Risky Behaviours Among Young People Living with HIV Attending Care and Treatment Clinics in Dar Es Salaam, Tanzania: Implications for Prevention with a Positive Approach.

Introduction: Prevention with a positive approach has been advocated as one of the main strategies to reduce new instances of HIV infection. Risky sexual behaviours among people living with HIV/AIDS are the cornerstone for this approach. Understanding the extent to which infected individuals practice risky behaviours is fundamental in designing appropriate population-specific interventions. With the HIV infection transmission rates remaining high among young people in sub-Saharan Africa, continued prevention among them remains a priority. This study therefore seeks to describe the magnitude and determinants of risky sexual behaviours among young people living with HIV. Methods: A cross-sectional study was conducted between June and July 2010 in selected Care and Treatment Clinics (CTCs) in Dar Es Salaam, Tanzania. A total of 282 HIV-positive patients aged 15-24 were interviewed about their sexual behaviours using a questionnaire. Results: Prevalence of unprotected sex was 40.0% among young males and 37.5% among young females (p<0.001). Multiple sexual partnerships were reported by 10.6% of males and 15.9% of females (p<0.005). More than 50% of the participants did not know about the HIV status of their sexual partners. A large proportion of participants had minimal knowledge of transmission (46.7% males vs. 60.4% females) and prevention (65.3% males vs. 73.4% females) of sexually transmitted infections (STIs). Independent predictors of condom use included non-use of alcohol [adjusted odds ratio (AOR), 0.40 95% confidence interval (CI); 0.17-0.84] and younger age (15-19 years) (AOR, 2.76, 95% CI: 1.05-7.27). Being on antiretroviral therapy (AOR, 0.38, 95% CI: 0.17-0.85) and not knowing partners' HIV sero-status (AOR, 2.62, 95% CI: 1.14-5.10) predicted the practice of multiple sexual partnership. Conclusions: Unprotected sex and multiple sexual partnerships were prevalent among young people living with HIV. Less knowledge on STI and lack of HIV disclosure increased the vulnerability and risk for HIV transmission among young people. Specific intervention measures addressing alcohol consumption, risky sexual behaviours, and STI transmission and prevention knowledge should be integrated in the routine HIV/AIDS care and treatment offered to this age group

Food insecurity : associated factors, nutritional and health related outcomes in a rural village, North-East Tanzania

Objective: The main aim of this study was to determine the prevalence of food insecurity and its associated socio-demographic characteristics in Oria village North-East Tanzania. It also aimed at exploring the relationship between food insecurity and nutritional and health outcomes in this population. Methods: A cross sectional analysis using data from the 1997 Health Systems Research and Health Promotion in Relation to Reproductive Health survey in Tanzania was conducted. A total of 898 individuals aged between 15-36 years of age were included. The participation rate for the survey was 79%. A questionnaire was administered including a question adopted from the third National Health and Nutrition Examination Survey (NHANES III) to assess the food security status of the household. Information on socio-demographic characteristics, general health status, infant feeding practice and sexual behaviour was collected. HIV testing was done using saliva samples. Analysis was adjusted for age, education and occupation. Results: Data analysis was done for 891/898 (99.2%) of the eligible respondents which included 402 men and 488 women. The overall prevalence of food insecurity was 25.2%. It was positively related to age, presence of children and having a health complaint among women and negatively associated with level of education among women and employment status among men. Food insecurity was not related to infant feeding practices. Food insecurity increased the odds of HIV infection among women by two though it did not remain statistically significant after adjusting for age, education and occupation. There was also an insignificant increase in the chance of food insecure households adopting risky sexual behaviour in both sexes. Conclusion: Food insecurity is prevalent in Oria and should be considered of public health importance. The apparent relationship between food insecurity and age, education, presence of children and having health complaints among women as well as employment status among men shows that some households are more vulnerable to food insecurity than others. Food insecurity is also likely to be associated with an increased chance of engaging in risky sexual behaviours associated with increased risk of disease in this case HIV/AIDS. KEY WORDS: Food insecurity, socio-demographic characteristics, infant feeding practices, risky sexual behaviours, HIV/AIDS, Tanzania

HIV serostatus disclosure among people living with HIV/AIDS in Mwanza, Tanzania.

Disclosing HIV serostatus is important for HIV prevention and maintenance of health for people living with HIV their spouses and the community, it plays a role in the social relation which is critical in reducing HIV transmission. The process may have positive and negative effects to the HIV infected people who disclose their status. The present study was undertaken to describe HIV serostatus disclosure among HIV infected people attending care and treatment clinic at Sekou-Toure hospital in Mwanza, Tanzania. A cross-sectional study was carried out on 270 HIV infected adults attending Care and Treatment Clinic (CTC) at Sekou-Toure hospital between September and October, 2010. A Swahili questionnaire was used to obtain demographic and HIV disclosure information. Hundred and ninety five (72.5%) of all recruited participants were females, 88.1% (238/270) were aged above 30 years and 44.1% (119/270) were married. The prevalence of serostatus disclosure was 93.3% (252/270) with participants aged above 30 years having significantly higher proportion of serostatus disclosure compared to those aged below 30 years (94.5% vs. 84.4%, p < 0.05). Among the participants who disclosed their status, 69.3% reported closeness to the disclosed person as the reason for disclosure while 25.8% (65/252) disclosed because they needed help. Two hundred (79.4%) reported to have received emotional support following disclosure while 25.8% and 29.7% received financial support and freedom to use their anti-retroviral drugs around the person they disclosed their status respectively. Thirty four participants reported to have been discriminated following disclosure and 12 participants reported to have been divorced. Rate of disclosure of HIV serostatus was noted to be high in this study. Delayed disclosure was also noted in small proportion of participants. Negative outcomes following disclosure of serostatus were reported by participants. Efforts need to be increased to promote disclosure of HIV serostatus in Tanzania through health education and awareness for both HIV infected individuals and the community

Incidence and Predictors of Adolescent's Early Sexual Debut After three Decades of HIV Interventions in Tanzania: A time to Debut Analysis.

To determine the incidence and predictors of adolescent's early sexual debut after three decades of HIV interventions in Tanzania. In a cross-section study of adolescents aged 16-19 residing in Morogoro Municipality, information on socio-demographic, parental-and-peer communication, and sexual behaviors were collected. Cox-regression analysis was used to examine predictors of time to sexual debut. A total of 316 adolescents with mean age of 17.5±0.9 were recruited. Half (48.7%) of adolescent were sexually active with mean age at sexual debut of 14.6±2.3. Of these, 57.8% had sex before their 15(th) birthday with incidence of early sexual debut of 17.4/1000 person-years at risk. Adolescent family characteristics, peer pressure, alcohol use, parental and peer communication were key predictors of early sexual debut. Parental and peer communication strategies works calling for efforts to increase its scope to reach all adolescents alongside promoting family stability and reducing adolescent alcohol consumption

Magnitude and factors associated with overweight and obesity among adolescents in in semi-rural area of Babati District, Tanzania

 Background: Childhood and adolescent overweight and obesity have increased dramatically in recent years. We assessed the burden and factors associated with overweight and obesity among adolescents in a semi-rural district of Babati in Tanzania.Methods: A school-based descriptive cross-sectional survey was conducted among adolescents attending secondary schools. Anthropometric measurements were taken using standard procedures. A Food Frequency Questionnaire and the International Physical Activity Questionnaire were adapted to assess dietary and physical activity patterns, respectively.Results: A total of 619 students were included in the analysis. The mean age and body mass index of the respondents were 16.7±1.68 years and 19.9±3.16 kg/m², respectively. The overall prevalence of overweight and obesity was 9.2% with more girls being overweight and obese than boys (P&lt;0.0001). In the Generalized Estimating Equations (GEE) models, girls (Odds Ratio [OR] = 5.6; 95% Confidence Interval [CI]: 1.97, 15.72]); unhealthy diet (OR = 2.2; 95% CI: 1.32, 3.63); vigorous physical activity (OR = 2.2; 95%CI: 1.34, 3.56) and physical inactivity (OR = 1.7; 95%CI: 1.08, 2.79) were independent predictors of overweight or obesity.Conclusion: The prevalence of overweight and obesity was modest. Female sex, unhealthy diet and physical inactivity were significantly predictive. There is a need for interventions in obesity to have a broader target audience to include adolescents and residents of rural areas. Primary preventive interventions are needed.

Prevalence and Factors Associated with Stunting among Public Primary School Pupils in Kasulu District, Western Tanzania

Background:&nbsp;Underfeeding of a child in the first 2 years of life results in irreversible growth damage. Globally, stunting has declined from 39.7% in 1990 to 26.7% in 2010 while in Africa has remained at 40% since 1990. However, stunting is little known in primary pupils.This study estimated the prevalence of stunting and contributing factors among public primary school pupils in Kasulu District.Method:&nbsp;Cross-sectional study was conducted among public primary pupils. Systematic random sampling was used to select study participants and then stratified to 5-7 and 8-12 years. Socio-economic factors, dietary practices, water, sanitation, and hygiene behaviours; school performance/attendance data were collected using a pretested questionnaire. Measurements were standardised to the World Health Organization HAZ-Scores for both girls and boys. Descriptive statistics, bivariate, and multivariable logistic regression were used to generate results.Results:&nbsp;A total of 400 pupils (100%RR) were recruited into the study, mean age of 7.51 (STD= 1.54) years and a half (50.3%) were boys. The prevalence of stunting was 127 (31.8%) (95% CI: 27.2%–36.6%), with no sex difference (63 (31.7%) – girls vs. 64 (31.8%) – boys; p = 0.969). Household wealth influenced stunting; lowest quintile (AOR= 28; 95% CI: 3.64 – 214.6; p&lt;0.001) 2nd quintile (AOR = 17; 95%CI: 2.20 – 138.5; p&lt;0.01), the 3rd quintile (AOR = 8.0; 95%CI: 0.99 – 64.67; p = 0.051) and 4th quintile (AOR = 4.2; 95%CI: 0.49 – 36.75; p = 0.191) when compared to 5th (highest) wealthquintile. Food insecurity (AOR = 10.6; 95%CI: 4.60 – 24.60; p&lt; 0.001), less protein in meal were the risk for stunting (AOR = 14.6; 95%CI: 4.07 – 52.42; p&lt;0.001).Inappropriate hand wash after toilets both at school, (AOR=3.5; 95%CI:1.62–7.58; p=0.001), and home (AOR = 13.0; 95%CI: 2.73 – 61.76; p = 0.001) were the risk for stunting. Stunted pupils had irregular school attendance (AOR = 9.4;95%CI: 4.42 – 19.93; p&lt;0.001) and poor performance (AOR = 23.6; 95%CI: 10.24 –54.19; p&lt;0.001). Food insecurity influenced poor performance (AOR = 3.9; 95%CI:1.67–8.92; p&lt;0.01) and irregular school attendance (AOR=5.4, p=0.000).Conclusion:&nbsp;Stunting among public primary school pupils is very high despite the prevention effort. Low wealth, food insecurity, poor hand hygiene, and lack of protein in a meal significantly influence stunting. Also, it affects the pupils’ academic performance and attendance, availability of food in both quantity and quality, community nutritio

Food Insecurity is Associated with Food Consumption Patterns and Anthropometric Measures but not Serum Micronutrient Levels in Adults in Rural Tanzania.

The purpose of the present paper is to assess the relationship between food insecurity and food consumption patterns, anthropometric measures and serum micronutrient levels in rural Kilimanjaro, Tanzania. A population-based cross-sectional study was carried out between March and May of 2005. Rural Kilimanjaro, Tanzania. Analysis was restricted to 1014 adults aged 15-44 years with children and complete data. A large majority of the participants (91 %) reported some kind of food insecurity. Food insecurity was significantly associated with age, marital status and occupation. Participants reporting food insecurity were significantly less likely to frequently consume animal products, fruits and vegetables compared with participants categorized as food secure. Women categorized as experiencing individual food insecurity had a larger waist circumference than food-secure women (P = 0.026) while the mean BMI of women appeared to decline if they had a child who was food insecure (P = 0.038). There were no observed differences in serum micronutrient levels by food insecurity status. Food insecurity is highly prevalent and associated with food consumption patterns, waist circumference and BMI of women in rural Tanzania. Further studies should apply self-report measures in assessing food insecurity to larger and more diversified populations

Socio-demographic determinants of dengue infection during an outbreak in Dar es Salaam City, Tanzania

AbstractBackground: In recent years, the eastern coast of Africa has witnessed a number of dengue outbreaks. This study was carried out to determine socio-demographic determinants of dengue infection during the 2014 outbreak in Dar es Salaam, Tanzania. Methods: Unmatched case-control analysis of secondary data from a cross-sectional dengue investigation in three districts of Dar es Salaam in June 2014 was conducted. Febrile patients seeking care at health facilities were recruited. Cases were serologically-confirmed dengue-positive while controls were serologically-confirmed dengue-negative patients. A questionnaire was used to collect sociodemographic information. The association between sociodemographic variables and dengue infection was examined using univariate analysis and multivariate logistic regression analysis. Results: A total of 81 cases and 281 controls were included in the analysis. Majority of the cases and controls were males (64.2% versus 54.1%; P=0.137) and were &gt;15 years of age (88.9% versus 72.9%; P =0.003). Living in Kinondoni (aOR = 4.28; 95% CI: 1.74 - 10.53); being employed (aOR = 2.06; 95% CI: 1.06-4.04); having piped water at home (aOR = 2.63; 95% CI: 1.40 - 4.95) and a recent visit of health facility (aOR = 1.94; 95% CI: 1.11 - 3.38) were significantly associated with dengue infection.Conclusions: Dengue infection in Dar es Salaam varied between the three districts and was associated with being employed, having piped water at home and a recent visit to the health facility. These findings provide primary understanding of the influence of socio-demographic factors on dengue and may be used to develop appropriate preventive interventions

Virologic and Immunologic Failure, Drug Resistance and Mortality during the First 24 Months Postpartum among HIV-Infected Women Initiated on Antiretroviral Therapy for Life in the Mitra plus Study, Dar es Salaam, Tanzania.

In the Mitra plus study of prevention of mother-to-child transmission of HIV-1, which included 501 women in Dar es Salaam, Tanzania, triple antiretroviral therapy (ART) was given from late pregnancy throughout breastfeeding up to 6 months postnatally. Here we report findings in a sub-cohort of women with ≤200 CD4cells/μL at enrolment who were continued on ART for life and followed up during 24 months after delivery to determine virologic and immunologic responses, drug resistance and mortality. Blood samples for viral load and CD4 counts testing were collected at enrolment and at 3, 6, 12 and 24 months postpartum. HIV drug resistance testing was performed at 12 months. Data analysis included descriptive statistics and multivariate analysis using Generalized Estimated Equations of 73 women with at least two postpartum assessments. The mortality analysis included 84 women who had delivered. The proportion of women with a viral load≥400 copies/mL was 97% (71/73) at enrolment, 16% (11/67), 22% (15/69), 61% (36/59) and 86% (48/56) at 3, 6, 12 and 24 months postpartum, respectively. The proportion of women with immunologic failure was 12% (8/69), 25% (15/60) and 41% (24/58) at 6, 12 and 24 months, respectively. At 12 months, drug resistance was demonstrated in 34% (20/59), including 12 with dual-class resistance. Self-report on drug adherence was 95% (64/68), 85% (56/66), 74% (39/53) and 65% (30/46) at 3, 6, 12 and 24 months, respectively. The mortality rate was 5.9% (95% CI 2.5-13.7%) at 24 months. The probability of virologic and immunologic failure was significantly higher among women who reported non-perfect adherence to ART at month 24 postpartum. Following an initial decline of viral load, virologic failure was common at 12 and 24 months postpartum among women initiated on ART for life during pregnancy because of low CD4 cell counts. A high proportion of viremic mothers also had resistance mutations. However, at 24 months follow-up, the mortality rate was still fairly low. Continuous adherence counseling and affordable means of monitoring of the virologic response are crucial for successful implementation of the WHO Option B+ guidelines to start all HIV-infected pregnant women on ART for life

Trends in HIV-1 prevalence and risk behaviours over 15 years in a rural population in Kilimanjaro region of Tanzania

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