Predictors of mHealth use in promoting adherence to pre-exposure prophylaxis among female sex workers: an evaluation of the Jichunge intervention in Dar es Salaam, Tanzania

Background

There is evidence that pre-exposure prophylaxis (PrEP) is effective in preventing HIV transmission, and PrEP is recommended by the World Health organization (WHO) for use by individuals at high risk of HIV infection. However, low adherence has been reported to hamper its effectiveness. Some evidence indicates that mHealth interventions may be a promising way of promoting PrEP adherence. Nevertheless, evaluations of mHealth interventions in Africa, the region most affected by HIV, are scarce. This study aimed at identifying the extent of and predictors for use of a smartphone based mHealth application among female sex workers in Dar es Salaam, Tanzania.

Methods

As part of a quasi-experimental study in Tanzania, 470 female sex workers who were eligible for PrEP and who owned a smartphone were recruited using respondent driven sampling. All participants were provided with an mHealth application called Jichunge, a smartphone-based app designed to promote adherence to PrEP by offering users information, advise and support during start-up and use of PrEP. We collected data through structured interviews at baseline and extracted user data from the app for a period of 30 days. Modified Poisson regression model with robust standard errors was used to identify predictors for the optimal use of the Jichunge app.

Results

Overall, the optimal use of the Jichunge app was 46.4%. Optimal use was significantly higher among women who were older (aPR = 1.3, 95% CI: 1.10-1.65, p = 0.004 for age 25-34 years, and aPR = 1.6, 95% CI: 1.19-2.07, p = 0.001 for age at least 35 years), who had secondary education or higher (aPR = 1.8, 95% CI: 1.08-2.94, p = 0.023), who had suboptimal social support (aPR = 1.2, 95% CI: 1.02-1.48, p = 0.030), who had high awareness of PrEP (aPR = 1.3, 95% CI: 1.08-1.55, p = 0.005), and who had experience using common mainstream social media applications (aPR = 1.4, 95% CI: 1.08-1.71, p = 0.009).

Conclusion

Optimal use of the Jichunge app was substantially higher among women with higher age, higher education, higher PrEP awareness, less social support, and experience using common social media applications. Individual and interpersonal factors should be considered in planning mHealth interventions. Further studies to determine predictors of longer-term mHealth engagement are needed.

Trial registration

International Clinical Trials Registry Platform PACTR202003823226570; 04.03.2020.

Development of a Mobile Health Application for HIV Prevention Among At-Risk Populations in Urban Settings in East Africa: A Participatory Design Approach

Background

There is limited evidence in Africa on the design and development of mobile health (mHealth) applications to guide best practices and ensure effectiveness. A pragmatic trial for HIV pre-exposure prophylaxis roll-out among key populations in Tanzania is needed.

Objective

We present the results of the development of a mobile app (Jichunge) intended to promote adherence to pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) and female sex workers (FSW) in Tanzania.

Methods

A participatory design approach was employed and guided by the information system research framework. MSM and FSW were the target populations. A total of 15 MSM and 15 FSW were engaged in the relevance and design cycles, while the piloting phase included 10 MSM and 20 FSW.

Results

The relevance cycle enabled the description of the existing problem, provided the compatible app features for the target population, and identified the need to develop an mHealth app that provides health services in a stigmatizing and discriminating environment. User involvement in the app’s design and evaluation provided an opportunity to incorporate social, cultural, and community-specific features that ensured usability. In addition, the participants suggested valuable information to inform the app, text message services, medication registration, and chat platform designs.

Conclusions

The participatory design approach in the development of mHealth apps is useful in identifying and validating population-specific functional features, improve usability, and ensuring future health impacts. Through this participatory process, the Jichunge app took end-user needs, perspectives, and experiences into account, eliciting enthusiasm regarding its potential role in supporting pre-exposure prophylaxis adherence for HIV and related behavioral change promotion.

Trial Registration

International Clinical Trials Registry Platform PACTR202003823226570; https://trialsearch.who.int/Trial2.aspx?TrialID=PACTR202003823226570

Access to Safe Water, Sanitation, and Hygiene: A Cross-Sectional Study among the Maasai in Tanzania

Safe water supply, sanitation, and hygiene (WaSH) are among key components to prevent and control waterborne diseases such as cholera, schistosomiasis, and other gastrointestinal morbidities in the community. In 2018, there was cholera outbreak in Ngorongoro district that was fueled by inadequate and unsafe water as well as poor sanitation and hygiene. We used an analytical cross-sectional study first to determine the proportion of households with access to WaSH and second to assess factors associated with coverage of household's access to WaSH. Methods included interviewing heads of the household to assess the availability of safe drinking water, use of unshared toilet/latrine by household members only, and the availability of functional handwashing facility. Eight percent of households had access to WaSH. Access to household's WaSH was positively associated with household's monthly income, education of heads of the household, and water use per person per week. To control water-related morbidities, there is a need to improve access to reliable safe drinking water, expand alternatives of households to earn more incomes, and enhance proper sanitation and hygiene services to rural areas and marginalized groups like the Maasai of Ngorongoro in Tanzania.

Knowledge, attitudes and practices on tuberculosis infection prevention and associated factors among rural and urban adults in northeast Tanzania: A cross-sectional study

Almost 10 million of the global population was infected with tuberculosis (TB) in 2017. Tanzania is among countries with high incidence of TB. Although control measures of TB are multi factorial, it is important to understand the individual's knowledge, attitudes and practices (KAP) in order to control TB infection. We conducted a cross-sectional study in northeast Tanzania; recruited and interviewed 1519 adults from two districts, one rural and another urban. We scored each participant using several questions for each construct of KAP. A study participant scoring at least 60% of the possible maximum scores was considered as having a good knowledge, positive attitude or good practices. And herein, a participant having positive TB attitude would mean they acknowledge TB exist, recognizes its impact on health and would seek or advise TB-infected individuals to seek the correct remedies. We applied multiple linear regression analysis to assess independent individual-level factors related to TB on KAP scores in the rural and urban populations. Overall, less than half (44%) of the study participants had good overall knowledge about TB infection and significantly more urban than rural adult population had good overall knowledge (p<0.001). Almost one in ten, (11%) of all study participants had positive attitudes towards TB infection. More urban study participants, (16%) had positive attitudes than their rural counterparts, 6%). Almost nine in ten (89%) of all study participants had good practices towards TB prevention and control; significantly more adults in urban, (97%) than the rural populations (56%) (p<0.01). Predictors of KAP scores were individual's education and main source of income. Adults in rural and urban northeast Tanzania have poor knowledge, attitudes and practices for TB infection and prevention. Strategies focusing on health education are important for control of TB, especially among rural communities.

Knowledge, attitude and practices about dengue fever among adults living in Pwani Region, Tanzania in 2019

BACKGROUND

Dengue fever (DF) is currently widespread in tropical and sub-tropical countries. Among the triggers of epidemic include urbanization and internal migrations. Within the past few years, there have been DF outbreaks in Tanzania. Although Pwani region is among the predicted risk areas for the DF, there is insufficient data about people's knowledge, attitude and practices towards prevention of DF in their settings. Therefore, the aim of this study was to assess knowledge, attitude and practices about DF among adults in Pwani region in Tanzania.

METHODS

The cross-sectional study conducted in Mkuranga District, Pwani region in Tanzania. We used face-to-face interviews to collect data. The main analytical procedure was descriptive using frequencies.

RESULTS

The majority, 97.7%, were aware of DF. Nevertheless, almost 80% had a low knowledge on symptoms, transmission and vector control measures. Furthermore, less than 20% had positive attitude towards dengue fever prevention, severity of the illness and health seeking behavior.

CONCLUSION

Lack of enough knowledge and positive attitude about disease transmission, symptoms and preventive measures put the population at high risk of contracting the disease. There is need to create and improve friendly, correct and simple information, education and education messages for the rural populations.

Use of modern contraceptives among advanced-level secondary school girls in the Rukwa Region, Tanzania, 2018

OBJECTIVES

To determine contraceptive uptake, reasons for non-use and predictors of use.

METHODS

We conducted a cross-sectional study among girls in advanced-level secondary schools in the Rukwa region of Tanzania. Using probability proportional to size (PPS), we recruited a random sample of 660 girls out of 1447-targeted participants. A tool for data collection was a questionnaire. Data analyses included univariate analysis to describe study participants and Poisson regression analysis to assess the effect of independent factors to the dependent variable. A 5%-level of significance was used in multivariate analysis.

RESULTS

More than 40% of the girls report being sexually active and only 25% reported current use of modern contraceptives. The main reported main method being use of male condoms (93%). Barriers for non-use of contraceptives included fear of side effects, fear of being perceived or labeled as promiscuous, inadequate knowledge about contraceptives and for religious reasons. The predictor for using modern contraceptives was attending class sessions about modern contraceptives.

CONCLUSIONS

Although girls in advanced-level secondary schools are sexually active, the use of modern contraceptives is still low. Girls report several barriers frustrating their intention to use contraceptives, mainly based on misconceptions and lack of knowledge.

Prevalence and Factors Associated with Parents Self-Medicating Under-Fives with Antibiotics in Bagamoyo District Council, Tanzania: a Cross-Sectional Study

BACKGROUND

Self-medication with antibiotics (SMA) is a global problem. This extends to medication of under-fives by their parents. In particular, there is currently insufficient information for this problem.

PURPOSE

To determine the proportion and factors associated with medication of under-fives with antibiotics by their parents.

MATERIALS AND METHODS

A cross-sectional study among parents/caregivers of under-fives in 30 hamlets/streets of Bagamoyo District Council, in Tanzania was conducted between July and August, 2019. Respondents were the under-fives' parents/caregivers aged at least 18 years selected from households using probability proportional to a size cluster-sampling method. Respondents were required to report whether or not the under-fives had been unwell within the past 12 months and to describe the type or specific name of any medicine administered to their child. We used descriptive and analytical procedures to analyze the data.

RESULTS

The study included 730 parents/caregivers of under-fives. Their mean age was 32.2 (SD=7.4) years. The majority 668 (91.5%) were biological mothers and 574 (78.6%) having completed primary education. The proportion of parental SMA to under-fives was 47.7% (95% CI=43.7, 51.8). Knowledge on the appropriate use of antibiotics among parents was low. The most commonly used antibiotic was amoxicillin, 181 (62.0%). Independent factors associated with parental SMA to under-fives were average household income, distance to the nearest health facility, knowledge about use of antibiotics and the parent/caregiver's awareness of prescription-only medicines (POMs).

CONCLUSION

Since the prevalence of SMA by parents to under-fives in Bagamoyo District is high, there is a need for health systems to enhance those measures that would control the sale of antibiotics without prescriptions. In addition, more than half of all study participants have a minimal understanding of the use of antibiotics and are unaware of POMs. Findings indicate a need to have routine continuous health education at the community level about the use of antibiotics.

Morbidity and mortality of children aged 2-59 months admitted in the Tanzania Lake Zone's public hospitals: a cross-sectional study

BACKGROUND

There is a growing concern about child mortality especially in developing countries. The Government of Tanzania and non-governmental organizations are fighting against diseases like malaria, anaemia, diarrhoea and pneumonia that contribute extensively to child mortality. This was a hospital-based, retrospective cohort study involving 1130 under-fives (excluding neonates) being either discharged from or died in public hospitals of the Lake Zone in Tanzania. We extracted information on symptoms and signs at admission, major diagnoses and causes of death from the medical records. We applied binary logistic regression models to assess risk factors associated with in-patient under-five death.

RESULTS

The major leading morbidities include malaria (49%), anemia (37%), diarrhea (27%), pneumonia (22%) and severe acute malnutrition (21%). We found the case fatality of 74 deaths per 1000 under-five admissions. Major underlying causes of deaths were severe anaemia, severe malaria and severe pneumonia. Factors associated with in-patient death were female sex (AOR 1.7; 95% CI 1.0, 2.8) and the odds significantly decreased with increasing level of maternal education.

CONCLUSIONS

Malaria remains a leading cause of admissions in hospitals among under-fives. Although the case fatality among children aged between 2 and 59 months admitted in hospitals in Lake Zone is decreasing, efforts are needed to address major causes of deaths (severe anaemia, severe malaria and severe pneumonia).

Satisfaction of Patients Attending Public HIV or AIDS Care and Treatment Centers in Kinondoni District, Tanzania

Satisfaction of care and treatment among HIV patients is one of the important elements for adherence. This study aimed to determine levels of satisfaction and associated factors among HIV-infected patients attending public care and treatment centers (CTCs) in Tanzania. The study was cross-sectional using face-to-face interviews. Satisfaction was measured using a total of 30 questions from a domain of six area of CTC service delivery. To assess independent predictors of levels of satisfaction, we used multilevel ordinal logistic regression analysis. We enrolled 434 study participants. Of these, 5% reported low satisfaction, 25% medium satisfaction, and 70% reported high satisfaction. The CTC environment was rated low by 56% of the patients. Predictors of levels of satisfaction were age of patient and health facility level. Low levels of satisfaction with CTC environment and laboratory services underscore the need for improvement of these areas.

Exclusive breastfeeding practices in the Coast region, Tanzania

BACKGROUND

Although breastfeeding in general is common and culturally accepted in many sub-Saharan countries, recommended exclusive breastfeeding infants to 6 months is rare. In rural Tanzania, data on infant feeding practices is rare.

OBJECTIVE

To examine and describe exclusive breastfeeding practices in rural settings (Coast Region) of Tanzania.

METHODS

A cross-sectional study was conducted in Coast Region of Tanzania involving 342 mothers. Only mothers with children aged between 6 and 23 months were interviewed in their residences. Data analyses included descriptive and logistic regression analyses.

RESULTS

The majority, 66%, of mothers reported to have breastfed their new born within the first hour of life. About 30% reported to have breastfed exclusively for up to at least six months. Those who did not practice complete exclusive breastfeeding mentioned insufficient milk as the main reason. Correlates of exclusive breastfeeding included maternal education and attitudes towards exclusive breastfeeding.

CONCLUSION

The rate of exclusive breastfeeding in rural areas like the Coast Region of Tanzania is still very low. Programs aimed to promote exclusive breastfeeding must take multi-factorial considerations.

Homicide death in Dar es Salaam, Tanzania 2005

Violence disproportionately affects low- and middle-income countries. Deeper understanding is needed in areas where little research has occurred. The objectives of the study were to: (a) ascertain rate of homicide death; (b) describe the victims and circumstances surrounding their deaths in Dar es Salaam, Tanzania in 2005. This study was developed by adapting the WHO/CDC Injury Surveillance Guidelines (Holder et al., 2001). Data on 12 variables were collected on all homicide deaths. Descriptive statistics and hypothesis tests were done when appropriate. Age standardised, age-specific and cause-specific mortality rates are presented. The overall homicide rate was 12.57 (males and females respectively: 22.26 and 2.64). Homicide deaths were 93.4% male, mostly unemployed, with a mean age of 28.2 years. Most deaths occurred in urban areas. Mob violence was the cause of 57% of deaths. The risk of homicide death for males was greater than the world average, but for females it was less. Most homicides were committed by community members policing against thieves.

Paternal age and the risk of birth defects in Norway

PURPOSE

We studied 1,869,388 births from The Medical Birth Registry of Norway to assess the effect of father's age on risks of birth defects in offspring.

METHOD

Thirteen separate categories were studied including pooled categories of neural tube defects and any type of defect. We used logistic regression models to adjust for maternal age, year of birth, maternity institution, parity, and correlation between siblings.

RESULTS

There was little evidence of increased risk by high paternal age for any category of defects, except for a category of "other central nervous system" where risk estimates were 2.5-fold (95% CI: 1.2-5.5) for fathers aged between 45 and 49 years compared with the reference age group (25-29 years). The risk for neural tube defects was 1.3-fold (95% CI: 1.1-1.5) when the father was aged between 20 and 24 years relative to the reference. A pattern of moderately higher risks for younger fathers was consistent for anencephaly and spina bifida. Increased risk of heart defects was also estimated among children of young fathers.

CONCLUSIONS

This study does not show consistent evidence that paternal ageing is a risk for birth defects among offspring. Low paternal age, or factors associated with younger parents, may however be associated with increased risk of neural tube defects in their offspring.

Estimates of maternal mortality by the sisterhood method in rural nothern Tanzania: a household sample and an antenatal clinic sample

OBJECTIVE

To estimate maternal mortality in two samples of a population in northern Tanzania.

SETTING

Rural communities and antenatal clinics, Mbulu and Hanang districts, Arusha region, Tanzania.

POPULATION

From a household survey 2,043 men and women aged 15-60, and from an antenatal clinic survey 4,172 women aged 15-59.

METHOD

The indirect sisterhood method.

MAIN OUTCOME MEASURES

The risk of maternal deaths per 100,000 live births (maternal mortality ratio), and the lifetime risk of a maternal death.

RESULTS

The risk of a maternal death per 100,000 live births was 362 (95% CI 269-456) and 444 (95% CI 371-517) for the household and antenatal clinic surveys, respectively. The lifetime risk of maternal death was 1 in 38 and 1 in 31, respectively, for the two surveys. A significantly lower risk of maternal death was observed for the respondents attending antenatal clinics closer to the hospital than for those attending clinics further away: 325 (95% CI 237-413) compared with 561 (95% CI 446-677) per 100,000 live births. Lifetime risk of maternal death was 1 in 42 and 1 in 25, respectively.

CONCLUSIONS

The risk of maternal death per 100,000 live births in this area were comparatively high, but in our survey substantially lower than in previous surveys in Tanzania. Increasing distance from the antenatal clinics to the hospital was associated with higher maternal mortality. There was no significant difference between results based on household and antenatal clinic data, suggesting that accessible health facility data using the sisterhood method may provide a basis for local assessment of maternal mortality in developing countries.