Short inter-pregnancy interval: why is it still high among women in Dar es Salaam?

Introduction: in Tanzania, for the past decade, there has been a rising trend of women with short inter-pregnancy interval (IPI) (16% to 19%). Short IPI is associated with poor maternal and neonatal outcomes. We aimed to determine the factors associated with short IPI among women attending antenatal clinic (ANC) at Mnazi Mmoja Hospital, Dar es Salaam, Tanzania. Methods: a cross-sectional study was conducted in September 2018 at Mnazi Mmoja hospital among women receiving ante-natal care. A total of 530 women were included in the analysis. Analysis was conducted through SPSS version 24 computer program using descriptive analyses to determine the IPI and characteristics thereof, and logistic regression analysis to examine factors associated with IPI among pregnant women. Associations with a p-value < 0.05 were considered statistically significant. Results: twenty-two percent of the women attending ANC in Mnazi Mmoja hospital had short IPI. Short IPI was associated with young(<25years) age (AOR=2.67, 95% CI=1.23-5.79); non-use of a contraceptive method (AOR=2.05, 95%CI=1.22-3.45); breastfeeding for less than 6 months (AOR=3.45,95% CI=1.17-10.13) and having an antecedent dead child at the time of index conception (AOR=3.38,95% CI=1.15-9.93). Conclusion: about 1 in every 5 women attending ANC in Dar es Salaam had a short IPI. Addressing short IPI will complement the government´s efforts to improve maternal indicators in Tanzania and areas with similar contexts. Such efforts should emphasize in adherence to recommended infant feeding practices, women at a younger reproductive age group, those with a history of pregnancy loss, and strengthening contraception use among women of reproductive age

National Non-Communicable Diseases Conferences- A Platform to Inform Policies and Practices in Tanzania

Background: Non-communicable diseases (NCDs) arise from diverse risk factors with differences in the contexts and variabilities in regions and countries. Addressing such a complex challenge requires local evidence. Tanzania has been convening stakeholders every year to disseminate and discuss scientific evidence, policies, and implementation gaps, to inform policy makers in NCDs responses. This paper documents these dissemination efforts and how they have influenced NCDs response and landscape in Tanzania and the region. Methods: Desk review was conducted through available MOH and conference organizers’ documents. It had both quantitative and qualitative data. The review included reports of the four NCDs conferences, conference organization, and conduct processes. In addition, themes of the conferences, submitted abstracts, and presentations were reviewed. Narrative synthesis was conducted to address the objectives. Recommendations emanated from the conference and policy uptake were reviewed and discussed to determine the impact of the dissemination. Findings: Since 2019, four theme-specific conferences were organized. This report includes evidence from four conferences. The conferences convened researchers and scientists from research and training institutions, implementers, government agencies, and legislators in Tanzania and other countries within and outside Africa. Four hundred and thirty-five abstracts were presented covering 14 sub-themes on health system improvements, financing, governance, prevention intervention, and the role of innovation and technology. The conferences have had a positive effect on governments’ response to NCDs, including health care financing, NCDs research agenda, and universal health coverage. Conclusion: The National NCDs conferences have provided suitable platforms where stakeholders can share, discuss, and recommend vital strategies for addressing the burden of NCDs through informing policies and practices. Ensuring the engagement of the right stakeholders, as well as the uptake and utilization of the recommendations from these platforms, remains crucial for addressing the observed epidemiological transition in Tanzania and other countries with similar contexts

Increasing prevalence of overweight and obesity among Tanzanian women of reproductive age intending to conceive: evidence from three Demographic Health Surveys, 2004-2016

# Background The prevalence of people who are overweight or obese is increasing globally, especially in low- and middle-income countries. High body mass index (BMI) among women of reproductive age is a risk factor for various adverse reproductive and pregnancy outcomes. This study aims to describe trends over time in the distribution of BMI among Tanzanian women of reproductive age intending to conceive between 2004/5 and 2015/16, and identify factors associated with high BMI. # Methods We used data on 20,819 women of reproductive age (15-49 years) intending to conceive who participated in the Tanzania Demographic and Health Surveys in 2004/5, 2010 and 2015/16. We estimated the prevalence of high BMI (being overweight \[≥25 to <30 kg/m^2^] and obesity \[≥30kg/m^2^) and trends in the prevalence of high BMI across the three surveys. Using survey-weighted multivariable logistic regression, we used the most recent 2015/16 survey data to identify factors associated with high BMI. # Results Median BMI increased from 21.7kg/m^2^ (inter-quartile range, IQR=19.9-24.1 kg/m^2^) in 2004/5 to 22.0 kg/m^2^ (IQR=20.0-24.8 kg/m^2^) in 2010 to 22.7 kg/m^2^ (IQR=20.4-26.0 kg/m^2^) in 2015/16. The prevalence of overweight women increased from 11.1% in 2004/5 to 15.8% in 2015 (P <0.001). The prevalence of obesity increased from 3.1% in 2004/5 to 8.0% in 2015/16 (P<0.001). Women in the highest wealth quintile had higher odds (adjusted odds ratio, aOR= 4.5; 95%CI 3.4-6.3, P<0.001) of high BMI than women in the lowest quintile. The odds of high BMI were about four times greater (aOR=3.9; 95%CI=2.9-5.4, P<0.001) for women 40-44 years compared to 20–24-year-olds. Women in the high-paying occupations had greater odds of high BMI than those working in agriculture (aOR=1.5; 95% CI=1.1-2.2, P=0.002). Women residing in the Southern zone had 1.9 (95%CI=1.5-2.5, P<0.001) greater odds of high BMI than Lake zone residents. # Conclusions In Tanzania, high BMI affects almost 1 in 4 women of reproductive age who intend to conceive. This contributes to the burden of poor maternal and reproductive health outcomes. We recommend developing and implementing health-system strategies for addressing high BMI, tailored to the modifiable risk factors identified among women of reproductive age

Non-communicable Diseases Week: Best Practices in Addressing the NCDs Burden from Tanzania

Background: Five million people die every year from non-communicable diseases (NCDs) globally. In Tanzania, more than two-thirds of deaths are NCD-related. The country is investing in preventive and advocacy activities as well as interventions to reduce the burden. Of particular interest, the Ministry of Health (MoH) commemorates NCDs’ week using a multisectoral and multi-stakeholders’ approach. This paper highlights activities conducted during NCDs week with the aim of sharing lessons for other countries with similar context and burdens. Methods: A thorough review of official reports and the national strategic plans for NCDs was done including the 2020 and 2021 National NCDs’ week reports, the National Strategic Plan for NCDs 2015–2020, and the National NCDs agenda. Findings: NCDs week is commemorated annually throughout the country involving the five key activities. First, community awareness and participation are encouraged through media engagement and community-based preventive and advocacy activities. Second, physical activities and sports festivals are implemented with a focus on developing and renovating infrastructures for sports and recreation. Third, health education is provided in schools to promote healthy behaviors for secondary school adolescents in transition to adulthood. Fourth, health service provision and exhibitions are conducted involving screening for hypertension, diabetes, obesity, alcohol use, and physical activities. The targeted screening of NCDs identified 10% of individuals with at least one NCD in 2020. In 2021, a third of all screened individuals were newly diagnosed with hypertension, and 3% were found to have raised blood glucose levels. Fifth, the national NCDs scientific conferences conducted within the NCDs week provide an avenue for stakeholders to discuss scientific evidence related to NCDs and recommend strategies to mitigate NCDs burden. Conclusion: The initiation of NCDs week has been a cornerstone in advocating for NCDs control and prevention in the country. It has created awareness on NCDs, encourage healthy lifestyles and regular screening for NCDs. The multi-stakeholder and multi-sectoral approaches have made the implementation of the mentioned activities feasible and impactful. This has set an example for the united efforts toward NCD control and prevention at national, regional, and global platforms while considering contextual factors during adoption and implementation

A mixed-methods study of maternal health care utilisation in six referral hospitals in four sub-Saharan African countries before and during the COVID-19 pandemic.

INTRODUCTION: In sub-Saharan Africa, referral hospitals are important sources of key maternal health services, especially during a crisis such as the COVID-19 pandemic. This study prospectively assessed the effect of the COVID-19 pandemic on maternal health service utilisation in six large referral hospitals in Guinea, Nigeria, Tanzania and Uganda during the first year of the pandemic. METHODS: Mixed-methods design combining three data sources: (1) quantitative data based on routine antenatal, childbirth and postnatal care data collected March 2019-February 2021, (2) qualitative data from recurring rounds of semi-structured interviews conducted July 2020-February 2021 with 22 maternity skilled heath personnel exploring their perceptions of service utilisation and (3) timeline data of COVID-19 epidemiology, global, national and hospital-level events. Qualitative and quantitative data were analysed separately, framed based on the timeline analysis and triangulated when reporting. RESULTS: Three periods including a first wave, slow period and second wave were identified. Maternal health service utilisation was lower during the pandemic compared with the prepandemic year in all but one selected referral hospital. During the pandemic, service utilisation was particularly lower during the waves and higher or stable during the slow period. Fear of being infected in hospitals, lack of transportation, and even when available, high cost of transportation and service closures were key reasons affecting utilisation during the waves. However, community perception that the pandemic was over or insinuation by Government of the same appeared to stabilise use of referral hospitals for childbirth. CONCLUSION: Utilisation of maternal health services across the continuum of care varied through the different periods and across countries. In crisis situations such as COVID-19, restrictions and service closures need to be implemented with consideration given to alternative options for women to access and use services. Information on measures put in place for safe hospital use should be communicated to women

A mixed-methods study of maternal health care utilisation in six referral hospitals in four sub-Saharan African countries before and during the COVID-19 pandemic

Introduction In sub-Saharan Africa, referral hospitals are important sources of key maternal health services, especially during a crisis such as the COVID-19 pandemic. This study prospectively assessed the effect of the COVID-19 pandemic on maternal health service utilisation in six large referral hospitals in Guinea, Nigeria, Tanzania and Uganda during the first year of the pandemic. Methods Mixed-methods design combining three data sources: (1) quantitative data based on routine antenatal, childbirth and postnatal care data collected March 2019–February 2021, (2) qualitative data from recurring rounds of semi-structured interviews conducted July 2020–February 2021 with 22 maternity skilled heath personnel exploring their perceptions of service utilisation and (3) timeline data of COVID-19 epidemiology, global, national and hospital-level events. Qualitative and quantitative data were analysed separately, framed based on the timeline analysis and triangulated when reporting. Results Three periods including a first wave, slow period and second wave were identified. Maternal health service utilisation was lower during the pandemic compared with the prepandemic year in all but one selected referral hospital. During the pandemic, service utilisation was particularly lower during the waves and higher or stable during the slow period. Fear of being infected in hospitals, lack of transportation, and even when available, high cost of transportation and service closures were key reasons affecting utilisation during the waves. However, community perception that the pandemic was over or insinuation by Government of the same appeared to stabilise use of referral hospitals for childbirth. Conclusion Utilisation of maternal health services across the continuum of care varied through the different periods and across countries. In crisis situations such as COVID-19, restrictions and service closures need to be implemented with consideration given to alternative options for women to access and use services. Information on measures put in place for safe hospital use should be communicated to women

‘We are not going to shut down, because we cannot postpone pregnancy’: a mixed-methods study of the provision of maternal healthcare in six referral maternity wards in four sub-Saharan African countries during the COVID-19 pandemic

Introduction Referral hospitals in sub-Saharan Africa are located in crowded urban areas, which were often epicentres of the COVID-19 pandemic. This paper prospectively assesses how maternal healthcare was provided in six referral hospitals in Guinea, Nigeria, Tanzania and Uganda during the first year of the COVID-19 pandemic. Methods Mixed-methods design using three data sources: (1) qualitative data from repeated rounds of semi-structured interviews conducted between July 2020 and February 2021 with 22 maternity skilled heath personnel (SHP) on perceptions of care provision; (2) quantitative monthly routine data on caesarean section and labour induction from March 2019 to February 2021; and (3) timeline data of COVID-19 epidemiology, national and hospital-level events. Qualitative and quantitative data were analysed separately, framed based on timeline analysis, and triangulated during reporting. Results We identified three periods: first wave, slow period and second wave. The first wave was challenging for SHP given little knowledge about COVID-19, lack of infection prevention and control training, and difficulties reaching workplace. Challenges that persisted beyond the first wave were shortage of personal protective equipment and no rapid testing for women suspected with COVID-19. We noted no change in the proportion of caesarean sections during the pandemic, and a small increase in the proportion of labour inductions. All hospitals arranged isolation areas for women suspected/confirmed with COVID-19 and three hospitals provided care to women with suspected/confirmed COVID-19. Breastfeeding was not discouraged and newborns were not separated from mothers confirmed with COVID-19. Care provision was maintained through dedication of SHP, support from hospital management and remote communication between SHP. Conclusion Routine maternal care provision was maintained in referral hospitals, despite first wave challenges. Referral hospitals and SHP contributed to guideline development for pregnant women suspected/confirmed with COVID-19. Maternity SHP, women and pregnancy must always be included in priority setting when responding to health system shocks, including outbreaks

Low Use of Long-Acting Reversible Contraceptives in Tanzania: Evidence from the Tanzania Demographic and Health Survey

We aimed to determine the prevalence and factors associated with the use of long-acting reversible contraceptives (LARCs) among women of reproductive age in Tanzania. We analyzed the Tanzania Demographic and Health Survey (DHS) data from 2015 to 2016. The study included 8189 women aged 15&ndash;49 years. The relationship between various factors and LARC use was determined through various analyses. Among women with a partner/husband, 7.27% used LARCs, 21.07% were grand multiparous, and 20.56% did not desire more children. Women aged 36&ndash;49 years (adjusted odds ratio (AOR)-2.10, 95% confidence interval (CI): 1.11&ndash;3.96), who completed secondary education (AOR-1.64, 95% CI: 1.05&ndash;2.55), who did not desire more children (AOR-2.28, 95% CI: 1.53&ndash;3.41), with a partner with primary level education (AOR-2.02, 95% CI: 1.34&ndash;3.02), or living in richer households (AOR-1.60, 95% CI: 1.12&ndash;2.27) were more likely to use LARCs. Further, women with a partner who wanted more children were less likely to use LARCs (AOR-0.69, 95% CI: 0.54&ndash;0.90). Tanzania has a low LARC usage rate. Women&rsquo;s age, wife and partner&rsquo;s education status, couple&rsquo;s desire for more children, and household wealth index influenced the use of LARCs, highlighting the need to reach more couples of lower socioeconomic status to improve LARC utilization

Indications for Caesarean Section for women of low obstetric risk - an audit

Introduction: The Caesarean Section (CS) rate is dramatically increasing across obstetric populations. This study aimed to determine the adherence to criteria for standard diagnosis of the common indications for CS among women of a low-risk group. This group, known as group 3 in the Robson classification, is multiparous, term with singleton pregnancy and have not had a previous CS. Methods: We conducted a cross-sectional study at Muhimbili National Hospital from August to December 2018. The criteria for standard diagnosis of foetal distress, obstructed labour, arrested labour and cephalopelvic disproportion were adopted from peer groups publications based on local expert consensus. Data were analysed using a statistical package for social sciences (SPSS) version 20. Results: A total of 1,670 emergency CS’s were performed during the study period, 392 (23.5%) were women of Robson group 3, of these women 101 (25.8%) had foetal distress, 92 (23.5%) obstructed labour, 88 (22.4%) arrested labour and 64 (16.4%) cephalopelvic disproportion. The proportion of CS’s which met the criteria for standard diagnosis of indications for CS were 61.4% foetal distress, 52.2% obstructed labour, 58% arrested labour, and 45.3% CPD with total average of 55.1%. Conclusion: Generally, the standard criteria for audited indications of CS have been met by 55.1% during the study period. Thus, follow up, on the job training and updating about adherence to standard criteria for best practice are recommended

Labour outcomes among low-risk women using WHO next-generation partograph versus WHO composite partograph: A quasi-experimental study

Background: Partogram is an important tool in the management of labor and delivery. Its correct use, has been shown to decrease maternal and newborn adverse events including deaths. In Tanzania, composite partograph is used as a standard of care. Recently, the World Health Organization (WHO) released Labour Care Guide (LCG), a next generation partograph which emphases on woman centered care. This study aimed to compare maternal and newborn outcomes among low-risk pregnant women who were monitored by using WHO LCG versus those who were monitored by using composite partograph. Methodology: This Quasi Experimental Study on LCG, was conducted at Mnazi Mmoja and Vijibweni hospitals in Dar es salaam, Tanzania. The following outcomes were compared as depicted in the WHO quality of care framework: mode of delivery, Post-Partum Hemorrhage, labour augmentation, duration of labor, maternal death, APGAR, admission to Neonatal Intensive Care Unit and perinatal death. Statistical analysis was done by using Statistical Package for Social Sciences. Stepwise logistic regression was done to identify factors associated with dichotomous outcomes. Adjusted Odds Ratio, and 95% confidence interval were used to present the results.P value \u3c0.05 was considered significant Results: A total of 482 women were enrolled; 241 in the intervention and 241 in the comparison group. There was no difference regarding maternal and newborn outcomes among women in the two study groups; Post-Partum Hemorrhage (p=0.69), Perineal trauma (p=0.65) and maternal death; APGAR score at 5 minutes (p=0.41), need for NICU admission (p= 0.80) and perinatal death (p=0.33). Parity of 3 and above was associated with better maternal outcome AOR= 3.05, 95%CI:1.40- 6.65; p=0.005 while augmentation of labour was associated with less chances of better maternal outcome AOR=0.33,95% CI: 0.16- 0.68: p= 0.003. Cesarean section was ssociated with less chances of better maternal outcome AOR=0.33,95% CI: 0.16- 0.68: p= 0.003. Cesarean section was associated with poor newborn outcome AOR= 0.43, 95% CI: 0.19- 0 .96; p=0.04. Conclusion: From this study, monitoring labour in low-risk women using WHO LCG had similar maternal and newborn outcome when compared with use of a composite partograph.Large studies powered to compare maternal and newborn outcomes including high risk pregnant women in busy labour ward are highly recommended