The Letter

It was fortunate that Mrs. Agwambo had, in what she would have thought uncharacteristic of herself, walked straight onto the carpet in her high and pointed heeled shoes, for the door she had just gently pushed shut narrowly missed her as it violently swung open. Mrs. Agwambo turned to see who it was, her forehead wrinkling in disapproval. Auntie, who had flung the front door open, did not come in. Breathing heavily, she leaned forward, most of her weight falling on her right hand which firmly gripped the handle of the door it had shot after and reined back. ‘There’s a letter for Bebi’s father,’ Auntie said, then paused to catch her breath, before continuing, ‘on the sideboard.

The Kenyan Mwananchi and the National Language: Kiswahili and “Pili Mswahili” by Moreno Batamba et l’Orchestre Moja One

The frame for this critical interpretation of the Kiswahili popular love song “Pili Mswahili” by Moreno Batamba et L’Orchestre Moja One (1981) is the discussion on African contributions to the making of modern Africa. The argument is that “Pili Mswahili” is an instance of the mwananchi’s, common person’s, agentive contribution to the establishment of Kiswahili as a national language in Kenya. The song is read as an urging of non-Swahili Kenyans to accept Kiswahili – which, in spite of its being an important lingua franca in Kenya, was, after all, the language of one ethnic group in a multi-ethnic state where “tribalism” is a major political factor – as their national language. It is shown that “Pili Mswahili” complemented the efforts of the makers and executors of government policy that had nation formation as the ultimate objective. Nation formation is understood to be a key strategy in the African appropriation of the African nation-state that started life as a colonial invention

Prevalence,awareness and factors associated with hypertension in North West Tanzania.

BACKGROUND: Hypertension is a public health problem, and yet few people are aware of it and even fewer access effective treatment. With the ongoing demographic transition in many parts of Sub-Saharan Africa, people are changing from rural, manual work to urban lifestyles, hence the risk of hypertension increases. OBJECTIVE: This study aimed at determining the prevalence, awareness and risk factors associated with hypertension in North West Tanzania. DESIGN: A community-based cross-sectional study was conducted among adults in Magu District in 2013. Information on socio-demographic, economic and lifestyle characteristics, medical conditions, and risk factors for hypertension were collected according to the WHO Steps survey tool. Measurements of blood pressure, blood sugar, pulse rate, and anthropometry were taken. Multivariate logistic regression was used to estimate the odds ratios (OR) and 95% confidence intervals (95% CI) for factors associated with hypertension (Blood pressure ≥140/90mm/Hg). Frequencies and percentages were used to determine the awareness, and treatment among hypertensive participants. RESULTS: Among 9678 participants, the prevalence of hypertension was 8.0% and pre-hypertension 36.2%. There was a higher prevalence of hypertension at older ages, among females (8.2%) compared to males (7.7%), and among urban dwellers (10.1%) compared to rural residents (6.8%). Overweight, obese, and diabetic individuals had a higher risk of hypertension while HIV positive participants had a lower risk of hypertension (OR = 0.56; 95% CI 0.39 - 0.79). Among participants with hypertension, awareness was less than 10%. CONCLUSION: By integrating blood pressure screening into our long-standing community HIV screening program, we were able to identify many previously undiagnosed cases of hypertension and pre-hypertension. Age, residence, overweight and obesity were the major associated factors for hypertension. Awareness and treatment rates are very low indicating the need for programs to improve awareness, and treatment of hypertension

Trends and factors associated with repeated adolescent pregnancies in Tanzania from 2004-2016: evidence from Tanzania demographic and health surveys

Introduction: a repeated pregnancy represents a failure of health and social systems to educate and provide the necessary services and skills to ensure adolescent girls do not experience any further unwanted pregnancies during this young age. We aimed to determine trends and factors associated with repeated adolescent pregnancies in Tanzania 2004-2016. Methods: an analytical cross-sectional study was conducted using secondary data from Tanzania demographic and health surveys of the years 2004-2005, 2010 and 2015-2016 among adolescent mothers aged 15 to 19 years. Data analysis was performed using STATA version 15 and considered the complex survey design. The Poisson regression model was used to estimate prevalence ratios (PR) and 95% confidence intervals for factors associated with repeated adolescent pregnancy. Results: the proportion of repeated adolescent pregnancies increased from 15.8% in 2004/2005 to 18.6% in 2010, then to 18.8% in 2015/2016. Adolescents who delivered their first pregnancy at home (APR: 1.36, 95% CI: 1.03, 1.78) and who started sexual activity before 15 years of age (APR: 1.80, 95% CI: 1.40, 2.31) were likely repeated adolescent pregnancy. In contrast, adolescents who used contraception (APR: 0.52, 95% CI: 0.34, 0.81) had a lower prevalence of repeated adolescent pregnancies. Conclusion: the prevalence of repeated adolescent pregnancies has increased and remains unacceptably high. Adolescents who had low education delivered their first pregnancy at home and were non-contraceptive users need to be targeted in policies and programs for the prevention of repeated adolescent pregnancies

Willingness to HPV self-sampling for cervical cancer screening and its predictors among women attending outpatient clinics in Meru District, Arusha Region, Northern Tanzania

Background: The ability for women to self-collect human papillomavirus (HPV) samples can potentially reduce the risk of cervical cancer and increase screening coverage. Objectives: To assess the willingness to HPV self-sampling for cervical cancer screening and its predictors among women attending outpatient clinics in Arusha region, northern Tanzania. Methods: A hospital-based cross-sectional study was conducted among 706 women aged 18-55 years in Meru District Hospital and Usa River Health Centre from March to April 2019. Face-to-face intervies were conducted using a questionnaire. Data analysis was performed using Stata version 14.0. The log-binomial regression was used to determine factors associated with willingness to self-collection of HPV samples. Results: Majority (70%) of the women were willing to self-collection of HPV samples for cervical cancer screening and was associated with attending Meru District hospital (PR=2.02, 95%CI 1.77-2.31); good knowledge about cervical cancer warning signs (PR=1.11, 95%CI 1.01-1.22), prevention (PR=1.13, 95%CI 1.04-1.20), and symptoms (PR=1.61, 95%CI 1.33-1.93); and having formal employment (PR=1.22, 95%CI 1.07-1.37). Conclusion: The majority of women were willing to self-collect HPV samples for cervical cancer screening. Self-collection is, therefore, an acceptable and viable means of screening for cervical cancer, which has great implications for Tanzania from a health policy perspective. Keywords: Cervical cancer; HPV testing; HPV self-collection; Tanzania

Paternal characteristics associated with low birth weight among singleton births: a hospital-based birth cohort study in northern Tanzania

Introduction: low birth weight (LBW) remains a devastating adverse pregnancy outcome in low and middle income countries (LMICs). There is evidence showing that maternal demographic and pregnancy-related characteristics are associated with LBW. Little attention is given to paternal characteristics, which may be associated with a higher risk of LBW. This study aimed to assess the effect of paternal characteristics on LBW among singleton deliveries at Kilimanjaro Christian Medical Centre (KCMC) zonal referral hospital in Kilimanjaro region, northern Tanzania. Methods: this was a secondary analysis of a hospital-based cohort study from maternally-linked medical birth registry data at KCMC between 2000 and 2018. A total of 47,035 singleton deliveries were included in this study. Data analysis was performed using statistical package for social sciences (SPSS), version 20 (IBM Corp., Armonk, NY). Relative risk and corresponding 95% confidence intervals (CI) were used to determine association between LBW and paternal characteristics using log-binomial regression models, with robust standard errors to account for clustering of deliveries within mothers. Results: the proportion of LBW during the study period was 9.6%. After adjusting for maternal characteristics, higher risk of LBW was among fathers with low education level (RR=1.72, 95% CI: 1.22, 2.41, p=0.002), aged ≤24 years old (RR=1.37, 95% CI: 1.21, 1.55), and those unemployed (RR= 1.11, 95% CI: 1.01, 1.21). Lower risk of LBW was among fathers aged ≥40 years (RR=0.97, 95% CI: 0.88, 1.08), but this association was not statistically significant. Conclusion: the study confirmed paternal young age (≤24 years old), paternal low education level and unemployment as predictors for LBW . Current evidence on the effect of paternal characteristics on LBW might suggest that programs and policies should target their engagement as a key strategy for improving birth outcomes during the perinatal period. Future studies should assess how paternal factors are associated with the risk of adverse birth outcomes

Longitudinal evaluation of Ocimum and other plants effects on the feeding behavioral response of mosquitoes (Diptera: Culicidae) in the field in Tanzania

<p>Abstract</p> <p>Background</p> <p>The use of repellent materials from plants against nuisance insects is common with great potential to compliment existing malaria control programmes and this requires evaluation in the field. Ocimum plant species, <it>Ocimum suave </it>(Willd) and <it>O. kilimandscharicum </it>(Guerke) materials and their essential oils extracted by steam distillation were evaluated in the field and experimental huts for repellence, exophily and feeding inhibition effects against three mosquito species, <it>Anopheles arabiensis </it>(Patton), <it>An. gambiae </it>ss (Giles) and <it>Culex quinquefasciatus </it>(Say). The protective effect of essential oils from Ocimum plants were compared with N, N-diethly-3- methylbenzamide (DEET), a standard synthetic repellent. Also, the protective effect of fumigation by burning of repellent plants; <it>Ocimum suave, Ocimum kilimandscharicum</it>, <it>Azadirachta indica</it>, <it>Eucalyptus globules </it>and <it>Lantana camara </it>were tested in experimental huts and selected local houses.</p> <p>Results</p> <p>In the field, protection by Ocimum plants from mosquito bites was high and there was small variation among different mosquito species. Protection efficiency was 93.4%, 91.98% and 89.75% for <it>An. arabiensis </it>while for <it>Cx</it>. <it>quinquefaciatus </it>it was 91.30%, 88.65% and 90.50% for DEET, <it>Ocimum suave </it>and <it>O. kilimandscharicum </it>respectively. In the experimental hut, deterrence induced by burning of Ocimum and other plants ranged from 73.1.0% to 81.9% for <it>An. arabiensis </it>and 56.5% to 67.8% for <it>Cx. quinquefaciatus</it>, while feeding inhibition was 61.1% to 100% for <it>An. arabiensis </it>and 50% to 100% for <it>Cx. quinquefaciatus</it>. Evaluations under field conditions confirmed high protective efficacy, enhanced feeding inhibition and house entry inhibition (Deterrence).</p> <p>Conclusion</p> <p>This study shows the potential of <it>Ocimum suave and Ocimum kilimandscharicum </it>crude extracts and whole plants of <it>Ocimum suave, Ocimum kilimandscharicum</it>, <it>Azadirachta indica</it>, <it>Eucalyptus globules and Lantana camara </it>for use in protecting against human biting while the burning of plants reduces significantly the indoor resting mosquitoes.</p

Longitudinal evaluation of Ocimum and other plants effects on the feeding behavioral response of mosquitoes (Diptera: Culicidae) in the field in Tanzania

<p>Abstract</p> <p>Background</p> <p>The use of repellent materials from plants against nuisance insects is common with great potential to compliment existing malaria control programmes and this requires evaluation in the field. Ocimum plant species, <it>Ocimum suave </it>(Willd) and <it>O. kilimandscharicum </it>(Guerke) materials and their essential oils extracted by steam distillation were evaluated in the field and experimental huts for repellence, exophily and feeding inhibition effects against three mosquito species, <it>Anopheles arabiensis </it>(Patton), <it>An. gambiae </it>ss (Giles) and <it>Culex quinquefasciatus </it>(Say). The protective effect of essential oils from Ocimum plants were compared with N, N-diethly-3- methylbenzamide (DEET), a standard synthetic repellent. Also, the protective effect of fumigation by burning of repellent plants; <it>Ocimum suave, Ocimum kilimandscharicum</it>, <it>Azadirachta indica</it>, <it>Eucalyptus globules </it>and <it>Lantana camara </it>were tested in experimental huts and selected local houses.</p> <p>Results</p> <p>In the field, protection by Ocimum plants from mosquito bites was high and there was small variation among different mosquito species. Protection efficiency was 93.4%, 91.98% and 89.75% for <it>An. arabiensis </it>while for <it>Cx</it>. <it>quinquefaciatus </it>it was 91.30%, 88.65% and 90.50% for DEET, <it>Ocimum suave </it>and <it>O. kilimandscharicum </it>respectively. In the experimental hut, deterrence induced by burning of Ocimum and other plants ranged from 73.1.0% to 81.9% for <it>An. arabiensis </it>and 56.5% to 67.8% for <it>Cx. quinquefaciatus</it>, while feeding inhibition was 61.1% to 100% for <it>An. arabiensis </it>and 50% to 100% for <it>Cx. quinquefaciatus</it>. Evaluations under field conditions confirmed high protective efficacy, enhanced feeding inhibition and house entry inhibition (Deterrence).</p> <p>Conclusion</p> <p>This study shows the potential of <it>Ocimum suave and Ocimum kilimandscharicum </it>crude extracts and whole plants of <it>Ocimum suave, Ocimum kilimandscharicum</it>, <it>Azadirachta indica</it>, <it>Eucalyptus globules and Lantana camara </it>for use in protecting against human biting while the burning of plants reduces significantly the indoor resting mosquitoes.</p

Barriers to accessibility and utilization of HIV testing and counseling services in Tanzania: experience from Angaza Zaidi programme

Introduction: While HIV testing and counseling (HTC) services remain to be amongst the effective strategies in slowing HIV transmission, its accessibility and uptake in Tanzania is low. In 2011, 50% of adults have been ever tested and received their results. We conducted this study to assess barriers to accessibility and utilization of HTC services in Tanzania. Methods: A mixed methods study was conducted using both quantitative and qualitative approaches. Data were collected in in 9 regions of Tanzania in 2012. Twelve (12) in-depth interviews, 8 Focus Group Discussions and 422 clients were approached for data collection. Quantitative data were entered and analysed using SPSS, proportions were compared using chi-square test. Qualitative data, content analysis approach was used. Results: Overall 422 exit clients were enrolled into the study, 4.9% clients reported spending &gt;2 hours at the HTC centre before they were attended (p&lt;0.0001). Of the 422 clients in our study 5.7 % received HIV testing before getting HIV counseling (p=0.0001). Of those clients who received counseling, 21.8% of reported counseling to be done in a group (p=0.0001). Majority of study participants reported that the counselling sessions were private, with sufficient information, and interactive (p&lt;0.0001). Mobile services clinics, the Post Test Clubs and couple counselling and testing were effective approaches in stimulating demand for and use of HTC services. Conclusion: Findings show that coverage of HTC was high, however long waiting time and lack of confidentiality impeded its accessibility and utilization. We recommend increase of staff and adherence to counselling ethics to safeguard clients' privacy.Pan African Medical Journal 2016; 2

Risk factors for inappropriate blood requisition among hospitals in Tanzania.

BACKGROUND: Blood is a critical aspect of treatment in life saving situations, increasing demand. Blood requisition practices greatly effect sufficient supply in blood banks. This study aimed to determine the risk factors for inappropriate blood requisition in Tanzania. METHODS: This was a cross sectional study using secondary data of 14,460 patients' blood requests from 42 transfusion hospitals. Primary data were obtained by using cluster-sampling design. Data were analysed using a two-level mixed-effects Poisson regression to determine fixed-effects of individual-level factors and hospital level factors associated with inappropriate blood requests. P-value <0.05 (2-tails) was considered statistically significant. RESULTS: Inappropriate requisition was 28.8%. Factors significantly associated with inappropriate requisition were; reporting pulse rate and capillary refill decrease the risk (RR 0.74; 95% CI 0.64, 0.84) and (RR 0.73; 95% CI 0.63, 0.85) respectively and the following increased the risk; having surgery during hospital stay (RR 1.22; 95% CI 1.06, 1.4); being in general surgical ward (RR 3.3; 95% CI 2.7, 4.2), paediatric ward (RR 1.8; 95% CI 1.2, 2.7), obstetric ward (RR 2.5; 95% CI 2.0, 3.1), gynaecological ward (RR 2.1; 95% CI 1.5, 2.9), orthopaedics ward (RR 3.8; 95% CI 2.2, 6.7). Age of the patient, pallor and confirmation of pre-transfusion haemoglobin level were also significantly associated with inappropriate requisition. Majority of appropriate requisitions within the wards were marked in internal medicine (91.7%) and gynaecological wards (77.8%). CONCLUSIONS: The proportion of inappropriate blood requests was high. Blood requisition was determined by clinical and laboratory findings and the ward patients were admitted to. Adherence to transfusion guidelines is recommended to assure the best use of limited blood supply