Factors for change in maternal and perinatal audit systems in Dar es Salaam hospitals, Tanzania

<p>Abstract</p> <p>Background</p> <p>Effective maternal and perinatal audits are associated with improved quality of care and reduction of severe adverse outcome. Although audits at the level of care were formally introduced in Tanzania around 25 years ago, little information is available about their existence, performance, and practical barriers to their implementation. This study assessed the structure, process and impacts of maternal and perinatal death audit systems in clinical practice and presents a detailed account on how they could be improved.</p> <p>Methods</p> <p>A cross sectional descriptive study was conducted in eight major hospitals in Dar es Salaam in January 2009. An in-depth interview guide was used for 29 health managers and members of the audit committees to investigate the existence, structure, process and outcome of such audits in clinical practice. A semi-structured questionnaire was used to interview 30 health care providers in the maternity wards to assess their awareness, attitude and practice towards audit systems. The 2007 institutional pregnancy outcome records were reviewed.</p> <p>Results</p> <p>Overall hospital based maternal mortality ratio was 218/100,000 live births (range: 0 - 385) and perinatal mortality rate was 44/1000 births (range: 17 - 147). Maternal and perinatal audit systems existed only in 4 and 3 hospitals respectively, and key decision makers did not take part in audit committees. Sixty percent of care providers were not aware of even a single action which had ever been implemented in their hospitals because of audit recommendations. There were neither records of the key decision points, action plan, nor regular analysis of the audit reports in any of the facilities where such audit systems existed.</p> <p>Conclusions</p> <p>Maternal and perinatal audit systems in these institutions are poorly established in structure and process; and are less effective to improve the quality of care. Fundamental changes are urgently needed for successful audit systems in these institutions.</p

Factors associated with child sexual abuse in Tanzania: a qualitative study

Background: Child sexual abuse (CSA) is one of the most pervasive occurrences which are reported all over the world. It often goes unnoticed and undocumented due to surrounding taboos; its sensitivity in nature and affects the less powerful population. Anecdote information is available on the nature and extent of sexual abuse among children in Tanzania. The aim of this study was to explore factors, forms, context of abuse and perpetrators of child sex abuse in selected regions of Tanzania.Methods: Key informant interviews were conducted among adults including parents of the victims to explore factors associated with sexual abuse of children under 10 years old in Tanzania. The interview guide centred on factors for child sexual abuse, the type of perpetrators and the context into which these abuses take place.Results: There were incidences of child sexual abuse in Tanzania and the major forms were anal and vaginal penetration, and the most affected were girls. The abuses were rarely reported due to shame and embarrassment faced by the affected children and parents. The causes of child sexual abuse were poverty, ambitions and moral degradation, myths and beliefs, urbanization, foreign culture and poor parental care. Incidents of CSA were reported to occur in perpetrators’ homes and in semi-finished housing structures, madrassa and recreational venues where children can freely access entertainment by watching movies. These acts were committed by people in position of power, close relationship and trusted by the children. Contexts where child sexual abuses occur included overcrowded living spaces and social activities that go on late into the night.Conclusion: We recommend for strengthened interventions at different levels within the society to address the root causes and different contexts in which child sex abuse occurs. Increased awareness of the root causes should go hand in hand with measures to encourage parents and survivors to report incidents to relevant authorities timely as they occur

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Child sexual abuse in urban Tanzania : possibilities and barriers for prevention

Background: Child sexual abuse is a global public health and human rights concern. Despite beinga crime in most countries, and with well-known physical and mental health consequences, the majority of sexual offences are not reported. Child sexual abuse is a maltreatment form characterized by contact or non-contact acts perpetrated by adults or older children toward younger children who have little power to resist. This thesis aims to understand the social context of child sexualabuse, and the perceived roles of parents, community, and key professionals in handling such incidents in urban Tanzania. Methods: A combination of qualitative and quantitative research designs were applied to four sub-studies performed in Temeke district, Dar es Salaam. Qualititative content analysis was conducted on 23 in-depth interviews to describe the perceptions of key professionals and their experiencesof handling cases of child sexual abuse, in addition, eight in-depth interviews with parents to capture their experiences of legal reporting of child sexual abuse incidents. Grounded theory was used to analyse 13 focus group discussions held with male and female community members to explore norm systems and community awareness related to child sexual abuse. Findings from these exploratory sub-studies paved the way for a school survey among 1359 students from 23 randomly selected secondary schools. Using descriptive statistics and multivariate regression analyses, prevalence, risk factors, and health consequences of child sexual abuse were estimated. Results: Lack of working tools and financial support were perceived as major problems among the key professionals. Corruption at community and institutional levels was seen as jeopardizing justice. Community passivity and lack of knowledge about laws regulating sexual offences were identifiedas additional challenges for conducting fair investigations. The community perspective illustrated that children’s rights were challenged by lack of agency. Community awareness about child sexual abuse was clear but there was also a lack of trust in that the healthcare and legal systems were capable of handling such cases. Myths and cultural beliefs justified abuse. Disclosure of abuse was threatened by fear of stigma and discrimination. Parental interviews identified four types of sexual abuse incidents. The type most strongly associated with a determination to seek justice was one with an innocent child. The youth who was forced into sex elicited feelings of parental betrayal. The consenting, curious youth created uncertainty in how to proceed, while the transactional sex youth evoked feelings of parental powerlessness. Shame and stigma, but also fear of perpetrator retaliation and breach of confidentiality, were seen as challenges for disclosure. The school survey showed that 28% (boys=30%, girls=26%) of the students were exposed to child sexual abuse, with boys more often affected than girls. Twenty-six per cent of boys and 19% of girls reported being forced to look at pornography. Forced sexual intercourse was experienced by 9.8% of boys and 8.7% of girls. Abuse increased with age and diminished self-rated health. Perpetrators were most often neighbours, teachers and peers. In contrast, survivor confidants were most often teachers, family members and friends. Most survivors did not want any action taken for the abuse. Proportions of students who perceived having fair/poor health increased with severity of abuse comparing the none-abused (7.0% and 6.3% of boys and girls respectively) with the ever abused (26% and 41% of boys and girls respectively) and those reporting penetrative sex (35% and 53% of boys and girls respectively). Likewise, suicidal ideation and attempts increased with severity of abuse when compared with those not abused. Conclusions and recommendations: Sexual abuse of children poses a devastating social, and public health challenge. In Tanzania neither the community nor the health or legal institutions are adequately prepared to handle these cases. Educating the community, economically empowering women and strengthening the medico-legal system are needed to increase the opportunity for human,legal and fair investigations and reactions. A national child protection system is needed to address the complexities of abuse at different levels and to safeguard the rights of children in Tanzania

Seroprevalence of Hepatitis B surface antigen and associated factors among pregnant women attending clinic at Mafiga health center, Morogoro, 2014.

Background: Hepatitis B virus (HBV) infection is one of the global public health problem; estimated to affect 400 million individuals, chronically infected, which results in nearly 1 million deaths each year from cirrhosis or hepatocellular carcinoma. Tanzania is one of the sub-Saharan countries with high endemicity levels with seroprevalence of HBs Ag among pregnant women varying between 4 to 6%Objective. To determine seroprevalence of Hepatitis B and associated factors among antenatal women attending clinic at Mafiga health centre, MorogoroMethodology: This is a cross-sectional study conducted at the antenatal clinic at Mafiga health centre between 16 June and 15 July 2014. A structured questionnaire was used and blood specimen was collected for screening of HBs Ag, syphilis and HIV antibodies by using commercial rapid test. Ethical clearance and informed consent were obtained prior to the enrolment in the study.Results:- A total of 252 pregnant women were recruited and the HBV seroprevalence was 3.6%, while seroprevalence of HIV and syphilis were 4.1% and 3.1%, respectively. One (14.3%) had HBV and syphilis The HBs Ag/Syphilis coinfection prevalence was 11.1% which was the same as the HBs Ag/HIV. The risk factors for HBV were age group 35-39 yrs, married and multiple partners.Conclusions: The prevalence of HBs Ag among women of child bearing age suggests that vertical transmission of HBV continue to be a public health problem in Mafiga Health Centre’s catchment population. There is need for having in place mechanism for control of vertical transmission of the disease

Parents' Experiences of Reporting Child Sexual Abuse in Urban Tanzania

This article reports parental experiences of legally reporting child sexual abuse in Tanzania. Based on in-depth interviews, four types of sexual abuse incidents are portrayed. Each evokes different reactions from parents and the community. An incident characterized as the innocent child was associated with a determination to seek justice. The forced-sex youth elicited feelings of parental betrayal of their child. The consenting curious youth resulted in uncertainty of how to proceed, while the transactional-sex youth evoked a sense of parental powerlessness to control the child because of low economic status. Differentiating between types of sexual abuse incidents may increase awareness of the complexities of child sexual abuse reporting. Education on laws regulating sexual offenses and a functional national child protection system are needed to address child sexual abuse complexities and safeguard the rights of children in Tanzania

Child sexual abuse and possible health consequences among secondary school students in urban Tanzania

Background: Child sexual abuse (CSA) is a global public health concern especially in developed countries and where legal measures take unprecedented time. The aim of this study was to estimate the prevalence of different forms of CSA, and the perceived health consequences among secondary school students in Tanzania.Methods: A cross-sectional survey was performed in Dar es Salaam using a random sample of 15 public and 8 private schools, each having participants from one randomly selected class. A self-administered questionnaire was supervised by research assistants to collect data and. Multivariate logistic regression analysis was used to identify CSA risk factors the perceived health consequences.Results: A total of 827 girls (61%) and 532 boys (39%) with a median age of 16 years participated. Those who experienced at least one incident of sexual abuse in their life time.were 376 (27.7% n=1359). Prevalence of any CSA and forced penetrative sex among boys and girls was 26% and 30% and 8.7% and 9.8% respectively. Of those exposed to CSA, 20% were exposed at least four times..Conclusions: CSA constitutes a public health problem in Tanzania. Awareness of sexual abuse incidents and associated health consequences need to be introduced to respective teaching curricul

Child Sexual Abuse: Community Concerns in Urban Tanzania

The aim of this study was to explore community perceptions about child sexual abuse in Tanzania. Thirteen focus group discussions were conducted with adult community members. The core category, children's rights challenged by lack of agency, was supported by eight categories. Aware but distressed portrayed feelings of hopelessness, lack of trust in the healthcare and legal systems reflected perceived malpractice, decreased respect for children's rights referred to poor parental care and substance abuse, myths justifying CSA illustrated cultural beliefs to rationalize child sexual abuse, disclosure threatened by fear of stigma and discrimination aligned the manifestations that prevent disclosure, actions driven by economic circumstances described the economical dependence of victims, urging a change in procedures reflected informants' wish to ally with local governance and pressure groups, and willingness to act indicated the community's role in supporting victims. The study showed how lack of agency calls for efforts to increase children's human rights at all levels

Acceptability of medical male circumcision among traidtionally non circumcising tribes attending health care services in Makambako hospital, Njombe, Tanzania.

Background: Male circumcision (MC) can reduce men’s risk of contracting Sexually Transmitted Infections (STIs) including HIV/AIDS for at least 50% or even as high as 66%. With this regard, WHO and UNAIDS urge international community to scaled-up MC among uncircumcised men especially in HIV hard hit regions. Residents of Makambako mainly the Bena Kinga do not have a circumcision custom.Objectives: This study examined acceptability of MC among traditionally non-circumcising males accessing health care in Makambako Hospital, Njombe Region, Tanzania.Methods: This was a quantitative descriptive cross-sectional study. Some 118 uncircumcised males were randomly selected to participate. In addition, 9 health care workers (HCW) and 8 community members were purposively recruited to participate in a qualitative survey. Kiswahili semi-structured questionnaires were administered to the uncircumcised males, and Focus Group Discussions (FGDs) were held with both HCWs and Community members.Results: About 70 % uncircumcised males indicated that MC is acceptable, while 97% understand the health importance of MC, signifying that MC is gradually gaining acceptance in the study population. Majority (84%) preferred medical circumcisers over traditional ones due to safety procedure. Data from FGD revealed readiness to undergoMC, and both HCW and Community members urged for reduced costs for such services. Recommendations: For sustainability of MC scaling–up, health education should be a permanent agenda to reach the uncircumcised individuals in Njombe District.KEY WORDS: Acceptability, sexually transmitted diseases, male circumcision scale-u

Contributions of socio-economic and cultural factors in Tungiasis at Kwakombo village in Korogwe district, Tanzania

Background: Tungiasis is an ectoparasitosis caused by the female sand flea, Tunga penetrans, or jiggers, which is an important, but not easily seen public health problem. Tungiasis is prevalent in many developing countries, in South America, Caribbian and Sub-Saharan Africa, including Tanzania.Objectives: To describe tungiasis and possible contributing socio-economic and cultural factors at Kwakombo Village in Korogwe District, Tanzania.Methodology: This was a cross-sectional descriptive study, which used quantitative and qualitative data collection methods. The sample included, randomly selected 720 villagers from a total of 3500 residents of Kwakwombo Village, surveyed for presence of Tungiasis infestation followed by a description of the 300 Tungiasis affected people Thirty four village leaders and 4 healthcare workers of the Village participated in the qualitative survey.Results: Out of the sample of 720 300 (41.7%) had infestation with Tunga penetrans, the majority of whom 207(69%) were males. The most vulnerable age group was 5-14 years (47%) and majority (95%) live in houses that are roofed with grass,with muddy floors and muddy walls, as well as share their houses with domestic animals, and 58% don’t wear shoes.Recommendations: More research is needed to establish the prevalence of the disease in the rest of Korogwe and Tanzania. Ministry of Health and Social Welfare and social leaders in Korogwe should be made aware and active against the disease