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Kadinde AW, Sangeda RZ, Mwenda L, Yahya-Malima KI, Masatu CF, Mwalwisi YH, Fimbo AM. Trends in Utilization of Emergency Contraceptives in Tanzania: A Retrospective Longitudinal Study From 2018 to 2023. Cureus 2024; 16:e57649. [PMID: 38707047 PMCID: PMC11070213 DOI: 10.7759/cureus.57649] [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] [Accepted: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction Emergency contraceptives (ECs) are a critical method for preventing unwanted pregnancies following unprotected sexual intercourse. However, Tanzania is experiencing an alarming surge in the misuse of ECs among reproductive-aged females, particularly younger girls and women. Reports of their use as regular contraceptives are a rising concern. Deviations from their intended use in emergencies may not only increase the risk of contraceptive failure but also increase the risk of adverse health events. This study aims to delineate and evaluate the utilization patterns of ECs over six consecutive years using importation data obtained from the Tanzania Medicines and Medical Devices Authority (TMDA). Materials and methods We analyzed the EC data collected by TMDA over six consecutive years using a retrospective longitudinal design. Microsoft Power BI (Microsoft® Corp., Redmond, WA) was used to clean, organize, and aggregate the data. IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States) was used to analyze annual trend utilization using linear regression. Results We analyzed 114 importation consignments for ECs, identifying 95.6% (109 records) as oral ECs and 4.4% (five records) as intrauterine devices (IUDs) between 2018 and 2023. This data revealed a significant increase in the volume of EC imports, with its contribution increasing from 1.9% in 2018 to 60.1% in 2023. This highlights the marked increase in EC consumption in Tanzania. In 2023, the defined daily dose per 1000 inhabitants per year (DID) peaked at 3.917826, indicating an unprecedented increase of 4,983.06% compared to the lowest DID observed in 2019 at 0.0873552. The year 2023 alone accounted for 41.63% of the total DID (9.43) over the entire study period. In 2019 and 2020, there was a decrease in EC consumption, followed by a rapid increase from 2021 to 2023. The reduction in EC consumption from 2019 to 2020 was 36.9% compared to that between 2021 and 2022. Conclusions The significant rise in EC importation and utilization in Tanzania between 2018 and 2023, marked by fluctuating consumption trends and a notable surge, highlights the urgent need for targeted educational and policy intervention. This will guide the rational and informed use of ECs, ensuring access aligns with best practices for reproductive health.
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Affiliation(s)
- Auleria W Kadinde
- Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TZA
| | - Raphael Z Sangeda
- Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TZA
| | - Lucy Mwenda
- Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TZA
| | - Khadija I Yahya-Malima
- Nursing Management, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TZA
| | - Cassian F Masatu
- Medicines Control, Tanzania Medicines and Medical Devices Authority, Dodoma, TZA
| | - Yonah H Mwalwisi
- Medicines Control, Tanzania Medicines and Medical Devices Authority, Dodoma, TZA
| | - Adam M Fimbo
- Medicines Control, Tanzania Medicines and Medical Devices Authority, Dodoma, TZA
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Sangeda RZ, Kadinde AW, Masatu CF, Mwalwisi YH, Yahya-Malima KI, Fimbo AM. Utilization Trends of Phosphodiesterase Type-5 Inhibitors for Erectile Dysfunction Between 2019 and 2023 in Tanzania. Cureus 2024; 16:e58419. [PMID: 38765328 PMCID: PMC11099501 DOI: 10.7759/cureus.58419] [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] [Accepted: 04/16/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Erectile dysfunction (ED) profoundly affects millions of people globally, including interfering with mental health and quality of life. Phosphodiesterase type-5 inhibitors (PDE5Is) such as sildenafil are pivotal in ED treatment. This study aimed to examine the utilization patterns of PDE5Is in Tanzania. Materials and methods In this retrospective longitudinal study, data on sildenafil and other similar PDE5Is imported between 2019 and 2023 were sourced from the Tanzania Medicines and Medical Devices Authority (TMDA). Pre-processing and visualization were performed using Microsoft Power BI Desktop, and further analysis was performed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States). Utilization trends were ascertained through curve fitting, Holt's linear trend model, and autoregressive integrated moving average (ARIMA) models. The defined daily doses (DDDS) per 1000 inhabitants (DID) were calculated using the World Health Organization (WHO) Anatomical Therapeutic Chemical (ATC) Classification System and the DDD methodology endorsed by the WHO Collaborating Centre for Drug Statistics Methodology. Results Between 2019 and 2023, there was a pronounced increase in the importation of approximately 587 consignments of PDE5Is. Employing the Holt model (R-square = 0.843), a substantial increase from 0.220910 DID in 2019 to 0.534272 DID by 2025 was observed and anticipated. The period witnessed sildenafil dominating 75.5% of the total use, with Erecto being the most consumed brand (37.6% of total DID). Notably, 2022 had the highest surge (27.2% of the total), albeit a slight decline was observed in 2023 (20.5%). This trend was supported by a linear regression model (R-square = 0.889). Conclusion We found increasing annual trends of PDE5Is of utilization. This requires critical oversight and effective policies to ensure appropriate use and risk minimization.
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Affiliation(s)
- Raphael Z Sangeda
- Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TZA
| | - Auleria W Kadinde
- Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TZA
| | - Cassian F Masatu
- Medicines Control, Tanzania Medicines and Medical Devices Authority, Dodoma, TZA
| | | | - Khadija I Yahya-Malima
- Nursing Management, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TZA
| | - Adam M Fimbo
- Medicines Control, Tanzania Medicines and Medical Devices Authority, Dodoma, TZA
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Triantafyllidi VE, Basinda MSA, Tayari MS, Amour A, Hamad NR, Macsali F, Michala L. A Qualitative Analysis of the Barriers to Healthcare and Education for Adolescent Girls in Tanzania. Cureus 2024; 16:e52384. [PMID: 38361687 PMCID: PMC10868653 DOI: 10.7759/cureus.52384] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Tanzania has a high adolescent birth rate and many sexually active adolescents do not have access to effective contraception. Teenage pregnancy is considered a high-risk pregnancy. Furthermore, it leads to social inequalities for both mother and offspring. METHODS We conducted semistructured interviews with 12 adolescent mothers during their stay in the postnatal ward of the maternity department of a tertiary hospital in Zanzibar. The study took place between November and December 2022. Data were then analyzed qualitatively. RESULTS The main theme that emerged from the interview data was that pregnancy seemed to affect the lives of young girls in a negative way. The majority of pregnancies were unplanned, and the girls reported low family planning uptake. Another recurring theme was that girls had many οbstacles in their education prior to pregnancy, which left them uncertain about their future. Finally, despite the advice of local doctors, the majority of the girls received minimal prenatal care, mostly because they did not regard obstetric care to be a priority. CONCLUSIONS Adolescent pregnancy remains an important public health issue in Tanzania, despite significant measures by authorities to reduce it. Educational changes and professional opportunities as well as family planning services may enable young girls to achieve professional and personal goals while delaying motherhood into adulthood.
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Affiliation(s)
- Varvara Ermioni Triantafyllidi
- 1st Department of Obstetrics and Gynecology, 'Alexandra' General Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | | | | | - Ahlam Amour
- Obstetrics and Gynecology, Mnazi Mmoja Hospital, Zanzibar, TZA
| | | | - Ferenc Macsali
- Obstetrics and Gynecology, Haukeland University Hospital, Bergen, NOR
| | - Lina Michala
- 1st Department of Obstetrics and Gynecology, 'Alexandra' General Hospital, National and Kapodistrian University of Athens, Athens, GRC
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Amoia CF, Hakizimana JN, Duggal NK, Chengula AA, Rohaim MA, Munir M, Weger-Lucarelli J, Misinzo G. Genetic Diversity of Newcastle Disease Virus Involved in the 2021 Outbreaks in Backyard Poultry Farms in Tanzania. Vet Sci 2023; 10:477. [PMID: 37505881 PMCID: PMC10385779 DOI: 10.3390/vetsci10070477] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/04/2023] [Accepted: 06/08/2023] [Indexed: 07/29/2023] Open
Abstract
Newcastle disease virus is a significant avian pathogen with the potential to decimate poultry populations all over the world and cause enormous economic losses. Distinct NDV genotypes are currently causing outbreaks worldwide. Due to the high genetic diversity of NDV, virulent strains that may result in a lack of vaccine protection are more likely to emerge and ultimately cause larger epidemics with massive economic losses. Thus, a more comprehensive understanding of the circulating NDV genotypes is critical to reduce Newcastle disease (ND) burden. In this study, NDV strains were isolated and characterized from backyard poultry farms from Tanzania, East Africa in 2021. Reverse-transcription polymerase chain reaction (RT-PCR) based on fusion (F) gene amplification was conducted on 79 cloacal or tracheal swabs collected from chickens during a suspected ND outbreak. Our results revealed that 50 samples out 79 (50/79; 63.3%) were NDV-positive. Sequencing and phylogenetic analyses of the selected NDV isolates showed that 39 isolates belonged to subgenotype VII.2 and only one isolate belonged to subgenotype XIII.1.1. Nucleotide sequences of the NDV F genes from Tanzania were closely related to recent NDV isolates circulating in southern Africa, suggesting that subgenotype VII.2 is the predominant subgenotype throughout Tanzania and southern Africa. Our data confirm the circulation of two NDV subgenotypes in Tanzania, providing important information to design genotype-matched vaccines and to aid ND surveillance. Furthermore, these results highlight the possibility of the spread and emergence of new NDV subgenotypes with the potential of causing future ND epizootics.
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Affiliation(s)
- Charlie F Amoia
- Department of Veterinary Microbiology, Parasitology and Biotechnology, Sokoine University of Agriculture, Morogoro 67125, Tanzania
- SACIDS Africa Centre of Excellence for Infectious Diseases, SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro 67125, Tanzania
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA 24060, USA
- Center for Emerging, Zoonotic, and Arthropod-Borne Pathogens, Virginia Tech, Blacksburg, VA 24060, USA
| | - Jean N Hakizimana
- SACIDS Africa Centre of Excellence for Infectious Diseases, SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro 67125, Tanzania
| | - Nisha K Duggal
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA 24060, USA
- Center for Emerging, Zoonotic, and Arthropod-Borne Pathogens, Virginia Tech, Blacksburg, VA 24060, USA
| | - Augustino A Chengula
- Department of Veterinary Microbiology, Parasitology and Biotechnology, Sokoine University of Agriculture, Morogoro 67125, Tanzania
| | - Mohammed A Rohaim
- Division of Biomedical and Life Sciences, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YG, UK
- Department of Virology, Faculty of Veterinary Medicine, Cairo University, Giza 12211, Egypt
| | - Muhammad Munir
- Division of Biomedical and Life Sciences, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YG, UK
| | - James Weger-Lucarelli
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA 24060, USA
- Center for Emerging, Zoonotic, and Arthropod-Borne Pathogens, Virginia Tech, Blacksburg, VA 24060, USA
| | - Gerald Misinzo
- Department of Veterinary Microbiology, Parasitology and Biotechnology, Sokoine University of Agriculture, Morogoro 67125, Tanzania
- SACIDS Africa Centre of Excellence for Infectious Diseases, SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro 67125, Tanzania
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Abraham ZS, Kahinga AA, Khamis KO, Liyombo E. Clinical spectrum of ear, nose and throat foreign bodies at a tertiary hospital: a cross-sectional study. Ann Med Surg (Lond) 2023; 85:3403-3408. [PMID: 37427175 PMCID: PMC10328674 DOI: 10.1097/ms9.0000000000000952] [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] [Received: 02/15/2023] [Accepted: 06/04/2023] [Indexed: 07/11/2023] Open
Abstract
Presence of foreign bodies (FBs) in the ears and upper aerodigestive tract is a common encounter in children unlike adults in otorhinolaryngology practice. FBs form a major part of emergencies in otorhinolaryngology. Studies on ear, nose and throat FBs in Tanzania are scarce. Objective To determine the clinical spectrum of ear, nose and throat FBs at the largest tertiary hospital. Methods A descriptive hospital based cross-sectional study was conducted where 95 patients were recruited at the Hospital from December 2019 to May 2020. Data were collected using semi-structured questionnaires and analyzed using Statistical Package for the Social Sciences (SPSSs) version 24. Results In this study, there were more females, 56 (58.9%) than males, 39 (41.1%) with female to male ratio being 1.4:1. Children aged younger than 10 years predominated in this study, 69 (72.6%). The nose, 36 (37.9%) and ear, 29 (30.5%) were the commonest sites where FBs lodged followed by the pharynx, 22 (23.2%) and oesophagus, 10 (8.4%). Regarding types of FBs, inorganic types, 49 (51.6%) predominated and were mostly coins, 17 (17.9%). Majority of FBs were removed in less than 24 h (53.7%) and complications were found in 29 (30.5%) patients and being more pronounced with nasal FBs. Majority of those with complications presented to the hospital 24-72 h post lodging of FBs. Conclusion FBs were encountered more commonly in children aged younger than 10 years. The nose was the commonly affected anatomical site followed by the ear, pharynx and oesophagus. The commonest FB was a coin. The inorganic FB type predominated and the most common inorganic type was a coin while the commonest organic type was a seed. Complications were encountered in those who presented between 24 and 72 h post FB lodgment.
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Affiliation(s)
| | | | | | - Edwin Liyombo
- Department of Otorhinolaryngology, Muhimbili National Hospital, Dar es Salaam, Tanzania
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Mbwambo OJ, Mremi A, Mugusi S, Mbwambo JS, Bright F, Mteta AK, Ngowi BN. Concomitant squamous cell carcinoma of the bladder and renal tuberculosis: A case report from northern Tanzania. Clin Case Rep 2023; 11:e7127. [PMID: 36992675 PMCID: PMC10041367 DOI: 10.1002/ccr3.7127] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/24/2023] [Accepted: 03/07/2023] [Indexed: 03/29/2023] Open
Abstract
Concomitant squamous cell carcinoma (SCC) and renal tuberculosis (TB) are a rare presentation. It is associated with poor prognosis and poses a challenge in the management. To the best of our knowledge, we present a challenging first document case of locally advanced SCC of the bladder with coactive renal tuberculosis.
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Affiliation(s)
- Orgeness Jasper Mbwambo
- Faculty of MedicineKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of UrologyKilimanjaro Christian Medical CentreMoshiTanzania
| | - Alex Mremi
- Faculty of MedicineKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of PathologyKilimanjaro Christian Medical centreMoshiTanzania
| | - Sabina Mugusi
- Department of Clinical Pharmacology, Campus College of MedicineMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Jasper Said Mbwambo
- Faculty of MedicineKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of UrologyKilimanjaro Christian Medical CentreMoshiTanzania
| | - Frank Bright
- Faculty of MedicineKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of UrologyKilimanjaro Christian Medical CentreMoshiTanzania
| | - Alfred Kien Mteta
- Faculty of MedicineKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of UrologyKilimanjaro Christian Medical CentreMoshiTanzania
| | - Bartholomeo Nicholaus Ngowi
- Faculty of MedicineKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of UrologyKilimanjaro Christian Medical CentreMoshiTanzania
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Coe M, Kawakyu N, Gimbel S, Nyakuya B, Gabriel N, Leonard D, Chale S, Masiye F, Banda CM, Manangwa S, Moyo G, Boyle G, Freistadt F, Kohler P. Nursing Workforce Optimization Study: A Multi-method Evaluation and Process Improvement Intervention for HIV Service Delivery in Tanzania and Zambia. J Assoc Nurses AIDS Care 2023; 34:146-157. [PMID: 36752744 PMCID: PMC10237310 DOI: 10.1097/jnc.0000000000000388] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
ABSTRACT Nurses are often suboptimally used in HIV care, due to misalignment of training and practice, workflow inefficiencies, and management challenges. We sought to understand nursing workforce capacity and support implementation of process improvement strategies to improve efficiency of HIV service delivery in Tanzania and Zambia. We conducted time and motion observations and task analyses at 16 facilities followed by process improvement workshops. On average, each nurse cared for 45 clients per day in Tanzania and 29 in Zambia. Administrative tasks and documentation occupied large proportions of nurse time. Self-reported competency was low at baseline and higher at follow-up for identifying and managing treatment failure and prescribing antiretroviral therapy. After workshops, facilities changed care processes, provided additional training and mentorship, and changed staffing and supervision. Efficiency outcomes were stable despite staffing increases. Collaborative approaches to use workforce data to engage providers in improvement strategies can support roll-out of nurse-managed HIV treatment.
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Affiliation(s)
- Megan Coe
- Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Nami Kawakyu
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Sarah Gimbel
- Department of Global Health, and the Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Baraka Nyakuya
- International Training and Education Center for Health (I-TECH), Dar es Salaam, Tanzania
| | - Neema Gabriel
- International Training and Education Center for Health (I-TECH), Dar es Salaam, Tanzania
| | - Devotha Leonard
- Training Program Training Coordinator, International Training and Education Center for Health (I-TECH), Dar es Salaam, Tanzania
| | - Stella Chale
- International Training and Education Center for Health (I-TECH), Dar es Salaam, Tanzania
| | - Felix Masiye
- Dean of the School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia and an Affiliate Assistant Professor at the Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, Washington, USA
| | - Charles Masili Banda
- Department of Economics, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Saturini Manangwa
- Nursing and Midwifery Quality Improvement, Ministry of Health Community Development, Gender, Elderly and Children (MOHCDGEC) Dodoma, Tanzania
| | - Gustav Moyo
- Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC) Dodoma, Tanzania
| | - Gabriela Boyle
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Fernanda Freistadt
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Pamela Kohler
- Department of Global Health, and the Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington, USA
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Watt MH, Cohen SR, Minja LM, Barabara M, Mlay P, Stephens MJ, Olomi G, Mlay J, Marchand V, Mmbaga BT. A simulation and experiential learning intervention for labor and delivery providers to address HIV stigma during childbirth in Tanzania: Study protocol for the evaluation of the MAMA intervention. Res Sq 2023:rs.3.rs-2285235. [PMID: 36778232 PMCID: PMC9915785 DOI: 10.21203/rs.3.rs-2285235/v1] [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] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background : The experience of HIV stigma during intrapartum care can impact women's trust in the health care system and undermine their long-term commitment to HIV care engagement. Delivery of respectful maternity care (RMC) to WLHIV can improve quality of life and clinical outcomes. The goal of this study is to conduct an evaluation of MAMA (Mradi wa Afya ya Mama Mzazi, Project to Support the Health of Women Giving Birth), a simulation team-training curriculum for labor and delivery providers that addresses providers' instrumental and attitudinal stigma toward WLHIV and promotes the delivery of evidence-based RMC for WLHIV. Methods : The MAMA intervention will be evaluated among healthcare providers across six clinics in the Kilimanjaro Region of Tanzania. To evaluate the impact of MAMA, we will enroll WLHIV who give birth in the facilities before (n=103 WLHIV) and after (n=103 WLHIV) the intervention. We will examine differences in the primary outcome (perceptions of RMC) and secondary outcomes (postpartum HIV care engagement; perceptions of HIV stigma in the facility; internal HIV stigma; clinical outcomes and evidence-based practices) between women enrolled in the two time periods. Will also assess participating providers (n=60) at baseline, immediate post, 1-month post training, and 2-month post training. We will examine longitudinal changes in the primary outcome (practices of RMC) and secondary outcomes (stigma toward WLHIV; self-efficacy in delivery intrapartum care). Quality assurance data will be collected to assess intervention feasibility and acceptability. Discussion : The implementation findings will be used to finalize the intervention for a train-the-trainer model that is scalable, and the outcomes data will be used to power a multi-site study to detect significant differences in HIV care engagement. Trial Registration : The trial is registered at clinicaltrials.gov, NCT05271903.
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Faini D, Msafiri F, Munseri P, Bakari M, Lyamuya E, Sandström E, Biberfeld G, Nilsson C, Hanson C, Aboud S. The Prevalence, Incidence, and Risk Factors for HIV Among Female Sex Workers-A Cohort Being Prepared for a Phase IIb HIV Vaccine Trial in Dar es Salaam, Tanzania. J Acquir Immune Defic Syndr 2022; 91:439-48. [PMID: 36126184 DOI: 10.1097/QAI.0000000000003097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 06/20/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND A cohort of female sex workers (FSWs) was established to determine HIV prevalence and incidence, and associated factors in preparation for a phase IIb HIV vaccine and pre-exposure prophylaxis trial (PrEPVacc). SETTING A cohort of FSWs in Dar es Salaam, Tanzania. METHODS FSWs aged 18-45 years were recruited using a respondent-driven sampling method. Social demographic data, HIV risk behavioral assessments, and blood samples for testing of HIV, syphilis, hepatitis B (HBV), and hepatitis C (HCV) infections were collected at baseline and then at 3, 6, 9, and 12 months. Poisson regressions were used to estimate the prevalence ratios for factors associated with HIV prevalence and to estimate the 12-month HIV incidence rate. RESULTS Between October and December 2018, a total of 773 FSWs were screened for eligibility and 700 were enrolled. The baseline prevalence of HIV, syphilis, HBV, and HCV was 7.6%, 1.2%, 1.7%, and 1.0%, respectively. HIV prevalence was associated with older age, using illicit drugs, and being infected with syphilis, HBV, or HCV. Attendance at 12 months was 80% (562/700). Twenty-one FSWs seroconverted during follow-up, giving a 12-month HIV incidence rate of 3.45 per 100 person-years at risk (95% CI; 2.25-5.28/100 person-years at risk). The HIV incidence rate was higher among FSWs aged 18-24 years, FSWs who used drugs, and those diagnosed with syphilis, HBV, or HCV. CONCLUSION The high HIV incidence rate and retention rate among FSWs enrolled into the cohort demonstrate that this population is suitable for participation in HIV prevention trials.
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Mbwasi R, Mbepera D, Mfuko W, Makanzo J, Kikwale M, Canavan R, Stoermer M, Wiedenmayer K. Assessing public–private procurement practices for medical commodities in Dar Es Salaam: a situation analysis. BMC Health Serv Res 2022; 22:1523. [PMCID: PMC9749154 DOI: 10.1186/s12913-022-08923-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/05/2022] [Indexed: 12/16/2022] Open
Abstract
Background In Tanzania, the Medical Stores Department is the principal pharmaceutical provider to public health facilities throughout the country. However, growing demand from health facilities has proved difficult to satisfy and stock-outs at health facilities are frequent. The aim of the current study was to conduct a situation analysis of the procedures and practices of procuring medicines and medical supplies from private suppliers in the Dar es Salaam region when those commodities are unavailable at the Medical Stores Department. Methods A mixed-method approach including qualitative and quantitative methods was applied to understand procurement procedures and practices and private suppliers’ performance at district level. Qualitative interviews with suppliers and district authorities, and a review of inventory documents at store level was conducted between February and March 2018. The quantitative approach included a review and analyses of relevant procurement documents from the 2016/2017 financial year to explore the funds used to procure health commodities from the private sector. The ten most frequently mandated private suppliers were assessed in more detail focusing on cost, quality and availability of medicines and lead times and delivery. Results A lack of consistency and written guidelines for procuring medicines and medical supplies from the private sector was observed. The procurement process was bureaucratic and lengthy requiring multiple steps between health facilities, suppliers and district authorities. A significant number of people were involved requiring a minimum of 13 signatures and 16 steps from order preparation to approval. Only 17 of 77 prequalified private suppliers received orders from public health facilities. The criteria for choosing which supplier to use were unclear. Completed orders amounted to USD 663,491. The bureaucratic process drove councils and healthcare facilities towards alternative ways to procure health commodities when Medical Stores Department stock-outs occurred. Conclusion The procurement procedure outside the Medical Stores Department is inefficient and cumbersome, often circumventing government regulations. General lack of accountability renders the process susceptible to leakage of funds and medicines. Increasing the transparency and efficiency of procurement procedures from the private sector with a prime vendor system would help to better manage Medical Stores Department stock-outs and help improve health care services overall.
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Affiliation(s)
- Romuald Mbwasi
- grid.442456.50000 0004 0484 1130St. John’s University of Tanzania, Dodoma, Tanzania
| | - Denis Mbepera
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, Tanzania
| | - William Mfuko
- Senior freelance pharmaceutical consultant, Dar es Salaam, Tanzania
| | - Jason Makanzo
- Regional Administrative Secretary’s Office, Dar es Salaam, Tanzania
| | - Martha Kikwale
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, Tanzania
| | - Robert Canavan
- grid.416786.a0000 0004 0587 0574Swiss Tropical and Public Health Institute, P.O. Box, CH-4123 Allschwil, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, P.O. Box, CH-4003 Basel, Switzerland
| | - Manfred Stoermer
- grid.416786.a0000 0004 0587 0574Swiss Tropical and Public Health Institute, P.O. Box, CH-4123 Allschwil, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, P.O. Box, CH-4003 Basel, Switzerland
| | - Karin Wiedenmayer
- grid.416786.a0000 0004 0587 0574Swiss Tropical and Public Health Institute, P.O. Box, CH-4123 Allschwil, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, P.O. Box, CH-4003 Basel, Switzerland
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11
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Ayub Kalufya, N, Ali Seif S, Masoi TJ. Knowledge and practice of umbilical cord care among young mothers of neonates in Tabora region: Analytical cross-sectional study. Medicine (Baltimore) 2022; 101:e31608. [PMID: 36626506 PMCID: PMC9750512 DOI: 10.1097/md.0000000000031608] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Knowledge of cord care influences the choice of cord care practices and has a great impact on neonate health. Poor cord care can lead to infection of the umbilical cord and thus have a bearing on the subsequent growth trajectory of the newborn. A health facility-based analytical cross-sectional study was carried out from January-March 2021 among 315 randomly selected young mothers aged 15 to 25 years with neonates aged between 7 and 28 days. An interviewer-administered structured questionnaire was used to collect data, and a chi-square test and a binary logistic regression model were used during data analysis. The level of significance was set at 5%. More than half of young mothers 196 (62.2%) had adequate knowledge of cord care, although practice of umbilical cord care was exceptionally poor, as only 21% of them had good cord care practice. Predictors of low knowledge were living in rural areas (adjusted odds ratio (AOR) = 2.54, P = .012), having no formal education (AOR = 15.4, P = .038), and delivering at home (AOR = 0.21. P = .001). While the predictors of poor umbilical cord care practices were having no formal education (AOR = 12.15, P = .001), having primary education (AOR = 7.8, P = .003), being a peasant (AOR = 6.6, P = .001), business woman (AOR = 3.6, P = .035), housewife (AOR = 4.2, P = .014) and prime para (AOR = 0.49, P = .004). Living in urban areas, having a higher education level, and having delivered in a health facility were important factors in having knowledge on cord care, while having a higher education level, being employed, and being a multipara were important factors in maintaining cord in a healthy state.
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Affiliation(s)
- Nuru Ayub Kalufya,
- Department of Clinical Nursing, The University of Dodoma, Dodoma, Tanzania
| | - Saada Ali Seif
- Department of Nursing Management and Education, The University of Dodoma, Dodoma, Tanzania
| | - Theresia John Masoi
- Department of Clinical Nursing, The University of Dodoma, Dodoma, Tanzania
- * Correspondence: Theresia John Masoi, Department of Clinical Nursing, The University of Dodoma P.O. Box 259 Dodoma, Tanzania (e-mail: )
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12
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Muacevic A, Adler JR, Panjwani S, Surani S, Aziz OM, Hameed K, Somji S, Mbithe H, Bakshi F, Mtega B, Kinasa G, Msimbe M, Mathew B, Aghan E, Chuwa H, Mwansasu C. Outcomes of Surgical Tracheostomy on Mechanically Ventilated COVID-19 Patients Admitted to a Private Tertiary Hospital in Tanzania. Cureus 2022; 14:e32245. [PMID: 36620782 PMCID: PMC9814027 DOI: 10.7759/cureus.32245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic has resulted in an increase in the number of patients necessitating prolonged mechanical ventilation. Data on patients with COVID-19 undergoing tracheostomy indicating timing and outcomes are very limited. Our study illustrates--- outcomes for surgical tracheotomies performed on COVID-19 patients in Tanzania. METHODS This was a retrospective observational study conducted at the Aga Khan Hospital in Dar es Salaam, Tanzania. RESULTS Nineteen patients with COVID-19 underwent surgical tracheotomy between 16th March and 31st December 2021. All surgical tracheostomies were performed in the operating theatre. The average duration of intubation prior to tracheotomy and tracheostomy to ventilator liberation was 16 days and 27 days respectively. Only five patients were successfully liberated from the ventilator, decannulated, and discharged successfully. CONCLUSIONS This is the first and largest study describing tracheotomy outcomes in COVID-19 patients in Tanzania. Our results revealed a high mortality rate. Multicenter studies in the private and public sectors are needed in Tanzania to determine optimal timing, identification of patients, and risk factors predictive of improved outcomes.
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13
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Mathias DV, Stellenberg| PEL, van der Heever DM. Situation Analysis of Healthcare Standards and Criteria That Contribute to the Care of Residents in Homes for Older People in Tanzania. Gerontol Geriatr Med 2022; 8:23337214221141272. [PMCID: PMC9716609 DOI: 10.1177/23337214221141272] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/10/2022] [Accepted: 11/04/2022] [Indexed: 12/05/2022] Open
Abstract
Problems experienced in homes for older people in Tanzania highlighted the need for a situation analysis of healthcare standards to identify the baseline of care provided to residents in these homes. This study conducted a situation analysis of structure healthcare standards and associated criteria with the aim of contributing to improved quality of care for residents in homes for older people in Tanzania. Thirty-two homes for older people in Tanzania were audited using an audit instrument that included seven fields, 26 structure standards, and 262 associated criteria. The analysis showed that overall, the homes were non-compliant with healthcare structure standards and associated criteria. The Tanzanian Government should urgently introduce measures to address the missing standards and associated criteria.
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Affiliation(s)
- Dr Victor Mathias
- Aga Khan University, Dar es Salaam, Tanzania,Victor Mathias, Aga Khan University, Dar es Salaam Campus, P. O. Box 38129, Tanzania. Emails: ;
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14
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Millinga VP, Im HB, Hwang JH, Choi SJ, Han D. Use of Herbal Medicines Among Breastfeeding Mothers in Tanzania: A Cross-Sectional Study. Front Pharmacol 2022; 13:751129. [PMID: 35571105 PMCID: PMC9096166 DOI: 10.3389/fphar.2022.751129] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background: There are limited data on the use of herbal medicines (HM) among breastfeeding mothers, despite the fact that knowledge of the possible benefits or harms of HM use has a direct relationship with the health of infants, especially in resource-limited countries. The study aims to determine the prevalence and factors associated with HM use among breastfeeding mothers in Tanzania. Methods: The study followed a cross-sectional design using a structured survey questionnaire. Survey participants were recruited from the reproductive and child health clinic at Uhuru health center in Morogoro, Tanzania. The survey instrument comprised of 34 questions, including demographic information, the pattern of HM use during breastfeeding, and women's perceptions of HM. Chi-square test and logistic regression were used for data analysis using SPSS ver. 24.0. Results: The majority of the respondents (53.8%) used HM during breastfeeding. The most commonly used HM was black pepper (Piper nigrum L.; 80.0%), followed by pumpkin seeds (Cucurbita pepo L.; 18.0%). About one-third (27.5%) of HM users discussed their use with their healthcare providers. In addition, higher education levels and low breastmilk supply were identified as potential predictors of HM use. Conclusion: The practice of HM use among breastfeeding mothers in Tanzania is popular to ease breastfeeding difficulties. However, the issue of the safety or effectiveness of HM is still an unknown agenda. This awakens the need to evaluate HM's safety, efficacy, and quality through pharmacological studies for scientific evidence. Lastly, a clinical guideline should be developed in healthcare settings to promote open dialogues between the healthcare providers and mothers to ensure the safe use of HM.
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Affiliation(s)
| | - Hyea Bin Im
- Department of Global Health and Development, Graduate School, Hanyang University, Seoul, South Korea.,Institute of Health Services Management, Hanyang University, Seoul, South Korea
| | - Jung Hye Hwang
- Department of Global Health and Development, Graduate School, Hanyang University, Seoul, South Korea.,Institute of Health Services Management, Hanyang University, Seoul, South Korea.,Department of Obstetrics and Gynecology, College of Medicine, Hanyang University, Seoul, South Korea
| | - Soo Jeung Choi
- Department of Global Health and Development, Graduate School, Hanyang University, Seoul, South Korea.,Institute of Health Services Management, Hanyang University, Seoul, South Korea
| | - Dongwoon Han
- Department of Global Health and Development, Graduate School, Hanyang University, Seoul, South Korea.,Institute of Health Services Management, Hanyang University, Seoul, South Korea.,Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, South Korea
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15
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Martin Henseler, Helene Maisonnave, Asiya Maskaeva. Economic impacts of COVID-19 on the tourism sector in Tanzania. Annals of Tourism Research Empirical Insights 2022; 3. [ DOI: 10.1016/j.annale.2022.100042] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 09/08/2023]
Abstract
The worldwide COVID-19 pandemic has affected the tourism sector by closing borders, reducing both the transportation of tourists and tourist demand. Developing countries, such as Tanzania, where the tourism sector contributes a high share to gross domestic product, are facing considerable economic consequences. Tourism interlinks domestic sectors such as transport, accommodation, beverages and food, and retail trade and thus plays an important role in household income. Our study assesses the macroeconomic impacts of COVID-19 on the tourism sector and the Tanzanian economy as a case study of an impacted developing economy. We use a computable general equilibrium model framework to simulate the economic impacts resulting from the COVID-19 pandemic and quantitatively analysed the economic impacts.
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16
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Hosaka KR, Mmbaga BT, Shayo AM, Gallis JA, Turner EL, O’Donnell KE, Cunningham CK, Boshe J, Dow DE. A group-based mental health intervention for Tanzanian youth living with HIV: Secondary analysis of a pilot trial. Medicine (Baltimore) 2022; 101:e28693. [PMID: 35363163 PMCID: PMC9282032 DOI: 10.1097/md.0000000000028693] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/07/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Youth living with human immunodeficiency virus (YLWH) are vulnerable to incomplete adherence to antiretroviral therapy in the context of stigma, decreased hope for future, and mental health challenges. Despite these challenges, few mental health interventions have been developed to support YLWH. Previous randomized results from the Sauti ya Vijana (SYV; "The Voice of Youth") mental health intervention were indicative of the intervention's benefits in promoting virologic suppression. METHODS SYV is a group-based mental health and life skills intervention (pilot, individually randomized group treatment trial) developed alongside YLWH. SYV was comprised of 10, 90-minute sessions based on evidence-based treatment models designed to improve coping, social support, and hope for future as a pathway to improved adherence and virologic suppression. At baseline, YLWH 12 to 24 years of age were randomized to SYV or standard of care. Participants included in this secondary analysis were enrolled in SYV's crossover waves due to either being randomized to standard of care or inability to attend an earlier group, and therefore delayed intervention exposure. Measured outcomes included self-reported mental health measures, self-reported human immunodeficiency virus measures (stigma and adherence), and human immunodeficiency virus ribonucleic acid. Data was collected at baseline, preintervention, and postintervention timepoints. Participants were included if they attended a crossover wave and had data at all 3 timepoints. RESULTS Twenty-one crossover participants met inclusion criteria. Mean scores of self-reported mental health questionnaires were in an asymptomatic range both pre- and postintervention. Viral suppression was N = 15 (71%) preintervention compared to N = 17 (81%) postintervention. The participants who became virologically suppressed had no change in antiretroviral therapy. CONCLUSIONS Despite the small sample size, findings from this study demonstrate that mental wellbeing may be an important pathway to improved HIV outcomes for YLWH. The same trend toward virologic suppression pre- to postintervention was demonstrated in the randomized pilot trial and suggests that SYV holds promise to improve HIV outcomes. Data from this analysis support the fully powered trial that is now underway.
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Affiliation(s)
- Kalei R.J. Hosaka
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi Tanzania
- Duke Global Health Institute, Duke University Medical Center, Durham, NC
| | - Aisa M. Shayo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi Tanzania
| | - John A. Gallis
- Duke Global Health Institute, Duke University Medical Center, Durham, NC
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC
| | - Elizabeth L. Turner
- Duke Global Health Institute, Duke University Medical Center, Durham, NC
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC
| | - Karen E. O’Donnell
- Center for Health Policy and Inequalities Research, Duke University, Durham, NC
- Center for Child and Family Health, Durham, NC
| | | | - Judith Boshe
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi Tanzania
| | - Dorothy E. Dow
- Duke Global Health Institute, Duke University Medical Center, Durham, NC
- Division of Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, NC
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Nyagabona SK, Mushi BP, Selekwa M, Philipo GS, Haddadi S, Kadhim EF, Breithaupt L, Maongezi S, Mwaiselage J, Balandya E, Leyna GH, Van Loon K, Mmbaga EJ. A mixed methods needs assessment and gap analysis for establishment of a cancer research training program in East Africa. J Glob Health Rep 2021; 5. [PMID: 34722937 PMCID: PMC8553223 DOI: 10.29392/001c.22120] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background The burden of non-communicable diseases (NCDs), including cancer, in Africa is rising. Policymakers are charged with formulating evidence-based cancer control plans; however, there is a paucity of data on cancers generated from within Africa. As part of efforts to enhance cancer research training in East Africa, we performed a needs assessment and gap analysis of cancer-related research training resources in Tanzania. Methods A mixed-methods study to evaluate existing individual, institutional, and national resources supporting cancer research training in Tanzania was conducted. Qualitative data were collected using in-depth interviews while quantitative data were collected using self-administered questionnaires and online surveys. The study also included a desk-review of policy and guidelines related to NCD research and training. Study participants were selected to represent five groups: (i) policymakers; (ii) established researchers; (iii) research support personnel; (iv) faculty members in degree training programs; and (v) post-graduate trainees. Results Our results identified challenges in four thematic areas. First, there is a need for coordination and monitoring of the cancer research agenda at the national level. Second, both faculty and trainees identified the need for incorporation of rigorous training to improve research competencies. Third, sustained mentoring and institutional investment in development of mentorship resources is critical to empowering early career investigators. Finally, academic institutions can enhance research outputs by providing adequate research infrastructure, prioritizing protected time for research, and recognizing research accomplishments by trainees and faculty. Conclusions As we look towards establishment of cancer research training programs in East Africa, investment in the development of rigorous research training, mentorship resources, and research infrastructure will be critical to empowering local health professionals to engage in cancer research activities.
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Affiliation(s)
- Sarah Kutika Nyagabona
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Beatrice Paul Mushi
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Musiba Selekwa
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Godfrey Sama Philipo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sumaiya Haddadi
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Emilie Fatima Kadhim
- Global Cancer Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
| | - Lindsay Breithaupt
- Global Cancer Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
| | - Sarah Maongezi
- Non-Communicable Diseases Program, United Republic of Tanzania Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Julius Mwaiselage
- Administrative services, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Emmanuel Balandya
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Germana Henry Leyna
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Katherine Van Loon
- Global Cancer Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
| | - Elia John Mmbaga
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
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18
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Rees CA, Kisenge R, Manji KP, Liu E, Fawzi WW, Duggan CP. Identifying Infants and Young Children at Risk of Unplanned Hospital Admissions and Clinic Visits in Dar es Salaam, Tanzania. Pediatr Infect Dis J 2020; 39:e428-34. [PMID: 32842043 DOI: 10.1097/INF.0000000000002875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pediatric inpatient mortality rates are as high as 11% in parts of sub-Saharan Africa. Unscheduled clinic visits also burden children in sub-Saharan Africa. Our objective was to identify factors associated with hospital admissions and unscheduled clinic visits among Tanzanian children < 24 months of age. METHODS We conducted a secondary analysis of 2 trials conducted in Dar es Salaam, Tanzania. We performed univariate and Poisson multivariable regression analyses to identify factors associated with hospital admissions and unscheduled clinic visits. RESULTS Of 4784 children < 24 months of age, 293 (6.1%) were hospitalized at least once and 1308 (27.3%) had ≥ 1 unscheduled clinic visit. Infants and children who were exposed to but HIV-negative had increased risk of hospital admission [adjusted risk ratios (aRR): 3.67; 95% CI: 2.45-5.50; P < 0.001] compared with HIV-unexposed children. Those who were HIV-positive had even higher risk of hospital admission compared with those not exposed to HIV (aRR: 10.87; 95% CI: 7.01-16.89; P < 0.001). Birth weight and breast-feeding status were not associated with increased risk of hospital admission. Children with Apgar scores < 7 (aRR: 1.32; 95% CI: 1.03-1.69; P = 0.001), not exclusively breast-fed up to 6 months of age (aRR: 1.34; 95% CI: 1.12-1.60; P = 0.001), and who were HIV-exposed and HIV-negative (aRR: 2.35; 95% CI: 2.08-2.66; P < 0.001) or HIV-positive (aRR: 3.02; 95% CI: 2.52-3.61; P < 0.001) had higher risk of unscheduled clinic visits. CONCLUSIONS Exposure to HIV and being HIV-positive were associated with the greatest risk for hospital admission and unplanned clinic visits among infants and children in Tanzania. Targeting these vulnerable populations in interventional studies may reduce morbidity.
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Irira M, Ngocho JS, Youze J, Shayo I, Komba V, Minja L, Karia FP, Bartlett J, Mmbaga BT. Prevalence and Outcome of HIV-associated Malignancies Among HIV-infected Children Enrolled into Care at Kilimanjaro Christian Medical Center 2006 to 2014: A Hospital-based Retrospective Analytical Study. J Pediatr Hematol Oncol 2020; 42:69-73. [PMID: 30601401 PMCID: PMC6597337 DOI: 10.1097/mph.0000000000001389] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aimed to establish the prevalence of human immunodeficiency virus (HIV)-associated malignancies in children attending a care and treatment clinic at Kilimanjaro Christian Medical Centre. MATERIALS AND METHODS This was a retrospective cross-sectional hospital-based study of children who attended an HIV care and treatment clinic between 2006 and 2014. Children 2 months to 17 years of age were eligible for participation. The data on social demographic and clinical characteristics were extracted from the medical record. A multivariate logistic regression model was developed to determine predictors of HIV-associated malignancies. RESULTS Medical records from 721 HIV-infected children were reviewed. The median age (interquartile range) at HIV diagnosis was 5.7 (2.0 to 9.4) years. Among them, 34 (4.7%) had HIV-associated malignancies. The most common (n=24, 70.3%) malignancy was the Kaposi sarcoma. Age at HIV diagnosis was significantly associated with HIV-associated malignancies (adjusted odds ratio, 1.2; 95% confidence interval, 1.0-1.3). Among 34 patients with HIV-associated malignancies, 11 (32.4%) died. Seven (20.6%) patients reported complete remission from their malignancies, and outcomes for 6 patients were unknown. CONCLUSIONS The prevalence of HIV-associated malignancies was high and was associated with late HIV diagnosis. The Kaposi sarcoma was the commonest malignancy. Early HIV diagnosis and treatment in children might reduce HIV-associated malignancies.
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Affiliation(s)
- Michael Irira
- Kilimanjaro Christian Medical University College Box 2240 Moshi Tanzania
- Kilimanjaro Christian Medical Centre Box 3010 Moshi Tanzania
| | - James Samwel Ngocho
- Kilimanjaro Christian Medical University College Box 2240 Moshi Tanzania
- Kilimanjaro Christian Medical Centre Box 3010 Moshi Tanzania
| | - Joshua Youze
- Kilimanjaro Christian Medical University College Box 2240 Moshi Tanzania
| | - Irene Shayo
- Kilimanjaro Christian Medical University College Box 2240 Moshi Tanzania
| | - Venancia Komba
- Kilimanjaro Christian Medical University College Box 2240 Moshi Tanzania
| | - Linda Minja
- Kilimanjaro Clinical Research Institute Box 2234 Moshi Tanzania
| | - Francis P. Karia
- Kilimanjaro Christian Medical University College Box 2240 Moshi Tanzania
- Kilimanjaro Christian Medical Centre Box 3010 Moshi Tanzania
| | - John Bartlett
- Kilimanjaro Christian Medical Centre Box 3010 Moshi Tanzania
- Duke Global Health Institute, Duke University, North Carolina, USA
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical University College Box 2240 Moshi Tanzania
- Kilimanjaro Christian Medical Centre Box 3010 Moshi Tanzania
- Duke Global Health Institute, Duke University, North Carolina, USA
- Kilimanjaro Clinical Research Institute Box 2234 Moshi Tanzania
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20
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Mazigo HD, Kirway L, Ambrose EA. Prevalence and intensity of Schistosoma mansoni infection in pediatric populations on antiretroviral therapy in north-western Tanzania: a cross-sectional study. BMJ Open 2019; 9:e029749. [PMID: 31345980 PMCID: PMC6661605 DOI: 10.1136/bmjopen-2019-029749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In areas where HIV and intestinal schistosomiasis are highly endemic, co-infections of the two diseases in a single human host are frequent. Evidence in adult populations indicates that HIV and intestinal schistosomiasis are associated with negative health impacts. However, the topic of HIV and schistosomiasis in paediatric populations has received little attention. The present study determined the prevalence and intensity of Schistosoma mansoni infection in a paediatric population on antiretroviral therapy (ART) in north-western Tanzania. DESIGN, SETTINGS AND PARTICIPANTS A cross-sectional study was conducted among HIV-infected children aged 1-16 years on ART attending a Care and Treatment Clinic at Ukerewe Designated District Hospital, north-western Tanzania. MAIN OUTCOME MEASURES Single stool and urine samples were collected and screened for S. mansoni eggs and circulating cathodic antigen (CCA), using the Kato-Katz (KK) technique and point-of-care CCA (POC-CCA) rapid urine test, respectively. RESULTS A total of 134 children with a median age of 10 years (IQR 7-12 years) participated in the study. Of these, 44.8% (60/134) and 55.2% (74/134) were female and male, respectively. The overall prevalence of S. mansoni based on the KK technique and POC-CCA rapid test were 10.7% (95% CI 5.9% to 18.4%) and 33.8% (95% CI 26.2% to 42.4%), respectively. The overall geometrical mean eggs per gram of faeces was 293.9 GM-epg (95% CI 123.3 to 700.9). A small proportion of the children had moderate (4.9%, 5/103) and heavy (3.8%, 4/103) intensity of infection. CONCLUSION Paediatric populations on ART are co-infected with S. mansoni infection. Screening and treatment of intestinal schistosomiasis at initiation of ART is recommended to reduce the risk of developing hepatosplenic disease, schistosomiasis-related immune reconstitution inflammatory syndrome and the possible adverse effect of schistosomiasis on outcome of ART.
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Affiliation(s)
- Humphrey D Mazigo
- Department of Medical Parasitology and Entomology, School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, United Republic of Tanzania
| | - Laurence Kirway
- Department of Pediatricts and Child Health, Bugando Medical Centre, Mwanza, United Republic of Tanzania
| | - Emmanuela Ausebio Ambrose
- Department of Biomedical Sciences, Bishop Nicodemus Hhando College of Health Scineces, Manyara, United Republic of Tanzania
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Harling G, Muya A, Ortblad KF, Mashasi I, Dambach P, Ulenga N, Barnhart D, Mboggo E, Oldenburg CE, Bärnighausen T, Spiegelman D. HIV risk and pre-exposure prophylaxis interest among female bar workers in Dar es Salaam: cross-sectional survey. BMJ Open 2019; 9:e023272. [PMID: 30898799 PMCID: PMC6475445 DOI: 10.1136/bmjopen-2018-023272] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Female bar workers (FBW) in East Africa often conduct sex work to supplement their incomes, and may be vulnerable to HIV acquisition. Pre-exposure prophylaxis (PrEP) offers protection against HIV acquisition. However, there is little research on FBW's sexual health. Our objective was to determine HIV risk behaviours and interest in PrEP among FBW in the largest city in East Africa. DESIGN Cross-sectional survey covering respondents' work and personal lives, including social and behavioural risk factors for HIV. The survey aimed to determine the feasibility of working with FBW and HIV prevalence estimates. Those who did not report being HIV positive were asked about their knowledge of and interest in PrEP. All women were offered free on-site HIV testing and counselling (HTC). SETTING Eight randomly selected workplaces, that is, bars, in Kinondoni district, Dar es Salaam (DSM). PARTICIPANTS 66 FBW (≥18 years) selected at random from all women working in selected bars on the day of visit. RESULTS Half of respondents reported having had sex for money: 20% with bar clients only, 15% with other men only and 15% with both. Almost all (98%) reported ≥1 non-commercial partners in the past 12 months; only 30% reported using condoms with these partners. 85% of respondents had ever been pregnant; 44% had had an unintended pregnancy. Only 5% of respondents had ever heard of PrEP. However, 54% were somewhat/very interested in daily-pill PrEP and 79% were somewhat/very interested in long-acting injectable PrEP. When asked to rank modalities, long-acting injectable PrEP was the most preferred. Seven per cent of the 56 respondents who completed HTC tested HIV positive. CONCLUSIONS FBW in DSM have elevated risk factors for HIV acquisition, and PrEP appears highly acceptable. Studies developing PrEP delivery models and assessing PrEP initiation and adherence in FBW appear warranted.
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Affiliation(s)
- Guy Harling
- Institute for Global Health, University College London, London, UK
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Aisa Muya
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Katrina F Ortblad
- International Clinical Research Center, University of Washington, Seattle, Washington, USA
| | - Irene Mashasi
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Peter Dambach
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Nzovu Ulenga
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Dale Barnhart
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Eric Mboggo
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Catherine E Oldenburg
- Francis I Proctor Foundation, University of California San Francisco, San Francisco, California, USA
- Departments of Ophthalmology & Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Till Bärnighausen
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Donna Spiegelman
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, Connecticut, USA
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Cavallaro FL, Pembe AB, Campbell O, Hanson C, Tripathi V, Wong KL, Radovich E, Benova L. Caesarean section provision and readiness in Tanzania: analysis of cross-sectional surveys of women and health facilities over time. BMJ Open 2018; 8:e024216. [PMID: 30287614 PMCID: PMC6173245 DOI: 10.1136/bmjopen-2018-024216] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To describe trends in caesarean sections and facilities performing caesareans over time in Tanzania and examine the readiness of such facilities in terms of infrastructure, equipment and staffing. DESIGN Nationally representative, repeated cross-sectional surveys of women and health facilities. SETTING Tanzania. PARTICIPANTS Women of reproductive age and health facility staff. MAIN OUTCOME MEASURES Population-based caesarean rate, absolute annual number of caesareans, percentage of facilities reporting to perform caesareans and three readiness indicators for safe caesarean care: availability of consistent electricity, 24 hour schedule for caesarean and anaesthesia providers, and availability of all general anaesthesia equipment. RESULTS The caesarean rate in Tanzania increased threefold from 2% in 1996 to 6% in 2015-16, while the total number of births increased by 60%. As a result, the absolute number of caesareans increased almost fivefold to 120 000 caesareans per year. The main mechanism sustaining the increase in caesareans was the doubling of median caesarean volume among public hospitals, from 17 caesareans per month in 2006 to 35 in 2014-15. The number of facilities performing caesareans increased only modestly over the same period. Less than half (43%) of caesareans in Tanzania in 2014-15 were performed in facilities meeting the three readiness indicators. Consistent electricity was widely available, and 24 hour schedules for caesarean and (less systematically) anaesthesia providers were observed in most facilities; however, the availability of all general anaesthesia equipment was the least commonly reported indicator, present in only 44% of all facilities (34% of public hospitals). CONCLUSIONS Given the rising trend in numbers of caesareans, urgent improvements in the availability of general anaesthesia equipment and trained anaesthesia staff should be made to ensure the safety of caesareans. Initial efforts should focus on improving anaesthesia provision in public and faith-based organisation hospitals, which together perform more than 90% of all caesareans in Tanzania.
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Affiliation(s)
- Francesca L Cavallaro
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrea B Pembe
- Department of Obstetrics and Gynaecology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Oona Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Claudia Hanson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Kerry Lm Wong
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Emma Radovich
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Mghanga FP, Genge CM, Yeyeye L, Twalib Z, Kibopile W, Rutalemba FJ, Shengena TM. Magnitude, Severity, and Morphological Types of Anemia in Hospitalized Children Under the Age of Five in Southern Tanzania. Cureus 2017; 9:e1499. [PMID: 28948119 PMCID: PMC5608490 DOI: 10.7759/cureus.1499] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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] [Indexed: 11/05/2022] Open
Abstract
Introduction Anemia is a significant public health problem among children and women globally. It is one of the most common causes of deaths among children admitted to hospitals in sub-Saharan Africa. Case fatality rates of 6 percent to 18 percent have been reported even in facilities that have blood transfusions services. The purpose of this study was to evaluate the magnitude, severity, and morphological types of anemia among hospitalized children under five years of age in the southern part of Tanzania. Methods A cross-sectional, hospital-based, retrospective analysis was conducted in February 2016 using hospital records of 303 children aged 0-59 months admitted to St. Benedict Ndanda Referral Hospital, Mtwara, Tanzania between 1 July 2015 and 31 December 2015. Results The mean hemoglobin (Hb) level of the study population was 7.87 ± 2.84 g/dL, the median was 8.00g/dL, the interquartile range (IQR) was 4.40g/dL, and the prevalence of anemia was 83.17 percent. The magnitude of mild, moderate, and severe anemia was 9.13 percent, 44.84 percent, and 46.03 percent, respectively, and about half of all anemic children had normocytic anemia. Conclusion Severe anemia is a common health problem among hospitalized children under five years of age in the study area. We recommend screening all admitted children under the age of five for anemia, and clinicians should pay attention to and put more emphasis on intervention strategies for anemia when treating children admitted for other diseases.
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Affiliation(s)
| | - Christopher M Genge
- Department of Obstetrics and Gynecology, Mtwara Clinical Officers Training Centre, Mtwara, Tanzania
| | - Leonia Yeyeye
- Department of Pediatrics, Mtwara Clinical Officers Training Centre, Mtwara, Tanzania
| | - Zainab Twalib
- Department of Pediatrics, Mtwara Clinical Officers Training Centre, Mtwara, Tanzania
| | - Wilfred Kibopile
- Department of Pediatrics, Mtwara Clinical Officers Training Centre, Mtwara, Tanzania
| | - Fredrick J Rutalemba
- Department of Pediatrics, Mtwara Clinical Officers Training Centre, Mtwara, Tanzania
| | - Tito M Shengena
- Department of Internal Medicine, Mtwara Clinical Officers Training Centre, Mtwara, Tanzania
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24
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Mosha NR, Mahande M, Juma A, Mboya I, Peck R, Urassa M, Michael D, Todd J. Prevalence,awareness and factors associated with hypertension in North West Tanzania. Glob Health Action 2017; 10:1321279. [PMID: 28598724 PMCID: PMC5496079 DOI: 10.1080/16549716.2017.1321279] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [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: 01/20/2016] [Accepted: 04/01/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hypertension is a public health problem, and yet few people are aware of it and even fewer access effective treatment. With the ongoing demographic transition in many parts of Sub-Saharan Africa, people are changing from rural, manual work to urban lifestyles, hence the risk of hypertension increases. OBJECTIVE This study aimed at determining the prevalence, awareness and risk factors associated with hypertension in North West Tanzania. DESIGN A community-based cross-sectional study was conducted among adults in Magu District in 2013. Information on socio-demographic, economic and lifestyle characteristics, medical conditions, and risk factors for hypertension were collected according to the WHO Steps survey tool. Measurements of blood pressure, blood sugar, pulse rate, and anthropometry were taken. Multivariate logistic regression was used to estimate the odds ratios (OR) and 95% confidence intervals (95% CI) for factors associated with hypertension (Blood pressure ≥140/90mm/Hg). Frequencies and percentages were used to determine the awareness, and treatment among hypertensive participants. RESULTS Among 9678 participants, the prevalence of hypertension was 8.0% and pre-hypertension 36.2%. There was a higher prevalence of hypertension at older ages, among females (8.2%) compared to males (7.7%), and among urban dwellers (10.1%) compared to rural residents (6.8%). Overweight, obese, and diabetic individuals had a higher risk of hypertension while HIV positive participants had a lower risk of hypertension (OR = 0.56; 95% CI 0.39 - 0.79). Among participants with hypertension, awareness was less than 10%. CONCLUSION By integrating blood pressure screening into our long-standing community HIV screening program, we were able to identify many previously undiagnosed cases of hypertension and pre-hypertension. Age, residence, overweight and obesity were the major associated factors for hypertension. Awareness and treatment rates are very low indicating the need for programs to improve awareness, and treatment of hypertension.
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Affiliation(s)
- Neema R. Mosha
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Michael Mahande
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Adinan Juma
- Kilimanjaro Christian Medical Centre, Ministry of Health, Moshi, Tanzania
- Social Welfare, Moshi and Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Innocent Mboya
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Rob Peck
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
- Center for Global Health, Weill Cornell Medical College, New York, NY, USA
| | - Mark Urassa
- National Institute for Medical Research, Mwanza, Tanzania
| | - Denna Michael
- National Institute for Medical Research, Mwanza, Tanzania
| | - Jim Todd
- National Institute for Medical Research, Mwanza, Tanzania
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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25
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Peck RN, Wang RJ, Mtui G, Smart L, Yango M, Elchaki R, Wajanga B, Downs JA, Mteta K, Fitzgerald DW. Linkage to Primary Care and Survival After Hospital Discharge for HIV-Infected Adults in Tanzania: A Prospective Cohort Study. J Acquir Immune Defic Syndr 2016; 73:522-530. [PMID: 27846069 PMCID: PMC5129656 DOI: 10.1097/qai.000000000001107] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Little is known about outcomes after hospitalization for HIV-infected adults in sub-Saharan Africa. We determined 12-month, posthospital mortality rates in HIV-infected vs. uninfected adults and predictors of mortality. METHODS In this prospective cohort study, we enrolled adults admitted to the medical wards of a public hospital in northwestern Tanzania. We conducted standardized questionnaires, physical examinations, and basic laboratory analyses including HIV testing. Participants or proxies were called at 1, 3, 6, and 12 months to determine outcomes. Predictors of in-hospital and posthospital mortality were determined using logistic regression. Cox regression models were used to analyze mortality incidence and associated factors. To confirm our findings, we studied adults admitted to another government hospital. RESULTS We enrolled 637 consecutive adult medical inpatients: 38/143 (26.6%) of the HIV-infected adults died in hospital vs. 104/494 (21.1%) of the HIV-uninfected adults. Twelve-month outcomes were determined for 98/105 (93.3%) vs. 352/390 (90.3%) discharged adults, respectively. Posthospital mortality was 53/105 (50.5%) for HIV-infected adults vs. 126/390 (32.3%) for HIV-uninfected adults (adjusted P = 0.006). The 66/105 (62.9%) HIV-infected adults who attended clinic within 1 month after discharge had significantly lower mortality than the other HIV-infected adults [adjusted hazards ratio = 0.17 (0.07-0.39), P < 0.001]. Adults admitted to a nearby government hospital had similar high rates of posthospital mortality. CONCLUSIONS Posthospital mortality is disturbingly high among HIV-infected adult inpatients in Tanzania. The posthospital period may offer a window of opportunity to improve survival in this population. Interventions are urgently needed and should focus on increasing posthospital linkage to primary HIV care.
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Affiliation(s)
- Robert N. Peck
- Weill Bugando School of Medicine
- Bugando Medical Centre
- Weill Cornell Medical College
| | - Richard J. Wang
- Weill Cornell Medical College
- University of California, San Francisco
| | - Graham Mtui
- Weill Bugando School of Medicine
- Bugando Medical Centre
| | - Luke Smart
- Weill Bugando School of Medicine
- Bugando Medical Centre
- Weill Cornell Medical College
| | - Missana Yango
- Weill Bugando School of Medicine
- University of Dodoma School of Medicine
| | | | | | - Jennifer A. Downs
- Weill Bugando School of Medicine
- Bugando Medical Centre
- Weill Cornell Medical College
| | - Kien Mteta
- Weill Bugando School of Medicine
- Bugando Medical Centre
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Hoza AS, Mfinanga SGM, Rodloff AC, Moser I, König B. Increased isolation of nontuberculous mycobacteria among TB suspects in Northeastern, Tanzania: public health and diagnostic implications for control programmes. BMC Res Notes 2016; 9:109. [PMID: 26887928 PMCID: PMC4756402 DOI: 10.1186/s13104-016-1928-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 02/09/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Non-tuberculous mycobacteria (NTM) are increasingly reported worldwide associated with human disease. Defining the significance of NTM in settings with endemic tuberculosis (TB) requires the discrimination of NTM from TB in suspect patients. Correct and timely identification of NTM will impact both therapy and epidemiology of TB and TB-like diseases. The present study aimed at determining the frequency and diversity of NTM among TB suspects in northeastern Tanzania. METHODS A cross-sectional study was conducted between November 2012 through January 2013. Seven hundred and forty-four sputum samples were collected from 372 TB suspects. Detection was done by using phenotypic, GenoType(®) Mycobacterium CM/AS kits, 16S rRNA and hsp65 gene sequencing for identification of isolates not identified by Hain kits. Binary regression model was used to analyse the predictors of NTM detection. RESULTS The prevalence of NTM was 9.7% of the mycobacterial isolates. Out of 36 patients with confirmed NTM infection, 12 were HIV infected with HIV being a significant predictor of NTM detection (P < 0.001). Co-infection with Mycobacterium tuberculosis (M. tb) was found in five patients. Twenty-eight NTM isolates were identified using GenoType(®) Mycobacterium CM/AS and eight isolates could not be identified. Identified species included M. gordonae and M. interjectum 6 (16.7%), M. intracelullare 4 (11.1%), M. avium spp. and M. fortuitum 2 (5.5%), M. kansasii, M. lentiflavum, M. simiae, M. celatum, M. marinum 1 (2.8%) each. Of isolates not identified to subspecies level, we identified M. kumamotonense (2), M. intracellulare/kansasii, M. intermedium/triplex, M. acapulcensis/flavescens, M. stomatepiae, M. colombiense and M. terrae complex (1) each using 16S rRNA sequencing. Additionally, hsp65 gene sequencing identified M. kumamotonense, M. scrofulaceum/M. avium, M. avium, M. flavescens/novocastrense, M. kumamotonense/hiberniae, M. lentiflavum, M. colombiense/M. avium and M. kumamotonense/terrae/hiberniae (1) each. Results of the 16S rRNA and hsp65 gene sequencing were concordant in three and discordant in five isolates not identified by GenoType(®) Mycobacterium CM/AS. CONCLUSION NTM infections may play a vital role in causing lung disease and impact management of TB in endemic settings. GenoType(®) Mycobacterium CM/AS represents a useful tool to identify clinical NTM infections. However, 16S rRNA gene sequencing should be thought for confirmatory diagnosis of the clinical isolates. Due to the complexity and inconsistence of NTM identification, we recommend diagnosis of NTM infections be centralized by strengthening and setting up quality national and regional infrastructure.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Bacterial Proteins
- Bacterial Typing Techniques
- Chaperonin 60
- Child
- Coinfection
- Communicable Disease Control/organization & administration
- Cross-Sectional Studies
- Diagnosis, Differential
- Female
- HIV/genetics
- HIV Infections/diagnosis
- HIV Infections/epidemiology
- HIV Infections/virology
- Humans
- Male
- Middle Aged
- Mycobacterium Infections, Nontuberculous/diagnosis
- Mycobacterium Infections, Nontuberculous/epidemiology
- Mycobacterium Infections, Nontuberculous/microbiology
- Mycobacterium tuberculosis/genetics
- Mycobacterium tuberculosis/isolation & purification
- Nontuberculous Mycobacteria/genetics
- Nontuberculous Mycobacteria/isolation & purification
- Public Health
- RNA, Ribosomal, 16S/genetics
- Tanzania/epidemiology
- Tuberculosis, Pulmonary/diagnosis
- Tuberculosis, Pulmonary/epidemiology
- Tuberculosis, Pulmonary/microbiology
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Affiliation(s)
- Abubakar S Hoza
- Institute of Medical Microbiology and Epidemiology of Infectious Diseases, University of Leipzig, Liebigstrasse 21, 04103, Leipzig, Germany.
- Sokoine University of Agriculture, Morogoro, Tanzania.
| | - Sayoki G M Mfinanga
- Muhimbili Centre, National Institute for Medical Research (NIMR), Dar es Salaam, Tanzania.
| | - Arne C Rodloff
- Institute of Medical Microbiology and Epidemiology of Infectious Diseases, University of Leipzig, Liebigstrasse 21, 04103, Leipzig, Germany.
| | - Irmgard Moser
- Federal Research for Animal Health, Friedrich Loeffler Institut, Jena, Germany.
| | - Brigitte König
- Institute of Medical Microbiology and Epidemiology of Infectious Diseases, University of Leipzig, Liebigstrasse 21, 04103, Leipzig, Germany.
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Shemdoe A, Mbaruku G, Dillip A, Bradley S, William J, Wason D, Hildon ZJL. Explaining retention of healthcare workers in Tanzania: moving on, coming to 'look, see and go', or stay? Hum Resour Health 2016; 14:2. [PMID: 26783192 PMCID: PMC4717661 DOI: 10.1186/s12960-016-0098-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 01/14/2016] [Indexed: 06/02/2023]
Abstract
BACKGROUND In the United Republic of Tanzania, as in many regions of Sub-Saharan Africa, staff shortages in the healthcare system are a persistent problem, particularly in rural areas. To explore staff shortages and ways of keeping workers in post, we ask, (a) Which cadres are most problematic to recruit and keep in post? (b) How and for what related reasons do health workers leave? (c) What critical incidents do those who stay face? (d) And why do they stay and cope? METHODS This is a multi-method paper based on analysis of data collected as part of a cross-sectional health facility study supporting maternal and reproductive health services in the United Republic of Tanzania. Qualitative data were generated through semi-structured interviews with Council Health Management Teams, and Critical Incident Technique interviews with mid-level cadres. Complementary quantitative survey data were collected from district health officials, which are used to support the qualitative themes. RESULTS Mid-level cadres were problematic to retain and caused significant disruptions to continuity of care when they left. Shortage of highly skilled workers is not only a rural issue but also a national one. Staff were categorised into a clear typology. Staff who left soon after arrival and are described by 'Look, See and Go'; 'Movers On' were those who left due to family commitments or because they were pushed to go. The remaining staff were 'Stayers'. Reasons for wanting to leave included perceptions of personal safety, feeling patient outcomes were compromised by poor care or as a result of perceived failed promises. Staying and coping with unsatisfactory conditions was often about being settled into a community, rather than into the post. CONCLUSIONS The Human Resources for Health system in the United Republic of Tanzania appears to lack transparency. A centralised monitoring system could help to avoid early departures, misallocation of training, and other incentives. The system should match workers' profiles to the most suitable post for them and track their progress and rewards; training managers and holding them accountable. In addition, priority should be given to workplace safety, late night staff transport, modernised and secure compound housing, and involving the community in reforming health services culture and practices.
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Affiliation(s)
- Aloisia Shemdoe
- />Ifakara Health Institute, Kiko Avenue, Plot 463, P.O. Box 78373, Mikocheni, Dar es Salaam, Tanzania
| | - Godfrey Mbaruku
- />Ifakara Health Institute, Kiko Avenue, Plot 463, P.O. Box 78373, Mikocheni, Dar es Salaam, Tanzania
| | - Angel Dillip
- />Ifakara Health Institute, Kiko Avenue, Plot 463, P.O. Box 78373, Mikocheni, Dar es Salaam, Tanzania
| | - Susan Bradley
- />School of Health Sciences, City University London, 1 Myddelton Street, London, EC1R 1UW England
| | - JeJe William
- />Oxford Policy Management, GEPF House, Plot No 37, New Bagamoyo Road, P.O Box 71166, Dar es Salaam, Tanzania
| | - Deborah Wason
- />Department of Public Health, NHS Ayrshire & Arran, Dalmellington Rd, Ayr, KA6 6AB Scotland
| | - Zoe Jane-Lara Hildon
- />Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, MD1, Science Drive 2, 117549 Singapore, Singapore
- />London School of Hygiene and Tropical Medicine, Faculty of Public Health & Policy, Department of Global Health and Development, Keppel Street, London, WC1E 7HT England
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LeFevre AE, Mpembeni R, Chitama D, George AS, Mohan D, Urassa DP, Gupta S, Feldhaus I, Pereira A, Kilewo C, Chebet JJ, Cooper CM, Besana G, Lutale H, Bishanga D, Mtete E, Semu H, Baqui AH, Killewo J, Winch PJ. Profile, knowledge, and work patterns of a cadre of maternal, newborn, and child health CHWs focusing on preventive and promotive services in Morogoro Region, Tanzania. Hum Resour Health 2015; 13:98. [PMID: 26703439 PMCID: PMC4690304 DOI: 10.1186/s12960-015-0086-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 11/02/2015] [Indexed: 05/26/2023]
Abstract
BACKGROUND Despite impressive decreases in under-five mortality, progress in reducing maternal and neonatal mortality in Tanzania has been slow. We present an evaluation of a cadre of maternal, newborn, and child health community health worker (MNCH CHW) focused on preventive and promotive services during the antenatal and postpartum periods in Morogoro Region, Tanzania. Study findings review the effect of several critical design elements on knowledge, time allocation, service delivery, satisfaction, and motivation. METHODS A quantitative survey on service delivery and knowledge was administered to 228 (of 238 trained) MNCH CHWs. Results are compared against surveys administered to (1) providers in nine health centers (n = 88) and (2) CHWs (n = 53) identified in the same districts prior to the program's start. Service delivery outputs were measured by register data and through a time motion study conducted among a sub-sample of 33 randomly selected MNCH CHWs. RESULTS Ninety-seven percent of MNCH CHWs (n = 228) were interviewed: 55% male, 58% married, and 52% with secondary school education or higher. MNCH CHWs when compared to earlier CHWs were more likely to be unmarried, younger, and more educated. Mean MNCH CHW knowledge scores were <50% for 8 of 10 MNCH domains assessed and comparable to those observed for health center providers but lower than those for earlier CHWs. MNCH CHWs reported covering a mean of 186 households and were observed to provide MNCH services for 5 h weekly. Attendance of monthly facility-based supervision meetings was nearly universal and focused largely on registers, yet data quality assessments highlighted inconsistencies. Despite program plans to provide financial incentives and bicycles for transport, only 56% of CHWs had received financial incentives and none received bicycles. CONCLUSIONS Initial rollout of MNCH CHWs yields important insights into addressing program challenges. The social profile of CHWs was not significantly associated with knowledge or service delivery, suggesting a broader range of community members could be recruited as CHWs. MNCH CHW time spent on service delivery was limited but comparable to the financial incentives received. Service delivery registers need to be simplified to reduce inconsistencies and yet expanded to include indicators on the timing of antenatal and postpartum visits.
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Affiliation(s)
- Amnesty E LeFevre
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Rose Mpembeni
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar es Salaam, Tanzania.
| | - Dereck Chitama
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar es Salaam, Tanzania.
| | - Asha S George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - David P Urassa
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar es Salaam, Tanzania.
| | - Shivam Gupta
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Isabelle Feldhaus
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Audrey Pereira
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Charles Kilewo
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar es Salaam, Tanzania.
| | - Joy J Chebet
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | - Giulia Besana
- Jhpiego, 1615 Thames Street, Baltimore, MD, 21231-3492, USA.
| | - Harriet Lutale
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania.
| | | | - Emmanuel Mtete
- Jhpiego, 1615 Thames Street, Baltimore, MD, 21231-3492, USA.
| | - Helen Semu
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania.
| | - Abdullah H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Japhet Killewo
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar es Salaam, Tanzania.
| | - Peter J Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Magoma M, Massinde A, Majinge C, Rumanyika R, Kihunrwa A, Gomodoka B. Maternal death reviews at Bugando hospital north-western Tanzania: a 2008-2012 retrospective analysis. BMC Pregnancy Childbirth 2015; 15:333. [PMID: 26670664 PMCID: PMC4681083 DOI: 10.1186/s12884-015-0781-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 12/08/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Unacceptably high levels of maternal deaths still occur in many sub-Saharan countries and the health systems may not favour effective use of lessons from maternal death reviews to improve maternal survival. We report results from the analysis of data from maternal death reviews at Bugando Medical Centre north-western Tanzania in the period 2008-2012 and highlight the process, challenges and how the analysis provided a better understanding of maternal deaths. METHODOLOGY Retrospective analysis using maternal death review data and extraction of missing information from patients' files. Analysis was done in STATA statistical package into frequencies and means ± SD and median with 95% CI for categorical and numerical data respectively. RESULTS There were 80 deaths; mean age of the deceased 27.1 ± 6.2 years and a median hospital stay of 11.0 days [95% CI 11.0-15.3]. Most deaths were from direct obstetric causes (90); 60% from eclampsia, severe pre-eclampsia, sepsis, abortion and anaesthetic complications. Information on ANC attendance was recorded in 36.2% of the forms and gestation age of the pregnancy resulting into the death in 23.8%. Sixty one deaths (76.3%) occurred after delivery. The mode of delivery, place of delivery and delivery assistant were recorded in 44 (72.1), 38 (62.3) and 23 (37.7%) respectively. CONCLUSION Routine maternal death reviews in this setting do not involve comprehensive documentation of all relevant information, including actions taken to address some identified systemic weaknesses. Periodic analysis of available data may allow better understanding of vital information to improve the quality of maternity care.
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Affiliation(s)
- Moke Magoma
- Evidence for Action Project Tanzania, P.O.BOX 1371, Dar es salaam, Tanzania.
- Department of Obstetrics & Gynaecology, Bugando Medical Centre, Mwanza, Tanzania.
| | - Antony Massinde
- Department of Obstetrics & Gynaecology, Bugando Medical Centre, Mwanza, Tanzania.
| | - Charles Majinge
- Department of Obstetrics & Gynaecology, Bugando Medical Centre, Mwanza, Tanzania.
| | - Richard Rumanyika
- Department of Obstetrics & Gynaecology, Bugando Medical Centre, Mwanza, Tanzania.
| | - Albert Kihunrwa
- Department of Obstetrics & Gynaecology, Bugando Medical Centre, Mwanza, Tanzania.
| | - Balthazar Gomodoka
- Department of Obstetrics & Gynaecology, Bugando Medical Centre, Mwanza, Tanzania.
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Gilyoma JM, Rambau PF, Masalu N, Kayange NM, Chalya PL. Head and neck cancers: a clinico-pathological profile and management challenges in a resource-limited setting. BMC Res Notes 2015; 8:772. [PMID: 26654449 PMCID: PMC4676813 DOI: 10.1186/s13104-015-1773-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 11/30/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Head and neck cancer (HNC) is one of the most common cancers worldwide and its incidence is reported to be increasing in resource-limited countries. There is a paucity of published data regarding head and neck cancers in Tanzania, and Bugando Medical Centre in particular. This study describes the clinicopathological profile of HNC in our local setting and highlights the challenges in the management of this disease. METHODS This was a retrospective study of histopathologically confirmed cases of head and neck cancers treated at Bugando Medical Center between January 2009 and December 2013. RESULTS A total of 346 patients (M:F = 2.1:1) were studied representing 9.5 % of all malignancies. The median age of patients was 42 years. Cigarette smoking (76.6 %) and heavy alcohol consumption (69.9 %) were the most frequently identified risk factors for head and neck cancer. The majority of patients (95.9 %) presented late with advanced stages. Twenty-five (7.2 %) patients were HIV positive with a median CD4+ count of 244 cells/μl. The oral cavity (37.3 %) was the most frequent anatomical site affected. The most common histopathological type was carcinomas (59.6 %) of which 75.7 % were squamous cell carcinoma. A total of 196 (56.6 %) patients underwent surgical procedures for HNC. Radiotherapy and chemotherapy was reported in 9.5 and 16.8 % of patients, respectively. Only 2 (0.6 %) patients received chemo-radiation therapy. The mortality rate was 24.4 %. The overall 5-year survival rate (5-YSR) was 20.6 %. The predictors of overall 5-YSR were age of patient at diagnosis, stage of disease, extent of lymph node involvement, HIV seropositivity and CD4+ count <200 cells/μl (P < 0.001). Local recurrence was reported in 22 (23.4 %) patients and this was significantly associated with positive resection margins, stage of the tumor and presence of metastasis at diagnosis and non-adherence to adjuvant therapy (P < 0.001). CONCLUSION Head and neck cancers are not uncommon at Bugando Medical Centre and show a trend towards a relative young age at diagnosis and the majority of patients present late with advanced stage cancer. Therefore, public enlightenment, early diagnosis, and effective cost-effective treatment and follow-up are urgently needed to improve outcomes of these patients in our environment.
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Affiliation(s)
- Japhet M Gilyoma
- Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania.
| | - Peter F Rambau
- Department of Pathology, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania.
| | - Nestory Masalu
- Department of Oncology, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania.
| | - Neema M Kayange
- Department of Paediatrics, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania.
| | - Phillipo L Chalya
- Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania.
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Petrucka P, Bassendowski S, Dietrich-Leurer M, Spence-Gress C, Athuman Z, Buza J. Maternal, newborn and child health needs, opportunities and preferred futures in Arusha and Ngorongoro: hearing women's voices. BMC Res Notes 2015; 8:773. [PMID: 26654627 PMCID: PMC4676882 DOI: 10.1186/s13104-015-1776-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 11/30/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With the approaching sunset on the Millennium Development Goals (MDGs), Tanzania continues with its final national push towards achievement of MDG #4 and MDG #5. The Mama Kwanza Socio-economic Health Initiative (MKSHI) was introduced in the hope of contributing to improving maternal, newborn, and child health in Arusha and Ngorongoro. The MKSHI project is a holistic, inter-sectoral approach to maternal, newborn, and child health which aligns with the Government of Tanzania's Vision 2025. At the project onset, a baseline assessment was conducted to launch ongoing benchmarking, monitoring, and evaluation of the project's impacts and implications. The aim of this baseline assessment was twofold. First it was to determine the state of maternal, newborn, and child health in the two project sites. Second it was to ensure that a baseline of key indicators was established as well as identification of unique indicators relevant to the populations of interest. RESULTS The baseline study was a mixed methods approach to identify maternal, newborn, and child risk factors and indicators in the two target sites. This paper focuses on the qualitative methods and findings. The qualitative component included a series of five community dialogue meetings and thirty-seven individual/dyad interviews with women, providers, and stakeholders. Initially, community meetings were held as open dialogues on maternal, newborn, and child health issues, opportunities, and preferred futures. Individual/dyad interviews were held with women, providers, and stakeholders who held unique information or experiences. Both community dialogue and interview data was analysed for themes and guiding or critical comments. Three over-arching findings emerged: What took you so long to come? How do we know what you know? and How will it change for our daughters? CONCLUSIONS Participant voices are vital in ensuring the achievement of local and global efforts and preferred futures for maternal, newborn, and child health services. This study contributes to the inclusion of women in all aspects of the planning, implementation, and delivery of maternal, newborn, and child health services in the target areas and beyond.
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Affiliation(s)
- Pammla Petrucka
- University of Saskatchewan, 4400 4th Avenue #100, Regina, SK, S4T 0H8, Canada.
| | - Sandra Bassendowski
- University of Saskatchewan, 4400 4th Avenue #100, Regina, SK, S4T 0H8, Canada.
| | | | - Cara Spence-Gress
- University of Saskatchewan, 4400 4th Avenue #100, Regina, SK, S4T 0H8, Canada.
| | - Zenath Athuman
- Mama Kwanza Socio-economic Health Initiative, Arusha, Tanzania.
| | - Joram Buza
- Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania.
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Ostermann J, Brown DS, Mühlbacher A, Njau B, Thielman N. Would you test for 5000 Shillings? HIV risk and willingness to accept HIV testing in Tanzania. Health Econ Rev 2015; 5:60. [PMID: 26285777 PMCID: PMC4540717 DOI: 10.1186/s13561-015-0060-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 08/03/2015] [Indexed: 05/11/2023]
Abstract
OBJECTIVES Despite substantial public health efforts to increase HIV testing, testing rates have plateaued in many countries and rates of repeat testing for those with ongoing risk are low. To inform policies aimed at increasing uptake of HIV testing, we identified characteristics associated with individuals' willingness-to-accept (WTA) an HIV test in a general population sample and among two high-risk populations in Moshi, Tanzania. METHODS In total, 721 individuals, including randomly selected community members (N = 402), female barworkers (N = 135), and male Kilimanjaro mountain porters (N = 184), were asked in a double-bounded contingent valuation format if they would test for HIV in exchange for 2000, 5000 or 10,000 Shillings (approximately $1.30, $3.20, and $6.40, respectively). The study was conducted between September 2012 and February 2013. RESULTS More than one quarter of participants (196; 27 %) stated they would be willing to test for Tanzania Shilling (TSH) 2000, whereas one in seven (98; 13.6 %) required more than TSH 10,000. The average WTA estimate was TSH 4564 (95 % Confidence Interval: TSH 4201 to 4927). Significant variation in WTA estimates by gender, HIV risk factors and other characteristics plausibly reflects variation in individuals' valuations of benefits of and barriers to testing. WTA estimates were higher among males than females. Among males, WTA was nearly one-third lower for those who reported symptoms of HIV than those who did not. Among females, WTA estimates varied with respondents' education, own and partners' HIV testing history, and lifetime reports of transactional sex. For both genders, the most significant association was observed with respondents' perception of the accuracy of the HIV test; those believing HIV tests to be completely accurate were willing to test for approximately one third less than their counterparts. The mean WTA estimates identified in this study suggest that within the study population, incentivized universal HIV testing could potentially identify undiagnosed HIV infections at an incentive cost of $150 per prevalent infection and $1400 per incident infection, with corresponding costs per quality adjusted life year (QALY) gained of $70 for prevalent and $620 for incident HIV infections. CONCLUSIONS The results support the value of information about the accuracy of HIV testing, and suggest that relatively modest amounts of money may be sufficient to incentivize at-risk populations to test.
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Affiliation(s)
- Jan Ostermann
- Duke Global Health Institute, Duke University, Box 90392, 310 Trent Drive, Durham, NC 27701 USA
- Center for Health Policy and Inequalities Research, Duke University, Durham, NC USA
- Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Derek S. Brown
- Center for Health Policy and Inequalities Research, Duke University, Durham, NC USA
- Brown School, Washington University in St. Louis, St. Louis, MO USA
| | - Axel Mühlbacher
- Center for Health Policy and Inequalities Research, Duke University, Durham, NC USA
- Institut Gesundheitsökonomie und Medizinmanagement, Hochschule Neubrandenburg, Neubrandenburg, Germany
| | - Bernard Njau
- Community Health Department, Kilimanjaro Christian Medical College, Moshi, Tanzania
| | - Nathan Thielman
- Duke Global Health Institute, Duke University, Box 90392, 310 Trent Drive, Durham, NC 27701 USA
- School of Medicine, Duke University, Durham, NC USA
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Kipanyula MJ. Why has canine rabies remained endemic in the Kilosa district of Tanzania? Lessons learnt and the way forward. Infect Dis Poverty 2015; 4:52. [PMID: 26631275 PMCID: PMC4668701 DOI: 10.1186/s40249-015-0085-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 11/18/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Domestic dogs are the main targets for rabies control as they are the principal reservoir for transmission of the rabies virus to humans and other domestic animals. The purpose of this study was to identify the factors that contribute to the rabies virus infecting the human population in a rural community of Eastern Tanzania. METHODS Using a cross-sectional study design, field visits were conducted to gather information on villagers' knowledge on and practices associated with canine rabies control and dog vaccination campaigns. RESULTS A total of 248 individuals were interviewed in the Kilosa district, Tanzania. Almost two-thirds (61.3 %) had a primary school education. The majority (91.1 %) of the respondents were aware that rabies is acquired through dog bites and 66.9 % knew about the clinical signs of rabies in an animal. Very few (17.7 %), however, were aware of the clinical signs of rabies in humans. Only 20.4 % of the respondents knew how rabies is controlled in dogs and 71 % were not aware of dog vaccination campaigns. The average number of dogs kept per household was 4 ± 3.3; 70.0 % of the respondents had one to five dogs, 28.3 % had six to dog dogs, and 1.6 % had 16-20 dogs. The dogs were primarily used to guard livestock and property, and to hunt. About 59.7 % of the respondents indicated that rabies was a public health problem. Low vaccination coverage was observed in the study area, with previous mass vaccination campaigns covering only 24.4 % of the dog population. Dogs appeared to have limited value in the studied community. Furthermore, there were no proper waste disposal facilities and oftentimes wild canids and felids visited the villages to scavenge on kitchen leftovers. CONCLUSION Although communities in the Kilosa district had knowledge on rabies in dogs, they were not aware of the public health implication of the disease, which thus led a poor response during mass dog vaccination campaigns. Establishment of a well-coordinated rabies control program, strategic public health awareness campaigns, and active and passive surveillance systems for humans and domestic and wild animals should be considered as strategies to control and eradicate rabies.
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Affiliation(s)
- M J Kipanyula
- Department of Veterinary Anatomy, Faculty of Veterinary Medicine, Sokoine University of Agriculture, P. O. Box 3016, Chuo Kikuu, Morogoro, Tanzania.
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Chalya PL, Kayange NM, Rambau PF, Manyama M, Gilyoma JM. Surgical management of vascular anomalies in children at a tertiary care hospital in a resource-limited setting: a Tanzanian experience with 134 patients. BMC Res Notes 2015; 8:732. [PMID: 26621505 PMCID: PMC4666117 DOI: 10.1186/s13104-015-1718-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 11/18/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Vascular anomalies pose major diagnostic and therapeutic challenges among pediatricians and pediatric surgeons practicing in resource limited countries. There is paucity of published data regarding this subject in Tanzania and Bugando Medical Centre in particular. This study describes our experiences on the challenges and outcome of surgical management of childhood vascular anomalies in our environment. METHODS Between January 2009 and December 2013, a prospective study on the surgical management of vascular anomalies was undertaken at Bugando Medical Centre. RESULTS A total of 134 patients (M; F = 1:2.5) were studied. The median age at presentation was 6 years. Of the 134 patients, 101 (75.4%) were diagnosed as having vascular tumors and 33 (24.6%) had vascular malformations. The head and the neck were the most frequent anatomical site recorded as having a tumor (56.7% of patients). Out of 134 patients, 129 (96.3%) underwent surgical treatment. Failure to respond to non-operative treatment (86.8%), huge disfiguring/obstructing mass (4.7%), infection (3.1%), ulceration (3.1%) and hemorrhage (2.3%) were indications for surgical intervention. Tumor excision and primary wound closure was the most common type of surgical procedure performed in 80.6% of patients. Surgical site infection was the most frequent complications accounting for 33.8% of cases. Mortality rate was 1.5%. Tumor excision and primary wound closure gave better outcome compared with other surgical options (p < 0.001). Outcome of injection sclerotherapy in 3 (3.7%) children, serial ligation of feeder vessels employed in 2 (1.6%), and conservative treatment in 5 (3.7%), were poor and required conversion to surgical excision. Despite low mortality rate recorded in this study, but ugly scar, 14 (20.6%) and limb deformity, 6 (8.8%) were problems. The overall result of surgical treatment at the end of follow up period was excellent in 108 (87.1%) patients. CONCLUSION Surgical excision and primary wound closure gave good outcome which could be employed in complicated and vascular anomalies which failed to respond to other treatment in regions with limited resources.
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Affiliation(s)
| | - Neema M Kayange
- Department of Paediatrics, Bugando Medical Centre, Mwanza, Tanzania.
| | - Peter F Rambau
- Department of Pathology, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania.
| | - Mange Manyama
- Department of Anatomy, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania.
| | - Japhet M Gilyoma
- Department of Surgery, Bugando Medical Centre, Mwanza, Tanzania.
- Department of Otorhinolaryngology, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania.
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Kalolo A, Kibusi SM. The influence of perceived behaviour control, attitude and empowerment on reported condom use and intention to use condoms among adolescents in rural Tanzania. Reprod Health 2015; 12:105. [PMID: 26563296 PMCID: PMC4643513 DOI: 10.1186/s12978-015-0097-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 11/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the declining trends of Human immunodeficiency virus (HIV) infection in Sub-Saharan Africa (SSA), unsafe sexual behaviours among adolescents still represent a public health challenge. It is important to understand factors acting at different levels to influence sexual behaviour among adolescents. This study examined the influence of perceived behaviour control, subjective norms, attitudes and empowerment on intention to use condoms and reported use of condoms among adolescents in rural Tanzania. METHODS We used a questionnaire to collect data from 403 adolescents aged 14 through 19 years from nine randomly selected secondary schools in the Newala district located in the Southern part of Tanzania. The self-administered questionnaire collected information on sexual practices and factors such as attitudes, subjective norms, perceived behaviour control and empowerment. Binary logistic regression was performed to identify factors associated with intention to use and reported use of condoms. RESULTS Sexually active adolescents constituted 40.6 % of the sample, among them 49.7 % did not use a condom at last sexual intercourse and 49.8 % had multiple sex partners. Many (85 %) of sexually active respondents had their sexual debut between the ages of 14 to 17 years. Girls became sexually active earlier than boys. Perceived behaviour control predicted intentions to use condoms (AOR = 3.059, 95 % CI 1.324-7.065), thus demonstrating its importance in the decision to use a condom. Empowerment (odds ratio = 3.694, 95 % CI 1.295-10.535) and a positive attitude (AOR = 3.484, 95 % CI 1.132-10.72) predicted reported condom use, thus turning the decision to actions. Subjective norms had only indirect effects on intention and reported use of condoms. CONCLUSION The findings suggest that unsafe sex practices are prevalent among school adolescents in rural areas of Tanzania. Perceived behaviour control and positive attitudes predict intensions to use condoms whereas empowerment predicts reported condom use. The findings may imply that safe sex promotion interventions that simultaneously address socio-cognitive and ecological determinants of sexual behaviours may improve adolescents' safe sex behaviours.
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Affiliation(s)
- Albino Kalolo
- Department of Community Health, St. Francis University college of Health and Allied Sciences, P.O.Box 175, Ifakara, Tanzania.
| | - Stephen Matthew Kibusi
- School of Nursing and Public Health, College of Health Sciences, The University of Dodoma, P.O. Box 395, Dodoma, Tanzania.
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Mubyazi GM, Exavery A, Tenu F, Massaga JJ, Rugemalila J, Malebo HM, Wiketye V, Makundi EA, Ikingura JK, Mushi AK, Malekia SE, Mziray A, Ogondiek JW, Kahwa A, Kafuye MM, Malecela MN. Determinants of demand for condoms to prevent HIV infections among barmaids and guesthouse workers in two districts, Tanzania. BMC Res Notes 2015; 8:630. [PMID: 26526184 PMCID: PMC4630838 DOI: 10.1186/s13104-015-1621-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 10/26/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Condoms are scientifically recommended as potential products for preventing infections attributable to human immuno-deficiency viruses (HIV). However, evidence on factors leading to their inadequate use in developing countries is still scanty. This paper reports an exploratory study of factors constraining condoms use in Tanzania from the perspectives of barmaids, guest-house workers and retailers. METHODS Data were collected in two districts-Mpwapwa in Dodoma Region and Mbeya Rural in Mbeya Region-between October and December 2011, using structured interviews with 238 individuals including barmaids, guesthouse workers and 145 retailers. Data analysis was performed using STATA 11 software. RESULTS Awareness about condoms was high among all study groups. Male condoms were more popular and available than female ones. A considerable proportion of the barmaids and guesthouses were disappointed with condoms being promoted and distributed to young children and disliked condom use during sexual intercourse. Accessibility of condoms was reported as being lowered by condom prices, shortage of information concerning their availability; short supply of condoms; some people shying away to be watched by children or adult people while purchasing condoms; retailers' using bad languages to condom customers; occasionally condom shops/kiosks found closed when they are urgently needed; and prevailing social perception of condoms to have low/no protective efficacy. Regression analysis of data from barmaids and guesthouse-workers indicated variations in the degree of condom acceptability and methods used to promote condoms among respondents with different demographic characteristics. CONCLUSION A combination of psychosocial and economic factors was found contributing to lower the demand for and actual use of condoms in study communities. Concerted measures for promoting condom use need to address the demand challenges and making operational research an integral element of monitoring and evaluation of the launched interventions, hence widening the evidence for informed policy decisions.
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Affiliation(s)
- Godfrey M Mubyazi
- National Institute for Medical Research (NIMR), P.O Box 9653, Dar es Salaam, Tanzania.
| | - Amon Exavery
- Ifakara Health Institute (IHI), P.O Box 78373, Dar es Salaam, Tanzania.
| | - Filemoni Tenu
- Amani Medical Research Centre (MRC), P.O Box 81, Muheza, Tanzania.
| | - Julius J Massaga
- National Institute for Medical Research (NIMR), P.O Box 9653, Dar es Salaam, Tanzania.
| | - Jovitha Rugemalila
- National Bureau of Statistics (NBS), P.O Box 796, Dar es Salaam, Tanzania.
| | - Hamisi M Malebo
- National Institute for Medical Research (NIMR), P.O Box 9653, Dar es Salaam, Tanzania.
| | - Victor Wiketye
- NIMR Ngongongare Research Station, Usa River, P.O Box 514, Arusha, Tanzania.
| | - Emmanuel A Makundi
- National Institute for Medical Research (NIMR), P.O Box 9653, Dar es Salaam, Tanzania.
| | - Joyce K Ikingura
- National Institute for Medical Research (NIMR), P.O Box 9653, Dar es Salaam, Tanzania.
| | - Adiel K Mushi
- National Institute for Medical Research (NIMR), P.O Box 9653, Dar es Salaam, Tanzania.
| | - Sia E Malekia
- National Institute for Medical Research (NIMR), P.O Box 9653, Dar es Salaam, Tanzania.
| | - Abubakary Mziray
- Amani Medical Research Centre (MRC), P.O Box 81, Muheza, Tanzania.
| | - John W Ogondiek
- NIMR Ngongongare Research Station, Usa River, P.O Box 514, Arusha, Tanzania.
| | - Amos Kahwa
- Muhimbili Medical Research Centre, P.O Box 5004, Dar es Salaam, Tanzania.
| | - Mwanaidi M Kafuye
- National Institute for Medical Research (NIMR), P.O Box 9653, Dar es Salaam, Tanzania.
| | - Mwelecele N Malecela
- National Institute for Medical Research (NIMR), P.O Box 9653, Dar es Salaam, Tanzania.
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Mohan D, Gupta S, LeFevre A, Bazant E, Killewo J, Baqui AH. Determinants of postnatal care use at health facilities in rural Tanzania: multilevel analysis of a household survey. BMC Pregnancy Childbirth 2015; 15:282. [PMID: 26518337 PMCID: PMC4628262 DOI: 10.1186/s12884-015-0717-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 10/22/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Postnatal care (PNC) for the mother and infant is a neglected area, even for women who give birth in a health facility. Currently, there is very little evidence on the determinants of use of postnatal care from health facilities in Tanzania. METHODS This study examined the role of individual and community-level variables on the use of postnatal health services, defined as a check up from a heath facility within 42 days of delivery, using multilevel logistic regression analysis. We analyzed data of 1931 women, who had delivered in the preceding 2-14 months, from a two-stage household survey in 4 rural districts of Morogoro region, Tanzania. Individual level explanatory variables included i) Socio-demographic factors: age, birth order, education, and wealth, ii) Factors related to pregnancy: frequency of antenatal visits, history of complications, mode of delivery, place of delivery care, and counseling received. Community level variables included community levels of family planning, health service utilization, trust, poverty and education, and distance to health facility. RESULTS Less than one in four women in Morogoro reported having visited a health facility for postnatal care. Individual-level attributes positively associated with postnatal care use were women's education of primary level or higher [Odds Ratio (OR) 1.37, 95 % Confidence Interval (CI) 1.04-1.81], having had a caesarean section or forceps delivery (2.95, 1.8-4.81), and being counseled by a community health worker to go for postnatal care at a health facility (2.3, 1.36-3.89). Other positive associations included those recommended HIV testing for baby (1.94, 1.19-3.15), and whose partners tested for HIV (1.41, 1.07-1.86). High community levels of postpartum family planning usage (2.48, 1.15-5.37) and high level of trust in health system (1.77, 1.12-2.79) were two significant community-level predictors. Lower postnatal care use was associated with having delivered at a hospital (0.5, 0.33-0.76), health center (0.57, 0.38-0.85), or dispensary (0.48, 0.33-0.69), and having had severe swelling of face and legs during pregnancy (0.65, 0.43-0.97). CONCLUSIONS In the context of low postnatal care use in a rural setting, programs should direct efforts towards reaching women who do not avail themselves of postnatal care as identified in our study.
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Affiliation(s)
- Diwakar Mohan
- Department of International health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Shivam Gupta
- Department of International health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Amnesty LeFevre
- Department of International health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | | | - Japhet Killewo
- Department of Biostatistics & Epidemiology, Muhimbili University of Allied Health Sciences, Dar es Salaam, Tanzania.
| | - Abdullah H Baqui
- Department of International health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
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Chalya PL, Igenge JZ, Mabula JB, Simbila S. Fournier's gangrene at a tertiary health facility in northwestern Tanzania: a single centre experiences with 84 patients. BMC Res Notes 2015; 8:481. [PMID: 26416258 PMCID: PMC4584465 DOI: 10.1186/s13104-015-1493-1] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 09/21/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Fournier's gangrene (FG) is a rare, rapidly progressive, necrotizing fasciitis of the external genitalia and perineum, leading to soft-tissue necrosis. Despite antibiotics and aggressive debridement, the mortality rate of FG remains high. This study describes our experiences in the management of FG and identifies prognostic factors. METHODS This was a descriptive retrospective study of patients with FG treated at Bugando Medical Centre between November 2006 and April 2014. RESULTS A total of 84 patients (M:F = 41:1) were studied. The median age was 34 years (range 15-76 years). The most common predisposing factor was diabetes mellitus (16.7%). Nine (11.3%) patients were HIV positive. Bacterial culture results were obtained in only 46 (54.8%) patients. Of these, 38(82.6%) had polymicrobial bacterial growth while 8 (17.4%) had monomicrobial bacterial growth. Escherichia coli (28.3%) were the most frequent bacterial organism isolated. All the microorganisms isolated showed high resistance to commonly used antibiotics except for Meropenem and imipenem, which were 100% sensitive each respectively. All patients were treated with a common approach of resuscitation, broad-spectrum antibiotics, and wide surgical excision. The median length of hospital stay (LOS) was 28 days and mortality rate was 28.6%. Systemic inflammatory response syndrome and diabetes mellitus were significantly associated with prolonged LOS (p < 0.001), whereas advancing age (>60 years), late presentation (>48 h), systemic inflammatory response syndrome on admission, diabetes mellitus, extension of infection to the abdominal wall, FG severity score >9 and HIV infection with CD4 count <200 μl/cells) were independent predictors of mortality (p < 0.001). CONCLUSION Fournier's gangrene remains a very severe disease with high mortality rates. Early recognition of infection associated with invasive and aggressive treatment is essential for attempting to reduce mortality rates associated with this disease in our setting.
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Affiliation(s)
- Phillipo L Chalya
- Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania.
| | - John Z Igenge
- Department of Urology, Bugando Medical Centre, Mwanza, Tanzania.
| | - Joseph B Mabula
- Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania.
| | - Samson Simbila
- Department of Urology, Bugando Medical Centre, Mwanza, Tanzania.
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Mkoka DA, Mahiti GR, Kiwara A, Mwangu M, Goicolea I, Hurtig AK. "Once the government employs you, it forgets you": Health workers' and managers' perspectives on factors influencing working conditions for provision of maternal health care services in a rural district of Tanzania. Hum Resour Health 2015; 13:77. [PMID: 26369663 PMCID: PMC4570215 DOI: 10.1186/s12960-015-0076-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 09/08/2015] [Indexed: 05/31/2023]
Abstract
BACKGROUND In many developing countries, health workforce crisis is one of the predominant challenges affecting the health care systems' function of providing quality services, including maternal care. The challenge is related to how these countries establish conducive working conditions that attract and retain health workers into the health care sector and enable them to perform effectively and efficiently to improve health services particularly in rural settings. This study explored the perspectives of health workers and managers on factors influencing working conditions for providing maternal health care services in rural Tanzania. The researchers took a broad approach to understand the status of the current working conditions through a governance lens and brought into context the role of government and its decentralized organs in handling health workers in order to improve their performance and retention. METHODS In-depth interviews were conducted with 22 informants (15 health workers, 5 members of Council Health Management Team and 2 informants from the District Executive Director's office). An interview guide was used with questions pertaining to informants' perspective on provision of maternal health care service, working environment, living conditions, handling of staff's financial claims, avenue for sharing concerns, opportunities for training and career progression. Probing questions on how these issues affect the health workers' role of providing maternal health care were employed. Document reviews and observations of health facilities were conducted to supplement the data. The interviews were analysed using a qualitative content analysis approach. RESULTS Overall, health workers felt abandoned and lost within an unsupportive system they serve. Difficult working and living environments that affect health workers' role of providing maternal health care services were dominant concerns raised from interviews with both health workers and managers. Existence of a bureaucratic and irresponsible administrative system was reported to result in the delay in responding to the health workers' claims timely and that there is no transparency and fairness in dealing with health workers' financial claims. Informants also reported on the non-existence of a formal motivation scheme and a free avenue for voicing and sharing health workers' concerns. Other challenges reported were lack of a clear strategic plan for staff career advancement and continuous professional development to improve health workers' knowledge and skills necessary for providing quality maternal health care. CONCLUSION Health workers working in rural areas are facing a number of challenges that affect their working conditions and hence their overall performance. The government and its decentralized organs should be accountable to create conducive working and living environments, respond to health workers' financial claims fairly and equitably, plan for their career advancement and create a free avenue for voicing and sharing concerns with the management. To achieve this, efforts should be directed towards improving the governance of the human resource management system that will take into account the stewardship role of the government in handling human resource carefully and responsibly.
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Affiliation(s)
- Dickson Ally Mkoka
- Department of Clinical Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Gladys Reuben Mahiti
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Angwara Kiwara
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Mughwira Mwangu
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Isabel Goicolea
- Department of Public Health and Clinical Medicine, Unit of Epidemiology and Global Health, Umeå University, 901 85, Umeå, Sweden.
| | - Anna-Karin Hurtig
- Department of Public Health and Clinical Medicine, Unit of Epidemiology and Global Health, Umeå University, 901 85, Umeå, Sweden.
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Piel AK, Cohen N, Kamenya S, Ndimuligo SA, Pintea L, Stewart FA. Population status of chimpanzees in the Masito-Ugalla Ecosystem, Tanzania. Am J Primatol 2015; 77:1027-35. [PMID: 26119006 DOI: 10.1002/ajp.22438] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 05/27/2015] [Indexed: 12/24/2022]
Abstract
More than 75 percent of Tanzania's chimpanzees live at low densities on land outside national parks. Chimpanzees are one of the key conservation targets in the region and long-term monitoring of these populations is essential for assessing the overall status of ecosystem health and the success of implemented conservation strategies. We aimed to assess change in chimpanzee density within the Masito-Ugalla Ecosystem (MUE) by comparing results of re-walking the same line transects in 2007 and 2014. We further used published remote sensing data derived from Landsat satellites to assess forest cover change within a 5 km buffer of these transects over that same period. We detected no statistically significant decline in chimpanzee density across the surveyed areas of MUE between 2007 and 2014, although the overall mean density of chimpanzees declined from 0.09 individuals/km(2) in 2007 to 0.05 individuals/km(2) in 2014. Whether this change is biologically meaningful cannot be determined due to small sample sizes and large, entirely overlapping error margins. It is therefore possible that the MUE chimpanzee population has been stable over this period and indeed in some areas (Issa Valley, Mkanga, Kamkulu) even showed an increase in chimpanzee density. Variation in chimpanzee habitat preference for ranging or nesting could explain variation in density at some of the survey sites between 2007 and 2014. We also found a relationship between increasing habitat loss and lower mean chimpanzee density. Future surveys will need to ensure a larger sample size, broader geographic effort, and random survey design, to more precisely determine trends in MUE chimpanzee density and population size over time.
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Affiliation(s)
- Alex K Piel
- Department of Archaeology and Anthropology, University of Cambridge, Cambridge CB2 3QG, United Kingdom.,Ugalla Primate Project, Kigoma, Tanzania
| | | | | | - Sood A Ndimuligo
- Centre for Ecological and Evolutionary Synthesis, Department of Biosciences, University of Oslo, Blindern, Oslo, Norway
| | - Lilian Pintea
- The Jane Goodall Institute, 1595 Spring Hill Road, Suite 550 Vienna, Virginia
| | - Fiona A Stewart
- Department of Archaeology and Anthropology, University of Cambridge, Cambridge CB2 3QG, United Kingdom.,Ugalla Primate Project, Kigoma, Tanzania
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Bintabara D, Mohamed MA, Mghamba J, Wasswa P, Mpembeni RNM. Birth preparedness and complication readiness among recently delivered women in chamwino district, central Tanzania: a cross sectional study. Reprod Health 2015; 12:44. [PMID: 25981513 PMCID: PMC4447013 DOI: 10.1186/s12978-015-0041-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 05/09/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unacceptably high maternal mortality rates remain a challenge in developing countries such as Tanzania. Birth Preparedness and Complication Readiness is among the key interventions that can reduce maternal mortality. Despite this, its status in Tanzania is not well documented. We assessed the practice and determinants of Birth preparedness and complication readiness among recently delivered women in Chamwino district, Central Tanzania. METHODS A community based cross-sectional study was conducted to women who delivered two years prior to survey in January 2014 at Chamwino district, Tanzania. Woman was considered as prepared for birth and its complication if she reported at least three of these; know expected date of delivery, saved money, identified a skilled birth attendant/health facility, mode of transport and Identified two compatible blood donors. Descriptive, bivariate and multivariable logistic regression analyses were performed at P value < 0.05 level of significance. RESULTS We interviewed 428 women whose median age (IQR) was 26.5 (22-33) years. About 249 (58.2 %) of the respondents were considered as prepared for birth and its complications. After controlling for confounding and clustering effect, significant determinants of birth preparedness and complication readiness were found to be maternal education (AOR = 2.26, 95 % CI; 1.39, 3.67), spouse employment (AOR = 2.18, 95 % CI; 1.46, 3.25), booking at ANC (AOR = 2.03, 95 % CI; 1.11, 3.72), Four or more antenatal visits, (AOR = 1.94, 95 % CI; 1.17, 3.21) and knowledge of key danger signs (AOR = 4.16, 95 % CI; 2.32, 7.45). Prepared for birth was found to be associated with institutional delivery (AOR = 2.45, 95 % CI; 1.12, 5.34). CONCLUSION The proportion of women who prepared for birth and its complications were found to be low. District reproductive and child health coordinator should emphasis on early and frequent antenatal care visits, since they were among predictors of birth preparedness and complication readiness.
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Affiliation(s)
- Deogratius Bintabara
- College of Health and Allied Sciences, University of Dodoma, P.O. Box 259, Dodoma, Tanzania.
| | | | - Janneth Mghamba
- Ministry of Health and Social Welfare, Dar Es Salaam, Tanzania.
| | - Peter Wasswa
- African Field Epidemiology Network (AFENET), P.O. Box 12874, Kampala, Uganda.
| | - Rose N M Mpembeni
- Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar Es, Salaam, Tanzania.
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Cundill B, Mbakilwa H, Chandler CI, Mtove G, Mtei F, Willetts A, Foster E, Muro F, Mwinyishehe R, Mandike R, Olomi R, Whitty CJ, Reyburn H. Prescriber and patient-oriented behavioural interventions to improve use of malaria rapid diagnostic tests in Tanzania: facility-based cluster randomised trial. BMC Med 2015; 13:118. [PMID: 25980737 PMCID: PMC4445498 DOI: 10.1186/s12916-015-0346-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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] [Received: 11/21/2014] [Accepted: 04/13/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The increasing investment in malaria rapid diagnostic tests (RDTs) to differentiate malarial and non-malarial fevers, and an awareness of the need to improve case management of non-malarial fever, indicates an urgent need for high quality evidence on how best to improve prescribers' practices. METHODS A three-arm stratified cluster-randomised trial was conducted in 36 primary healthcare facilities from September 2010 to March 2012 within two rural districts in northeast Tanzania where malaria transmission has been declining. Interventions were guided by formative mixed-methods research and were introduced in phases. Prescribing staff from all facilities received standard Ministry of Health RDT training. Prescribers from facilities in the health worker (HW) and health worker-patient (HWP) arms further participated in small interactive peer-group training sessions with the HWP additionally receiving clinic posters and patient leaflets. Performance feedback and motivational mobile-phone text messaging (SMS) were added to the HW and HWP arms in later phases. The primary outcome was the proportion of patients with a non-severe, non-malarial illness incorrectly prescribed a (recommended) antimalarial. Secondary outcomes investigated RDT uptake, adherence to results, and antibiotic prescribing. RESULTS Standard RDT training reduced pre-trial levels of antimalarial prescribing, which was sustained throughout the trial. Both interventions significantly lowered incorrect prescribing of recommended antimalarials from 8% (749/8,942) in the standard training arm to 2% (250/10,118) in the HW arm (adjusted RD (aRD) 4%; 95% confidence interval (CI) 1% to 6%; P = 0.008) and 2% (184/10,163) in the HWP arm (aRD 4%; 95% CI 1% to 6%; P = 0.005). Small group training and SMS were incrementally effective. There was also a significant reduction in the prescribing of antimalarials to RDT-negatives but no effect on RDT-positives receiving an ACT. Antibiotic prescribing was significantly lower in the HWP arm but had increased in all arms compared with pre-trial levels. CONCLUSIONS Small group training with SMS was associated with an incremental and sustained improvement in prescriber adherence to RDT results and reducing over-prescribing of antimalarials to close to zero. These interventions may become increasingly important to cope with the wider range of diagnostic and treatment options for patients with acute febrile illness in Africa.
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Affiliation(s)
- Bonnie Cundill
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, WCIE 7HT, UK.
| | - Hilda Mbakilwa
- Joint Malaria Programme, Kilimanjaro Christian Medical Centre, Box 2228, Moshi, Tanzania.
| | - Clare Ir Chandler
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel St, London, WCIE 7HT, UK.
| | - George Mtove
- National Institute for Medical Research, Amani Centre, Tanga, Tanzania.
| | - Frank Mtei
- Joint Malaria Programme, Kilimanjaro Christian Medical Centre, Box 2228, Moshi, Tanzania.
| | - Annie Willetts
- Wellsense International Public Health Consultants, P.O. Box 788, Kilifi, Kenya.
| | - Emily Foster
- Joint Malaria Programme, Kilimanjaro Christian Medical Centre, Box 2228, Moshi, Tanzania.
| | - Florida Muro
- Joint Malaria Programme, Kilimanjaro Christian Medical Centre, Box 2228, Moshi, Tanzania.
| | - Rahim Mwinyishehe
- National Institute for Medical Research, Amani Centre, Tanga, Tanzania.
| | - Renata Mandike
- National Malaria Control Programme, Ministry of Health and Social Welfare, Ocean Road, Dar es Salaam, Tanzania.
| | - Raimos Olomi
- Joint Malaria Programme, Kilimanjaro Christian Medical Centre, Box 2228, Moshi, Tanzania.
| | - Christopher Jm Whitty
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London, WCIE 7HT, UK.
| | - Hugh Reyburn
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London, WCIE 7HT, UK.
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Vats R, Thomas S. A study on use of animals as traditional medicine by Sukuma Tribe of Busega District in North-western Tanzania. J Ethnobiol Ethnomed 2015; 11:38. [PMID: 25947365 PMCID: PMC4472419 DOI: 10.1186/s13002-015-0001-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 01/17/2015] [Indexed: 05/13/2023]
Abstract
BACKGROUND Faunal resources have played an extensive range of roles in human life from the initial days of recorded history. In addition to their importance, animals have been acknowledged in religion, art, music and literature and several other different cultural manifestations of mankind. Human beings are acquainted with use of animals for foodstuff, cloth, medicine, etc. since ancient times. Huge work has been carried out on ethnobotany and traditional medicine. Animal and their products are also holding medicinal properties that can be exploited for the benefit of human beings like plants. In Tanzania, many tribal communities are spread all over the country and these people are still totally depended on local customary medicinal system for their health care. In the world Tanzania is gifted with wide range of floral and faunal biodiversity. The use of traditional medicine from animals by Sukuma ethnic group of Busega district is the aim of the present study. METHOD In order to collect the information on ethnozoological use about animal and their products predominant among this tribe in Busega district, a study was carried out from August 2012, to July 2013. Data were collected through semi-structured questionnaire and open interview with 180 (118 male and 62 females) selected people. The people from whom the data were collected comprise old age community members, traditional health practicener, fishermen and cultural officers. The name of animal and other ethnozoological information were documented. Pictures and discussion were also recorded with the help of camera and voice recorder. RESULT A total of 42 various animal species were used in nearly 30 different medicinal purposes including STD, stoppage of bleeding, reproductive disorders, asthma, weakness, tuberculosis, cough, paralysis and wound and for other religious beliefs. It has been noticed that animal used by Sukuma tribe, comprise of seventeen mammals, seven birds, four reptiles, eight arthropods and two mollusks. Some of the protected species were also used as important medicinal resources. We also found that cough, tuberculosis, asthma and other respiratory diseases are the utmost cited disease, as such, a number of traditional medicines are available for the treatment. CONCLUSIONS The present work indicates that 42 animal species were being used to treat nearly 30 different ailments and results show that ethnozoological practices are an important alternative medicinal practice by the Sukuma tribe living in Bungesa district. The present study also indicates the very rich ethnozoological knowledge of these people in relation to traditional medicine. So there is a critical need to properly document to keep a record of the ethnozoological information. We hope that the information generated in this study will be useful for further research in the field of ethnozoology, ethnopharmacology and conservation approach.
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Affiliation(s)
- Rajeev Vats
- School of Biological Sciences, College of Natural and Mathematical Sciences, the University of Dodoma, Dodoma, Tanzania.
| | - Simion Thomas
- School of Biological Sciences, College of Natural and Mathematical Sciences, the University of Dodoma, Dodoma, Tanzania.
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Maar M, Yeates K, Barron M, Hua D, Liu P, Moy Lum-Kwong M, Perkins N, Sleeth J, Tobe J, Wabano MJ, Williamson P, Tobe SW. I-RREACH: an engagement and assessment tool for improving implementation readiness of researchers, organizations and communities in complex interventions. Implement Sci 2015; 10:64. [PMID: 25935849 PMCID: PMC4424962 DOI: 10.1186/s13012-015-0257-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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: 09/23/2014] [Accepted: 04/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-communicable chronic diseases are the leading causes of mortality globally, and nearly 80% of these deaths occur in low- and middle-income countries (LMICs). In high-income countries (HICs), inequitable distribution of resources affects poorer and otherwise disadvantaged groups including Aboriginal peoples. Cardiovascular mortality in high-income countries has recently begun to fall; however, these improvements are not realized among citizens in LMICs or those subgroups in high-income countries who are disadvantaged in the social determinants of health including Aboriginal people. It is critical to develop multi-faceted, affordable and realistic health interventions in collaboration with groups who experience health inequalities. Based on community-based participatory research (CBPR), we aimed to develop implementation tools to guide complex interventions to ensure that health gains can be realized in low-resource environments. METHODS We developed the I-RREACH (Intervention and Research Readiness Engagement and Assessment of Community Health Care) tool to guide implementation of interventions in low-resource environments. We employed CBPR and a consensus methodology to (1) develop the theoretical basis of the tool and (2) to identify key implementation factor domains; then, we (3) collected participant evaluation data to validate the tool during implementation. RESULTS The I-RREACH tool was successfully developed using a community-based consensus method and is rooted in participatory principles, equalizing the importance of the knowledge and perspectives of researchers and community stakeholders while encouraging respectful dialogue. The I-RREACH tool consists of three phases: fact finding, stakeholder dialogue and community member/patient dialogue. The evaluation for our first implementation of I-RREACH by participants was overwhelmingly positive, with 95% or more of participants indicating comfort with and support for the process and the dialogue it creates. CONCLUSIONS The I-RREACH tool was designed to (1) pinpoint key domains required for dialogue between the community and the research team to facilitate implementation of complex health interventions and research projects and (2) to identify existing strengths and areas requiring further development for effective implementation. I-RREACH has been found to be easily adaptable to diverse geographical and cultural settings and can be further adapted to other complex interventions. Further research should include the potential use of the I-RREACH tool in the development of blue prints for scale-up of successful interventions, particularly in low-resource environments.
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Affiliation(s)
- Marion Maar
- Faculty of Medicine, Northern Ontario School of Medicine, Laurentian University, Sudbury, ON, Canada.
| | - Karen Yeates
- Department of Medicine, Queens University, Kingston, ON, Canada.
| | | | - Diane Hua
- Department of Nephrology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.
| | - Peter Liu
- University of Ottawa Heart Institute, Ottawa, ON, Canada.
| | - Margaret Moy Lum-Kwong
- Department of Research, Advocacy and Health Promotion, Heart and Stroke Foundation of Ontario, Toronto, ON, Canada.
| | - Nancy Perkins
- Department of Nephrology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.
| | - Jessica Sleeth
- Department of Medicine, Queens University, Kingston, ON, Canada.
| | - Joshua Tobe
- Department of Medicine, Western University, London, ON, Canada.
| | | | | | - Sheldon W Tobe
- Faculty of Medicine, Northern Ontario School of Medicine, Laurentian University, Sudbury, ON, Canada.
- Department of Nephrology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.
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Scholz S, Ngoli B, Flessa S. Rapid assessment of infrastructure of primary health care facilities - a relevant instrument for health care systems management. BMC Health Serv Res 2015; 15:183. [PMID: 25928252 PMCID: PMC4421986 DOI: 10.1186/s12913-015-0838-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 04/08/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Health care infrastructure constitutes a major component of the structural quality of a health system. Infrastructural deficiencies of health services are reported in literature and research. A number of instruments exist for the assessment of infrastructure. However, no easy-to-use instruments to assess health facility infrastructure in developing countries are available. Present tools are not applicable for a rapid assessment by health facility staff. Therefore, health information systems lack data on facility infrastructure. METHODS A rapid assessment tool for the infrastructure of primary health care facilities was developed by the authors and pilot-tested in Tanzania. The tool measures the quality of all infrastructural components comprehensively and with high standardization. Ratings use a 2-1-0 scheme which is frequently used in Tanzanian health care services. Infrastructural indicators and indices are obtained from the assessment and serve for reporting and tracing of interventions. The tool was pilot-tested in Tanga Region (Tanzania). RESULTS The pilot test covered seven primary care facilities in the range between dispensary and district hospital. The assessment encompassed the facilities as entities as well as 42 facility buildings and 80 pieces of technical medical equipment. A full assessment of facility infrastructure was undertaken by health care professionals while the rapid assessment was performed by facility staff. Serious infrastructural deficiencies were revealed. The rapid assessment tool proved a reliable instrument of routine data collection by health facility staff. CONCLUSIONS The authors recommend integrating the rapid assessment tool in the health information systems of developing countries. Health authorities in a decentralized health system are thus enabled to detect infrastructural deficiencies and trace the effects of interventions. The tool can lay the data foundation for district facility infrastructure management.
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Affiliation(s)
- Stefan Scholz
- University of Greifswald, Department of Health Care Management, Greifswald, Germany.
| | - Baltazar Ngoli
- GIZ Office Tanzania, Tanzanian German Programme to Support Health, Dar es Salaam, Tanzania.
| | - Steffen Flessa
- University of Greifswald, Department of Health Care Management, Greifswald, Germany.
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Patil CL, Turab A, Ambikapathi R, Nesamvuni C, Chandyo RK, Bose A, Islam MM, Ahmed AMS, Olortegui MP, de Moraes ML, Caulfield LE. Early interruption of exclusive breastfeeding: results from the eight-country MAL-ED study. J Health Popul Nutr 2015; 34:10. [PMID: 26825923 PMCID: PMC5025973 DOI: 10.1186/s41043-015-0004-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 02/24/2015] [Indexed: 05/25/2023]
Abstract
We report the infant feeding experiences in the first month of life for 2,053 infants participating in "Malnutrition and Enteric Infections: Consequences for Child Health and Development" (MAL-ED). Eight sites (in Bangladesh, India, Nepal, Pakistan, Brazil, Peru, South Africa, Tanzania), each followed a cohort of children from birth (by day 17), collecting detailed information on infant feeding practices, diet and illness episodes. Mothers were queried twice weekly regarding health status, breastfeeding and the introduction (or no) of non-breast milk liquids and foods. Here, our goal is to describe the early infant feeding practices in the cohort and evaluate factors associated with termination of exclusive breastfeeding in the first month of life. With data from enrollment to a visit at 28-33 days of life, we characterized exclusive, predominant or partial breastfeeding (using a median of 6-9 visits per child across the sites). Only 6 of 2,053 infants were never breastfed. By one month, the prevalences of exclusive breastfeeding were < 60% in 6 of 8 sites, and of partial breastfeeding (or no) were > 20% in 6 of 8 sites. Logistic regression revealed that prelacteal feeding (given to 4-63% of infants) increased the likelihood of partial breastfeeding (Odds Ratio (OR): 1.48 (95% confidence interval (CI): 1.04, 2.10), as did the withholding of colostrum (2-16% of infants) (OR: 1.63:1.01, 2.62), and being a first-time mother (OR: 1.38:1.10, 1.75). Our results reveal diversity across these sites, but an overall trend of early transition away from exclusive breastfeeding in the first month of life. Interventions which introduce or reinforce the WHO/UNICEF Ten Steps for Successful Breastfeeding are needed in these sites to improve breastfeeding initiation, to reinforce exclusive breastfeeding and delay introduction of non-breast milk foods and/or liquids.
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Affiliation(s)
- Crystal L Patil
- Department of Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA.
| | - Ali Turab
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
| | - Ramya Ambikapathi
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA.
| | - Cebisa Nesamvuni
- Department of Nutrition, School of Health Sciences, University of Venda, Thohoyandou, Limpopo Province, South Africa.
| | - Ram Krishna Chandyo
- Centre for International Health, University of Bergen, Norway and Department of Child Health and Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
| | | | - M Munirul Islam
- Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
| | | | | | - Milena Lima de Moraes
- The Johns Hopkins Bloomberg School of Public Health, Department of International Health, 615 North Wolfe Street, W2041, Baltimore, MD, USA, 21205.
| | - Laura E Caulfield
- The Johns Hopkins Bloomberg School of Public Health, Department of International Health, 615 North Wolfe Street, W2041, Baltimore, MD, USA, 21205.
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Gewa CA, Leslie TF. Distribution and determinants of young child feeding practices in the East African region: demographic health survey data analysis from 2008-2011. J Health Popul Nutr 2015; 34:6. [PMID: 26825452 PMCID: PMC5026023 DOI: 10.1186/s41043-015-0008-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 09/29/2014] [Indexed: 06/05/2023]
Abstract
We utilized the most recent Demographic Health Survey data to explore the distribution of feeding practices and examine relationships between complementary feeding and socio-demographic and health behaviour indicators in Kenya, Uganda and Tanzania. We based our analysis on complementary dietary diversity scores calculated for children 6-23 months old. Geographically, Kenya displayed clear division of children's diet diversity scores across its regions, unlike Uganda and Tanzania. Less than 40% of the children's meal frequencies in Uganda and Tanzania had met the minimum daily recommended levels. Only 30-40% of children in Kenya, Tanzania and Uganda had consumed diets with adequate diversity. Children's age, breastfeeding status, mother's education level and working status, household wealth index, prenatal care visits, receiving vitamin A supplements, using modern contraceptives and meal frequencies were significantly associated with adequate complementary food diversity in at least one of the three countries included in the current analyses. These analyses contribute to a better understanding and targeting of infant and young child feeding within the East African region.
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Affiliation(s)
- Constance A Gewa
- Department of Nutrition and Food Studies, George Mason University, 4400 University Dr. MSN 1F8, Fairfax, VA, 22030, USA.
| | - Timothy F Leslie
- Department of Geography and Geoinformation Science, George Mason University, 4400 University Dr. MSN 6C3, Fairfax, VA, 22030, USA.
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Roberton T, Applegate J, Lefevre AE, Mosha I, Cooper CM, Silverman M, Feldhaus I, Chebet JJ, Mpembeni R, Semu H, Killewo J, Winch P, Baqui AH, George AS. Initial experiences and innovations in supervising community health workers for maternal, newborn, and child health in Morogoro region, Tanzania. Hum Resour Health 2015; 13:19. [PMID: 25880459 PMCID: PMC4403773 DOI: 10.1186/s12960-015-0010-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 03/08/2015] [Indexed: 05/21/2023]
Abstract
BACKGROUND Supervision is meant to improve the performance and motivation of community health workers (CHWs). However, most evidence on supervision relates to facility health workers. The Integrated Maternal, Newborn, and Child Health (MNCH) Program in Morogoro region, Tanzania, implemented a CHW pilot with a cascade supervision model where facility health workers were trained in supportive supervision for volunteer CHWs, supported by regional and district staff, and with village leaders to further support CHWs. We examine the initial experiences of CHWs, their supervisors, and village leaders to understand the strengths and challenges of such a supervision model for CHWs. METHODS Quantitative and qualitative data were collected concurrently from CHWs, supervisors, and village leaders. A survey was administered to 228 (96%) of the CHWs in the Integrated MNCH Program and semi-structured interviews were conducted with 15 CHWs, 8 supervisors, and 15 village leaders purposefully sampled to represent different actor perspectives from health centre catchment villages in Morogoro region. Descriptive statistics analysed the frequency and content of CHW supervision, while thematic content analysis explored CHW, supervisor, and village leader experiences with CHW supervision. RESULTS CHWs meet with their facility-based supervisors an average of 1.2 times per month. CHWs value supervision and appreciate the sense of legitimacy that arises when supervisors visit them in their village. Village leaders and district staff are engaged and committed to supporting CHWs. Despite these successes, facility-based supervisors visit CHWs in their village an average of only once every 2.8 months, CHWs and supervisors still see supervision primarily as an opportunity to check reports, and meetings with district staff are infrequent and not well scheduled. CONCLUSIONS Supervision of CHWs could be strengthened by streamlining supervision protocols to focus less on report checking and more on problem solving and skills development. Facility health workers, while important for technical oversight, may not be the best mentors for certain tasks such as community relationship-building. We suggest further exploring CHW supervision innovations, such as an enhanced role for community actors, who may be more suitable to support CHWs engaged primarily in health promotion than scarce and over-worked facility health workers.
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Affiliation(s)
- Timothy Roberton
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Jennifer Applegate
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Amnesty E Lefevre
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Idda Mosha
- Muhimbili University of Health and Allied Sciences, United Nations Road, 65001, Dar es Salaam, Tanzania.
| | | | - Marissa Silverman
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Isabelle Feldhaus
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Joy J Chebet
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Rose Mpembeni
- Muhimbili University of Health and Allied Sciences, United Nations Road, 65001, Dar es Salaam, Tanzania.
| | - Helen Semu
- Ministry of Health and Social Welfare, 6 Samora Machel Avenue, 11478, Dar es Salaam, Tanzania.
| | - Japhet Killewo
- Muhimbili University of Health and Allied Sciences, United Nations Road, 65001, Dar es Salaam, Tanzania.
| | - Peter Winch
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Abdullah H Baqui
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Asha S George
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
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Sommer M, Likindikoki S, Kaaya S. "Bend a fish when the fish is not yet dry": adolescent boys' perceptions of sexual risk in Tanzania. Arch Sex Behav 2015; 44:583-95. [PMID: 25583374 PMCID: PMC4359081 DOI: 10.1007/s10508-014-0406-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 09/18/2014] [Accepted: 09/22/2014] [Indexed: 06/04/2023]
Abstract
Despite decades of effort, the spread of HIV/AIDS continues among many African young people. A key contributor is unsafe sexual behavior that is desired, persuaded, or coerced. We explored the masculinity norms shaping pubescent boys' perceptions of and engagement in (unsafe) sexual behaviors in Tanzania. Through a comparative case study in rural and urban Tanzania, qualitative and participatory methods were used with 160 adolescent boys in and out of school to better understand the social and contextual factors promoting unsafe sexual behaviors. Adolescent boys in both the rural and urban sites reported struggling with intense sexual desires, strong peer pressures to have sex, and social norms dissuading condom use. A growing "normalization" of AIDS suggests messages promoting the dangers of HIV infection may be less effective. Findings reinforce the need for interventions with very young adolescents. Research is needed to identify more effective approaches for promoting safer sexual practices among boys in sub-Saharan Africa. Harm reduction approaches and gender transformative approaches might prove more effective than current HIV prevention efforts focused on youth.
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Affiliation(s)
- Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Samuel Likindikoki
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sylvia Kaaya
- Office of the Dean, Medical School, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Lunsford SS, Fatta K, Stover KE, Shrestha R. Supporting close-to-community providers through a community health system approach: case examples from Ethiopia and Tanzania. Hum Resour Health 2015; 13:12. [PMID: 25884699 PMCID: PMC4387620 DOI: 10.1186/s12960-015-0006-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 03/08/2015] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Close-to-community (CTC) providers, including community health workers or volunteers or health extension workers, can be effective in promoting access to and utilization of health services. Tasks are often shifted to these providers with limited resources and support from CTC programmes or communities. The Community Health System Strengthening (CHSS) model is part of an improvement approach which draws on existing formal and informal networks within a community, such as agricultural or women's groups, to support CTC providers and address gaps in community-based health services. The model offers a framework for bringing representatives from existing community networks, CTC providers, and health facility staff together to form a community team charged with identifying challenges in service delivery, testing solutions, and monitoring changes. CTC providers draw upon fellow community team members to disseminate health messages and refer community members in need of services. CASES Two cases are presented. In Ethiopia, the CHSS model was applied in 18 communities to increase HIV testing among pregnant women and antenatal care service utilization and improve sanitation. Prior to implementation, representatives from community groups were unaware of health extension workers or were uncomfortable making referrals. By participating on the community team, representatives became familiar with and comfortable referring people to health extension workers and spreading health messages. During implementation, more pregnant women registered for antenatal care and tested for HIV; health extension workers conducted more postnatal visits; and more households had functioning latrines and proper latrine use increased. In Tanzania, the CHSS model was applied in five communities to improve HIV testing and retention into care. Community team members talked to their families and social networks about HIV testing and, when they identified someone who had dropped out of treatment, they referred those individuals to the home-based care volunteer. Increases in HIV testing and a reduction in patients lost to follow-up were observed. DISCUSSION AND CONCLUSION The CHSS model brings together existing networks within communities to support and lend legitimacy to CTC providers. This approach may result in sustainable community-based programmes, especially in HIV where the continuum of care extends beyond the facility and into the community.
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Affiliation(s)
| | - Kate Fatta
- University Research Co, LLC, 7200 Wisconsin Ave., Bethesda, MD, 20814, USA.
| | - Kim Ethier Stover
- University Research Co, LLC, 7200 Wisconsin Ave., Bethesda, MD, 20814, USA.
| | - Ram Shrestha
- University Research Co, LLC, 7200 Wisconsin Ave., Bethesda, MD, 20814, USA.
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