Road traffic accidents in Tanzania: A ten year epidemiological appraisal

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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

Knowledge about safe motherhood and HIV/AIDS among school pupils in a rural area in Tanzania

\ud The majority of adolescents in Africa experience pregnancy, childbirth and enter motherhood without adequate information about maternal health issues. Information about these issues could help them reduce their pregnancy related health risks. Existing studies have concentrated on adolescents' knowledge of other areas of reproductive health, but little is known about their awareness and knowledge of safe motherhood issues. We sought to bridge this gap by assessing the knowledge of school pupils regarding safe motherhood in Mtwara Region, Tanzania. We used qualitative and quantitative descriptive methods to assess school pupils' knowledge of safe motherhood and HIV/AIDS in pregnancy. An anonymous questionnaire was used to assess the knowledge of 135 pupils ranging in age from 9 to 17 years. The pupils were randomly selected from 3 primary schools. Underlying beliefs and attitudes were assessed through focus group interviews with 35 school children. Key informant interviews were conducted with six school teachers, two community leaders, and two health staffs. Knowledge about safe motherhood and other related aspects was generally low. While 67% of pupils could not mention the age at which a girl may be able to conceive, 80% reported it is safe for a girl to be married before she reaches 18 years. Strikingly, many school pupils believed that complications during pregnancy and childbirth are due to non-observance of traditions and taboos during pregnancy. Birth preparedness, important risk factors, danger signs, postpartum care and vertical transmission of HIV/AIDS and its prevention measures were almost unknown to the pupils. Poor knowledge of safe motherhood issues among school pupils in rural Tanzania is related to lack of effective and coordinated interventions to address reproductive health and motherhood. For long-term and sustained impact, school children must be provided with appropriate safe motherhood information as early as possible through innovative school-based interventions.\u

Health worker motivation in the context of HIV care and treatment challenges in Mbeya Region, Tanzania: A qualitative study

Health worker motivation can potentially affect the provision of health services. The HIV pandemic has placed additional strain on health service provision through the extra burden of increased testing and counselling, treating opportunistic infections and providing antiretroviral treatment. The aim of this paper is to explore the challenges generated by HIV care and treatment and their impact on health worker motivation in Mbeya Region, Tanzania. Thirty in-depth interviews were conducted with health workers across the range of health care professions in health facilities in two high HIV-prevalence districts of Mbeya Region, Tanzania. A qualitative framework analysis was adopted for data analysis. The negative impact of HIV-related challenges on health worker motivation was confirmed by this study. Training seminars and workshops related to HIV contributed to the shortage of health workers in the facilities. Lower status workers were frequently excluded from training and were more severely affected by the consequent increase in workload as seminars were usually attended by higher status professionals who controlled access. Constant and consistent complaints by clients have undermined health workers' expectations of trust and recognition. Health workers were forced to take responsibility for dealing with problems arising from organisational inefficiencies within the health system. HIV-related challenges undermine motivation among health workers in Mbeya, Tanzania with the burden falling most heavily on lower status workers. Strained relations between health workers and the community they serve, further undermine motivation of health workers

Informal support to first-parents after childbirth: a qualitative study in low-income suburbs of Dar es Salaam, Tanzania

<p>Abstract</p> <p>Background</p> <p>In Tanzania, and many sub-Saharan African countries, postpartum health programs have received less attention compared to other maternity care programs and therefore new parents rely on informal support. Knowledge on how informal support is understood by its stakeholders to be able to improve the health in families after childbirth is required. This study aimed to explore discourses on health related informal support to first-time parents after childbirth in low-income suburbs of Dar es Salaam, Tanzania.</p> <p>Methods</p> <p>Thirteen focus group discussions with first-time parents and female and male informal supporters were analysed by discourse analysis.</p> <p>Results</p> <p>The dominant discourse was that after childbirth a first time mother needed and should be provided with support for care of the infant, herself and the household work by the maternal or paternal mother or other close and extended family members. In their absence, neighbours and friends were described as reconstructing informal support. Informal support was provided conditionally, where poor socio-economic status and non-adherence to social norms risked poor support. Support to new fathers was constructed as less prominent, provided mainly by older men and focused on economy and sexual matters. The discourse conveyed stereotypic gender roles with women described as family caretakers and men as final decision-makers and financial providers. The informal supporters regulated the first-time parents' contacts with other sources of support.</p> <p>Conclusions</p> <p>Strong and authoritative informal support networks appear to persist. However, poverty and non-adherence to social norms was understood as resulting in less support. Family health in this context would be improved by capitalising on existing informal support networks while discouraging norms promoting harmful practices and attending to the poorest. Upholding stereotypic notions of femininity and masculinity implies great burden of care for the women and delimited male involvement. Men's involvement in reproductive and child health programmes has the potential for improving family health after childbirth. The discourses conveyed contradicting messages that may be a source of worry and confusion for the new parents. Recognition, respect and raising awareness for different social actors' competencies and limitations can potentially create a health-promoting environment among families after childbirth.</p

Why do health workers in rural Tanzania prefer public sector employment?

Severe shortages of qualified health workers and geographical imbalances in the workforce in many low-income countries require the national health sector management to closely monitor and address issues related to the distribution of health workers across various types of health facilities. This article discusses health workers' preferences for workplace and their perceptions and experiences of the differences in working conditions in the public health sector versus the church-run health facilities in Tanzania. The broader aim is to generate knowledge that can add to debates on health sector management in low-income contexts. The study has a qualitative study design to elicit in-depth information on health workers' preferences for workplace. The data comprise ten focus group discussions (FGDs) and 29 in-depth interviews (IDIs) with auxiliary staff, nursing staff, clinicians and administrators in the public health sector and in a large church-run hospital in a rural district in Tanzania. The study has an ethnographic backdrop based on earlier long-term fieldwork in Tanzania. The study found a clear preference for public sector employment. This was associated with health worker rights and access to various benefits offered to health workers in government service, particularly the favourable pension schemes providing economic security in old age. Health workers acknowledged that church-run hospitals generally were better equipped and provided better quality patient care, but these concerns tended to be outweighed by the financial assets of public sector employment. In addition to the sector specific differences, family concerns emerged as important in decisions on workplace. The preference for public sector employment among health workers shown in this study seems to be associated primarily with the favourable pension scheme. The overall shortage of health workers and the distribution between health facilities is a challenge in a resource constrained health system where church-run health facilities are vital in the provision of health care in rural areas and where patients tend to prefer these services. In order to ensure equity in distribution of qualified health workers in Tanzania, a national regulation and legislation of the pension schemes is required

Patterns of Road Traffic Injuries and Associated Factors among School-aged Children in Dar es Salaam, Tanzania

A study was conducted to describe the pattern of road traffic injuries and associated factors among schoolaged children attending public hospitals in Dar es Salaam, Tanzania, between May and October 1999. The study included all children younger than 18 years, and data were collected using a structured interview guide. This article is based on an analysis of 286 children who sustained road traffic injuries out of a total of 1886 children presenting with various injuries during the study period. Almost 52% of these children were in primary school, with the most common age group between 5 and 9 years. A large majority of the children came from the poorer socio-economic residential areas of the city. Almost one-third of the victims and 36% of guardians were unaware of safer ways of walking on the road. Parents or guardians perceived the risk of road traffic injuries as low, with one-third thinking that they were not a major problem in their community. Similarly, two-thirds of guardians thought that collisions to children could not be prevented. This study demonstrates that road traffic injuries are a major problem among school-aged children in Dar es Salaam. Furthermore, the study reveals that there is significant ignorance about safe road usage among the parents or guardians of injured children, and that the majority of them think that collisions are not preventable. African Safety Promotion Vol.1(1) 2002: 37-4

Childhood Burn Injuries in Children in Dar es Salaam: Patterns and Perceptions of Prevention

A study was conducted in the three city hospitals of Dar es Salaam and two national referral hospitals to describe the pattern of burn injuries and to determine victims\' and guardians\' perceptions of the causes and prevention of burns. The study included all injured children younger than 18 years attending Mwananyamala, Ilala and Temeke city hospitals, Muhimbili National Hospital and Muhimbili Orthopaedic Institute between May and November 1999. Data were obtained by filling in a prepared questionnaire. A total of 253 children attended the hospitals with burn injuries during the period of study. Children younger than five years of age constituted 63.6% of the group. Scalding from hot liquids accounted for 75.8% of the burns, followed by open flame burns (16.2%). Most burns (82.9%) occurred in low socio-economic groups, and 94.4% occurred at home. Over half of the parents (51.5%) thought that burns could not be prevented since ‘accidents\' are unpreventable and it is difficult to control children; 48.5% of the parents thought that burns could be prevented. There is a need to change parental and guardians\' attitudes and beliefs that burns are unpreventable, if burn prevention interventions are to be effective. African Safety Promotion Vol.1(1) 2002: 42-4

Malaria treatment practices in the transition from sulfadoxine-pyrimethamine to artemether-lumefantrine: A pilot study in Temeke municipality, Tanzania

Background: Tanzania has changed its malaria treatment policy twice; in the first change Sulfadoxine - Pyrimethamine (SP) replaced chloroquine (CQ) in August 2001. In the second change Artemether –Lumefantrine (ALu) replaced SP in January 2007. It is not known how experiences with previous policies would influence the uptake the new policy.Objective: This study assessed malaria treatment practices in the transition from SP to ALu and the implications for the uptake of the new policy.Methods: Two months prior to change from SP to ALu a survey of randomly selected households (HHs) was carried out to explore the factors influencing malaria therapy choices and formulations of antimalarial drugs preferred. Perceptions on single versus multiple doses of antimalarial drugs, awareness on dosage calculation and compliance were also explored.Results: Two thirds of the respondents held the perceptions that childhood illness corresponding to malaria would require an antimalarial drug. However, about a quarter (24.3%) held the perception that childhood convulsion is not amenable by modern medicines. Half (50.7%) held the perception that high fever causes convulsions, however only a small percentage (5.8%) linked convulsions with severe malaria. SP was the most commonly available antimalarial drug (81.8%); followed by amodiaquine (35.4%), quinine (25.5%), artemisinin monotherapies (3.2%) and chloroquine (3.2%). The larger majority (85.9%) preferred antimalarial drugs syrup for children below 12 months old; about half (52.2%) also preferred syrup for children 1 – 5 years old. More than half (57.5%) preferred antimalarial drugs as tablets for older children and adults. Less than a quarter were aware that antimalarial drugs doses are calculated based on weight and age by about a half (48.5%). About three quarters (76.5%) were aware that SP is given as a single dose. About two thirds (63.8%) preferred antimalarial drugs as a single dose; only about a third (34.5%) preferred multiple dosages.Conclusions: For uncomplicated malaria, the community would seek antimalarial drugs while traditional medicines may initially be sought for severe malaria in the form of convulsions. Experiences with and preference of single SP dose may negatively influence compliance with multiple dose ALu therapy. The absence of ALu syrup formulation may negatively influence its acceptance for young children; while the absence of injectable formulation may negatively influence its acceptance to adult patients.Key words: malaria, community, policy changes, artemisinin based combination therapy, Tanzani