Pregnant women's beliefs, expectations and experiences of antenatal ultrasound in Northern Tanzania

This qualitative study explored pregnant women's beliefs, expectations and experiences of the recently introduced antenatal ultrasound service in BomaNg'ombe hospital, Tanzania. Thematic analysis of 25 semi-structured interviews and 41 questionnaires was employed. The majority of women desired ultrasonography despite many not understanding the procedure or purpose. Patient's expectations included discovering fetal position, fetal sex and pregnancy problems. However, women frequently over-estimated the capacity of ultrasound, and had significant fears of harm. One sixth of questionnaire respondents said they did not want ultrasonography. Nonetheless since the service was introduced no woman has declined, and numerous interviewees believed scans were obligatory. Despite fears, some women reported enjoyment of ultrasound. Interviewees believed ultrasound would increase antenatal care (ANC) attendance. An informed consent policy and an education campaign are needed to reduce fears and maximiseuptake and health gains. The effects of ultrasound availability on timely ANC uptake, including amongst women not currently accessing ANC, should be further researche

Risk factors associated with pre-term birth in Dar es Salaam, Tanzania: a case-control study

Background: Preterm birth remains one of the most serious problems in obstetrics care. Its aetiology is complex and multifactorial. This study was carried out to determine risk factors for preterm birth in Dar es Salaam City in Tanzania.Methods: This case-control study was conducted in three municipal hospitals namely, Amani, Mwananyamala and Temeke in Dar es Salaam. It involved 377 pairs of women with preterm birth (cases) and term birth (controls). Eligible women who agreed to participate and who signed the consent form completed a short interview regarding demographic and lifestyle factors, had their baby examined for maturity, and had their medical records abstracted. All cases and controls were interviewed face-to-face using a specially designed questionnaire. Multivariate logistic regression after controlling for potential confounders was used to measure the strength of associations between preterm birth and related factors.Results: Several significant risk factors associations with pre-term birth were multiple pregnancies (AOR = 8.6; 95%CI 4.5-16.5; p-value <0.001), untreated vaginal discharge (AOR = 5.2; 95%CI 1.1-24.4; p-value 0.034), public prenatal care (AOR = 2.1; 95%CI 1.1-4.1; p-value 0.017), untreated urinary tract infection (AOR = 2.7; 95%CI 1.2-6.1; p-value 0.016), complication during pregnancy (AOR = 2.7; 95%CI 1.3-5.3; p-value 0.004), cervical incompetence (AOR = 11.6; 95%CI 1.1-121.5; p-value 0.04), polyhydramnios (AOR = 8.3; 95%CI 1.7-40.2; p-value 0.008), and lack of antenatal visits  (AOR = 5.1; 95%CI 1.4-17.8; p-value 0.042).Conclusion: This study has identified several risk factors for preterm birth in the city of Dar es Salaam. It is important that planners design community-based interventions to address complications from preterm birth

Predictors of linkage to care following community-based HIV counseling and testing in rural Kenya

Despite innovations in HIV counseling and testing (HCT), important gaps remain in understanding linkage to care. We followed a cohort diagnosed with HIV through a community-based HCT campaign that trained persons living with HIV/AIDS (PLHA) as navigators. Individual, interpersonal, and institutional predictors of linkage were assessed using survival analysis of self-reported time to enrollment. Of 483 persons consenting to follow-up, 305 (63.2%) enrolled in HIV care within 3 months. Proportions linking to care were similar across sexes, barring a sub-sample of men aged 18–25 years who were highly unlikely to enroll. Men were more likely to enroll if they had disclosed to their spouse, and women if they had disclosed to family. Women who anticipated violence or relationship breakup were less likely to link to care. Enrolment rates were significantly higher among participants receiving a PLHA visit, suggesting that a navigator approach may improve linkage from community-based HCT campaigns.Vestergaard Frandse

PEG1/MEST and IGF2 DNA methylation in CIN and in cervical cancer

IntroductionAlthough most invasive cervical cancer (ICC) harbor 30years further strengthened these associations.ConclusionsWhile the small sample size limits inference, these findings show that altered DNA methylation at imprinted domains including IGF2/H19 and PEG1/MEST may mediate the association between HPV and ICC risk

Knowledge and Perceptions of Couples' Voluntary Counseling and Testing in Urban Rwanda and Zambia: A Cross-Sectional Household Survey

Most incident HIV infections in sub-Saharan Africa occur between cohabiting, discordant, heterosexual couples. Though couples' voluntary HIV counseling and testing (CVCT) is an effective, well-studied intervention in Africa, <1% of couples have been jointly tested.We conducted cross-sectional household surveys in Kigali, Rwanda (n = 600) and Lusaka, Zambia (n = 603) to ascertain knowledge, perceptions, and barriers to use of CVCT.Compared to Lusaka, Kigali respondents were significantly more aware of HIV testing sites (79% vs. 56%); had greater knowledge of HIV serodiscordance between couples (83% vs. 43%); believed CVCT is good (96% vs. 72%); and were willing to test jointly (91% vs. 47%). Stigma, fear of partner reaction, and distance/cost/logistics were CVCT barriers.Though most respondents had positive attitudes toward CVCT, the majority were unaware that serodiscordance between cohabiting couples is possible. Future messages should target gaps in knowledge about serodiscordance, provide logistical information about CVCT services, and aim to reduce stigma and fear

Mistrust in marriage-Reasons why men do not accept couple HIV testing during antenatal care- a qualitative study in eastern Uganda

<p>Abstract</p> <p>Background</p> <p>A policy for couple HIV counseling and testing was introduced in 2006 in Uganda, urging pregnant women and their spouses to be HIV tested together during antenatal care (ANC). The policy aims to identify HIV-infected pregnant women to prevent mother-to-child transmission of HIV through prophylactic antiretroviral treatment, to provide counseling, and to link HIV-infected persons to care. However, the uptake of couple testing remains low. This study explores men's views on, and experiences of couple HIV testing during ANC.</p> <p>Methods</p> <p>The study was conducted at two time points, in 2008 and 2009, in the rural Iganga and Mayuge districts of eastern Uganda. We carried out nine focus group discussions, about 10 participants in each, and in-depth interviews with 13 men, all of whom were fathers. Data were collected in the local language, Lusoga, audio-recorded and thereafter translated and transcribed into English and analyzed using content analysis.</p> <p>Results</p> <p>Men were fully aware of the availability of couple HIV testing, but cited several barriers to their use of these services. The men perceived their marriages as unstable and distrustful, making the idea of couple testing unappealing because of the conflicts it could give rise to. Further, they did not understand why they should be tested if they did not have symptoms. Finally, the perceived stigmatizing nature of HIV care and rude attitudes among health workers at the health facilities led them to view the health facilities providing ANC as unwelcoming. The men in our study had several suggestions for how to improve the current policy: peer sensitization of men, make health facilities less stigmatizing and more male-friendly, train health workers to meet men's needs, and hold discussions between health workers and community members.</p> <p>Conclusions</p> <p>In summary, pursuing couple HIV testing as a main avenue for making men more willing to test and support PMTCT for their wives, does not seem to work in its current form in this region. HIV services must be better adapted to local gender systems taking into account that incentives, health-seeking behavior and health system barriers differ between men and women.</p

PEG1/MEST and IGF2 DNA methylation in CIN and in cervical cancer

INTRODUCTION: Although most invasive cervical cancer (ICC) harbor <20 human papillomavirus (HPV) genotypes, use of HPV screening to predict ICC from HPV has low specificity, resulting in multiple and costly follow-up visits and overtreatment. We examined DNA methylation at regulatory regions of imprinted genes in relation to ICC and its precursor lesions to determine if methylation profiles are associated with progression of HPV-positive lesions to ICC. MATERIALS AND METHODS: We enrolled 148 controls, 38 CIN and 48 ICC cases at Kilimanjaro Christian Medical Centre from 2008 to 2009. HPV was genotyped by linear array and HIV-1 serostatus was tested by two rapid HIV tests. DNA methylation was measured by bisulfite pyrosequencing at regions regulating eight imprinted domains. Logistic regression models were used to estimate odd ratios. RESULTS: After adjusting for age, HPV infection, parity, hormonal contraceptive use, and HIV-1 serostatus, a 10 % decrease in methylation levels at an intragenic region of IGF2 was associated with higher risk of ICC (OR 2.00, 95 % CI 1.14–3.44) and cervical intraepithelial neoplasia (CIN) (OR 1.51, 95 % CI 1.00–2.50). Methylation levels at the H19 DMR and PEG1/MEST were also associated with ICC risk (OR 1.51, 95 % CI 0.90–2.53, and OR 1.44, 95 % CI 0.90–2.35, respectively). Restricting analyses to women >30 years further strengthened these associations. CONCLUSIONS: While the small sample size limits inference, these findings show that altered DNA methylation at imprinted domains including IGF2/H19 and PEG1/MEST may mediate the association between HPV and ICC risk

EDIBLE GRASSHOPPERS (Ruspolia differens) AS ALTERNATIVE SOURCE OF PROTEIN FROM INSECTS TO COMBAT MALNUTRITION

One of the most common public health issues affecting both children and adults in poor nations is malnutrition. Malnutrition is frequently attributed to food insecurity or a lack of access to enough food. Malnutrition is a serious issue in Tanzania mainland and Zanzibar, that requires attention. More cases of malnutrition than any other category are caused by protein-energy deficiencies. Compared to plantbased protein, animal protein offers essential amino acids in a better pattern. Nonetheless, it is a significant problem to produce enough animal proteins to feed the expanding global population of 9 billion people. Throughout the months of November and December each year, the Kagera region of Tanzania collects a large number of edible grasshoppers (Ruspolia differens) from the Muleba and Bukoba Districts. Grasshoppers processed in different methods are a rich source of nutrients such as protein (7.80-44.70%), fat (36.30-83.00%), fibre (8.70-11.20), ash (2.20-2.40%), total carbohydrates (5.30-12.10%), total energy (614-807 Kcal/100 g), Ca (35.80-55.00 mg/100 g), P (305.40-496.80 mg/100 g), Mg (33.30- 56.50 mg/100 g), Fe (12.90-179.10 mg/100 g), Cu (1.60-2.30 mg/100 g), Mn (2.90- 5.30 mg/100 g), Zn (8.50-18.40 mg/100 g) and Co (28.60-33.10 mg/100 g). The Kagera region's residents roast these insects and either consume them alone or in combination with other dishes like bananas. A few months after collection, grasshoppers begin to spoil due to their perishability. The shelf life of these products could be increased by at least a year with the right processing methods. In order to battle hunger and raise the community's revenue, these grasshoppers are a great source of nutrients that may be utilized to augment other crops with low nutritional value, such as bananas, cassava, rice, millets, sorghum and maize. In order to combat malnutrition, this review will examine the research on the utilization of edible insects as alternate source of protein and micronutrients

EDIBLE GRASSHOPPERS (Ruspolia differens) AS ALTERNATIVE SOURCE OF PROTEIN FROM INSECTS TO COMBAT MALNUTRITION

One of the most common public health issues affecting both children and adults in poor nations is malnutrition. Malnutrition is frequently attributed to food insecurity or a lack of access to enough food. Malnutrition is a serious issue in Tanzania mainland and Zanzibar, that requires attention. More cases of malnutrition than any other category are caused by protein-energy deficiencies. Compared to plantbased protein, animal protein offers essential amino acids in a better pattern. Nonetheless, it is a significant problem to produce enough animal proteins to feed the expanding global population of 9 billion people. Throughout the months of November and December each year, the Kagera region of Tanzania collects a large number of edible grasshoppers (Ruspolia differens) from the Muleba and Bukoba Districts. Grasshoppers processed in different methods are a rich source of nutrients such as protein (7.80-44.70%), fat (36.30-83.00%), fibre (8.70-11.20), ash (2.20-2.40%), total carbohydrates (5.30-12.10%), total energy (614-807 Kcal/100 g), Ca (35.80-55.00 mg/100 g), P (305.40-496.80 mg/100 g), Mg (33.30- 56.50 mg/100 g), Fe (12.90-179.10 mg/100 g), Cu (1.60-2.30 mg/100 g), Mn (2.90- 5.30 mg/100 g), Zn (8.50-18.40 mg/100 g) and Co (28.60-33.10 mg/100 g). The Kagera region's residents roast these insects and either consume them alone or in combination with other dishes like bananas. A few months after collection, grasshoppers begin to spoil due to their perishability. The shelf life of these products could be increased by at least a year with the right processing methods. In order to battle hunger and raise the community's revenue, these grasshoppers are a great source of nutrients that may be utilized to augment other crops with low nutritional value, such as bananas, cassava, rice, millets, sorghum and maize. In order to combat malnutrition, this review will examine the research on the utilization of edible insects as alternate source of protein and micronutrients