Caesarean Section among Referred and Self-Referred Birthing Women: A Cohort Study from a Tertiary Hospital, Northeastern Tanzania.

The inequity in emergency obstetric care access in Tanzania is unsatisfactory. Despite an existing national obstetric referral system, many birthing women bypass referring facilities and go directly to higher-level care centres. We wanted to compare Caesarean section (CS) rates among women formally referred to a tertiary care centre versus self-referred women, and to assess the effect of referral status on adverse outcomes after CS. We used data from 21,011 deliveries, drawn from the birth registry of a tertiary hospital in northeastern Tanzania, during 2000-07. Referral status was categorized as self-referred if the woman had bypassed or not accessed referral, or formally-referred if referred by a health worker. Because CS indications were insufficiently registered, we applied the Ten-Group Classification System to determine the CS rate by obstetric group and referral status. Associations between referral status and adverse outcomes after CS delivery were analysed using multiple regression models. Outcome measures were CS, maternal death, obstetric haemorrhage ≥ 750 mL, postpartum stay > 9 days, neonatal death, Apgar score < 7 at 5 min and neonatal ward transfer. Referral status contributed substantially to the CS rate, which was 55.0% in formally-referred and 26.9% in self-referred birthing women. In both groups, term nulliparous singleton cephalic pregnancies and women with previous scar(s) constituted two thirds of CS deliveries. Low Apgar score (adjusted OR 1.42, 95% CI 1.09-1.86) and neonatal ward transfer (adjusted OR 1.18, 95% CI 1.04-1.35) were significantly associated with formal referral. Early neonatal death rates after CS were 1.6% in babies of formally-referred versus 1.2% in babies of self-referred birthing women, a non-significant difference after adjusting for confounding factors (adjusted OR 1.37, 95% CI 0.87-2.16). Absolute neonatal death rates were > 2% after CS in breech, multiple gestation and preterm deliveries in both referral groups. Women referred for delivery had higher CS rates and poorer neonatal outcomes, suggesting that the formal referral system successfully identifies high-risk birth, although low volume suggests underutilization. High absolute rates of post-CS adverse outcomes among breech, multiple gestation and preterm deliveries suggest the need to target self-referred birthing women for earlier professional intrapartum care

Politics, Child Mortality, and Health System Development in Tanzania and Uganda, 1995-2009.

Sub-Saharan African countries have diverged sharply in health status in recent years: Some have reduced premature mortality rapidly while others have made little progress, despite significant health-oriented foreign aid. This article identifies political economy and institutional factors that help explain dramatic differences in the pace of child mortality reduction between Tanzania and Uganda from 1995-96 to 2006-07. The existing literature largely explains divergence in basic health outcomes like child mortality with reference to economic variables such as GDP per capita, or in terms of inputs such as the level of public sector health spending. However, these factors cannot explain recent divergence across African countries with similar levels of GDP per capita, rates of economic growth, and levels of health funding. I argue that in addition to economic factors, governance-related variables can play a large role in determining health outcomes. I argue that institutional and governance divergences between Tanzania and Uganda can be linked directly to differing levels of coverage of key child health interventions (especially related to malaria control), and thus to differing child health outcomes. These governance-related divergences are found in the institutional dynamics of malaria control, in the degree of meritocracy and bureaucratic autonomy found at the Ministry of Health, in the political economy of health sector decentralization, and in corruption levels in the pharmaceutical supply chain. These institutional differences can be explained in part by historical factors, but the more relevant causes can be found in recent years. In Tanzania, there was an unusually effective project of institution-building in the health sector, centered on malaria policy and research institutions, and on district-level reforms driven by use of demographic surveillance systems. In Uganda, by contrast, there was a negative political shock to the health system, driven by the repatrimonialization of the Ugandan state after President Yoweri Museveni’s decision to eliminate term limits in the 2001-2006 period and embark on the “president-for-life project.” This repatrimonialization process reversed previous health sector institutional gains and had particularly negative effects on child health service delivery in Uganda

Abandoning presumptive antimalarial treatment for febrile children aged less than five years--a case of running before we can walk?

Current guidelines recommend that all fever episodes in African children be treated presumptively with antimalarial drugs. But declining malarial transmission in parts of sub-Saharan Africa, declining proportions of fevers due to malaria, and the availability of rapid diagnostic tests mean it may be time for this policy to change. This debate examines whether enough evidence exists to support abandoning presumptive treatment and whether African health systems have the capacity to support a shift toward laboratory-confirmed rather than presumptive diagnosis and treatment of malaria in children under five

Explaining inconsistencies between data on condom use and condom sales

BACKGROUND: Several HIV prevention programs use data on condom sales and survey-based data on condom prevalence to monitor progress. However, such indicators are not always consistent. This paper aims to explain these inconsistencies and to assess whether the number of sex acts and the number of condoms used can be estimated from survey data. This would be useful for program managers, as it would enable estimation of the number of condoms needed for different target groups. METHODS: We use data from six Demographic and Health Surveys to estimate the total annual number of sex acts and number of condoms used. Estimates of the number of sex acts are based on self-reported coital frequency, the proportion reporting intercourse the previous day, and survival methods. Estimates of the number of condoms used are based on self-reported frequency of use, the proportion reporting condom use the previous day and in last intercourse. The estimated number of condoms used is then compared with reported data on condom sales and distribution. RESULTS: Analysis of data on the annual number of condoms sold and distributed to the trade reveals very erratic patterns, which reflect stock-ups at various levels in the distribution chain. Consequently, condom sales data are a very poor indicator of the level of condom use. Estimates of both the number of sexual acts and the number of condoms used vary enormously based on the estimation method used. For several surveys, the highest estimate of the annual number of condoms used is tenfold that of the lowest estimate. CONCLUSIONS: Condom sales to the trade are a poor indicator of levels of condom use, and are therefore insufficient to monitor HIV prevention programs. While survey data on condom prevalence allow more detailed monitoring, converting such data to an estimated number of sex acts and condoms used is not straightforward. The estimation methods yield widely different results, and it is impossible to determine which method is most accurate. Until the reliability of these various estimation methods can be established, estimating the annual number of condoms used from survey data will not be feasible. Collecting survey data on the number of sex acts and the number of condoms used in a fixed time period may enable the calculation of more reliable estimates of the number of sex acts and condoms used

Are poor, remote areas left behind in agricultural development

"In Tanzania, as in many other developing countries, the conventional wisdom is that economic reforms may have stimulated economic growth, but that the benefits of this growth have been uneven, favoring urban households and farmers with good market access. This idea, although quite plausible, has rarely been tested empirically. In this paper, we develop a new approach to measuring trends in poverty and apply it to Tanzania in order to explore the distributional aspects of economic growth and the relationship between rural poverty and market access. We find that, between 1991 and 2003, a period of extensive economic reforms, the overall rate of poverty fell about 9 percentage points. The degree of poverty reduction was similar between rural and urban areas, though poverty appears not to have declined in Dar es Salaam. The poverty rate fell more among households with a less educated head of household than among those with a more educated head. The gains were greater among male-headed households than female-headed households. We find that rural poverty is associated with remoteness, but the relationship is surprisingly weak and it varies depending on the definition used. Rural poverty is more closely related to access to regional urban centers than distance to roads or to Dar es Salaam. We find little evidence that remote rural areas are being “left behind” in terms of the absolute decline in the poverty rate. " Authors' AbstractMarket access ,Agricultural development ,rural areas ,Economic reform ,measurement ,Rural poverty Tanzania ,

CONSUMER PREFERENCES AS DRIVERS OF THE COMMON BEAN TRADE IN TANZANIA: A MARKETING PERSPECTIVE

The objective of this study was to determine the impact of bean grain quality characteristics on market price. The data was collected from retail markets in Tanzania. Hedonic pricing provides a statistical estimate of premiums and discounts. Implications for development of bean markets include: i) extension agents should identify cost-effective ways to educate producers on targeting urban market niches based on consumer preferences for varieties, ii) breeding for bruchid resistant beans and use of appropriate storage technologies would alleviate the problems of storage damage, and iii) requiring a portfolio of grain quality characteristics to fit consumer preferences in local markets.Beans, markets, consumer preferences, hedonic, storage, Tanzania

Costing Artemisinin-based Combination Therapy for Malaria in Tanzania

Malaria continues to be a major contributor to the burden of disease in Tanzania, with a prevalence of 33.39 percent nationally. As antimalarial resistance to sulfadoxine-pyrimethamine in Tanzania continues to grow, the government is in the process of changing its national policy regarding first-line treatment for uncomplicated malaria to an artemisinin-based combination therapy (ART). ACT, a new type of antimalarial drug combination, has proved to be effective at treating malaria and reducing malaria transmission. The PHRplus project, on behalf of the Roll Back Malaria \ud Partnership in conjunction with the World Bank, undertook a costing study to estimate the five-year financing needs and identify financing gaps for procurement of three possible ACT combinations, Coartem®, artesunate amodiaquine (ART AQ), and ArtecomTM. The Global Fund to Fight AIDS, Tuberculosis and Malaria award for malaria during the fourth round of proposals will cover the majority of the first year of public sector ACT implementation if Coartem® (with a financing gap of US$1.4 million) is chosen, or the bulk of public sector implementation for the full five-year period under ART AQ or Artecom. ACT funding must be secured for the medium- to long-term future. Financing for the purchase of ACTs is likely to come from the Global Fund, the World Bank, and the various other partner agencies

Incidence of human brucellosis in the Kilimanjaro Region of Tanzania in the periods 2007-2008 and 2012-2014

Background: Brucellosis causes substantial morbidity among humans and their livestock. There are few robust estimates of the incidence of brucellosis in sub-Saharan Africa. Using cases identified through sentinel hospital surveillance and health care utilization data, we estimated the incidence of brucellosis in Moshi Urban and Moshi Rural Districts, Kilimanjaro Region, Tanzania, for the periods 2007–2008 and 2012–2014. Methods: Cases were identified among febrile patients at two sentinel hospitals and were defined as having either a 4-fold increase in Brucella microscopic agglutination test titres between acute and convalescent serum or a blood culture positive for Brucella spp. Findings from a health care utilization survey were used to estimate multipliers to account for cases not seen at sentinel hospitals. Results: Of 585 patients enrolled in the period 2007–2008, 13 (2.2%) had brucellosis. Among 1095 patients enrolled in the period 2012–2014, 32 (2.9%) had brucellosis. We estimated an incidence (range based on sensitivity analysis) of brucellosis of 35 (range 32–93) cases per 100 000 persons annually in the period 2007–2008 and 33 (range 30–89) cases per 100 000 persons annually in the period 2012–2014. Conclusions: We found a moderate incidence of brucellosis in northern Tanzania, suggesting that the disease is endemic and an important human health problem in this area

Colonial Legacy of Gender Inequality: Christian Missionaries in German East Africa

Why does sub-Saharan Africa exhibit the highest rates of gender inequality in the world? This article evaluates the contributions of Christian missionary societies in German East Africa to current socioeconomic gender inequalities in Tanzania. Previous studies ascribe a comparatively benign long-term effect of missionary societies, in particular of the Protestant denomination, on economic, developmental, and political outcomes. This article contrasts that perception by focusing on the wider cultural impact of the civilizing mission in colonial Africa. The analysis rests on a novel georeferenced dataset on German East Africa - based on digitized colonial maps and extensive historical records available in the German colonial archives - and the most recently available DHS-surveys. The results highlight the formative role of Catholic missionary societies in German East Africa in shaping gender inequalities currently witnessed in Tanzania