Assessment of heavy metals in Hibiscus sabdariffa calyces and Moringa oleifera leaves collected from different areas in Tanzania

Medicinal plants are known in prevention and curing of diseases. Contamination of medicinal plants by heavy metals is one of the factors affecting quality of medicinal products from medicinal plants. Heavy metals may enter the edible and medicinal plants through contaminated environment such as water bodies, air or soil.  Hibiscus sabdariffa calyces and Moringa oleifera leaves are used in Tanzania as nutritional and disease-remedial herbal drinks. This study assessed heavy metal contamination of Hibiscus sabdariffa calyces and Moringa oleifera leaves collected from Dodoma region (Vikonje, Msanga, Nzuguni A and Nzuguni B village), Pwani region (Kongowe and Chalinze village) and Shinyanga region (Mwime village). Lead, arsenic, chromium, cadmium and mercury were analyzed by Atomic Absorption Spectrometry. Microsoft excel 2010 software were used to analyze the means of heavy metal concentrations. Levels of chromium in the calyces and leaves of H. sabdariffa and M. oleifera ranged between 0.029-0.221 ppm and 0.019-0.088 ppm respectively while Arsenic was 0.096-0.204 ppm and 0.096-0.219 ppm, respectively. Mercury and Lead were found only in leaves of M. oleifera, mercury was between 0.017 ppm and 0.042 ppm and lead was 0.056 ppm. Cadmium was not detected in all plant materials. The concentrations of heavy metals in the selected samples were statistically significant at (P˂0.05). M. oleifera leaves and H. sabdariffa calyces, collected from different regions, had the low levels of heavy metals than recommended limits provided by the Tanzania Medicine and Medical Devices Authority (TMDA) and WHO

Equity of child and adolescent treatment, continuity of care and mortality, according to age and gender among enrollees in a large HIV programme in Tanzania

Abstract Introduction: Global scale up of anti‐retroviral therapy (ART) has led to expansion of HIV treatment and prevention across sub‐Saharan Africa. However, age and gender‐specific disparities persist leading to failures in fulfillment of Sustainability Development Goals, including SDG3 (achieving healthy lives and wellbeing for all, at all ages) and SDG5 (gender equality). We assessed ART initiation and adherence, loss to follow‐up, all‐cause death and early death, according to SDG3 and SDG5 indicators among a cohort of HIV‐infected children and adolescents enrolled in care in Dar‐es‐Salaam, Tanzania Methods: SDG3 indicators included young (<5 years) and older paediatric children (5 to <10 years), early adolescent (10 to <15 years) and late adolescent (15 to <20 years) age group divisions and the SDG5 indicator was gender. Associations of age group and gender with ART initiation, loss to follow‐up and all‐cause death, were analysed using Cox proportional hazards regression and with adherence, using generalized estimating equations (GEE) with the Poisson distribution. Associations of age group and gender with early death were analysed, using log‐Poisson regression with empirical variance. Results: A total of 18,315 enrollees with at least one clinic visit were included in this cohort study. Of these 7238 (40%) were young paediatric , 4169 (23%) older paediatric, 2922 (16%) early adolescent and 3986 (22%) late adolescent patients at enrolment. Just over half of paediatric and early adolescents and around four fifths of the late adolescents were female. Young paediatric patients were at greater risk of early death, being almost twice as likely to die within 90 days. Males were at greater risk of early death once initiated on ART (HR 1.35, 95% CI 1.09, 1.66)), while females in late adolescence were at greatest risk of late death (HR 2.44 [1.60, 3.74] <0.01). Late adolescents demonstrated greater non‐engagement in care (RR 1.21 (95% CI 1.16, 1.26)). Among both males and females, early paediatric and late adolescent groups experienced significantly greater loss to follow‐up. Conclusion: These findings highlight equity concerns critical to the fulfillment of SDG3 and SDG5 within services for children and adolescents living with HIV in sub‐Saharan Africa. Young paediatric and late adolescent age groups were at increased risk of late diagnosis, early death, delayed treatment initiation and loss of continuity of care. Males were more likely to die earlier. Special attention to SDG3 and SDG5 disparities for children and adolescents living with HIV will be critical for fulfillment of the 2030 SDG agenda

Community Health Workers to Improve Antenatal Care and PMTCT Uptake in Dar es Salaam, Tanzania: A Quantitative Performance Evaluation

Background: Home visits by community health workers (CHW) could be effective in identifying pregnant women in the community before they have presented to the health system. CHW could thus improve the uptake of antenatal care (ANC), HIV testing, and prevention of mother-to-child transmission (PMTCT) services. Methods: Over a 16-month period, we carried out a quantitative evaluation of the performance of CHW in reaching women early in pregnancy and before they have attended ANC in Dar es Salaam, Tanzania. Results: As part of the intervention, 213 CHW conducted more than 45,000 home visits to about 43,000 pregnant women. More than 75% of the pregnant women identified through home visits had not yet attended ANC at the time of the first contact with a CHW and about 40% of those who had not yet attended ANC were in the first trimester of pregnancy. Over time, the number of pregnant women the CHW identified each month increased, as did the proportion of women who had not yet attended ANC. The median gestational age of pregnant women contacted for the first time by a CHW decreased steadily and significantly over time (from 21/22 to 16 weeks, P-value for test of trend <0.0001). Conclusions: A large-scale CHW intervention was effective in identifying pregnant women in their homes early in pregnancy and before they had attended ANC. The intervention thus fulfills some of the conditions that are necessary for CHW to improve timely ANC uptake and early HIV testing and PMTCT enrollment in pregnancy

Evaluation of a community health worker intervention and the World Health Organization’s Option B versus Option A to improve antenatal care and PMTCT outcomes in Dar es Salaam, Tanzania: study protocol for a cluster-randomized controlled health systems implementation trial

Background: Mother-to-child transmission of HIV remains an important public health problem in sub-Saharan Africa. As HIV testing and linkage to PMTCT occurs in antenatal care (ANC), major challenges for any PMTCT option in developing countries, including Tanzania, are delays in the first ANC visit and a low overall number of visits. Community health workers (CHWs) have been effective in various settings in increasing the uptake of clinical services and improving treatment retention and adherence. At the beginning of this trial in January 2013, the World Health Organization recommended either of two medication regimens, Option A or B, for prevention of mother-to-child transmission of HIV (PMTCT). It is still largely unclear which option is more effective when implemented in a public healthcare system. This study aims to determine the effectiveness, cost-effectiveness, acceptability, and feasibility of: (1) a community health worker (CWH) intervention and (2) PMTCT Option B in improving ANC and PMTCT outcomes. Methods/Design This study is a cluster-randomized controlled health systems implementation trial with a two-by-two factorial design. All 60 administrative wards in the Kinondoni and Ilala districts in Dar es Salaam were first randomly allocated to either receiving the CHW intervention or not, and then to receiving either Option B or A. Under the standard of care, facility-based health workers follow up on patients who have missed scheduled appointments for PMTCT, first through a telephone call and then with a home visit. In the wards receiving the CHW intervention, the CHWs: (1) identify pregnant women through home visits and refer them to antenatal care; (2) provide education to pregnant women on antenatal care, PMTCT, birth, and postnatal care; (3) routinely follow up on all pregnant women to ascertain whether they have attended ANC; and (4) follow up on women who have missed ANC or PMTCT appointments. Trial registration ClinicalTrials.gov: EJF22802. Registration date: 14 May 2013. Electronic supplementary material The online version of this article (doi:10.1186/1745-6215-15-359) contains supplementary material, which is available to authorized users

The effect of a community health worker intervention on public satisfaction: evidence from an unregistered outcome in a cluster-randomized controlled trial in Dar es Salaam, Tanzania

Background: There is a dearth of evidence on the causal effects of different care delivery approaches on health system satisfaction. A better understanding of public satisfaction with the health system is particularly important within the context of task shifting to community health workers (CHWs). This paper determines the effects of a CHW program focused on maternal health services on public satisfaction with the health system among women who are pregnant or have recently delivered. Methods: From January 2013 to April 2014, we carried out a cluster-randomized controlled health system implementation trial of a CHW program. Sixty wards in Dar es Salaam, Tanzania, were randomly allocated to either a maternal health CHW program (36 wards) or the standard of care (24 wards). From May to August 2014, we interviewed a random sample of women who were either currently pregnant or had recently delivered a child. We used five-level Likert scales to assess women’s satisfaction with the CHW program and with the public-sector health system in Dar es Salaam. Results: In total, 2329 women participated in the survey (response rate 90.2%). Households in intervention areas were 2.3 times as likely as households in control areas to have ever received a CHW visit (95% CI 1.8, 3.0). The intervention led to a 16-percentage-point increase in women reporting they were satisfied or very satisfied with the CHW program (95% CI 3, 30) and a 15-percentage-point increase in satisfaction with the public-sector health system (95% CI 3, 27). Conclusions: A CHW program for maternal and child health in Tanzania achieved better public satisfaction than the standard CHW program. Policy-makers and implementers who are involved in designing and organizing CHW programs should consider the potential positive impact of the program on public satisfaction. Trial registration: ClinicalTrials.gov, EJF2280

UPAYA PENINGKATAN PEMBELAJARAN MATEMATIKA DI SEKOLAH DASAR PADA KELOMPOK KKG GUGUS I PONTIANAK BARAT

Kualitas pendidikan, khususnya pendidikan matematika di Sekolah Dasar, sangat penting. Hasil penelitian menunjukkan bahwa pada umumnya siswa-siswa tidak senang dengan pembelajaran matematika, Hal ini juga disebabkan gaya pembelajaran dari guruguru mereka yang kaku sehingga mereka merasa tegang sewaktu proses pembelajaran matematika berlangsung. Pendekatan Berlajar Sambil Bermain diterapkan ini adalah pengembangan dari Problem posing (pengajuan soal) yaitu soal diolah menjadi suatu teka-teki yang mengandung operasi pecahan. Obyek atau sasaran penelitian pada siswa kelas dua dan kelas satu. Pembelajaran dimulai dengan sebuah teka teki atau suatu permainan menyembunyikan angka, digunakan pengantar sebagai soal cerita sehingga siswa-siswa telibat di dalamnya membuat mereka gembira sehingga mereka lebih aktif dan kreatif sehingga hasil yang diperoleh lebih baik dari yang pembelajaran biasa.Kata kunci : Belajar, Bermain (Study by Playing

Upaya Peningkatan Pembelajaran Matematika di Sekolah Dasar pada Kelompok Kkg Gugus I Pontianak Barat

Kualitas pendidikan, khususnya pendidikan matematika di Sekolah Dasar, sangat penting. Hasil penelitian menunjukkan bahwa pada umumnya siswa-siswa tidak senang dengan pembelajaran matematika, Hal ini juga disebabkan gaya pembelajaran dari guruguru mereka yang kaku sehingga mereka merasa tegang sewaktu proses pembelajaran matematika berlangsung. Pendekatan Berlajar Sambil Bermain diterapkan ini adalah pengembangan dari Problem posing (pengajuan soal) yaitu soal diolah menjadi suatu teka-teki yang mengandung operasi pecahan. Obyek atau sasaran penelitian pada siswa kelas dua dan kelas satu. Pembelajaran dimulai dengan sebuah teka teki atau suatu permainan menyembunyikan angka, digunakan pengantar sebagai soal cerita sehingga siswa-siswa telibat di dalamnya membuat mereka gembira sehingga mereka lebih aktif dan kreatif sehingga hasil yang diperoleh lebih baik dari yang pembelajaran biasa

Chemical composition of essential oils from Eucalyptus globulus and Eucalyptus maculata grown in Tanzania

This study examined the chemical composition of essential oil from the leaves of Eucalyptus maculata and Eucalyptus globulus found in Tanzania. The chemical composition of essential oils of other species viz. E. saligna, E. citriodora and E. camaldulensis has been described, but due to low abundance of Eucalyptus globulus and Eucalyptus maculata the composition of these plants grown in different parts of Tanzania are unknown. The essential oil was extracted by steam distillation and was analyzed for various chemical compositions using GC–MS. The major identified compounds in the leaf essential oil of E. maculata were Eucalyptol (54.29%), p-cymene (10.10%), α-pinene (7.78%), β-myrcene (7.78%), γ-terpinene (1.73%) and citronellal (1.62%); while Eucalyptol (51.62%), α-pinene (23.62%), p-cymene (10%), β-myrcene (8.74%), Terpinen-4-ol (2.74%) and γ-terpinene (2.59%) were the major compounds for E. globulus