Factors associated with major structural birth defects among newborns delivered at Muhimbili National Hospital and Municipal Hospitals in Dar Es Salaam, Tanzania 2011 – 2012

Introduction: ninety-four percent of all birth defects and 95% of deaths due to the birth defects occur in low and middle income countries,Tanzania among them. In Tanzania there are currently limited birth defects prevention strategies in place due to limited information on factorsassociated with the occurrence of birth defects.Methods: we conducted a case control study that included newborns born from October, 2011through February, 2012 at 4 participating hospitals. A case was defined as any newborn of a Dar es salaam resident with a neural tube defect,orofacial clefts, limb reduction defects or musculo-skeletal defects (SBD) born during the study period. A control was defined as the next threenewborns (delivered after the case) without birth defects. Univariate, bivariate and multivariate analysis were done using Epi Info version 3.5.1.Results: a total of 400 newborns participated in the study, 100 cases and 300 controls. Factors associated with higher odds of a SBD includedmaternal fever (adjusted odds ratio (AOR) = 1.99; 95% confidence interval (CI): 1.14-3.52), maternal hypertension (AOR=3.99; 95% CI: 1.67-9.54), and low birth weight (AOR=3.48; 95% CI: 1.77-6.85). Antimalarial use during pregnancy was protective (AOR=0.48; 95% CI: 0.28-0.84).Folic acid supplementation was protective only in bivariate analysis (OR=0.56; 95% CI: 0.32-0.96). Conclusion: maternal fever, hypertension, and low birth weight are associated with higher odds of SBD. Antimalarial use during pregnancy was associated with lower odds of SBD. Early screening of pregnant mothers for hypertension and other causes of low birth weight may reduce SBD in Dar Es Salaam

Acute adenolymphangitis due to bancroftian filariasis in Rufiji district, south east Tanzania

A longitudinal prospective surveillance for acute adenolymphagitis (ADL) was carried out in three villages in Rufiji district. A sample population of 3000 individuals aged 10 years and above was monitored fortnightly for a period of 12 months. The annual incidence of ADL was found to be 33 per 1000 population and was significantly higher in males than females (52.7/1000 and 18.7/1000 respectively). ADL episodes were more frequent in the age group of 40 years and above. Individuals with chronic manifestations seemed to be more vulnerable to ADL attacks with 62.2% of the total episodes occurring in this group. Furthermore, individuals with lymphoedema experienced more frequent acute episodes compared to those with hydrocele and \u27normal exposed\u27. ADL episodes ranged from one to five per annum and the majority of the affected (60.4%) experienced a single episode. The average duration of an ADL episode was 8.6 days and in 72.5% of the episodes the affected individuals were incapacitated and unable to do their normal activities for an average duration of 3.7 days. The physical incapacitation associated with ADL episodes emphasizes the significance of lymphatic filariasis as a major public health problem of substantial socio-economic consequences. (C) 2000 Elsevier Science B.V

Intermittent Preventive Therapy and Treatment of Malaria during Pregnancy: A Study of Knowledge among Pregnant Women in Rufiji District, Southern Tanzania

Purpose: To assess the knowledge and awareness of pregnant women regarding the use of sulfadoxinepyrimethamine (SP) for intermittent preventive therapy (IPT) and artemether-lumefantrine (ALu) for treatmentof malaria during pregnancy.Methods: The study was conducted in Rufiji district, southern Tanzania from March 2011 to September 2011. Four hundred and seventy (470) pregnant women in their second and third trimesters were interviewed whenattending antenatal clinics at the selected hospitals, health centers and dispensaries. Focus group discussions (FGDs) were also conducted with 46 pregnant women at the health facilities in the district.Results: More than half (54.3 %) of pregnant women did not know if SP it was used for IPT. Most women (76.6 %) did not know the use of SP for IPT in relationship with gestation age. Overall, the results show that most women had very low knowledge about the use of SP for IPT. Forty three (9.1 %) pregnant women reported to have had malaria during their current pregnancies. The antimalarials reported to be used by pregnant women were quinine 18(42.9 %), SP (23.8 %), ALu (21.4%) and sulphamethoxyprazinepyrimethamine (2.4%). Irrespective of the gestation age of pregnancy, almost all (98.3 %) pregnant women perceived ALu as unsafe drug to be used during pregnancy.Conclusion: Most pregnant women had minimum knowledge about the use and benefits of SP for IPT and ALu for treatment of malaria during  pregnancy. Some erroneous beliefs about the safety of ALu during pregnancy were also identified among pregnant women. For effective implementation of IPT policy and treatment of malaria during pregnancy, pregnant women should be sensitized and educated on the use andbenefits of antimalarial drugs.Keywords: Artemether-lumefantrine, Antenatal clinic, Knowledge, Pregnant women, Sulfadoxinepyrimethamin

Lung functions among patients with pulmonary tuberculosis in Dar es Salaam – a cross-sectional study

Background Approximately 40–60 % of patients remain sufferers of sequela of obstructive, restrictive or mixed patterns of lung disease despite treatment for pulmonary tuberculosis (PTB). The prevalence of these abnormalities in Tanzania remains unknown. Methods A descriptive cross-sectional study was carried out among 501 patients with PTB who had completed at least 20 weeks of treatment. These underwent spirometry and their lung functions were classified as normal or abnormal (obstructive, restrictive or mixed). Logistic regression models were used to explore factors associated with abnormal lung functions. Results Abnormal lung functions were present in 371 (74 %) patients. There were 210 (42 %) patients with obstructive, 65 (13 %) patients with restrictive and 96 (19 %) patients with mixed patterns respectively. Significant factors associated with abnormal lung functions included recurrent PTB (Adj OR 2.8, CI 1.274 - 6.106), Human Immunodeficiency Virus (HIV) negative status (Adj OR 1.7, CI 1.055 - 2.583), age more than 40 years (Adj OR 1.7, CI 1.080 - 2.804) and male sex (Adj OR 1.7, CI 1.123 - 2.614). Conclusion The prevalence of abnormal lung functions is high and it is associated with male sex, age older than 40 years, recurrent PTB and HIV negative status

Community Health Workers Can Improve Male Involvement in Maternal Health: Evidence from Rural Tanzania.

Male involvement in maternal health is recommended as one of the interventions to improve maternal and newborn health. There have been challenges in realising this action, partly due to the position of men in society and partly due to health system challenges in accommodating men. The aim of this study was therefore to evaluate the effect of Home Based Life Saving Skills training by community health workers on improving male involvement in maternal health in terms of knowledge of danger signs, joint decision-making, birth preparedness, and escorting wives to antenatal and delivery care in a rural community in Tanzania. A community-based intervention consisting of educating the community in Home Based Life Saving Skills by community health workers was implemented using one district as the intervention district and another as comparison district. A pre-/post-intervention using quasi-experimental design was used to evaluate the effect of Home Based Life Saving Skills training on male involvement and place of delivery for their partners. The effect of the intervention was determined using difference in differences analysis between the intervention and comparison data at baseline and end line. The results show there was improvement in male involvement (39.2% vs. 80.9%) with a net intervention effect of 41.1% (confidence interval [CI]: 28.5-53.8; p <0.0001). There was improvement in the knowledge of danger signs during pregnancy, childbirth, and postpartum periods. The proportion of men accompanying their wives to antenatal and delivery also improved. Shared decision-making for place of delivery improved markedly (46.8% vs. 86.7%), showing a net effect of 38.5% (CI: 28.0-49.1; p <0.0001). Although facility delivery for spouses of the participants improved in the intervention district, this did not show statistical significance when compared to the comparison district with a net intervention effect of 12.2% (95% CI: -2.8-27.1: p=0.103). This community-based intervention employing community health workers to educate the community in the Home Based Life Saving Skills programme is both feasible and effective in improving male involvement in maternal healthcare

Lung functions among patients with pulmonary tuberculosis in Dar es Salaam – a cross-sectional study

Background Approximately 40–60 % of patients remain sufferers of sequela of obstructive, restrictive or mixed patterns of lung disease despite treatment for pulmonary tuberculosis (PTB). The prevalence of these abnormalities in Tanzania remains unknown. Methods A descriptive cross-sectional study was carried out among 501 patients with PTB who had completed at least 20 weeks of treatment. These underwent spirometry and their lung functions were classified as normal or abnormal (obstructive, restrictive or mixed). Logistic regression models were used to explore factors associated with abnormal lung functions. Results Abnormal lung functions were present in 371 (74 %) patients. There were 210 (42 %) patients with obstructive, 65 (13 %) patients with restrictive and 96 (19 %) patients with mixed patterns respectively. Significant factors associated with abnormal lung functions included recurrent PTB (Adj OR 2.8, CI 1.274 - 6.106), Human Immunodeficiency Virus (HIV) negative status (Adj OR 1.7, CI 1.055 - 2.583), age more than 40 years (Adj OR 1.7, CI 1.080 - 2.804) and male sex (Adj OR 1.7, CI 1.123 - 2.614). Conclusion The prevalence of abnormal lung functions is high and it is associated with male sex, age older than 40 years, recurrent PTB and HIV negative status

Physical activity and cardiovascular disease risk factors among young and middleaged men in urban Mwanza, Tanzania

Background: Cardiovascular diseases (CVD) risk factors are increasing at an unprecedented rate in developing countries. However, fewer studies have evaluated the role of physical activity in preventing CVD in these countries. We assessed level physical activity and its relationship with CVD risk factors among young and middle aged men in a fast growing city of Mwanza in Tanzania. Methods: Physical activity was assessed among 97 healthy men aged 20-50years using Sub-Saharan Africa Activity Questionnaire. An updated compendium of physical activity was used to code the metabolic equivalent. Energy expenditure was calculated using Harris Benedict equation. Anthropometric measurements, blood pressure,&nbsp; fasting blood glucose and serum lipids were also measured. Results: The mean energy expenditure in this population was 6,466 &plusmn; 252 kcal/week. More than half (53.6%) of the participants had energy expenditure of H4,000 kcal/week. Only three (3.1%) had energy expenditure below the recommended 1,000 kcal/week. Except for hypertension, prevalence of CVD risk factors was low in this population; hypertension 23.7%, low HDLcholesterol 10.3%, high LDL-cholesterol 9.3% and obesity 4.1%. Physical activity energy expenditure had an inversely relationship with waist to hip ratio, systolic blood pressure, heart rate, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides and fasting blood glucose. Conclusion: Physical activity energy expenditure was high in this population and was inversely correlated with CVD risk factors. Physical activity may play an important role in the prevention of CVD in this urban population of young and middle aged men

Factors associated with child sexual abuse in Tanzania: a qualitative study

Background: Child sexual abuse (CSA) is one of the most pervasive occurrences which are reported all over the world. It often goes unnoticed and undocumented due to surrounding taboos; its sensitivity in nature and affects the less powerful population. Anecdote information is available on the nature and extent of sexual abuse among children in Tanzania. The aim of this study was to explore factors, forms, context of abuse and perpetrators of child sex abuse in selected regions of Tanzania.Methods: Key informant interviews were conducted among adults including parents of the victims to explore factors associated with sexual abuse of children under 10 years old in Tanzania. The interview guide centred on factors for child sexual abuse, the type of perpetrators and the context into which these abuses take place.Results: There were incidences of child sexual abuse in Tanzania and the major forms were anal and vaginal penetration, and the most affected were girls. The abuses were rarely reported due to shame and embarrassment faced by the affected children and parents. The causes of child sexual abuse were poverty, ambitions and moral degradation, myths and beliefs, urbanization, foreign culture and poor parental care. Incidents of CSA were reported to occur in perpetrators’ homes and in semi-finished housing structures, madrassa and recreational venues where children can freely access entertainment by watching movies. These acts were committed by people in position of power, close relationship and trusted by the children. Contexts where child sexual abuses occur included overcrowded living spaces and social activities that go on late into the night.Conclusion: We recommend for strengthened interventions at different levels within the society to address the root causes and different contexts in which child sex abuse occurs. Increased awareness of the root causes should go hand in hand with measures to encourage parents and survivors to report incidents to relevant authorities timely as they occur

Сквозное творческое задание как диагностика компетенций студентов по дисциплине «Физическая культура»

BACKGROUND: Male involvement in maternal health is recommended as one of the interventions to improve maternal and newborn health. There have been challenges in realising this action, partly due to the position of men in society and partly due to health system challenges in accommodating men. The aim of this study was therefore to evaluate the effect of Home Based Life Saving Skills training by community health workers on improving male involvement in maternal health in terms of knowledge of danger signs, joint decision-making, birth preparedness, and escorting wives to antenatal and delivery care in a rural community in Tanzania. DESIGN: A community-based intervention consisting of educating the community in Home Based Life Saving Skills by community health workers was implemented using one district as the intervention district and another as comparison district. A pre-/post-intervention using quasi-experimental design was used to evaluate the effect of Home Based Life Saving Skills training on male involvement and place of delivery for their partners. The effect of the intervention was determined using difference in differences analysis between the intervention and comparison data at baseline and end line. RESULTS: The results show there was improvement in male involvement (39.2% vs. 80.9%) with a net intervention effect of 41.1% (confidence interval [CI]: 28.5-53.8; p &lt;0.0001). There was improvement in the knowledge of danger signs during pregnancy, childbirth, and postpartum periods. The proportion of men accompanying their wives to antenatal and delivery also improved. Shared decision-making for place of delivery improved markedly (46.8% vs. 86.7%), showing a net effect of 38.5% (CI: 28.0-49.1; p &lt;0.0001). Although facility delivery for spouses of the participants improved in the intervention district, this did not show statistical significance when compared to the comparison district with a net intervention effect of 12.2% (95% CI: -2.8-27.1: p=0.103). CONCLUSION: This community-based intervention employing community health workers to educate the community in the Home Based Life Saving Skills programme is both feasible and effective in improving male involvement in maternal healthcare

"You should go so that others can come"; The Role of Facilities in Determining an Early Departure after Childbirth in Morogoro Region, Tanzania.

Tanzania is among ten countries that account for a majority of the world's newborn deaths. However, data on time-to-discharge after facility delivery, receipt of postpartum messaging by time to discharge and women's experiences in the time preceding discharge from a facility after childbirth are limited. Household survey of 1267 women who delivered in the preceding 2-14 months; in-depth interviews with 24 women, 12 husbands, and 5 community elders. Two-thirds of women with vaginal, uncomplicated births departed within 12 h; 90 % within 24 h, and 95 % within 48 h. Median departure times varied significantly across facilities (hospital: 23 h, health center: 10 h, dispensary: 7 h, p < 0.001). Quantitative and qualitative data highlight the importance of type of facility and facility amenities in determining time-to-discharge. In multiple logistic regression, level of facility (hospital, health center, dispensary) was the only significant predictor of early discharge (p = 0.001). However across all types of facilities a majority of women depart before 24 h ranging from hospitals (54 %) to health centers (64 %) to dispensaries (74 %). Most women who experienced a delivery complication (56 %), gave birth by caesarean section (90 %), or gave birth to a pre-term baby (70 %) stayed longer than 24 h. Reasons for early discharge include: facility practices including discharge routines and working hours and facility-based discomforts for women and those who accompany them to facilities. Provision of postpartum counseling was inadequate regardless of time to discharge and regardless of type of facility where delivery occurred. Our quantitative and qualitative findings indicate that the level of facility care and comforts existing or lacking in a facility have the greatest effect on time to discharge. This suggests that individual or interpersonal characteristics play a limited role in deciding whether a woman would stay for shorter or longer periods. Implementation of a policy of longer stay must incorporate enhanced postpartum counseling and should be sensitive to women's perceptions that it is safe and beneficial to leave hospitals soon after birth