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

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

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Prevalence and risk factors for HIV-1 infection in rural Kilimanjaro region of Tanzania: Implications for prevention and treatment

BACKGROUND: Variability in stages of the HIV-1 epidemic and hence HIV-1 prevalence exists in different areas in sub-Saharan Africa. The purpose of this study was to investigate the magnitude of HIV-1 infection and identify HIV-1 risk factors that may help to develop preventive strategies in rural Kilimanjaro, Tanzania. METHODS: A cross-sectional study was conducted between March and May of 2005 involving all individuals aged between 15–44 years having an address in Oria Village. All eligible individuals were registered and invited to participate. Participants were interviewed regarding their demographic characteristics, sexual behaviors, and medical history. Following a pre-test counseling, participants were offered an HIV test. RESULTS: Of the 2 093 eligible individuals, 1 528 (73.0%) participated. The overall age and sex adjusted HIV-1 prevalence was 5.6%. Women had 2.5 times higher prevalence (8.0% vs. 3.2%) as compared to men. The age group 25–44 years, marriage, separation and low education were associated with higher risk of HIV-1 infection for both sexes. HIV-1 infection was significantly associated with >2 sexual partners in the past 12 months (women: Adjusted odds ratio [AOR], 2.5 (95%CI: 1.3–4.7), and past 5 years, [(men: AOR, 2.2 (95%CI:1.2–5.6); women: AOR, 2.5 (95%CI: 1.4–4.0)], unprotected casual sex (men: AOR,1.8 95%CI: 1.2–5.8), bottled alcohol (Men: AOR, 5.9 (95%CI:1.7–20.1) and local brew (men: AOR, 3.7 (95%CI: 1.5–9.2). Other factors included treatment for genital ulcers and genital discharge in the past 1 month. Health-related complaints were more common among HIV-1 seropositive as compared to seronegative participants and predicted the presence of HIV-1 infection. CONCLUSION: HIV-1 infection was highly prevalent in this population. As compared to our previous findings, a shift of the epidemic from a younger to an older age group and from educated to uneducated individuals was observed. Women and married or separated individuals remained at higher risk of infection. To prevent further escalation of the HIV epidemic, efforts to scale up HIV prevention programmes addressing females, people with low education, lower age at marriage, alcohol consumption, condom use and multiple sexual partners for all age groups remains a top priority. Care and treatment are urgently needed for those infected in rural areas

Epidemiology of Measles in Tanzania: A Hospital-Based Survey of Measles Morbidity and Mortality

Objective: To estimate measles morbidity and mortality in selected regions on mainland Tanzania Design: Cross-sectional study Setting: Hospital-based review of existing records on measles morbidity and mortality in the selected district hospitals on mainland Tanzania. Methods: Review of records on measles morbidity and mortality was performed using a standard instrument adopted from the Ministry of Health. The instrument was pre-tested before use. Researchers were recruited from the Muhimbili University College of Health Sciences and were trained on how to collect data from the hospital records. Ethical clearance was obtained from the Ministry of Health in Dar es Salaam. Upon arrival in the respective regions, the researchers recruited and trained local research assistants on methods of data collection. Completed questionnaire forms were entered into a computer and data cleaning was done before data analysis. Results: Measles was found to occur in individuals of over 15 years of age and beyond. Overall 35% (N=2277) of all measles cases were reported from the Iringa region while Mara region had the lowest number of cases. On the other hand Shinyanga had the highest case fatality rate (6%) compared with other regions. Mortality was higher in children below two years of age and among individuals who had no history of measles vaccination. Conclusion: We conclude that despite high measles vaccination coverage, measles is still a public health problem in Tanzania. Efforts should be made to give several booster doses up to the age of 15 years

Knowledge, Attitudes and Practices Regrading Cholera Outbreaks in Ilala Municipality of Dar Es Salaam Region, Tanznia

Objective: The aim of the study was to determine knowledge, attitudes and practices regarding cholera outbreaks and measure socio cultural practices that influence cholera outbreaks in Ilala Municipality in Dar es Salaam city, Tanzania. Study design: A cross sectional study was conducted in Ilala municipality in Dar es Salaam city. Methods: The study population was obtained using multistage sampling technique. One ward was sampled and within the ward 10 hamlets (administrative cluster consisting of 10 households) were randomly selected. All households within the hamlets were included into the study sample. A structured questionnaire was used to collect data concerning knowledge, attitudes and practices about cholera and factors influencing cholera occurrence within household settings. Information collected included the number of families and number of people in one house, availability of toilet facilities and number of toilets in one house. The research project was cleared by the ethical clearance committee of the Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania. Informed consent was obtained from each consenting participant. Results: Three hundred and ten (310) respondents were included in the study of whom 186 (59.9%) were females and 124 (40.1%) were males aged between 18 and 84 years. The proportion of respondents with good knowledge of cholera in the study was 85%. The study revealed that the main practices associated with cholera occurrence among respondents with high level of knowledge in Ilala by water source were: use of piped water 84.3%, water from deep wells 88.3% and shallow wells 71.4%. The distribution of respondents by low knowledge and water source were: piped water 15.7%, shallow well 28.6% and deep well 11.7%. The proportions of respondents by low knowledge and water quantity were: adequate water 13.6% and inadequate water 18.3%. About 14% of the respondents with low level of knowledge of cholera drink water from wells without boiling while 31.8% drink unboiled piped water and wash their hands in a common container 21.6%. Furthermore the proportion of respondents with positive attitudes towards cholera prevention in this study was 97.4%. Conclusion and recommendations: The hygienic practices concerning cholera prevention were lagging behind knowledge and attitudes. A range of specific interventions are likely to be necessary for the control of cholera in this population. Misconceptions about transmissibility of cholera that cholera cannot be transmitted through cow’s dung, young children stool and chicken faeces need to be addressed.

DETERMINANTS OF UTILISATION OF MOSQUITO BEDNETS FOR MALARIA PREVENTION AMONG PREGNANT WOMEN IN KIGOMA URBAN DISTRICT, WESTERN TANZANIA

Objectives: To determine factors influencing utilisation of mosquito bednets for malaria prevention among pregnant women in Kigoma urban district in western Tanzania. Setting: Kigoma urban MCH clinics Methodology: Pregnant women attending antenatal care clinic in Kigoma municility were interviewed using a structured questionnaire. The questionnaire originally developed in the English language was translated into Swahili language and pre-tested before use. A trained team administered the questionnaire as part of a larger baseline study involving several malaria chemoprophylaxis strategies among pregnant women. Informed consent was obtained from each pregnant woman before questionnaire administration. The project was reviewed and cleared by the ethical clearance committee of the Muhimbili University College of Health Sciences. Results: A total of 729 pregnant women participated in the interview. The age of the participating women ranged from 14-45 years with mean age of 26.7 years and standard deviation (SD) of 5.4. Of the 729 pregnant women interviewed, 61.0% (445) knew about malaria and of these 69.4% (309) stated that they knew how to protect themselves against malaria. About 47% (N=728) of the pregnant women interviewed reported being current users of bednets. Reported use of bednets appeared to increase with increasing age of the pregnant women. Single and divorced pregnant women were less likely to report being users of bednets as compared to married or cohabiting pregnant women (49.2% versus 18.6%, odds ratio (OR) = 0.24, 95% confidence interval (95%CI) = 0.12 - 0.46). Similarly, reported use of bednets significantly increased with increasing level of education. Employed and those engaged in business were significantly more likely to be bednet users than housewives or peasants. Conclusion: We conclude that factors influencing use of bednets among pregnant women in Kigoma urban district include marital status, educational level and occupational status

ASYMPTOMATIC PARASITAEMIA AND PLACENTAL MALARIA INFECTION AMONG PREGNANT WOMEN IN KIGOMA URBAN DISTRICT, WESTERN TANZANIA

Objective: To determine the magnitude of malaria infection and anaemia among pregnant women in Kigoma Municipality, western Tanzania. Setting: An urban maternal and child health clinic (MCH) located in the Kigoma Municility in western Tanzania. Methods: A cross-sectional study was conducted in an urban MCH clinic in Kigoma Municility. Informed consent to participate in the study was sought from each pregnant woman. Consenting Pregnant women were interviewed to solicit for socio-demographic characteristics and information relating to use of malaria preventive measures. The women were also examined for anaemia and malaria parasitaemia. At delivery, the women were also examined for malaria infection of the placenta. The research was cleared by the Ethical Clearance Committee of the Muhimbili University College of Health Sciences, Dar es Salaam. Data were managed and analysed using SPSS/PC+ for windows. Results: The mean age of the pregnant women was 26.7 years (SD = 5.4) with the youngest woman being 14 years and the oldest being 45 years. The response proportion to participate in the study was 96.7% (N= 705). It was found that 8.4% of the women examined had asymptomatic malaria parasitaemia while2.8% had malaria infection of the placenta. Women with placental malaria were more likely to deliver low birth weight babies than others (8.8% versus 2.1%. Pregnant women who reported using bednets were less likely to have placental malaria compared to those not using bednet (2.2% versus 3.3%). Similarly, pregnant women who reported using bednets were less likely to have asymptomatic malaria parasitaemia than others (5.9% versus 10.4%). Conclusions: We conclude that placental malaria occurs in Kigoma municipality and it appears that use of bednets might be an effective strategy in controlling malaria among pregnant women in Tanzania

CIGARETTE SMOKING AND USE OF SMOKELESS TOBACCO IN MOSHI RURAL DISTRICT IN NORTHERN TANZANIA

Background: We assessed age and sex differences in cigarette smoking and use of smokeless tobacco over time in a rural population in Tanzania. This paper presents data on tobacco use among men and women 15-36 years old from 1991 to 1997. Methods: Cross-sectional studies were conducted in 1991, 1993 and 1997 in the Oria rural village situated 30 kilometres south of Moshi town in Kilimanjaro region. Verbal informed consent was obtained from each participant before questionnaire administration. Interviewers were fully trained on how to administer the questionnaire. Results: The overall prevalence of cigarette smoking in men declined from 36.0% in 1991 to 23.1% in 1997 while for women prevalence declined from 3.0% in 1991 to 1.0% in 1997. Prevalence of cigarette smoking increased significantly with increasing age (p = 0.001). The overall self-reported prevalence of consumption of nasal tobacco snuff was 0.6% and that of oral snuff was 1.9%. There was no significant difference observed on the use of nasal tobacco snuff among men as compared to women (0.5% versus 0.6%). However, significantly more women than men used oral tobacco snuff in this population (3.0 versus 0.5%) (OR =6.31; 95% CI 1.45 to 57.11). Conclusions: More men than women reported being cigarette smokers while for oral tobacco snuff more women than men used it. Cigarette smoking declined over time and may have been due to economic hardships following floods that hit the village in 1997

AIDS Knowledge and Risk Perception in Urban and Rural Communities in Arusha Region, Tanzania

The purpose of this study was to investigate demographic, cognitive and behavioral factors associated with levels of AIDS knowledge and perceived susceptibility to HIV. Cross-sectional, population-based surveys were conducted in two urban communities, two townships and two rural villages in Arusha region, Tanzania. Eligible participants were 15 to 54 years old living in randomly selected household clusters. A total of 3068 of the eligible men and women participated (62%). The large majority of participants from all six communities had heard of AIDS (96%) and perceived AIDS to be a serious threat to their community (97%). Both men and women had high levels of AIDS knowledge (67% answered at least 17 out of 18 questions correctly). Men reported to discuss AIDS more frequently than did women, and they perceived themselves as being at high risk for HIV infection more often than did women. For both men and women, having higher education and reporting having frequently discussed AIDS were significantly associated with a high score on the AIDS knowledge scale. Living in an urban community, frequently discussing AIDS and previous sexu al behavior were significantly associated with perceived susceptibility for HIV infection among both men and women. It is recommended that future educational efforts focus on creating opportunities for people to discuss HIV/AIDS in safe and supporting environments

Utilization of Health Care Services for STD Treatment in Kahe Community of Kilimanjaro Region in Tanzania.

A population based survey set to find out the existence of Sexually Transmitted Diseases (STDs) and use of health care services among residents of Oria village in Kahe ward of Kilimanjaro region in northern Tanzania in 1997. A few of the STDs symptoms covered were history of painful micturation (dysuria), urethral discharge and genital ulcer(s). This was a cross-sectional study using quantitative data collection technique in which a total of 898 villagers were interviewed. Findings revealed that in the past 223 (25.4%) had dysuria, 69 (7.7%) had urethral discharge while 28 (3.1%) had genital ulcer. At the time of the interview, 88 (9.8%) people had dysuria, 29 (3.2%) had urethral discharge and 9 (1.0%) had genital ulcer. Health care was sought from different sources, mostly from modern health care especially government health facilities (HFs) followed by private HFs and less so to pharmacies and traditional healers. No significant differences were found between the proportions of respondents that pertained to the different demographic variables with regard to utilization of the different health services. However, it is doubtful as to whether people treat themselves adequately since among those currently having STDs symptoms, some had previous history of treatment for the same problems. This may be due to either inadequate treatment, re-infection from untreated partners or new infections. A real explanation ought to be explored through future studies. Meanwhile, there is need to re-direct the existing strategies in addressing STDs in Oria village. The increasing demand for STDs management requires an increase in the number of HFs both private and public that have skilled health workers, the necessary supplies and drugs. Special efforts be made to target high risk groups using different health education packages on STDs and reinforce contact tracing while alternative sources of health care need to be explored further