The pattern of infections among under-fives: a call for actions

INTRODUCTION Infectious diseases are by far the most frustrating challenges in the health systems of most tropical nations. Unlike other challenges, infections have their causes known and solutions at hand. Paediatric world is the most important victim of infectious ailments. Various models, interventions for reduction/elimination of infectious diseases have been put forth but the strategies (in most tropical nations) have not bore the anticipated fruits. OBJECTIVES To assess the pattern of infections and its association with nutritional status among under-five years population of Dodoma in August – September 2007. METHODOLOGY A descriptive, cross-sectional community based study was done at Makulu ward of Dodoma district involving 396 under five year population derived from 322 different families. Data was collected using a standard structured questionnaire and analysed using epi-info 6 software. RESULTS Among 396 children studied, 52.3% were females. Maximum representation was found in the age range of 12-23 months (mode at age of 14.0 months). More than half (50.8%) of all children surveyed were found to have fever (at the time of the survey) and 58.8% were reported to have had fever within a period of 1 month prior to conduction of the study. Among children with fever, 52.3% had a normal weight to age ratio. More than 90% of surveyed children were reported to have been weaned before 6 months of age. CONCLUSION The prevalence of fever was found to be high (reflecting infectious nature) in this study. RECOMMENDATIONS More analytical studies are needed in this area to explain for the nature and causes of fever in this age group at Makulu ward

TBA Knowledge performance and Relation with the Formal Health System in Lindi Region and the role of Maternal Waiting Homes

In Lindi region 110 active trained TBAs (10 or more deliveries per year) and women who delivered with TBAs were interviewed about the role of these TBAs, their knowledge and practice and their relationship with the health facilities. In addition key information in the communities, the districts and the health care system were interviewed. The study that play a unique role in their respective communities as care giver for delivering mother and as principal advisor to families in all issues related to birth –giving. They are highly appreciated by their clients and the communities and often preferred to the health facilities, which are perceived as too expensive, hardly accessible and staff often not friendly to the clients. The training has increased the reputation of the TBAs in the community because they are perceived as comparable to the staff in the facility where they went for training. TBAs complained that I cases where the local government financed the training clients afterwards expect to get the service free of change because it was the community who paid for training. In addition communities are suspicious that the trained TBA gets money from the government. The TBAs do not play the expected role in referral because referral to the health facilities is perceived as a professional failure on the side of the TBA and as a shame on the part of the woman. The communication between health services and the TBAs is not satisfactory. There is no supervision and monitoring, no visits to the TBAs or any kind of meeting and supply of gloves or other equipment. Proper records are not available especially regarding problems during delivery (death of mother or the child). It is recommended that working relation between formal health system and TBAs has to be improved. Maternal waiting homes are not yet available in Lindi Region however a need is perceived by professionals and communities because many villages are too far from the nearest health facilities to make use of it for delivery. One church hospital offers a simple house for woman and their relatives where they can stay while waiting. However it does not yet meet the criteria defined by the Maternal Waiting Homes

Factors Associated with First Antenatal Care Booking among Pregnant Women at a Reproductive Health Clinic in Tanzania: A Cross Sectional Study

Background: Antenatal care (ANC) is a key basic intervention targeting maternal and perinatal morbidity and mortality. The World Health Organization (WHO) recommends the first ANC booking before 12 weeks of gestation. This enhances positive maternal and fetal outcomes through early detection of complications, prompt treatment, referral, and management of expected physiological changes. Despite high ANC coverage (98%), free contacts, and easy accessibility, little is known why few (24%) pregnant women in Tanzania book their first ANC-visit early. This study aimed to identify factors associated with first ANC booking among pregnant women in a Tanzanian reproductive health clinic. Methods: Systematic random sampling was used to recruit 311 eligible pregnant women. Study data were collected using a structured interviewer-administered questionnaire containing 22 closed ended questions. Data were analyzed using descriptive statistics. Frequency distribution tables and figures were generated. Multivariate analysis was used to assess the influence of the independent variables on the dependent variable. A p-value \u3c 0.05 was considered statistically significant. Results: In total, 311 pregnant women were interviewed; 31.2% (n = 97) booked their first ANC-visit within 12 weeks of gestation and 68.8% (n = 214) after 12 weeks of gestation. Early ANC booking was associated with tertiary education, planned pregnancy, earlier pregnancy recognition, and experience or presence of any complications. Commonly reported barriers to early ANC booking included not knowing the recommended time to initiate booking (37.6%), waiting for the fetus to move (28.6%), and previous experience of waiting a long time (15.8%). Conclusion: Most pregnant women booked their first ANC visit later than WHO and national recommendations. Women thus miss accurate early pregnancy assessment for better positive pregnancy outcomes

Perceived barriers to access available health services among men who have sex with men in Dar es Salaam, Tanzania

Background: Men who have sex with men (MSM) continue to be highly affected with the HIV infection worldwide. Studies have shown that the organization of healthcare systems and how the MSM perceive it play a major role in granting or denying them access to healthcare services. Little is known in Tanzania regarding the barriers that MSM face while accessing health services within the country. The study was geared towards determining the proportion of MSM who accessed health care and disclose their sexual orientations to health care workers (HCW). It also intended to find out the anticipated barriers from HCW’s if they were to disclose their sexual orientations to them and consider the types of social networks used when facing various challenges.Methods: The study employed both quantitative and qualitative methods. Participants were enrolled in the study Respondent Driven Sampling. Quantitative data was entered and analysed using the Statistical Package for the Social Sciences v.20. Qualitative data was collected using in-depth interviews read and interpreted to identify themes and create categories. These were manually analysed and interpreted according to the study objectives.Results: The majority (87.7%) of MSM accessed healthcare services when sick, only a few (3.4%) did nothing due to lack of financial resources. Only a third of them had ever disclosed their sexual orientations to healthcare workers. This was due to lack of confidentiality, fear of stigma and discrimination, shame and mistreatment at the health facilities, and fear of the healthcare worker’s reaction after they disclosed their sexual orientation to them.Conclusion: MSM need to be empowered to overcome their perceived fears towards healthcare workers and health facilities. Efforts should be put into breaking the cycle of negative information and perceptions MSM have about healthcare workers and how they deal with same sex practices’ health related problems

Road traffic accidents in Tanzania: A ten year epidemiological appraisal

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Difficult choices: Infant feeding experiences of HIV-positive mothers in northern Tanzania

Infant feeding represents a great challenge in the prevention of mother-to-child transmission of HIV (pMTCT). The international guidelines informing infant feeding counselling suggest feeding methods that reduce the risk of HIV transmission, and discourage mixed feeding (combining breastfeeding with other fluids and solids).The feasibility and the social acceptability of the recommended feeding methods are hotly debated currently.Through the documentation of HIV-positive women\'s experiences, this article aims to provide empirically grounded knowledge on the relevance of the proposed feeding methods. Drawing upon cultural theory and a view of infant feeding practices as socially and culturally embedded, the article discusses the so-called ‘informed choice\' of infant feeding method among women enrolled in the pMTCT programme at Kilimanjaro Christian Medical Centre in northern Tanzania.The study is based on interviews and follow-up of 20 HIV-positive mothers during the last part of pregnancy, delivery and the first six months after birth.The article details four of these cases describing the challenges linked to exclusive breastfeeding, cow\'s milk feeding and formula feeding.The study demonstrates the gap between intentions and infant feeding practice in a context where the social expectations to breastfeed are high, and where kin and neighbours are part of the decision-making team surrounding infant feeding. It highlights the tension between the competing concerns of the medical and social risks involved in the choice of infant feeding method, and documents that the feeding options may be difficult to adhere to, whether a mother chooses exclusive breastfeeding or replacement feeding. SAHARA J Vol. 4 (1) 2007: pp. 544-55

The Potential Role of Mother-in-Law in Prevention of Mother-to-Child Transmission of HIV: A Mixed Methods Study from the Kilimanjaro Region, Northern Tanzania.

In the Kilimanjaro region the mother-in-law has traditionally had an important role in matters related to reproduction and childcare. The aim of this study was to explore the role of the mothers-in-law in prevention of mother-to-child transmission (PMTCT) service utilization and adherence to infant feeding guidelines. The study was conducted during 2007-2008 in rural and urban areas of Moshi district in the Kilimanjaro region of Tanzania. Mixed methods were used and included focus group discussions with mothers-in-law, mothers and fathers; in-depth interviews with mothers-in-law, mothers, fathers and HIV-infected mothers, and a survey of 446 mothers bringing their four-week-old infants for immunisation at five reproductive and child health clinics. The study demonstrated that the mother-in-law saw herself as responsible for family health issues in general and child care in particular. However she received limited trust, and couples, in particular couples living in urban areas, tended to exclude her from decisions related to childbearing and infant feeding. Mothers-in-law expected their daughters-in-law to breastfeed in a customary manner and were generally negative towards the infant feeding methods recommended for HIV-infected mothers; exclusive replacement feeding and exclusive breastfeeding. Decreasing influence of the mother-in-law and increasing prominence of the conjugal couples in issues related to reproduction and child care, reinforce the importance of continued efforts to include male partners in the PMTCT programme. The potential for involving mothers-in-law in the infant feeding component, where she still has influence in some areas, should be further explored

Reliability and Validity of Clinicopathological Features Associated with Frailty Syndrome in Elderly Population

Geriatrics is an applied science as its practice is an art of medicine. As a scientific discipline, there exists a potential race for measurements. Frailty stands as among poorly defined concepts in geriatric medicine. There are philosophical, circumstantial, and practical justifications behind this rather seemingly clinical tragedy. This chapter contributes toward reliability and validity aspects of currently applied frailty scales and indicators across different population base. It acknowledges the contribution of Fried’s frailty scale. It also describes different frailty scales and indicators tested in America, Europe, and Asia. Lastly, the chapter contrasts the popular belief behind applications of Cronbach’s α coefficient of test scores for reliability assessment in clinical research. Other research gaps are also highlighted including merging clinical research findings in geriatrics with psychosocial aspects under the emerging field of geropsychology. It also proposes a solution for usage in future studies that aim at assessing reliability of test scores in clinical and biomedical sciences

Demographic Transition in Sub-Saharan Africa: From Grassroots to Ivory Towers

The concept of demographic transition has been evident to European, North American and Japanese population since the early 1960’s. It loosely followed natural patterns that were postulated as far back as 1795. However, scientists and policy makers, still erroneously consider demographic transition to be absent in sub-Saharan Africa. The aim of this chapter is to uncover the hidden truth behind population censa in sub-Sahara African countries using Statistical tools. The chapter analyses philosophical basis of sub-Saharan Africa demographic dividends from 1960 to 2000. It then cautiously highlights how demographic transition is emerging in sub-Saharan Africa. Specifically, it endeavours to highlight how different African countries are in different stages of demographic transition. The chapter also contrasts some of the prevalent misconceptions about Africans, especially the delusional idea of Africans as a homogenous population group on genetic basis. Lastly, it offers solution, to the current demographic chaos, and their relationship to future matured demographic transition in sub-Saharan Africa

Availability and Usage of Drugs at Household Level i Tanzania: Case Study in Kinondoni District, Dar es Salaam

A survey was conducted in 400 households in Kinondoni District, Tanzania, to determine the availability, source, storage condition, and usage of medicinal drugs. Majority of the households (73.3 %) stored drugs at home. Seven hundred and sixty one (761) different types of drug preparations were encountered. Only 64.7 % of these drugs were in use at the time of study. About 45 % of the antibacterials found in the households were being kept for future use in self-medication. Large proportions of these drugs were obtained from authorised private health facilities. Only a minority (10 %) were obtained from unauthorised sources. Sixty seven percent of all the drugs kept at the households were not stored properly. Majority of the respondents (83 %) admitted practising self-medication. Sharing of drugs within and across households was also practised. Key Words: Household, storage condition, drug use status, self-medication. East and Central African Journal of Pharmaceutical Sciences Vol.5(3) 2002: 49-5