The banana project: A qualitative study of caregivers' and teachers' experiences of preschool children participating in a free banana school fruit scheme in rural Tanzania

Introduction Good nutrition is the foundation of sustainable growth and development among children. The United Nations aims to achieve food security and improve nutrition through its Sustainable Development Goal 2 - Zero Hunger. In close collaboration with local communities and authorities, the Tanga International Competence Centre, Tanzania, supports projects aimed at achieving the United Nations Sustainable Development Goals. One of their initiatives, The Banana Project, which is a free school fruit scheme, started in 2011 based on a recognised need for nutritional support among preschool children at a rural school in Tanga District. In the interest of improving nutrition, the free school fruit scheme provides one banana 5 school days a week to each child in the class. This study aimed to explore caregivers’ (parents and/or guardians) and teachers’ experiences with preschool children’s participation in the project, with a specific focus on nutrition and health. Methods This qualitative study was performed in 2017. A total of 16 semistructured indepth interviews with 14 caregivers and 2 teachers of the preschool children participating in the project were conducted. Data were analysed using a hermeneutic perspective. Results Caregivers and teachers of the preschool children participating in the intervention experienced that bananas (1) reduced children’s hunger and nutritional deficiency, (2) increased fruit intake and improved their appetite for other foods, (3) improved their physical health and provided energy, and (4) supported cognitive and socioemotional development. Conclusion These findings indicate that the banana intervention has several benefits to preschool children and has an impact on their families. To improve health and reduce the risk of malnutrition of children in rural Tanzania, The Banana Project can be an recommended as a simple, cost-effective and sustainable health and nutrition promotion initiatives.publishedVersio

Retired Nurses Can Improve Retention in Prevention of Mother-to-Child Transmission Programmes

Background: The success of prevention of mother-to-child transmission (PMTCT) programmes depends on retention of mothers throughout the PMTCT cascade.   Methods: In a clinical trial of short-course combination antiretroviral therapy (cART) for PMTCT in Tanzania, senior nurses were employed to reduce the substantial loss-to-follow up (LTFU) rate.   Results: Following intervention, the relative risk (RR) of receiving a CD4 count result and antiretroviral therapy was 1.16 (95% confidence interval [CI], 1.05 to 1.27), the RR of delivery at clinic was 2.51 (95% CI, 2.06 to 3.06), the RR for reporting for follow-up at 6 to 8 weeks postpartum was 4.63 (95% CI, 3.41 to 6.27), and the RR for being retained until 9 months postpartum was 28.19 (95% CI, 11.81 to 67.28). No significant impact on transmission was found.   Conclusion: Significantly higher retention was found after senior nurses were employed. No impact on transmission was found. Relatively low transmission was found in both study arms

Possible causes of fever among patients with blood smear negative for malaria parasites at Bombo Regional Referral Hospital in Tanga, Tanzania

Background: Due to its diverse and non‐specific clinical presentations, malaria has been associated with most infections causing febrile illnesses. Despite being non-specific, clinical diagnosis is still the main method of malaria diagnosis in most health facilities in sub-Saharan Africa. This study aimed to establish the probable diagnoses among fever cases admitted at Bombo Hospital in north-eastern Tanzania.Methods: This study involved patients admitted in Medical and Paediatric wards with a clinical diagnosis of severe malaria but having negative blood smears (BS) for malaria parasites. Finger prick blood specimens were collected for blood smear microscopy and rapid diagnostic test. Blood and urine cultures were done for all specimens collected.  Some patients were also screened for HIV infection.Results: A total of 227 patients were recruited and the majority (62.1%) were under-five children. Out of the 227 blood specimens cultured, 25 (11.0%) grew different bacteria species. Staphylococcus aureus was the most frequent pathogen (68.0%), followed by S. pneumoniae (24.0%), Salmonella species (4.0%) and Streptococcus pyogenes (4.0%).  Only 7 (3.2%) out of 219 urine specimens cultured showed growth of Escherichia coli, Pseudomonas aeruginosa, S. aureus and Klebsiella pneumoniae. Of the 215 patients screened for HIV, 17 (7.9%) had positive reaction.Conclusion: The findings indicate that S. aureus and S. pneumoniae as the commonest bacteria isolates from blood and P. aeruginosa, S. aureus and K. pneumoniae from urine cultures. These bacteria and HIV should be considered as important contributors to febrile illness cases among patients found with negative BS for malaria parasites

Addressing the fear and consequences of stigmatization - a necessary step towards making HAART accessible to women in Tanzania: a qualitative study

<p>Abstract</p> <p>Background</p> <p>Highly Active Antiretroviral Therapy (HAART) has been available free of charge in Tanga, Tanzania since 2005. However we have found that a high percentage of women referred from prevention of mother-to-child transmission services to the Care and Treatment Clinics (CTC) for HAART never registered at the CTCs. Few studies have focused on the motivating and deterring factors to presenting for HAART particularly in relation to women. This study seeks to remedy this gap in knowledge.</p> <p>Methodology</p> <p>A qualitative approach using in-depth interviews and focus group discussions was chosen to understand these issues as perceived and interpreted by HIV infected women themselves.</p> <p>Results</p> <p>The main deterrent to presenting for treatment appears to be fear of stigmatization including fear of ostracism from the community, divorce and financial distress. Participants indicated that individual counselling and interaction with other people living with HIV encourages women, who are disinclined to present for HAART, to do so, and that placing the entrance to the CTC so as to provide discrete access increases the accessibility of the clinic.</p> <p>Conclusion</p> <p>Combating stigma in the community, although it is essential, will take time. Therefore necessary steps towards encouraging HIV infected women to seek treatment include reducing self-stigma, assisting them to form empowering relationships and to gain financial independence and emphasis by example of the beneficial effect of treatment for themselves and for their children. Furthermore ensuring a discrete location of the CTC can increase its perceived accessibility.</p

Early Infant Diagnosis of HIV in Three Regions in Tanzania; Successes and Challenges.

By the end of 2009 an estimated 2.5 million children worldwide were living with HIV-1, mostly as a consequence of vertical transmission, and more than 90% of these children live in sub-Saharan Africa. In 2008 the World Health Organization (WHO), recommended early initiation of Highly Active Antiretroviral Therapy (HAART) to all HIV infected infants diagnosed within the first year of life, and since 2010, within the first two years of life, irrespective of CD4 count or WHO clinical stage. The study aims were to describe implementation of EID programs in three Tanzanian regions with differences in HIV prevalences and logistical set-up with regard to HIV DNA testing. Data were obtained by review of the prevention from mother to child transmission of HIV (PMTCT) registers from 2009-2011 at the Reproductive and Child Health Clinics (RCH) and from the databases from the Care and Treatment Clinics (CTC) in all the three regions; Kilimanjaro, Mbeya and Tanga. Statistical tests used were Poisson regression model and rank sum test. During the period of 2009 - 2011 a total of 4,860 exposed infants were registered from the reviewed sites, of whom 4,292 (88.3%) were screened for HIV infection. Overall proportion of tested infants in the three regions increased from 77.2% in 2009 to 97.8% in 2011. A total of 452 (10.5%) were found to be HIV infected (judged by the result of the first test). The prevalence of HIV infection among infants was higher in Mbeya when compared to Kilimanjaro region RR = 1.872 (95%CI = 1.408 - 2.543) p < 0.001. However sample turnaround time was significantly shorter in both Mbeya (2.7 weeks) and Tanga (5.0 weeks) as compared to Kilimanjaro (7.0 weeks), p=<0.001. A substantial of loss to follow-up (LTFU) was evident at all stages of EID services in the period of 2009 to 2011. Among the infants who were receiving treatment, 61% were found to be LFTU during the review period. The study showed an increase in testing of HIV exposed infants within the three years, there is large variations of HIV prevalence among the regions. Challenges like; sample turnaround time and LTFU must be overcome before this can translate into the intended goal of early initiation of lifelong lifesaving antiretroviral therapy for the infants

Factors influencing growth of children aged 12-24 months in the Tanga Region, Tanzania

Background - The first 1000 days of life, from conception to the second birthday, offer a unique window of opportunity for optimal growth, critical for future health. The primary aim of this study was to analyze growth of children between 12 and 24 months age in Tanzanian children, and to explore possible predictors for growth. Methods - Observational, cross-sectional study performed between March and April 2017. Eligible children, and their mothers, attended routine follow-up at two health clinics in Tanga, Tanzania. At the study day, the child’s weight and height were recorded. The mothers answered a structured interview regarding breastfeeding, immunization and socioeconomic conditions. Results - We recruited 300 mother–child pairs. Median [interquartile range (IQR)] age at study visit was 16 (14–20) months. Mothers reported that 170 (57%) of their children were exclusively breastfed for a minimum of 6 months; median (IQR) 6 (4–6) months. Using the World Health Organization (WHO) standard growth curves, mean weight-for-age Z-score was −0.30 and mean length-for-age Z-score was −0.47. Children whose mothers had higher education had higher Z-scores for weight and length compared to children of mothers with lower education. Education remained the most important predictor for growth also after adjusting for other variables. Overall, 48/300 (16%) were moderate-severe stunted and 25/300 (8.4%) had moderate-severe underweight. Conclusion - Children aged 12–24 months in this region of Tanzania had weight and height below the WHO standard. Higher educated mothers had children with better growth parameters. Duration of exclusive breastfeeding was long, but did not predict growth parameters

Experiences from cross-cultural collaboration in health campaigns in Tanzania: a qualitative study

Abstract Background Health campaigns are an important aspect of preventive health work. They can aim to improve health literacy in rural areas where residents lack access to health information and knowledge, and to improve both local and global health through cross-cultural collaboration. In Tanga District, Tanzania, exchange students and local youths participate together with Tanga International Competence Centre (TICC) to plan and accomplish health campaigns in local communities. The aim of this study was to explore the participants’ experiences with the cross-cultural collaboration in the planning and delivery of TICC’s health campaigns. Methods This study used a focused ethnographic approach. Five weeks of fieldwork included four observations of health campaigns and nine interviews: three individual interviews with employees at TICC (all Tanzanians), two group interviews with nine Norwegian nursing students, two group interviews with five local youths enrolled in TICC’s Youth Program, one interview with a local village leader, and one interview with a local primary school teacher. The interview material was analyzed using systematic text condensation. Results All participants experienced the cross-cultural collaboration as successful. Having enough time, adapting to local conditions, and understanding the needs of the target groups were perceived as essential to the campaigns’ success. Music and role-play, which are dominant within Tanzanian culture but not common among the Norwegian students, created excitement and motivation among the audiences. The interviewees identified changes in people’s health behavior in the aftermath of the campaigns. Conclusion All participants in this study identified positive outcomes from the cross-cultural collaboration within TICC’s health campaigns. The health campaigns were considered beneficial because of the poor access to health information among residents in the local communities

The banana project: A qualitative study of caregivers' and teachers' experiences of preschool children participating in a free banana school fruit scheme in rural Tanzania

Introduction Good nutrition is the foundation of sustainable growth and development among children. The United Nations aims to achieve food security and improve nutrition through its Sustainable Development Goal 2 - Zero Hunger. In close collaboration with local communities and authorities, the Tanga International Competence Centre, Tanzania, supports projects aimed at achieving the United Nations Sustainable Development Goals. One of their initiatives, The Banana Project, which is a free school fruit scheme, started in 2011 based on a recognised need for nutritional support among preschool children at a rural school in Tanga District. In the interest of improving nutrition, the free school fruit scheme provides one banana 5 school days a week to each child in the class. This study aimed to explore caregivers’ (parents and/or guardians) and teachers’ experiences with preschool children’s participation in the project, with a specific focus on nutrition and health. Methods This qualitative study was performed in 2017. A total of 16 semistructured indepth interviews with 14 caregivers and 2 teachers of the preschool children participating in the project were conducted. Data were analysed using a hermeneutic perspective. Results Caregivers and teachers of the preschool children participating in the intervention experienced that bananas (1) reduced children’s hunger and nutritional deficiency, (2) increased fruit intake and improved their appetite for other foods, (3) improved their physical health and provided energy, and (4) supported cognitive and socioemotional development. Conclusion These findings indicate that the banana intervention has several benefits to preschool children and has an impact on their families. To improve health and reduce the risk of malnutrition of children in rural Tanzania, The Banana Project can be an recommended as a simple, cost-effective and sustainable health and nutrition promotion initiatives