Distribution of primary health care facilities in Mtwara District, Tanzania: availability and accessibility of services

Background: Access to health care services is a significant factor to health seeking practices that contributes to a healthy population. Improving health care accessibility is an important health priority in low-income countries. The objective of this study was to determine distribution of health care facilities and identify the high priority areas, which require more services in Mtwara, southern Tanzania.Methods: This study was carried in Mtwara Rural district of southern Tanzania and involved health care facilities. A hand held global positioning system was used to geo-reference the coordinates of all facilities. A questionnaire with both closed and open-ended questions was used to gather information from patients who attended the respective facilities. Interviews with district health officials and facility in-charges were conducted.Results:  There were 38 health in the district. Most of them were located within southern part of the district. The majority of facilities (97%) were government owned. On average each facility was serving 2,400 population. Malaria management, reproductive and child health services, family planning and integrated management of childhood illnesses were offered by all health facilities in the district. Prevention of mother to child transmission of HIV was offered by 34 (89.5%) facilities. Tuberculosis services were offered by only 3 facilities while voluntary counselling and testing of HIV and anti-retroviral treatment services were available in 15 and 10 health facilities, respectively. Only 4 facilities had laboratory and inpatients services. The majority of the staff included Medical Attendants (39%), Nurse Midwives (34%), and Clinical Officers (20%). Assistant Medical Officers and Nursing Officers each accounted for 2% of the total staff. There were no Medical Officers, laboratory technicians or pharmaceutical technicians in the district.  A total of 408 health facility clients (≥18yrs) were interviewed. Factors influencing the choice of a health facility were the availability of special services, medicine and qualified human resources.Conclusion: The majority of facilities in Mtwara are government and there is disparity in the distribution of the facilities. Availability of medicines and qualified human resources were the major factors on the preference for accessing health care services

Comparative assessment of the human and animal health surveillance systems in Tanzania: Opportunities for an integrated one health surveillance platform

Globally, there have been calls for an integrated zoonotic disease surveillance system. This study aimed to assess human and animal health surveillance systems to identify opportunities for One Health surveillance platform in Tanzania. A desk review of policies, acts and strategies addressing disease surveillance that support inter-sectoral collaboration was conducted. A semi-structured questionnaire was administered to key informants from the two sectors. Databases with potential relevance for surveillance were assessed. One Health-focused policies, acts, strategic plans and guidelines emphasising inter-sectoral collaboration strengthening were in place. Stable systems for collecting surveillance data with trained staff to implement surveillance activities at all levels in both sectors were available. While the human surveillance system was a mix of paper-based and web-based, the animal health system was mainly paper-based. The laboratory information system existed in both sectors, though not integrated with the epidemiological surveillance systems. Both the animal and human surveillance systems had low sensitivity to alert outbreaks. The findings indicate that individual, organisational, and infrastructure opportunities that support the integration of surveillance systems from multiple sectors exist. Challenges related to data sharing and quality need to be addressed for the effective implementation of the platform

Patterns and causes of hospital maternal mortality in Tanzania: A 10-year retrospective analysis.

BackgroundMaternal mortality is among the most important public health concerns in Sub-Saharan Africa. There is limited data on hospital-based maternal mortality in Tanzania. The objective of this study was to determine the causes and maternal mortality trends in public hospitals of Tanzania from 2006-2015.Methods and findingsThis retrospective study was conducted between July and December 2016 and involved 34 public hospitals in Tanzania. Information on causes of deaths due to pregnancy and delivery complications among women of child-bearing age (15-49 years old) recorded for the period of 2006-2015 was extracted. Data sources included inpatient and death registers and International Classification of Disease (ICD)-10 report forms. Maternal deaths were classified based on case definition by ICD 10 and categorized as direct and indirect causes. A total of 40,052 deaths of women of child-bearing age were recorded. There were 1,987 maternal deaths representing 5·0% of deaths of all women aged 15-49 years. The median age-at-death was 27 years (interquartile range: 22, 33). The average age-at-death increased from 25 years in 2006 to 29 years in 2015. Two thirds (67.1%) of the deaths affected women aged 20-34 years old. The number of deaths associated with teenage pregnancy (15-19 years) declined significantly (p-valueConclusionsDuring the ten year period (2006-2015) there was an increase in the number of hospital maternal deaths in public hospitals in Tanzania. Maternal deaths accounted for 5% of all women of child-bearing age in-hospital mortalities. Most maternal deaths were due to direct causes including eclampsia, haemorrhage and sepsis. The findings of this study provide evidence for better planning and policy formulation for reproductive health programmes to reduce maternal deaths in Tanzania

Improving disease surveillance data analysis, interpretation, and use at the district level in Tanzania

An effective disease surveillance system is critical for early detection and response to disease epidemics. This study aimed to assess the capacity to manage and utilize disease surveillance data and implement an intervention to improve data analysis and use at the district level in Tanzania. Mapping, in-depth interview and desk review were employed for data collection in Ilala and Kinondoni districts in Tanzania. Interviews were conducted with members of the council health management teams (CHMT) to assess attitudes, motivation and practices related to surveillance data analysis and use. Based on identified gaps, an intervention package was developed on basic data analysis, interpretation and use. The effectiveness of the intervention package was assessed using pre-and post-intervention tests. Individual interviews involved 21 CHMT members (females = 10; males = 11) with an overall median age of 44.5 years (IQR = 37, 53). Over half of the participants regarded their data analytical capacities and skills as excellent. Analytical capacity was higher in Kinondoni (61%) than Ilala (52%). Agreement on the availability of the opportunities to enhance capacity and skills was reported by 68% and 91% of the participants from Ilala and Kinondoni, respectively. Reported challenges in disease surveillance included data incompleteness and difficulties in storage and accessibility. Training related to enhancement of data management was reported to be infrequently done. In terms of data interpretation and use, despite reporting of incidence of viral haemorrhagic fevers for five years, no actions were taken to either investigate or mitigate, indicating poor use of surveillance data in monitoring disease occurrence. The overall percentage increase on surveillance knowledge between pre-and post-training was 37.6% for Ilala and 20.4% for Kinondoni indicating a positive impact on of the training. Most of CHMT members had limited skills and practices on data analysis, interpretation and use. The training in data analysis and interpretation significantly improved skills of the participants

Hospital mortality statistics in Tanzania: availability, accessibility, and quality 2006–2015

Abstract Background Accurate and reliable hospital information on the pattern and causes of death is important to monitor and evaluate the effectiveness of health policies and programs. The objective of this study was to assess the availability, accessibility, and quality of hospital mortality data in Tanzania. Methods This cross-sectional study involved selected hospitals of Tanzania and was carried out from July to October 2016. Review of hospital death registers and forms was carried out to cover a period of 10 years (2006–2015). Interviews with hospital staff were conducted to seek information as regards to tools used to record mortality data, staff involved in recording and availability of data storage and archiving facilities. Results A total of 247,976 death records were reviewed. The death register was the most (92.3%) common source of mortality data. Other sources included the International Classification of Diseases (ICD) report forms, Inpatient registers, and hospital administrative reports. Death registers were available throughout the 10-year period while ICD-10 forms were available for the period of 2013–2015. In the years between 2006 and 2010 and 2011–2015, the use of death register increased from 82 to 94.9%. Three years after the introduction of ICD-10 procedure, the forms were available and used in 28% (11/39) hospitals. The level of acceptable data increased from 69% in 2006 to 97% in 2015. Inconsistency in the language used, use of non-standard nomenclature for causes of death, use of abbreviations, poorly and unreadable handwriting, and missing variables were common data quality challenges. About 6.3% (n = 15,719) of the records had no patient age, 3.5% (n = 8790) had no cause of death and ~ 1% had no sex indicated. The frequency of missing sex variable was most common among under-5 children. Data storage and archiving in most hospitals was generally poor. Registers and forms were stored in several different locations, making accessibility difficult. Conclusion Overall, this study demonstrates gaps in hospital mortality data availability, accessibility, and quality, and highlights the need for capacity strengthening in data management and periodic record reviews. Policy guidelines on the data management including archiving are necessary to improve data

Cause-specific mortality patterns among hospital deaths in Tanzania, 2006-2015.

BACKGROUND:Understanding the causes of inpatient mortality in hospitals is important for monitoring the population health and evidence-based planning for curative and public health care. Dearth of information on causes and trends of hospital mortality in most countries of Sub-Saharan Africa has resulted to wide use of model-based estimation methods which are characterized by estimation errors. This retrospective analysis used primary data to determine the cause-specific mortality patterns among inpatient hospital deaths in Tanzania from 2006-2015. MATERIALS AND METHODS:The analysis was carried out from July to December 2016 and involved 39 hospitals in Tanzania. A review of hospital in-patient death registers and report forms was done to cover a period of 10 years. Information collected included demographic characteristics of the deceased and immediate underlying cause of death. Causes of death were coded using international classification of diseases (ICD)-10. Data were analysed to provide information on cause-specific, trends and distribution of death by demographic and geographical characteristics. PRINCIPAL FINDINGS:A total of 247,976 deaths were captured over a 10-year period. The median age at death was 30 years, interquartile range (IQR) 1, 50. The five leading causes of death were malaria (12.75%), respiratory diseases (10.08%), HIV/AIDS (8.04%), anaemia (7.78%) and cardio-circulatory diseases (6.31%). From 2006 to 2015, there was a noted decline in the number of deaths due to malaria (by 47%), HIV/AIDS (28%) and tuberculosis (26%). However, there was an increase in number of deaths due to neonatal disorders by 128%. Malaria and anaemia killed more infants and children under 5 years while HIV/AIDS and Tuberculosis accounted for most of the deaths among adults. CONCLUSION:The leading causes of inpatient hospital death were malaria, respiratory diseases, HIV/AIDS, anaemia and cardio-circulatory diseases. Death among children under 5 years has shown an increasing trend. The observed trends in mortality indicates that the country is lagging behind towards attaining the global and national goals for sustainable development. The increasing pattern of respiratory diseases, cancers and septicaemia requires immediate attention of the health system