Primary health care providers’ knowledge and practices on asthma management within Dar es salaam region health facilities

Background: Asthma is a common chronic health problem worldwide with considerable variation in the way it is managed. In the sub- Saharan Africa there is substantial gaps in asthma care; countries like Tanzania with inadequate health care structure are lagging far behind in both correct diagnosis and management of asthma. The increasing prevalence of asthma within populations is attributed to a number of the following factors; Patient behavior, Health service structure and access, Environmental factors and Provider\u27s knowledge and practices. There is lack of required standard asthma care under provider\u27s factors, hindering effective control of the disease. This could be attributed to lack of awareness among health care professionals on internationally available management protocols, which have proven to be effective when disseminated and incorporated for implementation into clinical practice. In the sub-Saharan Africa the competence of primary care provider in managing asthma has been put in question with varying quality of care among the providers. Few studies in sub Saharan Africa and perhaps none in Tanzania have investigated the quality of delivery of asthma care with a particular focus on the provider factor. Objectives: Determine the primary health care providers\u27 knowledge in diagnosing and managing asthma patients according to the existing guidelines; evaluate the actual practice involved in managing asthma patients and design a questionnaire tool that would be educative on current standards of asthma care during the interview process. Methodology: A cross sectional descriptive survey study was designed to interview the eligible primary health care providers in health facilities within the three districts of Dar es Salaam region. 100 Primary care providers (PHCPs) were statistically identified as sufficient sample size for the study of 384 (PHCPs) target population. The structured questionnaire was administered and the initial responses were systematically coded and analyzed by computer SPSS software program; the findings were statistically analyzed for significance taken at P value \u3c 0.05 within 95% confidence limits. Cross tabulation of data, bi variate and linear correlation analysis were applied in determining the values of important outcome variables. Results: The survey involved 110 PHCPs, the response rate was 90%and therefore 100 PHCPs responded. Assistant medical officers (NON MDs) contributed a major clinical work force in most of health facilities surveyed by 70% as compared to Medical officers(MDs) 30% (P=0.006). 5.3% of MDs were practicing in public hospitals with remaining majority practicing in private hospitals (P=0.001). The awareness among PHCPs on GINA or other international guideline on asthma care was far below at 3% despite handling a significant volume of asthma patients in their practices which accounted for 7% among disease conditions seen in an average week. The actual performance of PHCPs on Asthma KAP study was below average score by 89%; while 13% of MDs and 1.4% of NON MDs were only above average score. (P=0.041) The organization level for asthma care within all surveyed health facilities was below average score by 98% and this is thought to be one of the important factors that impacted negatively on asthma KAP among the PHCPs. Conclusion: There urgent need to formulate local/national guideline on current asthma care management which should be disseminated and incorporated into daily clinical practice by PHCP; on the other hand the organization infrastructure for asthma care is in pathetic state in most health facilities which calls for reversal of this declining trend by concerned stakeholders so as to minimize its deleterious impact in asthma care

Hepatitis B vaccination coverage among healthcare workers at national hospital in Tanzania: how much, who and why?

Abstract Background Hepatitis B vaccination for healthcare workers (HCWs) is a key component of the WHO Hepatitis B Elimination Strategy 2016–2021. Data on current hepatitis B vaccine coverage among health care workers in Sub-Saharan Africa are scarce, but these data are vital for effective programming. We assessed the proportion of HCWs vaccinated for hepatitis B and the factors associated with adequate vaccination coverage at a national hospital in Tanzania. Methods A descriptive cross-sectional study was conducted among consenting healthcare workers between 30th July and 30th September 2015. Vaccination histories were obtained through self-administered questionnaires. Means and proportions were used to summarize the data. Student’s t and chi-squared tests were used as appropriate. Logistic regression was used to determine the factors associated with vaccination. Results A total of 348 HCWs were interviewed, of whom 198 (56.9%) had received at least one dose of hepatitis B vaccination, while only 117 (33.6%) were fully vaccinated. About half of the 81 HCWs with partial vaccination (49.4%) had missed their subsequent vaccination appointments. Among unvaccinated HCWs, 14 (9.3%) had either HBV infection or antibodies against HBV infection upon pre-vaccination screening. However, the remaining participants were not vaccinated and did not know their immune status against HBV. Nearly all respondents (347, 99.3%) had heard about the hepatitis B viral vaccine. The following reasons for non-vaccination were given: 98 (65.3%) reported that they had not been offered the vaccine; 70 (46.7%) observed standard precautions to ensure infection prevention and 60 (41.3%) blamed a low level of awareness regarding the availability of the hepatitis B vaccine. Conclusion The current vaccination coverage among practicing healthcare workers at Muhimbili National Hospital is low, despite a high level of awareness and the acceptance of the vaccine. Expedited and concerted efforts to scale vaccine uptake should include improved access to the vaccine, especially for newly recruited HCWs. The extension of the study to private healthcare settings and lower-level facilities would be useful

Role of hepatitis C virus core antigen assay in hepatitis C care in Africa

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High prevalence and poor linkage to care of transfusion‐transmitted infections among blood donors in Dar‐es‐Salaam, Tanzania

International audienceBlood transfusion is one of the most commonly relied upon therapies in sub-Saharan Africa. Existing safeguards recommended include systematic screening for transfusion-transmitted infections and restricted voluntary nonremunerated blood donor selection. We report the transfusion-transmitted infection screening and notification practice at a large urban blood transfusion centre in Dar-es-Salaam, Tanzania. Between October 2016 and March 2017 anonymized records of all donors registered at the blood transfusion unit were accessed to retrospectively note demographic information, donor status, first-time status, transfusion-transmitted infection result and notification. 6402 consecutive donors were screened for transfusion-transmitted infections; the majority were family/replacement blood donors (88.0%) and male (83.8%). Overall transfusion-transmitted infections prevalence was 8.4% (95% CI 7.8-9.1), with hepatitis B being the most prevalent infection (4.1% (95% CI 3.6-4.6)). Transfusion-transmitted infections were more common in family/replacement blood donors (9.0% (95% CI 8.3-9.8)) as compared to voluntary nonremunerated blood donor (4.1% (95% CI 2.8-5.7)). A minority of infected-donors were notified of a positive result (8.5% (95% CI 6.3-11.2)). Although transfusion-transmitted infections are more prevalent among family/replacement blood donors, overall risk of transfusion-transmitted infections across all groups is considerable. In addition, existing efforts to notify donors of a positive transfusion-transmitted infection are poor. Future policies must focus on improving linkage to care for newly diagnosed patients with transfusion-transmitted infections

Effect of the COVID-19 pandemic on viral hepatitis services in sub-Saharan Africa

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