The feasibility and acceptability of screening for hypertension in private drug retail outlets: a pilot study in Mwanza region, Tanzania.

BACKGROUND: Hypertension is a major contributor to ill health in sub-Saharan Africa. Developing countries need to increase access for screening. This study assesses the feasibility and acceptability of using private sector drug retail outlets to screen for hypertension in Mwanza region, Tanzania. METHODS: A pilot study took place in eight drug retail outlets from August 2013 to February 2014. Customers ≥18 years were invited for screening. Socio-demographic characteristics, hypertension knowledge, hypertension screening and treatment history were collected. Subjects with systolic blood pressure over 140 mmHg were referred for follow up. Referral slips captured attendance. Mystery client visits and follow up phone calls were conducted to assess service quality. RESULTS: A total of 971 customers were screened, one person refused; 109 (11.2%) had blood pressure over 140/90 mmHg and were referred for ongoing assessment; 85/109 (78.0%) were newly diagnosed. Customers reported that the service was acceptable. Service providers were able to follow the protocol. Only 18/85 (21%) newly diagnosed participants visited the referral clinic within two weeks. CONCLUSIONS: Blood pressure screening was feasible and acceptable to customers of private drug retail outlets. However many who were referred failed to attend at a referral centre and further research is needed in this area

Antibiotics prescription practices for provisional malaria cases in three hospitals in Moshi, northern Tanzania

Background: Irrational antibiotic use is an important factor for development and spread of resistance to currently used antibiotics. This study was carried out to assess antibiotic prescribing practices among cases diagnosed as malaria at three hospitals in Moshi Municipality in northern Tanzania.Methods: This was a cross sectional, retrospective study that included patients files from Kilimanjaro Christian Medical Centre (KCMC), Mawenzi Regional Hospital and St Joseph Hospital. Patient files whose primary provisional diagnosis was malaria were analysed using a convenient sampling method. Variables of interest were the types of medications prescribed, whether or not a laboratory test was requested and treatment was initiated before laboratory reports.Results: A total of 250 patients’ files were included in the analysis (KCMC=62.8%; Mawenzi=23.2%; St. Joseph=14.0%). In 232 (92.8%) prescriptions made in the three hospitals, laboratory tests were requested to confirm diagnoses. Among laboratory tests requested, 89.2% were blood slides for microscopic detection of malaria parasites, 3.01% malaria rapid diagnostic tests and 3.01% other tests. The majority of prescriptions across all three hospitals (KCMC=86.4%; Mawenzi=91.4%; St. Joseph= 72.4%; X2=7.787). Clinicians at Mawenzi were more likely to start treatment before laboratory findings than their counterparts at KCMC and St Joseph hospitals (X2=7.787, p≤0.05). A significantly higher number of prescriptions made before laboratory findings were observed at KCMC than Mawenzi and St. Joseph hospitals (X2=7.787, p<0.05). Prescriptions from KCMC were more likely to include at least one type of antibiotic than in the other two facilities. Over one third (KCMC=34.0%; St. Joseph=42.1%; Mawenzi=38.1%) of the prescriptions made contained at least one type of an antibiotic. There was a strong association between health facilities and antibiotics prescription in which KCMC prescribed antibiotics at the highest rate while Mawenzi Regional Hospital prescribed antibiotics at the lowest rates (X2=29.234, p<0.001).Conclusion: Antibiotics are prescribed at a high rate among provisionally diagnosed malaria cases before availability of laboratory results. Efforts should be made to improve laboratory services in terms of trained personnel and equipment to reduce irrational use of antibiotics in provisionally diagnosed malaria cases

Risk factors for placental malaria and associated adverse pregnancy outcomes in Rufiji, Tanzania: a hospital based cross sectional study.

Background: Prevention and treatment of malaria during pregnancy is crucial for reduction of malaria in pregnancy and its adverse outcomes. The spread of parasite resistance to Sulphadoxine-Pyrimethamine (SP) used for Intermittent Preventive Treatment for malaria in pregnancy (IPTp), particularly in East Africa has raised concerns about the usefulness and the reliability of the IPTp regimen. We aimed to assess the effectiveness of two doses of SP in treating and preventing occurrence of adverse pregnancy outcomes. Methodology: The study was an analytical cross sectional study which enrolled 350 pregnant women from Kibiti Health Centre, South Eastern Tanzania. Structured questionnaires were used to obtain previous obstetrics and medical history of participants and verified by reviewing antenatal clinic cards. Maternal placental blood samples for microscopic examination of malaria parasites were collected after delivery. Data was analyzed for associations between SP dosage, risk for PM and pregnancy outcome. Sample size was estimated based on precision Results: Prevalence of placental maternal (PM) was 8% among pregnant women (95%CI, 4.4-13.1%). Factors associated with increased risk of PM were primigravidity (P<0.001) and history of fever during pregnancy (P= 0.02). Use of at least 2 doses of SP for IPTp during pregnancy was insignificantly associated with reducing the risk PM (P=0.08), low birth weight (P=0.73) and maternal anemia (P=0.71) but associated significantly with reducing the risk of preterm birth (P<0.001). Conclusion: Two doses of SP for IPTp regime are ineffective in preventing and treating PM and adverse pregnancy outcome. Hence a review to the current IPTp regimen should be considered with possibility of integrating it with other malaria control strategies

Prevalence,awareness and factors associated with hypertension in North West Tanzania.

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

Using participatory action research to empower district hospital staff to deliver quality-assured essential surgery to rural populations in Malawi, Zambia and Tanzania

Background: In 2017 the SURG-Africa project set out to institute a surgical, obstetric, trauma and anesthesia (SOTA) care capacity-building intervention focused on non-specialist providers at district hospitals in Zambia, Malawi and Tanzania. The aim was to scale up quality-assured SOTA care for rural populations. This paper reports the process of developing the intervention and our experience of initial implementation, using a participatory approach. Methods: Participatory Action Research workshops were held in the 3 countries in July–October 2017 and in October 2018–July 2019, involving representatives of key local stakeholder groups: district hospital (DH) surgical teams and administrators, referral hospital SOTA specialists, professional associations and local authorities. Through semi-structured discussions, qualitative data were collected on participants’ perceptions and experiences of barriers to the provision of SOTA care at district level, and on the training and supervision needs of district surgical teams. Data were compared for themes across countries and across surgical team cadres. Results: All groups reported a lack of in-service training to develop essential skills to manage common SOTA cases; use and care of equipment; essential anesthesia care including resuscitation skills; and infection prevention and control. Very few district surgical teams had access to supervision. SOTA providers at DHs reported a demand for more feedback on referrals. Participants prioritized training needs that could be addressed through regular in-service training and supervision visits from referral hospital specialists to DHs. These data were used by participants in an action-planning cycle to develop site-specific training plans for each research site. Conclusion: The inclusive, participatory approach to stakeholder involvement in SOTA system strengthening employed by this study supported the design of a locally relevant and contextualized intervention. This study provides lessons on how to rebalance power dynamics in Global Surgery, through giving a voice to district surgical teams

Critical shortage of capacity to deliver safe paediatric surgery in sub-Saharan Africa: evidence from 67 hospitals in Malawi, Zambia, and Tanzania

IntroductionPaediatric surgical care is a significant challenge in Sub-Saharan Africa (SSA), where 42% of the population are children. Building paediatric surgical capacity to meet SSA country needs is a priority. This study aimed to assess district hospital paediatric surgical capacity in three countries: Malawi, Tanzania and Zambia (MTZ).MethodsData from 67 district-level hospitals in MTZ were collected using a PediPIPES survey tool. Its five components are procedures, personnel, infrastructure, equipment, and supplies. A PediPIPES Index was calculated for each country, and a two-tailed analysis of variance test was used to explore cross-country comparisons.ResultsSimilar paediatric surgical capacity index scores and shortages were observed across countries, greater in Malawi and less in Tanzania. Almost all hospitals reported the capacity to perform common minor surgical procedures and less complex resuscitation interventions. Capacity to undertake common abdominal, orthopaedic and urogenital procedures varied—more often reported in Malawi and less often in Tanzania. There were no paediatric or general surgeons or anaesthesiologists at district hospitals. General medical officers with some training to do surgery on children were present (more often in Zambia). Paediatric surgical equipment and supplies were poor in all three countries. Malawi district hospitals had the poorest supply of electricity and water.ConclusionsWith no specialists in district hospitals in MTZ, access to safe paediatric surgery is compromised, aggravated by shortages of infrastructure, equipment and supplies. Significant investments are required to address these shortfalls. SSA countries need to define what procedures are appropriate to national, referral and district hospital levels and ensure that an appropriate paediatric surgical workforce is in place at district hospitals, trained and supervised to undertake these essential surgical procedures so as to meet population needs

Using participatory action research to empower district hospital staff to deliver quality-assured essential surgery to rural populations in Malawi, Zambia, and Tanzania

BackgroundIn 2017 the SURG-Africa project set out to institute a surgical, obstetric, trauma and anesthesia (SOTA) care capacity-building intervention focused on non-specialist providers at district hospitals in Zambia, Malawi and Tanzania. The aim was to scale up quality-assured SOTA care for rural populations. This paper reports the process of developing the intervention and our experience of initial implementation, using a participatory approach.MethodsParticipatory Action Research workshops were held in the 3 countries in July–October 2017 and in October 2018–July 2019, involving representatives of key local stakeholder groups: district hospital (DH) surgical teams and administrators, referral hospital SOTA specialists, professional associations and local authorities. Through semi-structured discussions, qualitative data were collected on participants’ perceptions and experiences of barriers to the provision of SOTA care at district level, and on the training and supervision needs of district surgical teams. Data were compared for themes across countries and across surgical team cadres.ResultsAll groups reported a lack of in-service training to develop essential skills to manage common SOTA cases; use and care of equipment; essential anesthesia care including resuscitation skills; and infection prevention and control. Very few district surgical teams had access to supervision. SOTA providers at DHs reported a demand for more feedback on referrals. Participants prioritized training needs that could be addressed through regular in-service training and supervision visits from referral hospital specialists to DHs. These data were used by participants in an action-planning cycle to develop site-specific training plans for each research site.ConclusionThe inclusive, participatory approach to stakeholder involvement in SOTA system strengthening employed by this study supported the design of a locally relevant and contextualized intervention. This study provides lessons on how to rebalance power dynamics in Global Surgery, through giving a voice to district surgical teams

Preparedness of health facilities in managing hypertension & diabetes mellitus in Kilimanjaro, Tanzania: a cross sectional study.

BACKGROUND: Hypertension and Diabetes mellitus are risk factors for cardiovascular diseases that cause 17 million deaths globally. Many of these deaths could have been prevented if hypertensive and diabetic patients had their blood pressure and glucose controlled. Less than 30% of hypertensive and diabetic patients on management have controlled their blood pressure and glucose respectively. This study aimed to determine the preparedness of health facilities in managing hypertensive and diabetic patients in terms of personnel; laboratory services provision, and local use of routinely collected data, and shows differences in preparedness between the levels of facilities. METHODS: We conducted a cross-sectional study in Government, faith-based and private health facilities in two districts in Kilimanjaro region in Tanzania from March to July 2017. We collected data through interviews and observations on the preparedness of the facilities for managing hypertension and DM. RESULTS: Forty-three (43) health facilities and 62 healthcare workers (HCW) participated in the survey. Services for hypertension and DM were available in 37 (86%) and 34 (79%) health facilities respectively. Eighteen (53%) and five (15%) facilities had HCW trained on hypertension and DM management respectively within two years preceding the survey. Regular adherence to treatment guideline was reported in 18 (53%) of the health facilities. More than third of health facilities were without basic equipment for managing hypertension and DM. All the recommended laboratory tests were only available in four (15%) hospitals and one health center. Valid first line medicines for both hypertension and DM were available in six (50%) health centers, four (24%) dispensaries and in four (80.0%) hospitals. Health data collection, analysis and local use for planning were reported in all hospitals, nine (75%) health centers and four (24%) dispensaries. CONCLUSIONS: Health facilities are not fully prepared to manage hypertension and DM. Health centers and dispensaries are mostly affected levels of health facilities. Government interventions to improve facility factors and collaborative approaches to build capacity to HCW are needed to enable health facilities be responsive to these diseases

Case Study #9-11 of the Program: ''Food Policy For Developing Countries: The Role Of Government In The Global Food System''

19 pp.©Cornell University, Ithaca, New York. All rights reserved. This case study may be reproduced for educational purposes without express permission but must include acknowledgment to Cornell University. No commercial use is permitted without permission.Migration of health professionals worldwide has resulted in an unequal distribution of medical staff globally. The movement of medical staff out of some developing countries, often termed brain drain, affects the health care system at multiple levels, including both doctors and nurses. Medical staff are leaving their countries because of both push and pull factors. Pull factors include better remuneration and working environment, job satisfaction, and prospects for further education. Push factors include lack of education opportunities, poor working environment, poor infrastructure, and lack of diagnostic equipment. Apart from push and pull factors, the mobility of medical professionals is influenced by their links to the receiving countries. This movement of medical professionals leaves the sending country not only with a shortage of medical professionals, but also increased morbidity and mortality. Without medical personnel, there cannot be timely diagnosis and intervention in the course of disease. Currently there is a global shortage of 4.25 million health care workers, with Sub-Saharan Africa alone in need of more than half of these workers (WHO 2006a). This shortage is fueled in part by the brain drain of medical personnel. As of 2006, Tanzania, with a population of 40 million, had only 1,264 doctors working in the country and 1,356 doctors working abroad. Tanzania will need to triple its number of doctors if it is to achieve the Millennium Development Goals of reducing child mortality and improving maternal health. The crisis of health workers is one of the most significant obstacles to improving the health system in Tanzania and other African countries. The global workforce crisis can be tackled if there is global responsibility, political will, financial commitment, and public-private partnerships for country-led and country-specific interventions that seek solutions beyond the health sector. Only when enough health workers can be trained, sustained, and retained in Sub-Saharan African countries will the region attain the Millennium Development Goals. Your assignment is to advise the government of Tanzania and other developing countries on a policy to attract health workers to clinical settings within their home countries, taking into account the interests of the important stakeholder groups.Cornell University Division of Nutritional Science

Factors Associated with Testing and Prompt Use of Recommended Antimalarials following Malaria Diagnosis: A Secondary Analysis of 2011-12 Tanzania HIV and Malaria Indicator Survey Data.

Malaria is still a public health problem in Sub-Saharan Africa. Malaria causes mortality mostly in children under-five years. Early detection and prompt treatment using recommended antimalarials is key to malaria control. However, in Tanzania, contrary to the national goals, a large proportion of children with fever taken to health facilities are not tested for malaria and those tested positive are not promptly treated using recommended antimalarials. The aim of this study was to determine factors associated with malaria testing and prompt use of recommended antimalarials among under-five children with fever in Tanzania.This was a secondary analysis of Tanzania HIV and Malaria Indicator Survey (THMIS) data 2011-12 obtained from a national cross sectional survey. The analysis involved children aged 6-59 months whose mothers reported they had fever two weeks preceding the survey. Factors associated with testing and uses of recommended antimalarials were obtained using logistic regression.Of the 1675 under-five children with fever, 951 (56.8%) were taken to the health facilities. Of the 951 children, only 394 (41.48%) febrile children were tested for malaria. Of those tested, 291 (78.91%) were diagnosed with malaria. Of those diagnosed with malaria, only 124 (42.68%) children used recommended antimalarials within 1st 24 hours of diagnosis. In multivariate analysis, children taken to health centers (OR 1.79; 95%CI: 1.07-3.00) and to the hospitals (OR 3.4; 95%CI: 1.75-6.77) had higher odds of being tested compared to those taken to dispensary and other lower level health facilities. Children were more likely to use recommended antimalarial promptly if they had a caretaker with secondary or higher education (OR: 4.07; 95%CI: 0.61-2.68) or living in the rural area (OR: 3.21; 95%CI: 1.09-9.44) compared to those with an uneducated caretaker or from an urban area.Training on malaria testing and treatment guidelines should be provided, and preventing stock outs of malaria testing kits and medications at dispensary level should be made available as it is the first point of health care for most Tanzanians. Reasons on why urban people are less likely to use recommended antimalarials need to be investigated and addressed for proper malaria management