Comparison of Mortality by Gender and Regions in Tanzania using Direct Standardized Death Rates (DSDR) Method

Background: Comparison of mortality is very useful in assessing population health. Crude rates can easily be computed from the mortality but they are not good for comparison across groups of the population. The aim of this paper was to compare mortality in Tanzania by region and gender using the 2012 Tanzania Population and Housing Census. Methods: Age-specific death rates for regions, Tanzania Mainland, Tanzania Zanzibar and entire Tanzania were obtained from Mortality and Health monograph data downloadable from the National Bureau of Statistics website. The direct standardization method was used to compare the mortality for male and female populations across all regions of Tanzania Mainland and Zanzibar. Results: Findings show that the mortality is low in Arusha, Manyara, and Kilimanjaro compared to other regions in Tanzania mainland implying that health status for both male and female population in those regions is better than the other regions while it is the worst in Njombe, Iringa, and Kagera implying the poor health status for those regions as compared to the rest regions in Tanzania Mainland. In Tanzania Zanzibar, high mortality was observed in Kusini Unguja and the lowest in Kaskazini Unguja for both male and female populations. By national wise and for almost all regions, the mortality for the male population is higher than that for the female population. Conclusion: Direct standardization methods can save as the best way for comparing mortality because it takes into consideration both the population at risk and the age structure. However, in estimating mortality, crude death rates should be used to give the magnitude while direct standardized death rates should be used for comparison purposes

Sexual harassment in public transport among female university students in Dar es Salaam, Tanzania

Background: Globally, women and girls are subjected to various forms of sexual harassment while using public transport daily. Objective: To determine the prevalence of sexual harassment and identify different forms and associated risk factors among female university students who use public transport in Dar es Salaam, Tanzania. Methods: A cross-sectional study design using a questionnaire was employed to collect data. Data were collected from female first-year undergraduate students, who use public transport and are aged 18 years and above studying at the University of Dar es Salaam and Muhimbili University of Health and Allied Sciences.      Results: The overall prevalence of sexual harassment on public transport was 88%. Study participants reported the highest levels of sexual harassment (91%). Verbal harassment was the most common form of sexual harassment (95%), and being called names such as baby, sweet, honey or love was reported by most students (78%). Factors associated with sexual harassment on public transport were: overcrowded vehicles (AOR=2.90, 95% CI: 0.09-4.50) and use of public transport as a form of transport (AOR=4.54, 95% CI: 0.40-8.90).  Conclusion: The study findings highlight the need for the implementation of plausible interventions on the issue of sexual harassment through awareness campaigns and the implementation of modern surveillance and reporting systems in public spaces

Predictors of condom use among unmarried sexually active women of Reproductive age in Tanzania

Background: Condom is one of the methods for prevention against Human Immunodeficiency Virus and other Sexually Transmitted Infections. It is also considered an effective method for preventing unwanted pregnancies. Despite the several interventions that have been put to promote condom use, still a large proportion of women do not use condom during sexual intercourse. Objectives: This study aimed at determining predictors of condom use among unmarried sexually active women of reproductive age in Tanzania. Methods: This study used secondary data from the 2015-16 Tanzania Demographic and Health Survey and Malaria Indicator Survey (2015-16 TDHS-MIS). It involved unmarried sexually active women aged 15-49 years. Multiple binary logistic regression was used to determine predictors for condom use at last sexual intercourse. Results: Overall, lower proportion (31.1%) of unmarried sexually active women used condom at last sexual intercourse. The odds of using condom during last sexual intercourse was lower aOR=0.67 and aOR=0.65 for women aged 20-24 and 25+ years respectively). Women who reported higher age (18+ years) at first sex had higher odds (aOR=1.65) of using condom compared to those started sex before 15 years old. Women owning telephone had higher odds (aOR=1.44) compared to women without telephone. Also, higher odds of using condom were observed for women in the Southern, South West highlands, and Eastern zones compared to the Central zone. Discussion: Age, marital union, parity, wealth, ownership of; mobile phone, television, access to newspapers, and radio significantly predicts condom use among unmarried sexually active women of reproductive age in Tanzania. Conclusion: The level of condom use among unmarried women in Tanzania is very low and varies by age, age at sex intercourse, ownership of phone and zones. Targeted interventions are needed to promote the condom use among unmarried women in order to mitigate the risk of HIV and un-intended pregnancies

Absence of Germline BRCA1 c.68_69delAG and c.5266dupC Mutations among Hormone Receptor-negative Breast Cancer Patients: A First Impression at a Tertiary Cancer-care Facility in Tanzania

The germline BRCA1 c.68_69delAG (185delAG) and c.5266dupC (5382insC) mutations are associated with hormone receptor-negative breast cancer (BC).  Limited studies have examined their contribution to alarming BC incidence in Sub Saharan Africa (SSA). Our study aimed to examine the contribution of  germline BRCA1 c.68_69delAG and c.5266dupC mutations to BC incidence among hormone receptor-negative BC patients admitted to Ocean Road Cancer Institute in Tanzania. Face-to-face interviews were conducted to capture socio-demographic characteristics, anthropometric measurements, family history of cancer and reproductive information from each patient. Their  histopathological data were extracted from the hospital medical records. The germline BRCA1 founder mutations were analyzed on blood samples using Sanger sequencing technology. The patients mean age at diagnosis was 47.05 ± 12.82 years. A family history of cancer was observed in 13.6% of patients. The germline BRCA1 c.68_69delAG and c.5266dupC mutations were not detected in the study group. Our findings indicate that the germline BRCA1 c.68_69delAG and c.5266dupC mutations do not contribute to BC manifestation in hormone receptor-negative BC patients in Tanzania. Thus, screening BC patients for these mutations has no clinical relevance. Our data further suggest that the c.68_69delAG and the c.5266dupC mutations should not be considered when developing genetic testing guidelines in Tanzania. Keywords: Breast cancer, germline BRCA1 mutation, c.68_69delAG (185delAG), c.5266dupC (5382insC), Tanzani

Factors associated with uptake of postpartum family planning services in Dodoma City Council, Tanzania: A cross-section study

Background: Postpartum family planning is very essential to mothers’ health. However, its utilization remains low in developing countries. Objective: To determine the proportion and factors associated with uptake of PPFP services in Dodoma Tanzania. Methods: A cross-sectional study employing a quantitative approach was conducted among women who gave birth one year before the study period (June 2020) in Dodoma city council. A two-stage sampling technique was employed to recruit a total number of 209 participants. An interviewer-administered questionnaire was used to collect data. Data were entered and cleaned using Epi Info 7 and later exported to and analyzed using SPSS version 25.0. Bivariate and multiple logistic regression models were employed during data analysis. Odds ratios with 95% confidence intervals were computed to identify factors associated with postpartum family planning. Results: Majority (53.6%) of women used contraceptives within one year after delivery. Three factors were significantly associated with the uptake of postpartum family planning. Lower odds for uptake of PPFP were found among self-employed women (AOR: 0.5, 95% CI 0.25–0.74) and unemployed women (AOR: 0.2, 95% CI 0.05–0.31) when compared with employed women. Using community health fund insurance (AOR: 2.4, 95% CI 1.09–6.42) and National Health Insurance Fund (AOR: 2.7, 95% CI 1.54–5.99) as a mode of payments for health had higher odds for uptake of PPFP compared to cash mode. Women with an adequate number of antenatal care visits had higher odds (AOR: 2.9, 95% CI 1.24–6.89) of uptake of PPFP compared to women with an inadequate number of antenatal care visits. Conclusion: The uptake of PPFP among women was not adequate and was associated with being employed, being covered by health insurance and adequate antenatal care visits. More interventions are needed to enhance PPFP use among women

Early disengagement from HIV pre-exposure prophylaxis services and associated factors among female sex workers in Dar es Salaam, Tanzania: a socioecological approach

Introduction Pre-exposure prophylaxis (PrEP) is an effective HIV prevention tool when taken as prescribed. However, suboptimal use may challenge its real-life impact. To support female sex workers in their efforts to prevent themselves from HIV, it is essential to identify factors that contribute to early disengagement from PrEP care. In this study, we aimed to estimate the risk of early disengagement from PrEP services among female sex workers in Tanzania and associated factors using a socioecological model as a guiding framework.Methods The study was conducted as part of a pragmatic mHealth trial for PrEP roll-out in Dar es Salaam in 2021. We estimated the risk of early disengagement, defined as not presenting for the first follow-up visit (within 56 days of enrolment), and its associations with individual, social, behavioural and structural factors (age, self-perceived HIV risk, mental distress, harmful alcohol use, condom use, number of sex work clients, female sex worker stigma and mobility) using multivariable logistic regression models, with marginal standardisation to obtain adjusted relative risks (aRR).Results Of the 470 female sex workers enrolled in the study, 340 (74.6%) did not attend the first follow-up visit (disengaged). Mental distress (aRR=1.14; 95% CI 1.01 to 1.27) was associated with increased risk of disengagement. Participants who reported a higher number of clients per month (10–29 partners: aRR=0.87; 95% CI 0.76 to 0.98 and ≥30 partners: aRR=0.80; 95% CI 0.68 to 0.91) and older participants (≥35 years) (RR=0.75; 95% CI 0.56 to 0.95) had a lower risk of disengagement.Conclusions and recommendations Early disengagement with the PrEP programme was high. Mental distress, younger age and having fewer clients were risk factors for disengagement. We argue that PrEP programmes could benefit from including mental health screening and treatment, as well as directing attention to younger sex workers and those reporting fewer clients

Predictors of mHealth use in promoting adherence to pre-exposure prophylaxis among female sex workers: an evaluation of the Jichunge intervention in Dar es Salaam, Tanzania

Background There is evidence that pre-exposure prophylaxis (PrEP) is effective in preventing HIV transmission, and PrEP is recommended by the World Health organization (WHO) for use by individuals at high risk of HIV infection. However, low adherence has been reported to hamper its effectiveness. Some evidence indicates that mHealth interventions may be a promising way of promoting PrEP adherence. Nevertheless, evaluations of mHealth interventions in Africa, the region most affected by HIV, are scarce. This study aimed at identifying the extent of and predictors for use of a smartphone based mHealth application among female sex workers in Dar es Salaam, Tanzania. Methods As part of a quasi-experimental study in Tanzania, 470 female sex workers who were eligible for PrEP and who owned a smartphone were recruited using respondent driven sampling. All participants were provided with an mHealth application called Jichunge, a smartphone-based app designed to promote adherence to PrEP by offering users information, advise and support during start-up and use of PrEP. We collected data through structured interviews at baseline and extracted user data from the app for a period of 30 days. Modified Poisson regression model with robust standard errors was used to identify predictors for the optimal use of the Jichunge app. Results Overall, the optimal use of the Jichunge app was 46.4%. Optimal use was significantly higher among women who were older (aPR = 1.3, 95% CI: 1.10-1.65, p = 0.004 for age 25-34 years, and aPR = 1.6, 95% CI: 1.19-2.07, p = 0.001 for age at least 35 years), who had secondary education or higher (aPR = 1.8, 95% CI: 1.08-2.94, p = 0.023), who had suboptimal social support (aPR = 1.2, 95% CI: 1.02-1.48, p = 0.030), who had high awareness of PrEP (aPR = 1.3, 95% CI: 1.08-1.55, p = 0.005), and who had experience using common mainstream social media applications (aPR = 1.4, 95% CI: 1.08-1.71, p = 0.009). Conclusion Optimal use of the Jichunge app was substantially higher among women with higher age, higher education, higher PrEP awareness, less social support, and experience using common social media applications. Individual and interpersonal factors should be considered in planning mHealth interventions. Further studies to determine predictors of longer-term mHealth engagement are needed. Trial registration International Clinical Trials Registry Platform PACTR202003823226570; 04.03.2020

Prescribing patterns of antimicrobials according to the WHO AWaRe classification at a tertiary referral hospital in the southern highlands of Tanzania

Summary: Background: Antimicrobial consumption continues to rise globally and contributes to the emergence and spread of antimicrobial resistance. This study aimed to evaluate antimicrobial prescribing patterns in a selected tertiary hospital in Tanzania. Methods: This cross-sectional study was conducted for one year (September 2021–September 2022) at Mbeya Zonal Referral Hospital, a public hospital in the southern highlands zone of Tanzania. Data on clinical diagnosis, laboratory tests, prescribed antimicrobials, and prescribers' designations were collected through a custom eMedical system, aligning antimicrobials with the WHO's 2021 AWaRe classification. Descriptive analysis was performed to assess the pattern of antimicrobial prescriptions. Results: Of 2,293 antimicrobial prescriptions, 62.41% were ACCESS, 37.42% were WATCH, and 0.17% fell in the RESERVE categories. Metronidazole, accounting for 23.8%, was the most commonly prescribed antimicrobial. More than 50% of the ACCESS and WATCH prescriptions were justified by laboratory diagnosis and were predominantly prescribed by clinicians. A very small proportion of prescriptions (<1%) were informed by culture and sensitivity (C/S) testing. The Paediatric department had the majority of WATCH prescriptions (72.2%). Conclusion: The prescribing patterns at the study hospital generally align with WHO AWaRe guidelines, potentially mitigating antimicrobial resistance. Nevertheless, the scarcity of culture and sensitivity testing is a concern that warrants targeted improvement

Development of a Mobile Health Application for HIV Prevention Among At-Risk Populations in Urban Settings in East Africa: A Participatory Design Approach

BackgroundThere is limited evidence in Africa on the design and development of mobile health (mHealth) applications to guide best practices and ensure effectiveness. A pragmatic trial for HIV pre-exposure prophylaxis roll-out among key populations in Tanzania is needed. ObjectiveWe present the results of the development of a mobile app (Jichunge) intended to promote adherence to pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) and female sex workers (FSW) in Tanzania. MethodsA participatory design approach was employed and guided by the information system research framework. MSM and FSW were the target populations. A total of 15 MSM and 15 FSW were engaged in the relevance and design cycles, while the piloting phase included 10 MSM and 20 FSW. ResultsThe relevance cycle enabled the description of the existing problem, provided the compatible app features for the target population, and identified the need to develop an mHealth app that provides health services in a stigmatizing and discriminating environment. User involvement in the app’s design and evaluation provided an opportunity to incorporate social, cultural, and community-specific features that ensured usability. In addition, the participants suggested valuable information to inform the app, text message services, medication registration, and chat platform designs. ConclusionsThe participatory design approach in the development of mHealth apps is useful in identifying and validating population-specific functional features, improve usability, and ensuring future health impacts. Through this participatory process, the Jichunge app took end-user needs, perspectives, and experiences into account, eliciting enthusiasm regarding its potential role in supporting pre-exposure prophylaxis adherence for HIV and related behavioral change promotion. Trial RegistrationInternational Clinical Trials Registry Platform PACTR202003823226570; https://trialsearch.who.int/Trial2.aspx?TrialID=PACTR20200382322657