Tancred T, Mandu R, Hanson C, Okuga M, Manzi F, Peterson S, Schellenberg J, Waiswa P, Marchant T. How people-centred health systems can reach the grassroots: experiences implementing community-level quality improvement in rural Tanzania and Uganda. Health Policy Plan 2018; 33:e1-e13. [PMID: 29304250 DOI: 10.1093/heapol/czu070] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2014] [Indexed: 01/01/2023] Open
Abstract
Background Quality improvement (QI) methods engage stakeholders in identifying problems, creating strategies called change ideas to address those problems, testing those change ideas and scaling them up where successful. These methods have rarely been used at the community level in low-income country settings. Here we share experiences from rural Tanzania and Uganda, where QI was applied as part of the Expanded Quality Management Using Information Power (EQUIP) intervention with the aim of improving maternal and newborn health. Village volunteers were taught how to generate change ideas to improve health-seeking behaviours and home-based maternal and newborn care practices. Interaction was encouraged between communities and health staff. Aim To describe experiences implementing EQUIP's QI approach at the community level. Methods A mixed methods process evaluation of community-level QI was conducted in Tanzania and a feasibility study in Uganda. We outlined how village volunteers were trained in and applied QI techniques and examined the interaction between village volunteers and health facilities, and in Tanzania, the interaction with the wider community also. Results Village volunteers had the capacity to learn and apply QI techniques to address local maternal and neonatal health problems. Data collection and presentation was a persistent challenge for village volunteers, overcome through intensive continuous mentoring and coaching. Village volunteers complemented health facility staff, particularly to reinforce behaviour change on health facility delivery and birth preparedness. There was some evidence of changing social norms around maternal and newborn health, which EQUIP helped to reinforce. Conclusions Community-level QI is a participatory research approach that engaged volunteers in Tanzania and Uganda, putting them in a central position within local health systems to increase health-seeking behaviours and improve preventative maternal and newborn health practices.
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Affiliation(s)
- Tara Tancred
- Ifakara Health Institute, Dar es Salaam, Tanzania.,Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Rogers Mandu
- Makerere University School of Public Health, Kampala, Uganda
| | - Claudia Hanson
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Monica Okuga
- Makerere University School of Public Health, Kampala, Uganda
| | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Stefan Peterson
- Makerere University School of Public Health, Kampala, Uganda.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,The Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Waiswa
- Makerere University School of Public Health, Kampala, Uganda.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Tanya Marchant
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
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32
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Manzi F, Daviaud E, Schellenberg J, Lawn JE, John T, Msemo G, Owen H, Barger D, Hanson C, Borghi J. Improving Newborn Survival in Southern Tanzania (INSIST) trial; community-based maternal and newborn care economic analysis. Health Policy Plan 2018; 32:i33-i41. [PMID: 27335165 PMCID: PMC5886149 DOI: 10.1093/heapol/czw048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2016] [Indexed: 12/19/2022] Open
Abstract
Despite health systems improvements in Tanzania, gaps in the continuum of care for maternal, newborn and child health persist. Recent improvements have largely benefited those over one month of age, leading to a greater proportion of under-five mortality in newborns. Community health workers providing home-based counselling have been championed as uniquely qualified to reach the poorest. We provide financial and economic costs of a volunteer home-based counselling programme in southern Tanzania. Financial costs of the programme were extracted from project accounts. Ministry of Health and Social Welfare costs associated with programme implementation were collected based on staff and project monthly activity plans. Household costs associated with facility-based delivery were also estimated based on exit interviews with post-natal women. Time spent on the programme by implementers was assessed by interviews conducted with volunteers and health staff. The programme involved substantial design and set-up costs. The main drivers of set-up costs were activities related to volunteer training. Total annualized costs (design, set-up and implementation) amounted to nearly US$300 000 for financial costs and just over US$400 000 for economic costs. Volunteers (n = 842) spent just under 14 hours per month on programme-related activities. When volunteer time was valued under economic costs, this input amounted to just under half of the costs of implementation. The economic consequences of increased service use to households were estimated at US$36 985. The intervention cost per mother–newborn pair visited was between US$12.60 and US$19.50, and the incremental cost per additional facility-based delivery ranged from US$85.50 to US$137.20 for financial and economic costs (with household costs). Three scale-up scenarios were considered, with the financial cost per home visit respectively varying from $1.44 to $3.21 across scenarios. Cost-effectiveness compares well with supply-side initiatives to increase coverage of facility-based deliveries, and the intervention would benefit from substantial economies of scale.
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Affiliation(s)
- Fatuma Manzi
- Ifakara Health Institute, Dar Es Salaam, P.O. Box 78 373, Tanzania
| | - Emmanuelle Daviaud
- Medical Research Council, Francie van Zijl Drive, Parowvallei, Cape; PO Box 19070 7505 Tygerberg, Cape Town, South Africa
| | - Joanna Schellenberg
- London School of Hygiene & Tropical Medicine, Keppel Street London WC1E 7HT, London, UK
| | - Joy E Lawn
- London School of Hygiene & Tropical Medicine, Keppel Street London WC1E 7HT, London, UK
| | - Theopista John
- World Health Organisation, Dar Es Salaam, United Republic of Tanzania, Tanzania
| | - Georgina Msemo
- Ministry of Health and Social Welfare, Sokoine Drive, Dar Es Salaam, Tanzania
| | - Helen Owen
- London School of Hygiene & Tropical Medicine, Keppel Street London WC1E 7HT, London, UK
| | - Diana Barger
- Save the Children, 899 North Capitol Street, Suite 900, Washington, DC 20002
| | - Claudia Hanson
- London School of Hygiene & Tropical Medicine, Keppel Street London WC1E 7HT, London, UK
| | - Josephine Borghi
- London School of Hygiene & Tropical Medicine, Keppel Street London WC1E 7HT, London, UK
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Daviaud E, Owen H, Pitt C, Kerber K, Bianchi Jassir F, Barger D, Manzi F, Ekipara-Kiracho E, Greco G, Waiswa P, Lawn JE. Overview, methods and results of multi-country community-based maternal and newborn care economic analysis. Health Policy Plan 2018; 32:i6-i20. [PMID: 28981766 DOI: 10.1093/heapol/czx055] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2017] [Indexed: 11/12/2022] Open
Abstract
Home visits for pregnancy and postnatal care were endorsed by the WHO and partners as a complementary strategy to facility-based care to reduce newborn and maternal mortality. This article aims to synthesise findings and implications from the economic analyses of community-based maternal and newborn care (CBMNC) evaluations in seven countries. The evaluations included five cluster randomized trials (Ethiopia, Ghana, South Africa, Tanzania, Uganda) and programmatic before/after assessments (Bolivia, Malawi). The economic analyses were undertaken using a standardized, comparable methodology the 'Cost of Integrated Newborn Care' Tool, developed by the South African Medical Research Council, with Saving Newborn Lives and a network of African economists. The main driver of costs is the number of community health workers (CHWs), determined by their time availability, as fixed costs per CHW (equipment, training, salary/stipend, supervision and management), independent from the level of activity (number of mothers visited) represented over 96% of economic and financial costs in five of the countries. Unpaid volunteers are not necessarily a cheap option. An integrated programme with multi-purpose paid workers usually has lower costs per visit but requires innovative management, including supervision to ensure that coverage, or quality of care are not compromised since these workers have many other responsibilities apart from maternal and newborn health. If CHWs reach 95% of pregnant women in a standardized 100 000 population, the additional financial cost in all cases would be under USD1 per capita. In five of the six countries, the programme would be highly cost-effective (cost per DALY averted < GDP/capita) by WHO threshold even if they only achieved a reduction of 1 neonatal death per 1000 live births. These results contribute useful information for implementation planning and sustainability of CBMNC programmes.
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Affiliation(s)
- Emmanuelle Daviaud
- Health System Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Helen Owen
- MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Catherine Pitt
- MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - Fatuma Manzi
- Ifakara Health Research and Development Centre, Ifakara, Tanzania
| | | | - Giulia Greco
- MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter Waiswa
- College of Health Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Joy E Lawn
- MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK
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34
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Abstract
Purpose The purpose of this paper is to describe a quality improvement (QI) intervention in primary health facilities providing childbirth care in rural Southern Tanzania. Design/methodology/approach A QI collaborative model involving district managers and health facility staff was piloted for 6 months in 4 health facilities in Mtwara Rural district and implemented for 18 months in 23 primary health facilities in Ruangwa district. The model brings together healthcare providers from different health facilities in interactive workshops by: applying QI methods to generate and test change ideas in their own facilities; using local data to monitor improvement and decision making; and health facility supervision visits by project and district mentors. The topics for improving childbirth were deliveries and partographs. Findings Median monthly deliveries increased in 4 months from 38 (IQR 37-40) to 65 (IQR 53-71) in Mtwara Rural district, and in 17 months in Ruangwa district from 110 (IQR 103-125) to 161 (IQR 148-174). In Ruangwa health facilities, the women for whom partographs were used to monitor labour progress increased from 10 to 57 per cent in 17 months. Research limitations/implications The time for QI innovation, testing and implementation phases was limited, and the study only looked at trends. The outcomes were limited to process rather than health outcome measures. Originality/value Healthcare providers became confident in the QI method through engagement, generating and testing their own change ideas, and observing improvements. The findings suggest that implementing a QI initiative is feasible in rural, low-income settings.
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Affiliation(s)
- Jennie Jaribu
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Suzanne Penfold
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Joanna Schellenberg
- Department of Disease Control and Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Moran AC, Charlet D, Madhavan S, Aruldas K, Donaldson M, Manzi F, Okuga M, Rosales A, Sharma V, Celone M, Brandes N, Sherry JM. Methodology for a mixed-methods multi-country study to assess recognition of and response to maternal and newborn illness. J Health Popul Nutr 2017; 36:51. [PMID: 29297390 PMCID: PMC5764055 DOI: 10.1186/s41043-017-0119-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Although maternal and newborn mortality have decreased 44 and 46% respectively between 1990 and 2015, achievement of ambitious Sustainable Development Goal targets requires accelerated progress. Mortality reduction requires a renewed focus on the continuum of maternal and newborn care from the household to the health facility. Although barriers to accessing skilled care are documented for specific contexts, there is a lack of systematic evidence on how women and families identify maternal and newborn illness and make decisions and subsequent care-seeking patterns. The focus of this multi-country study was to identify and describe illness recognition, decision-making, and care-seeking patterns across various contexts among women and newborns who survived and died to ultimately inform programmatic priorities moving forward. METHODS This study was conducted in seven countries-Ethiopia, Tanzania, Uganda, Nigeria, India, Indonesia, and Nepal. Mixed-methods were utilized including event narratives (group interviews), in-depth interviews (IDIs), focus group discussions (FDGs), rapid facility assessments, and secondary analyses of existing program data. A common protocol and tools were developed in collaboration with study teams and adapted for each site, as needed. Sample size was a minimum of five cases of each type (e.g., perceived postpartum hemorrhage, maternal death, newborn illness, and newborn death) for each study site, with a total of 84 perceived PPH, 45 maternal deaths, 83 newborn illness, 55 newborn deaths, 64 IDIs/FGDs, and 99 health facility assessments across all sites. Analysis included coding within and across cases, identifying broad themes on recognition of illness, decision-making, and patterns of care seeking, and corresponding contextual factors. Technical support was provided throughout the process for capacity building, quality assurance, and consistency across sites. CONCLUSION This study provides rigorous evidence on how women and families recognize and respond to maternal and newborn illness. By using a common methodology and tools, findings not only were site-specific but also allow for comparison across contexts.
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Affiliation(s)
- Allisyn C. Moran
- United States Agency for International Development, Bureau for Global Health, Washington, DC, USA
| | | | - Supriya Madhavan
- United States Agency for International Development, Bureau for Global Health, Washington, DC, USA
| | | | | | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Monica Okuga
- Makerere University School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Vandana Sharma
- The Abdul Latif Jameel Poverty Action Lab, Massachusetts Institute of Technology, Cambridge, MA USA
| | | | - Neal Brandes
- United States Agency for International Development, Bureau for Global Health, Washington, DC, USA
| | - James M. Sherry
- University Research Co., LLC, Bethesda, MD USA
- School of Public Health, City University of New York, New York, New York USA
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Okuga M, Waiswa P, Mandu R, Wachira J, Hanson C, Manzi F. Illness recognition and care-seeking for maternal and newborn complications in rural eastern Uganda. J Health Popul Nutr 2017; 36:47. [PMID: 29297398 PMCID: PMC5764049 DOI: 10.1186/s41043-017-0125-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND To enhance understanding of the roles of community-based initiatives in poor rural societies, we describe and explore illness recognition, decision-making, and appropriate care-seeking for mothers and newborn illnesses in two districts in eastern Uganda where in one implementation district, a facility and community quality improvement approach was implemented. METHODS This was a cross-sectional study using qualitative methods. We conducted 48 event narratives: eight maternal and newborn deaths and 16 maternal and newborn illnesses. Additionally, we conducted six FGDs with women's saving groups and community leaders. Qualitative data were analyzed thematically using Atlas.ti software. RESULTS Women and caretakers reported that community initiatives including the presence of community health workers and women's saving groups helped in enhancing illness recognition, decision-making, and care-seeking for maternal and newborn complications. Newborn illness seemed to be less well understood, and formal care was often delayed. Care-seeking was complicated by accessing several stations from primary to secondary care, and often, the hospital was reached too late. CONCLUSIONS Our qualitative study suggests that community approaches may play a role in illness recognition, decision-making, and care-seeking for maternal and newborn illness. The role of primary facilities in providing care for maternal and newborn emergencies might need to be reviewed.
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Affiliation(s)
- Monica Okuga
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda
- Center of Excellence for Maternal, Newborn and Child Health, Makerere University, Kampala, Uganda
| | - Peter Waiswa
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda
- Center of Excellence for Maternal, Newborn and Child Health, Makerere University, Kampala, Uganda
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Rogers Mandu
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda
- Center of Excellence for Maternal, Newborn and Child Health, Makerere University, Kampala, Uganda
| | - Juddy Wachira
- School of Medicine/AMPATH, Moi University, Nairobi, Kenya
| | - Claudia Hanson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- London School of Hygiene and Tropical Medicine, London, UK
| | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, Tanzania
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Hanson C, Gabrysch S, Mbaruku G, Cox J, Mkumbo E, Manzi F, Schellenberg J, Ronsmans C. Access to maternal health services: geographical inequalities, United Republic of Tanzania. Bull World Health Organ 2017; 95:810-820. [PMID: 29200522 PMCID: PMC5710083 DOI: 10.2471/blt.17.194126] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 10/03/2017] [Accepted: 10/05/2017] [Indexed: 11/27/2022] Open
Abstract
Objective To determine if improved geographical accessibility led to increased uptake of maternity care in the south of the United Republic of Tanzania. Methods In a household census in 2007 and another large household survey in 2013, we investigated 22 243 and 13 820 women who had had a recent live birth, respectively. The proportions calculated from the 2013 data were weighted to account for the sampling strategy. We examined the association between the straight-line distances to the nearest primary health facility or hospital and uptake of maternity care. Findings The percentages of live births occurring in primary facilities and hospitals rose from 12% (2571/22 243) and 29% (6477/22 243), respectively, in 2007 to weighted values of 39% and 40%, respectively, in 2013. Between the two surveys, women living far from hospitals showed a marked gain in their use of primary facilities, but the proportion giving birth in hospitals remained low (20%). Use of four or more antenatal visits appeared largely unaffected by survey year or the distance to the nearest antenatal clinic. Although the overall percentage of live births delivered by caesarean section increased from 4.1% (913/22 145) in the first survey to a weighted value of 6.5% in the second, the corresponding percentages for women living far from hospital were very low in 2007 (2.8%; 35/1254) and 2013 (3.3%). Conclusion For women living in our study districts who sought maternity care, access to primary facilities appeared to improve between 2007 and 2013, however access to hospital care and caesarean sections remained low.
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Affiliation(s)
- Claudia Hanson
- Department of Disease Control, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT England
| | - Sabine Gabrysch
- Institute of Public Health, Ruprecht-Karls-University, Heidelberg, Germany
| | - Godfrey Mbaruku
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | - Jonathan Cox
- Bill and Melinda Gates Foundation, Seattle, United States of America
| | - Elibariki Mkumbo
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT England
| | - Carine Ronsmans
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, England
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Waiswa P, Manzi F, Mbaruku G, Rowe AK, Marx M, Tomson G, Marchant T, Willey BA, Schellenberg J, Peterson S, Hanson C. Effects of the EQUIP quasi-experimental study testing a collaborative quality improvement approach for maternal and newborn health care in Tanzania and Uganda. Implement Sci 2017; 12:89. [PMID: 28720114 PMCID: PMC5516352 DOI: 10.1186/s13012-017-0604-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/30/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Quality improvement is a recommended strategy to improve implementation levels for evidence-based essential interventions, but experience of and evidence for its effects in low-resource settings are limited. We hypothesised that a systemic and collaborative quality improvement approach covering district, facility and community levels, supported by report cards generated through continuous household and health facility surveys, could improve the implementation levels and have a measurable population-level impact on coverage and quality of essential services. METHODS Collaborative quality improvement teams tested self-identified strategies (change ideas) to support the implementation of essential maternal and newborn interventions recommended by the World Health Organization. In Tanzania and Uganda, we used a plausibility design to compare the changes over time in one intervention district with those in a comparison district in each country. Evaluation included indicators of process, coverage and implementation practice analysed with a difference-of-differences and a time-series approach, using data from independent continuous household and health facility surveys from 2011 to 2014. Primary outcomes for both countries were birth in health facilities, breastfeeding within 1 h after birth, oxytocin administration after birth and knowledge of danger signs for mothers and babies. Interpretation of the results considered contextual factors. RESULTS The intervention was associated with improvements on one of four primary outcomes. We observed a 26-percentage-point increase (95% CI 25-28%) in the proportion of live births where mothers received uterotonics within 1 min after birth in the intervention compared to the comparison district in Tanzania and an 8-percentage-point increase (95% CI 6-9%) in Uganda. The other primary indicators showed no evidence of improvement. In Tanzania, we saw positive changes for two other outcomes reflecting locally identified improvement topics. The intervention was associated with an increase in preparation of clean birth kits for home deliveries (31 percentage points, 95% CI 2-60%) and an increase in health facility supervision by district staff (14 percentage points, 95% CI 0-28%). CONCLUSIONS The systemic quality improvement approach was associated with improvements of only one of four primary outcomes, as well as two Tanzania-specific secondary outcomes. Reasons for the lack of effects included limited implementation strength as well a relatively short follow-up period in combination with a 1-year recall period for population-based estimates and a limited power of the study to detect changes smaller than 10 percentage points. TRIAL REGISTRATION Pan African Clinical Trials Registry: PACTR201311000681314.
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Affiliation(s)
- P Waiswa
- College of Health Sciences, School of Public Health, Makerere University, Kampala, Uganda
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - F Manzi
- Ifakara Health Institute, Dar-es-Salaam, Tanzania
| | - G Mbaruku
- Ifakara Health Institute, Dar-es-Salaam, Tanzania
| | - A. K. Rowe
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - M Marx
- Evaplan GmbH the University of Heidelberg, Heidelberg, Germany
| | - G Tomson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Department of Learning, Informatics, Management, Ethics, Karolinska Institutet, Stockholm, Sweden
| | - T Marchant
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - B. A. Willey
- Department Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - J Schellenberg
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - S Peterson
- College of Health Sciences, School of Public Health, Makerere University, Kampala, Uganda
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- International Maternal and Child Health Unit, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - C Hanson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
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Tancred T, Manzi F, Schellenberg J, Marchant T. Facilitators and Barriers of Community-Level Quality Improvement for Maternal and Newborn Health in Tanzania. Qual Health Res 2017; 27:738-749. [PMID: 27022034 DOI: 10.1177/1049732316638831] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
A quality improvement intervention for maternal and newborn health was carried out in southern Tanzania at the community level. It sought to improve health-seeking behaviors and uptake of community-level maternal and newborn health practices. A process evaluation populated using data primarily from in-depth interviews and focus group discussions with the intervention's implementers was undertaken in four villages receiving the intervention to evaluate the intervention's implementation, uncover facilitators and barriers of quality improvement, and highlight contextual factors that might have influenced implementation. Performance implementation scores were used to rank the villages. Identifying higher- and lower-performing villages highlighted key facilitators and barriers of community-level quality improvement related to support from local leaders, motivation through use of local quality improvement data, and regular education around quality improvement and maternal and newborn health. These findings can be taken formatively in the design of similar interventions in the future.
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Affiliation(s)
- Tara Tancred
- 1 London School of Hygiene & Tropical Medicine, London, UK
| | - Fatuma Manzi
- 2 Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | - Tanya Marchant
- 1 London School of Hygiene & Tropical Medicine, London, UK
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Baker U, Hassan F, Hanson C, Manzi F, Marchant T, Swartling Peterson S, Hylander I. Unpredictability dictates quality of maternal and newborn care provision in rural Tanzania-A qualitative study of health workers' perspectives. BMC Pregnancy Childbirth 2017; 17:55. [PMID: 28166745 PMCID: PMC5294891 DOI: 10.1186/s12884-017-1230-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 01/20/2017] [Indexed: 11/10/2022] Open
Abstract
Background Health workers are the key to realising the potential of improved quality of care for mothers and newborns in the weak health systems of Sub Saharan Africa. Their perspectives are fundamental to understand the effectiveness of existing improvement programs and to identify ways to strengthen future initiatives. The objective of this study was therefore to examine health worker perspectives of the conditions for maternal and newborn care provision and their perceptions of what constitutes good quality of care in rural Tanzanian health facilities. Methods In February 2014, we conducted 17 in-depth interviews with different cadres of health workers providing maternal and newborn care in 14 rural health facilities in Tandahimba district, south-eastern Tanzania. These facilities included one district hospital, three health centres and ten dispensaries. Interviews were conducted in Swahili, transcribed verbatim and translated into English. A grounded theory approach was used to guide the analysis, the output of which was one core category, four main categories and several sub-categories. Results ‘It is like rain’ was identified as the core category, delineating unpredictability as the common denominator for all aspects of maternal and newborn care provision. It implies that conditions such as mothers’ access to and utilisation of health care are unreliable; that availability of resources is uncertain and that health workers have to help and try to balance the situation. Quality of care was perceived to vary as a consequence of these conditions. Health workers stressed the importance of predictability, of ‘things going as intended’, as a sign of good quality care. Conclusions Unpredictability emerged as a fundamental condition for maternal and newborn care provision, an important determinant and characteristic of quality in this study. We believe that this finding is also relevant for other areas of care in the same setting and may be an important defining factor of a weak health system. Increasing predictability within health services, and focusing on the experience of health workers within these, should be prioritised in order to achieve better quality of care for mothers and newborns. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1230-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ulrika Baker
- Department of Public Health sciences, Global health - Health Systems and Policy Research, Widerströmska huset, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden. .,Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institutet, Nobels allé 12, 141 83, Huddinge, Sweden.
| | - Farida Hassan
- Ifakara Health Institute, Plot 463 Kiko Avenue, Mikocheni, Dar es Salaam, P.O. Box 78 373, Tanzania
| | - Claudia Hanson
- Department of Public Health sciences, Global health - Health Systems and Policy Research, Widerströmska huset, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden.,Department for Disease Control, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
| | - Fatuma Manzi
- Ifakara Health Institute, Plot 463 Kiko Avenue, Mikocheni, Dar es Salaam, P.O. Box 78 373, Tanzania
| | - Tanya Marchant
- Department for Disease Control, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
| | - Stefan Swartling Peterson
- Department of Public Health sciences, Global health - Health Systems and Policy Research, Widerströmska huset, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden.,International Maternal and Child Health, Uppsala University, Drottninggatan 4, 751 85, Uppsala, Sweden.,Makerere School of Public Health, Kampala, Uganda
| | - Ingrid Hylander
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institutet, Nobels allé 12, 141 83, Huddinge, Sweden
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Jaribu J, Penfold S, Manzi F, Schellenberg J, Pfeiffer C. Improving institutional childbirth services in rural Southern Tanzania: a qualitative study of healthcare workers' perspective. BMJ Open 2016; 6:e010317. [PMID: 27660313 PMCID: PMC5051329 DOI: 10.1136/bmjopen-2015-010317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To describe health workers' perceptions of a quality improvement (QI) intervention that focused on improving institutional childbirth services in primary health facilities in Southern Tanzania. DESIGN A qualitative design was applied using in-depth interviews with health workers. SETTING This study involved the Ruangwa District Reproductive and Child Health Department, 11 dispensaries and 2 health centres in rural Southern Tanzania. PARTICIPANTS 4 clinical officers, 5 nurses and 6 medical attendants from different health facilities were interviewed. RESULTS The healthcare providers reported that the QI intervention improved their skills, capacity and confidence in providing counselling and use of a partograph during labour. The face-to-face QI workshops, used as a platform to refresh their knowledge on maternal and newborn health and QI methods, facilitated peer learning, networking and standardisation of care provision. The onsite follow-up visits were favoured by healthcare providers because they gave the opportunity to get immediate help, learn how to perform tasks in practice and be reminded of what they had learnt. Implementation of parallel interventions focusing on similar indicators was mentioned as a challenge that led to duplication of work in terms of data collection and reporting. District supervisors involved in the intervention showed interest in taking over the implementation; however, funding remained a major obstacle. CONCLUSIONS Healthcare workers highlighted the usefulness of applying a QI approach to improve maternal and newborn health in rural settings. QI programmes need careful coordination at district level in order to reduce duplication of work.
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Affiliation(s)
- Jennie Jaribu
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Basel University, Basel, Switzerland
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | | | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | | | - Constanze Pfeiffer
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Basel University, Basel, Switzerland
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Tancred T, Marchant T, Hanson C, Schellenberg J, Manzi F. Birth preparedness and place of birth in Tandahimba district, Tanzania: what women prepare for birth, where they go to deliver, and why. BMC Pregnancy Childbirth 2016; 16:165. [PMID: 27422526 PMCID: PMC4947316 DOI: 10.1186/s12884-016-0945-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 06/03/2016] [Indexed: 01/01/2023] Open
Abstract
Background As making preparations for birth and health facility delivery are behaviours linked to positive maternal and newborn health outcomes, we aimed to describe what birth preparations were made, where women delivered, and why. Methods Outcomes were tabulated using data derived from a repeated sample (continuous) quantitative household survey of women aged 13–49 who had given birth in the past year. Insights into why behaviours took place emerged from analysis of in-depth interviews (12) and birth narratives (36) with recently delivered mothers and male partners. Results Five hundred-twenty three women participated in the survey from April 2012–November 2013. Ninety-five percent (496/523) of women made any birth preparations for their last pregnancy. Commonly prepared birth items were cotton gauze (93 %), a plastic cover to deliver on (84 %), gloves (72 %), clean clothes (70 %), and money (42 %). Qualitative data suggest that preparation of items used directly during delivery was perceived as necessary to facilitate good care and prevent disease transmission. Sixty-eight percent of women gave birth at a health facility, 30 % at home, and 2 % on the way to a health facility. Qualitative data suggested that health facility delivery was viewed positively and that women were inclined to go to a health facility because of a perception of: increased education about delivery and birth preparedness; previous health facility delivery; and better availability and accessibility of facilities in recent years. Perceived barriers: were a lack of money; absent health facility staff or poor provider attitudes; women perceiving that they were unable to go to a health facility or arrange transport on their own; or a lack of support of pregnant women from their partners. Conclusions The majority of women made at least some birth preparations and gave birth in a health facility. Functional items needed for birth seem to be given precedence over practices like saving money. As such, maintaining education about the importance of these practices, with an emphasis on emergency preparedness, would be valuable. Alongside education delivered as part of focussed antenatal care, community-based interventions that aim to increase engagement of men in birth preparedness, and support agency among women, are recommended.
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Affiliation(s)
- Tara Tancred
- London School of Hygiene and Tropical Medicine, London, UK.
| | - Tanya Marchant
- London School of Hygiene and Tropical Medicine, London, UK
| | - Claudia Hanson
- London School of Hygiene and Tropical Medicine, London, UK.,Karolinska Institute, Stockholm, Sweden
| | | | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, Tanzania
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Tani K, Exavery A, Baynes CD, Pemba S, Hingora A, Manzi F, Phillips JF, Kanté AM. Unit cost analysis of training and deploying paid community health workers in three rural districts of Tanzania. BMC Health Serv Res 2016; 16:237. [PMID: 27391368 PMCID: PMC4938973 DOI: 10.1186/s12913-016-1476-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 06/24/2016] [Indexed: 11/18/2022] Open
Abstract
Background Tanzania, like other African countries, faces significant health workforce shortages. With advisory and partnership from Columbia University, the Ifakara Health Institute and the Tanzanian Training Centre for International Health (TTCIH) developed and implemented the Connect Project as a randomized cluster experimental trial of the childhood survival impact of recruiting, training, and deploying of a new cadre of paid community health workers (CHW), named “Wawazesha wa afya ya Jamii” (WAJA). This paper presents an estimation of the cost of training and deploying WAJA in three rural districts of Tanzania. Methods Costing data were collected by tracking project activity expenditure records and conducting in-depth interviews of TTCIH staff who have led the training and deployment of WAJA, as well as their counterparts at Public Clinical Training Centres who have responsibility for scaling up the WAJA training program. The trial is registered with the International Standard Randomized Controlled Trial Register number (ISRCTN96819844). Results The Connect training cost was US$ 2,489.3 per WAJA, of which 40.1 % was for meals, 20.2 % for accommodation 10.2 % for tuition fees and the remaining 29.5 % for other costs including instruction and training facilities and field allowance. A comparable training program estimated unit cost for scaling-up this training via regional/district clinical training centres would be US$ 833.5 per WAJA. Of this unit cost, 50.3 % would involve the cost of meals, 27.4 % training fees, 13.7 % for field allowances, 9 % for accommodation and medical insurance. The annual running cost of WAJA in a village will cost US$ 1.16 per capita. Conclusion Costs estimated by this study are likely to be sustainable on a large scale, particularly if existing regional/district institutions are utilized for this program.
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Affiliation(s)
- Kassimu Tani
- Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania.
| | - Amon Exavery
- Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania
| | - Colin D Baynes
- Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania.,Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue (B2), New York, NY, 10032, USA
| | - Senga Pemba
- Tanzanian Training Centre for International Health, P.O. BOX 39, Ifakara, Tanzania
| | - Ahmed Hingora
- Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania
| | - Fatuma Manzi
- Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania
| | - James F Phillips
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue (B2), New York, NY, 10032, USA
| | - Almamy Malick Kanté
- Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania.,Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue (B2), New York, NY, 10032, USA
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Liccardi G, Baldi G, Berra A, Ciccarelli A, Cutajar M, D'Amato M, D'Angelo R, Gargano D, Giannattasio D, Leone G, Lo Schiavo M, Madonna F, Montera C, Monti R, Parente R, Pedicini A, Pio A, Russo M, Salzillo A, Stanziola A, Vatrella A, Manzi F, Bilò MB. Allergy in urban elderly population living in Campania region (Southern Italy). A multicenter study. Eur Ann Allergy Clin Immunol 2016; 48:156-160. [PMID: 27425174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Given the increasing life expectancy observed in Western countries, there is a marked interest to know more about how aging could influence respiratory health. The aim of our study was to assess the prevalence, clinical characteristics and age of onset of allergic sensitization and clinical symptoms in a sample of atopic elders living in Campania region area (Southern Italy). Fourteen Allergy units or Centres examined a total of 462 patients. In this context 215 (46.53%) had positive skin prick tests (SPTs) to at least one allergen and were diagnosed with respiratory allergy. Parietaria represents the most common sensitizing agent in elders living in Campania region, followed by dust mites, grass pollen and Olea europaea. A relatively high percentage of atopic subjects suffered from respiratory symptoms at a fairly advanced age, namely 8.3% at 60-64 years, 10.2% at 65-70 and 5.7% at > 70 years. In conclusion, the prevalence and clinical significance of airway allergic sensitization in the elderly living in Campania region is more significant than expected in latter stages of life. Physicians should not neglect the role of atopy as a risk factor for the onset of allergic respiratory symptoms even in elderly patients.
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Affiliation(s)
- G Liccardi
- Department of Pulmonology, Haematology and Oncology, Division of Pulmonology and Allergology, High Speciality "A. Cardarelli" Hospital, Naples, Italy. Phone: +39 081 747 3335-4-3 Fax: + 39 081 747 3331 E-mail:
| | - G Baldi
- Respiratory Medicine Unit. ASL (district 66), Salerno, Italy
| | - A Berra
- Respiratory Allergy Unit, G. Da Procida Hospital, Salerno, Italy
| | - A Ciccarelli
- Allergy Unit, Presidio Sanitario Polispecialistico "Loreto Crispi", Naples, Italy
| | - M Cutajar
- Allergy Center, Division of Internal Medicine, Ospedali Riuniti Penisola Sorrentina, Sorrento, Naples, Italy
| | - M D'Amato
- Department of Respiratory Disease, "Federico II" University, AO "Dei Colli", Naples, Italy
| | - R D'Angelo
- Department of Pulmonology, Haematology and Oncology, Division of Pulmonology and Allergology, High Speciality "A. Cardarelli" Hospital, Naples, Italy
| | - D Gargano
- Allergy Unit, High Speciality "San Giuseppe Moscati" Hospital, Avellino, Italy
| | - D Giannattasio
- Respiratory physiopathology and allergy, High Speciality Center, "Mauro Scarlato" Hospital, Scafati, Salerno, Italy
| | - G Leone
- Allergy and Clinical Immunology Unit, High Speciality "Sant'Anna and San Sebastiano" Hospital, Caserta, Italy
| | - M Lo Schiavo
- Allergy and Clinical Immunology. "G. Fucito" Hospital and University Hospital, Salerno, Italy
| | - F Madonna
- Allergy Unit, ASL (Sanitary District 12), Caserta, Italy
| | - C Montera
- Allergy and Clinical Immunology. "G. Fucito" Hospital and University Hospital, Salerno, Italy
| | - R Monti
- Private Center for Allergy Diagnosis, Ischia, Naples, Italy
| | - R Parente
- Department of Medicine and Surgery, University of Salerno, Italy
| | - A Pedicini
- Unit of Allergology, Division of Internal Medicine, "Fatebenefratelli" Hospital, Benevento, Italy
| | - A Pio
- Allergy and Clinical Immunology. "G. Fucito" Hospital and University Hospital, Salerno, Italy
| | - M Russo
- Department of Pulmonology, Haematology and Oncology, Division of Pulmonology and Allergology, High Speciality "A. Cardarelli" Hospital, Naples, Italy
| | - A Salzillo
- Department of Pulmonology, Haematology and Oncology, Division of Pulmonology and Allergology, High Speciality "A. Cardarelli" Hospital, Naples, Italy
| | - A Stanziola
- Department of Respiratory Disease, "Federico II" University, AO "Dei Colli", Naples, Italy
| | - A Vatrella
- Department of Medicine and Surgery, University of Salerno, Italy
| | - F Manzi
- Department of Pulmonology, Haematology and Oncology, Division of Pulmonology and Allergology, High Speciality "A. Cardarelli" Hospital, Naples, Italy
| | - M B Bilò
- Allergy Unit, Department of Immunology, Allergy and Respiratory Diseases. University Hospital Ancona, Italy
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Liccardi G, Triggiani M, Piccolo A, Salzillo A, Parente R, Manzi F, Vatrella A. Sensitization to Common and Uncommon Pets or Other Furry Animals: Which May Be Common Mechanisms? Transl Med UniSa 2016; 14:9-14. [PMID: 27326390 PMCID: PMC4912333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Exposure to animal allergens constitutes a relevant risk factor for the development of allergic sensitization. Moreover, an increasing number of people become owners of less common animals. In this article we summarize aspects related to sensitization to cat/dog which may be applied also to uncommon pets or other furry animals. The data discussed here suggest that several different factors may induce allergic sensitization to furry animals with or without previous contact. Allergic sensitization without animal exposure is a relevant risk for patients because they are not aware about the possibility that even severe respiratory symptoms may develop after an occasional animal contact. This aspect should be taken into account by susceptible individuals before acquiring pets or beginning a contact for working/leisure activity with a common as well as uncommon animal. As a consequence, skin prick test and/or evaluation of specific IgE antibodies (by classic ImmunoCAP or micro-array technique ImmunoCAP ISAC) also to less common ("new") mammalian allergens could be recommended in individuals already sensitized to common pets to identify the occurrence of allergic sensitization and consequently to avoid future exposures to uncommon animal allergens.
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Affiliation(s)
- G Liccardi
- Department of Chest Diseases, Division of Pneumology and Allergology. High Speciality “A.Cardarelli” Hospital, Naples Italy,Corresponding author:
| | - M Triggiani
- Division of Allergy and Clinical Immunology, Department of Medicine and Surgery, University of Salerno, Italy
| | - A Piccolo
- Department of Chest Diseases, Division of Pneumology and Allergology. High Speciality “A.Cardarelli” Hospital, Naples Italy
| | - A Salzillo
- Department of Chest Diseases, Division of Pneumology and Allergology. High Speciality “A.Cardarelli” Hospital, Naples Italy
| | - R Parente
- Division of Allergy and Clinical Immunology, Department of Medicine and Surgery, University of Salerno, Italy
| | - F Manzi
- Department of Chest Diseases, Division of Pneumology and Allergology. High Speciality “A.Cardarelli” Hospital, Naples Italy
| | - A Vatrella
- Division of Respiratory Disease, Department of Medicine and Surgery, University of Salerno, Italy
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Kuwawenaruwa A, Baraka J, Ramsey K, Manzi F, Bellows B, Borghi J. Poverty identification for a pro-poor health insurance scheme in Tanzania: reliability and multi-level stakeholder perceptions. Int J Equity Health 2015; 14:143. [PMID: 26626873 PMCID: PMC4666058 DOI: 10.1186/s12939-015-0273-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 11/17/2015] [Indexed: 11/10/2022] Open
Abstract
Background Many low income countries have policies to exempt the poor from user charges in public facilities. Reliably identifying the poor is a challenge when implementing such policies. In Tanzania, a scorecard system was established in 2011, within a programme providing free national health insurance fund (NHIF) cards, to identify poor pregnant women and their families, based on eight components. Using a series of reliability tests on a 2012 dataset of 2,621 households in two districts, this study compares household poverty levels using the scorecard, a wealth index, and monthly consumption expenditures. Methods We compared the distributions of the three wealth measures, and the consistency of household poverty classification using cross-tabulations and the Kappa statistic. We measured errors of inclusion and exclusion of the scorecard relative to the other methods. We also gathered perceptions of the scorecard criteria through qualitative interviews with stakeholders at multiple levels of the health system. Findings The distribution of the scorecard was less skewed than other wealth measures and not truncated, but demonstrated clumping. There was a higher level of agreement between the scorecard and the wealth index than consumption expenditure. The scorecard identified a similar number of poor households as the “basic needs” poverty line based on monthly consumption expenditure, with only 45 % errors of inclusion. However, it failed to pick up half of those living below the “basic needs” poverty line as being poor. Stakeholders supported the inclusion of water sources, income, food security and disability measures but had reservations about other items on the scorecard. Conclusion In choosing poverty identification strategies for programmes seeking to enhance health equity it’s necessary to balance between community acceptability, local relevance and the need for such a strategy. It is important to ensure the strategy is efficient and less costly than alternatives in order to effectively reduce health disparities.
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Affiliation(s)
- August Kuwawenaruwa
- Ifakara Health Institute, Plot 463, Kiko Avenue Mikocheni, P.O. Box 78 373, Dar es Salaam, Tanzania.
| | - Jitihada Baraka
- Ifakara Health Institute, Plot 463, Kiko Avenue Mikocheni, P.O. Box 78 373, Dar es Salaam, Tanzania.
| | - Kate Ramsey
- Columbia University, Mailman School of Public Health, New York, NY, USA.
| | - Fatuma Manzi
- Ifakara Health Institute, Plot 463, Kiko Avenue Mikocheni, P.O. Box 78 373, Dar es Salaam, Tanzania.
| | | | - Josephine Borghi
- Ifakara Health Institute, Plot 463, Kiko Avenue Mikocheni, P.O. Box 78 373, Dar es Salaam, Tanzania. .,Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
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Amare Y, Shamba DD, Manzi F, Bee MH, Omotara BA, Iganus RB, Adejuyigbe EA, Odebiyi AL, Skordis-Worrall J, Hill ZE. Current Neonatal Skin Care Practices in Four African Sites. J Trop Pediatr 2015; 61:428-34. [PMID: 26314307 DOI: 10.1093/tropej/fmv053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Data for this study on skin care practices and emollient use in four African sites were collected using in-depth interviews, focus-group discussions and observations. Respondents were mothers, grandmothers, fathers, health workers, birth attendants and people selling skin-care products. Analysis included content and framework analyses.Emollient use was a normative practice in all sites, with frequent application from an early age in most sites. There were variations in the type of emollients used, but reasons for use were similar and included improving the skin, keeping the baby warm, softening/strengthening the joints/bones, shaping the baby, ensuring flexibility and encouraging growth and weight gain. Factors that influenced emollient choice varied and included social pressure, cost, availability and deep-rooted traditional norms. Massage associated with application was strong and potentially damaging to the skin in some sites.Given the widespread use of emollients, the repeated exposure of newborns in the first month of life and the potential impact of emollients on mortality, trials such as those that have been conducted in Asia are needed in a range of African settings.
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Affiliation(s)
- Yared Amare
- Consultancy for Social Development, Ethiopia
| | | | | | - Margaret H Bee
- Institute for Global Health, University College London, United Kingdom
| | | | | | | | | | | | - Zelee E Hill
- Institute for Global Health, University College London, United Kingdom
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Hanson C, Cox J, Mbaruku G, Manzi F, Gabrysch S, Schellenberg D, Tanner M, Ronsmans C, Schellenberg J. Maternal and perinatal mortality in resource-limited settings - Authors' reply. Lancet Glob Health 2015; 3:e673. [PMID: 26475009 DOI: 10.1016/s2214-109x(15)00157-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 07/23/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Claudia Hanson
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK; Department of Public Health Science (Global Health), Karolinska Institutet, 171 77 Stockholm, Sweden.
| | - Jonathan Cox
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Fatuma Manzi
- Ifakara Health Institute, Dar-es-Salaam, Tanzania
| | - Sabine Gabrysch
- Institute of Public Health, Ruprecht-Karls-University, Heidelberg, Germany
| | - David Schellenberg
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Marcel Tanner
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Carine Ronsmans
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
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Hanson C, Waiswa P, Marchant T, Marx M, Manzi F, Mbaruku G, Rowe A, Tomson G, Schellenberg J, Peterson S. Erratum to: Expanded Quality Management Using Information Power (EQUIP): protocol for a quasi-experimental study to improve maternal and newborn health in Tanzania and Uganda. Implement Sci 2015; 10:152. [PMID: 26515014 PMCID: PMC4627429 DOI: 10.1186/s13012-015-0343-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 10/20/2015] [Indexed: 11/10/2022] Open
Affiliation(s)
- Claudia Hanson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. .,Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom. .,Ifakara Health Institute, Dar-es-Salaam, Tanzania.
| | - Peter Waiswa
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Makerere University, College of Health Sciences, School of Public Health, Kampala, Uganda
| | - Tanya Marchant
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michael Marx
- Evaplan GmbH the University of Heidelberg, Heidelberg, Germany
| | - Fatuma Manzi
- Ifakara Health Institute, Dar-es-Salaam, Tanzania
| | | | - Alex Rowe
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, USA
| | - Göran Tomson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Department of Learning, Informatics, Management, Ethics; Karolinska Institutet, Stockholm, Sweden
| | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stefan Peterson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Makerere University, College of Health Sciences, School of Public Health, Kampala, Uganda.,Department of Women's and Children's Health, International Maternal and Child Health Unit, Uppsala University, Uppsala, Sweden
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50
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Adejuyigbe EA, Bee MH, Amare Y, Omotara BA, Iganus RB, Manzi F, Shamba DD, Skordis-Worrall J, Odebiyi A, Hill ZE. "Why not bathe the baby today?": A qualitative study of thermal care beliefs and practices in four African sites. BMC Pediatr 2015; 15:156. [PMID: 26466994 PMCID: PMC4607092 DOI: 10.1186/s12887-015-0470-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 10/02/2015] [Indexed: 01/21/2023] Open
Abstract
Background Recommendations for care in the first week of a newborn’s life include thermal care practices such as drying and wrapping, skin to skin contact, immediate breastfeeding and delayed bathing. This paper examines beliefs and practices related to neonatal thermal care in three African countries. Methods Data were collected in the same way in each site and included 16–20 narrative interviews with recent mothers, eight observations of neonatal bathing, and in-depth interviews with 12–16 mothers, 9–12 grandmothers, eight health workers and 0–12 birth attendants in each site. Results We found similarities across sites in relation to understanding the importance of warmth, a lack of opportunities for skin to skin care, beliefs about the importance of several baths per day and beliefs that the Vernix caseosa was related to poor maternal behaviours. There was variation between sites in beliefs and practices around wrapping and drying after delivery, and the timing of the first bath with recent behavior change in some sites. There was near universal early bathing of babies in both Nigerian sites. This was linked to a deep-rooted belief about body odour. When asked about keeping the baby warm, respondents across the sites rarely mentioned recommended thermal care practices, suggesting that these are not perceived as salient. Conclusion More effort is needed to promote appropriate thermal care practices both in facilities and at home. Programmers should be aware that changing deep rooted practices, such as early bathing in Nigeria, may take time and should utilize the current beliefs in the importance of neonatal warmth to facilitate behaviour change.
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Affiliation(s)
| | - Margaret Helen Bee
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Yared Amare
- Consultancy for Social Development, Addis Ababa, Ethiopia.
| | | | | | - Fatuma Manzi
- Ifakara Health Institute, Dar es Saalam, Tanzania.
| | | | - Jolene Skordis-Worrall
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
| | | | - Zelee Elizabeth Hill
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
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