The Dangers of Being Old in Rural Tanzania: A Call for Interventions for Strengthening Palliative Care in Low-Income Communities

Tanzania is currently implementing political reforms that, with time, are expected to improve quality of life among individuals regardless of their age. This improvement in quality of life, consequently prolonged life expectancy implies that the aging population will significantly increase in a few years to come. Research projects that the number of people aged 60 years and above will increase from the current 4- percent to 10-percent of the total population by 2050 (United Republic of Tanzania, 2003; Kivelia and Kirway, 2011; Morrissette andWane, 2012). The projected increase suggests that the older population will be at a disadvantage because majority of older people in Tanzania resides in rural areas where financial support and access to social services including Primary Health Care (PHC) services is often limited (Kivelia and Kirway, 2011; Morrissette and Wane, 2012; Sanga, 2013; Musa, 2016). The older population in Tanzania continues to form a significant percentage of people seeking care for chronic diseases in PHC facilities. Reports indicate that older patients (aged 60 years and above) contribute significantly to aging related diseases, for instance, cardiovascular diseases (United Republic of Tanzania, 2007; UNFPA, 2009; Isangula andMeda, 2017). The prevalence of hypertension in Tanzania for example, is much higher among older people as compared to much younger population (Isangula andMeda, 2017).This calls for strong policies that seek to ensure that the older population are well cared for within rural PHC facilities in their final years of life. While aged care institutions are the cornerstone of Western care, similar institutions are lacking in low-income rural African communities. Consequently, older people in rural settings, mostly uneducated, uninsured, unable to work and often charged with the care of grandchildren, continue to rely on sons and daughters (if any) and neighbors to meet their daily socioeconomic needs (Sanga, 2013; Musa, 2016; United Republic of Tanzania, 2007; UNFPA, 2009). This dependency often contributes to persistent limited access to quality nutrition and medical care among the older population when family members lack the financial capacity to support them. This brings us the question of how better we can, as a country, care for our aging population as part of ensuring they enjoy their final years of life. This paper examines the challenges faced by the older population in a low-income rural community of Shinyanga in relation to access to the much-needed palliative care

Improving Women and Family’s Health through Integrated Microfinance, Health Education and Promotion in Rural Areas

While increasing number of women enjoys more freedom and power in urban areas, women in rural areas are at a disadvantage in almost all aspects of life when compared to men. Investing in economic empowerment of women particularly in rural areas by supporting them to implement local context based business ideas and basic finance capacity and skills development may reverse these trends, however, when combined with heath education and promotion through trainings focusing on preventive health yields greater impact. This paper is a systematic review of the peer - reviewed research papers and project reports in English language on how rural women, children and family’s health can be improved through integrating income generation and health education & promotion activities. Generally, integrated microfinance, health education and promotion activities has resulted in significant reduction of intimate-partner violence, reduction in HIV/AIDS risk, promotion of mental health and improved women and family health. The findings may guide the process of designing and planning of integrated programs for sustainable women’s income and family health especially in rural areas

Using theories and models for operationalization of patient trust in doctors in chronic disease response in low income Africa: ‘Best Fit Approach’

Background: Recent evidence suggest that improved patient trust in doctors can facilitate their healthcare seeking, adherence and continuity with care. With the growing burden of chronic disease in low income Africa (LIA) characterized by challenges of poor patient healthcare seeking, non-adherence and poor continuity with care, trust forms an important entry point for addressing these challenges. However, the topic of trust has generally received weaker attention among researchers in LIA contexts. To date, there has been no attempts to generate a clear guide for theory-driven inquiries as a means of operationalization of trust as a public health lens for chronic disease response in LIA. Objective: This paper revisits the ‘Best fit approach’, a potentially useful but less used strategy to offer a step by step guide for systematically identifying theories and models for theory-driven inquiries of trust in patient-provider relationships in LIA. Methods/Design: The ‘Best fit framework analysis’ approach is revisited as a potentially useful in systematically identifying ‘best fit’ theories and models of trust to aid theory-driven inquiries. The paper proposes a step by step guide on how to gather theories and models, use thematic analysis approach for coding of themes from selected theoretical literature and lastly, generating an interview guide for theory-driven research in LIA. Conclusion: The review of existing trust theories and models may facilitate generating useful constructs for developing an interview guide for theory driven research on patient-provider trust in LIA. When data from theory-driven inquiries are analysed, they form an important step in operationalization of trust in therapeutic relationships as a lens for addressing the challenges of chronic diseases in LIA context

Evaluation of Suitability to Mothers of Low Literacy Level of Websites Information on Basics of Baby Bath Using DISCERN Tool

One of the challenges in Newborn care is bathing a baby especially for new parents. Baby bath as part of newborn care is of critical importance for healthier development of a baby. Increasingly, Internet resources have been publishing different information on neonatal care complementing the traditional sources. Internet information is readily available and involve no or minimal cost as far as medical costs are concerns thus new parents with access, may use internet as the main source of baby care information. The purpose of this paper is to evaluate the suitability to mothers of low literacy level, of baby bathing information published on websites using a DISCERN tool

The leaking pocket: The implicit struggle for skilled health workers between private not-for-profit and public sector in Tanzania

Public health services in sub-Sahara Africa countries face severe health workforce shortages exacerbated by both outward migration and internal public to private sector migration—Tanzania is no exception. This review was conducted to characterize the extent of health workforce shortages in Tanzania, and the factors impacting on the shortage. The authors reviewed publicly available data to assess the extent of health workforce shortages within Tanzania and the range of ‘pull’ and ‘push’ factors contributing to the shortages. Findings highlight significant health workforce shortages in Tanzania. Pull factors, the advantages offered that \u27pull\u27 workers towards the new jobs and well as Push factors, those negative factors that push workers out of their jobs, such as poor pay, working conditions, and management and governance issues, were identified. The issue of health workforce flow from the public to private not-for-profit sector was particularly notable and the impact this has on the ability to provide an effectively functioning public health system in Tanzania. The authors conclude that opportunities exist for the private not-for-profit sector to take an active role in the production of skilled human resources for health in Tanzania

Patient trust in doctors in rural Tanzania: meanings, factors and benefits in the context of NCDs and hypertension care

Noncommunicable diseases (NCDs) are becoming a major public health challenge in low-income countries. Different strategies have been implemented to alleviate the burden of NCDs, but service uptake, compliance and continuing engagement with care remain suboptimal. This thesis investigated patient trust in doctors to establish whether it could form part of the NCD response in low-income African countries. To date, most studies on this issue have been conducted in high-income countries. This thesis provides much needed evidence around trust by exploring: the meaning of patient trust in doctors; what factors shape trust; and whether trust matters in hypertension care in rural Tanzania. Semi-structured interviews were conducted in Swahili with 36 patients and eight providers. Participants were drawn from Western and traditional healing practices. Interviews were concurrently translated and transcribed, then systematically coded to facilitate the development of themes. The findings show that participants’ understanding of trust related to: patient expectations of a doctor before an encounter, patient satisfaction with the doctors’ actions and behaviours during encounters and their post-encounter satisfaction with health outcomes associated with the doctor’s treatment. Factors shaping trust in this rural Tanzanian context can be classified as patient, provider and health system factors. Novel factors identified were patients’ faith in medications, patients’ expectations of hypertension cure and the interplay between Western and traditional systems. Participants suggested that trust mattered in hypertension care in rural Tanzania because of its benefits in facilitating patient healthcare seeking, disclosure, adherence, return for subsequent hospital care, and reduced financial burden. Trust also matters because it benefited doctors by increasing their reputation and work morale, and benefited hospitals by improving their reputation and income. The interviews also revealed a range of potential disadvantages of trust, including increased patients’ vulnerability to malpractice, inflated self-pride among doctors and increased workload. This thesis establishes the value of improving patient trust in doctors as a means of increasing patient healthcare service uptake, adherence and continuity with hospital care for NCD response. The thesis offers context-specific considerations, and practice and policy recommendations for developing strategies to improve patient trust in doctors in low-income African countries

HIV Testing for PMTCT in Tanzania: Time to move from ‘Voluntary’ to ‘Mandatory’?

Introduction: Every year many infants are infected with HIV, mostly in sub Saharan Africa. This is predominantly attributed to mother-to-child or “vertical” transmission during pregnancy, labor and delivery, and breastfeeding. Advances in antiretroviral therapy (ART) and funding have made the prevention of mother-to-child transmission (PMTCT) of HIV more affordable in sub-Saharan Africa. However, despite this advance and its potential in PMTCT, the uptake of HIV testing among pregnant women as an entry point to PMTCT services remains unsatisfactory in many countries. Methods & Results: In the present paper, authors’ present a viewpoint that supports mandatory HIV testing for pregnant women and argue that a mandatory HIV testing policy should be adopted in Tanzania. The ongoing debate about implementing mandatory pregnant women is discussed in terms of a parental obligation towards protecting a newborn child. Evidence for mandatory HIV testing in prisons e.g. for prostitution related crimes and sexual offenses, as well which the legal framework in Tanzania could support mandatory testing is discussed. Conclusion: Authors’ highlight how a national policy of mandatory HIV testing will increase the enrollment of pregnant women into PMTCT services, minimize the risk of HIV transmission to newborn children, improve health outcomes for both parents and children, and contribute to reducing the burden on limited health )resources

Nurses\u27 preparedness for disaster response in rural and urban primary healthcare settings in Tanzania

Introduction: Nurses are often on the frontline of disaster management, providing care to patients with emerging physical, mental, and emotional turbulence, and acting as educators for health promotion and disaster prevention in both rural and urban contexts. However, the literature suggests that nurses are inadequately prepared for disaster response. This study examined preparedness for disaster response among nurses in rural and urban primary healthcare settings in Tanzania. Methods: This qualitative descriptive study involved purposefully selected qualified nurses and nurse administrators working in rural (n=20) and urban (n=11) primary healthcare facilities in Tanzania. Telephone-based interviews were conducted to gather data that were then analyzed thematically. Results: Five themes emerged from the analysis: previous experiences, technical capacity, current strategies, challenges, and overall preparedness. Previous experiences included personally caring for victims, working in disaster response teams, working in administrative roles during disasters, and conducting community sensitization. Most nurses in rural contexts had not received training on disaster response and relied on past experience, knowledge from nursing school, observing peers, and knowledge from the internet and movies. Current strategies for disaster response included response teams (although these were considered ‘weak’), ensuring the availability of equipment and supplies, and infrastructure for victim management. Challenges in disaster response included inadequate resources, understaffing, lack of expertise at primary healthcare facilities, nurses tasked with multiple responsibilities, inadequate technical capacity, fears of infection, poor interpersonal relationships, inadequate community knowledge, poor reporting systems, delayed healthcare seeking, long distances to facilities, and poor road infrastructure. These challenges were more pronounced in rural settings. Most nurses felt they were well prepared to respond to disasters, although this appeared to be rooted in a willingness to provide care rather than having adequate knowledge, skills, and resources for disaster response. Suggestions for better preparing nurses for disaster response included training, increasing essential equipment and medical supplies, increasing the nursing workforce, improving reporting systems, disseminating local guidelines, strengthening disaster response teams, and improving the nursing training curricula to cover disaster management. Conclusion: A range of institutional, individual, and community challenges affect nurses’ preparedness for disaster response in rural and urban primary healthcare settings. Addressing these challenges requires multiple strategies that extend beyond the capacity building of nurses to strengthen health system disaster preparedness in general, prioritizing rural contexts

Knowledge about continuous positive airway pressure machine usage among nurses at a tertiary hospital in Tanzania

Introduction: Continuous Positive Airway Pressure (CPAP) provides an air pressure that maintains the patency of the airway in patients with a variety of breathing problems. Nurses provide the hour to hour management of patients who require CPAP. The aim of this study was to assess the knowledge of nurses about CPAP machine usage at the tertiary hospital in Tanzania which serves the largest number of patients who require CPAP. Method: A hospital-based descriptive cross-sectional study was carried out from March to June 2019 at Muhimbili National Hospital (MNH) and Jakaya Kikwete Cardiac Institute (JKCI) where 149 nurses who consented to participate were recruited. Data were collected using structured questionnaires and analysed using a statistical package for social sciences (SPSS) version 20. P-value\u3c0.05 was considered to be statistically significant. Results: Of the149 nurses recruited 80(53.7%) were female and 69 (46.3%) were male; 99 (66.4.%) were aged 26-35 years; 78 (52.3%) had a diploma in nursing as the highest level of education and 138 (93.9%) had work experience of less than ten years. Forty five percent of nurses had moderate knowledge about CPAP machine usage. High and moderate level of knowledge among nurses about CPAP general information each equally accounted for 38.9% and poor level of knowledge accounted for 2.7%. Moreover, moderate level of knowledge about CPAP device contraindications accounted for 43% whilst poor knowledge attributed 8.7%. There was no significant association between nurses’ knowledge and their socio-demographic characteristics. Conclusion: Just under half of the nurses had moderate knowledge of CPAP device use and most of them had attended only a single training session on CPAP device use and the range of time from training until completing questionnaires was at least six months. Regular training on CPAP machine usage should be provided to nurses since they are in the front line in management of patients requiring CPAP

What factors shape doctors’ trustworthiness? Patients’ perspectives in the context of hypertension care in rural Tanzania

Introduction: There is increasing evidence that improving patient trust in doctors can improve patients’ use of healthcare services, compliance and continuing engagement with care –particularly for chronic diseases. Consequently, much of the current literature on trust in therapeutic relationships focuses on factors shaping doctors’ trustworthiness. However, few studies on this issue have been conducted among rural populations in low-income Africa, where health service delivery, cultural norms and patient expectations differ from those in high-income countries. This study examined patients’ perspectives of factors that shape doctors’ trustworthiness in rural Tanzania in the context of hypertension care. Methods: A qualitative inquiry using in-depth interviews was conducted between 2015 and 2016 in two characteristically rural districts of Tanzania. Data were analysed thematically. Results: The accounts of 34 patients from a Western-based care setting were examined. There was broad consensus about factors shaping doctors’ trustworthiness along the care trajectory (before, during and after a therapeutic encounter). Two major themes emerged: doctors’ interpersonal behaviours and doctors’ technical competence. Good interpersonal behaviour and technical skills in healthcare settings were factors that constructed a positive reputation in the community and shaped patients’ initial trust before a physical encounter. Doctors’ interpersonal behaviours that portrayed good customer care, understanding and sympathy shaped trustworthiness during a physical encounter. Finally, doctors’ technical competence shaped trustworthiness during and after an encounter. Participants used these factors to differentiate a trustworthy (‘good’) doctor from an untrustworthy (‘bad’) doctor. Conclusion: Good interpersonal behaviours and good technical skills are important in shaping patients’ judgements of doctors’ trustworthiness in rural Tanzania. The present findings provide useful insights for designing interventions to improve patient trust in doctors to address challenges associated with non-communicable diseases in rural low-income Africa