Informal support networks of tanzanians with chronic diseases: predictors of support provision and treatment adherence

Objectives: To examine the role of NCD patients' social ties as informal caregivers and whether receiving their support is associated with engagement in care. Methods: NCD outpatients (N(2) = 100) in rural Tanzania completed a cross-sectional questionnaire to characterize the support role of their social ties (N(1) = 304). Bivariate analyses explored predictors of social support and whether social support is associated with engagement in care. Results: This study found that 87% of participants had health insurance, yet 25% received financial support for financing healthcare. Patient gender, age and marital status were found to be important predictors of social support, with NCD-related disability and disease severity being predictive to a lesser degree. Monthly receipt of both material and non-material support were associated with increased odds of adherence to prescribed medications. Conclusion: These findings indicate that patients' social ties play an important role in filling the gaps in formal social health protection and incur substantial costs by doing so. The instrumental role of even non-material social support in promoting engagement in care deserves greater attention when developing policies for improving this population's engagement in care

Evolving Strategies, Opportunistic Implementation: HIV Risk Reduction in Tanzania in the Context of an Incentive-Based HIV Prevention Intervention.

\ud Behavior change communication (BCC) interventions, while still a necessary component of HIV prevention, have not on their own been shown to be sufficient to stem the tide of the epidemic. The shortcomings of BCC interventions are partly due to barriers arising from structural or economic constraints. Arguments are being made for combination prevention packages that include behavior change, biomedical, and structural interventions to address the complex set of risk factors that may lead to HIV infection. In 2009/2010 we conducted 216 in-depth interviews with a subset of study participants enrolled in the RESPECT study - an HIV prevention trial in Tanzania that used cash awards to incentivize safer sexual behaviors. We analyzed community diaries to understand how the study was perceived in the community. We drew on these data to enhance our understanding of how the intervention influenced strategies for risk reduction. We found that certain situations provide increased leverage for sexual negotiation, and these situations facilitated opportunistic implementation of risk reduction strategies. Opportunities enabled by the RESPECT intervention included leveraging conditional cash awards, but participants also emphasized the importance of exploiting new health status knowledge from regular STI testing. Risk reduction strategies included condom use within partnerships and/or with other partners, and an unexpected emphasis on temporary abstinence. Our results highlight the importance of increasing opportunities for implementing risk reduction strategies. We found that an incentive-based intervention could be effective in part by creating such opportunities, particularly among groups such as women with limited sexual agency. The results provide new evidence that expanding regular testing of STIs is another important mechanism for providing opportunities for negotiating behavior change, beyond the direct benefits of testing. Exploiting the latent demand for STI testing should receive renewed attention as part of innovative new combination interventions for HIV prevention.\u

Governance factors that affect the implementation of health financing reforms in Tanzania: an exploratory study of stakeholders' perspectives

The development of effective and inclusive health financing reforms is crucial for the progressive realisation of universal health coverage in low-income and middle-income countries. Tanzania has been reforming health financing policies to expand health insurance coverage and achieve better access to quality healthcare for all. Recent reforms have included improved community health funds (iCHFs), and others are underway to implement a mandatory national health insurance scheme in order to expand access to services and improve financial risk protection. Governance is a crucial structural determinant for the successful implementation of health financing reforms, however there is little understanding of the governance elements that hinder the implementation of health financing reforms such as the iCHF in Tanzania. Therefore, this study used the perspectives of health sector stakeholders to explore governance factors that influence the implementation of health financing reforms in Tanzania. We interviewed 36 stakeholders including implementers of health financing reforms, policymakers and health insurance beneficiaries in the regions of Dodoma, Dar es Salaam and Kilimanjaro. Normalisation process theory and governance elements guided the structure of the in-depth interviews and analysis. Governance factors that emerged from participants as facilitators included a shared strategic vision for a single mandatory health insurance, community engagement and collaboration with diverse stakeholders in the implementation of health financing policies and enhanced monitoring of iCHF enrolment due to digitisation of registration process. Governance factors that emerged as barriers to the implementation were a lack of transparency, limited involvement of the private sector in service delivery, weak accountability for revenues generated from community level and limited resources due to iCHF design. If stakeholders do not address the governance factors that hinder the implementation of health financing reforms, then current efforts to expand health insurance coverage are unlikely to succeed on their own

How long-distance truck drivers and villagers in rural southeastern Tanzania think about heterosexual anal sex: a qualitative study

Objective: To explore ideas of truck drivers and villagers from rural Tanzania about heterosexual anal sex (HAS) and the associated health risks. Methods: Qualitative study using 8 in-depth interviews (IDIs) and 2 focus group discussions (FGDs) with truck drivers and 16 IDIs and 4 FGDs with villagers from the Morogoro region. Study participants included 24 women and 46 men. Data analysis was performed thematically employing standard qualitative techniques. Results: Reasons why men would practice HAS included sexual pleasure, the belief that anal sex is safer than vaginal sex, alternative sexual practice, exploration and proof of masculinity. Reasons why women would practice HAS included financial need, retaining a partner, alternative for sex during menses, pregnancy prevention and beauty enhancement because HAS is believed to ‘fatten the female buttocks’. Most participants believed that condoms are not needed during HAS. This was linked to the ideas that infections only ‘reside in wet places’ (vagina) and that the anus is not ‘conducive’ for condom use; condoms reduce ‘dryness’ and ‘friction’ (pleasure) and may ‘get stuck inside’. Conclusions: The study participants reported practices and ideas about HAS that put them at risk for HIV and sexually transmitted infections. Greater attention to education about HAS is urgently needed in Tanzania, where this sexual practice is still regarded as a taboo. This study offers useful information that could be included in sex education programmes

Comparative study of three community seed supply strategies in Tanzania

Community seed production projects are being implemented throughout Africa. This case study compares three such projects in central Tanzania. All three programs seek to encourage small-scale farmers to produce and sell sorghum and pearl millet varieties, but use different approaches to solve the common problems of seed multiplication and distribution. Three projects were relatively successful in promoting seed production. Training was provided in seed quality control, and growers generally understood the differences between seed and grain. However, questions remain about the practicality of producing certified seed, quality declared seed, or common grade seed. External investments remain necessary for the production and delivery of source seed. The biggest threat to the viability of these programs is the problem of seed marketing. While farmers are expected to sell seed to their neighbors, most sought marketing assistance from external buyers. Further investments are still needed in testing alternative marketing strategies. The study highlights a number of policy issues. None of the three programs is likely to continue without external technical support and funding. The appropriate, long-term levels of public investment need to be defined. In addition, the relationship between public and private sector investments in seed production and distribution needs to be explicitly define

The psychosocial determinants of the intention to test for HIV among young men in KwaZulu-Natal province, South Africa

: Voluntary counselling and testing is one of the effective prevention strategies against the HIV/AIDS epidemic. This study investigated the psychosocial determinants of the intention to be tested for HIV among young men in South Africa’s KwaZulu-Natal province using the theory of planned behaviour as the guiding framework. A facilitator-administered questionnaire was used to collect data among 350 isiZulu-speaking men between the ages of 18 and 35. Results show that 24% reported ever having tested. Intention to test showed strong positive correlations with subjective norm to test (r = 0.67), intention to use condoms (r = 0.65), intention to reduce alcohol use (r = 0.60), subjective norm to reduce alcohol use (r = 0.54), and subjective norm to use condoms (r = 0.51). For multiple regression, attitude, subjective norm and perceived behavioural control explained 43% of the variance in intention to test, with subjective norm and perceived behavioural control making significant unique contributions. An additional 12% of the variance was explained by intention to reduce alcohol and drug use, and use condoms

Preliminary Evaluation of Slaughter Value and Carcass Composition of Indigenous Sheep and Goats from Traditional Production System in Tanzania

The aim of the pilot study was to evaluate slaughter characteristics and carcass composition of indigenous long fat tailed sheep and Small East African goats purchased from the auction markets slaughtered at 1.5 to 2 yrs of age and 20 kg to 25 kg live weight. The animals were slaughtered according to halal standard procedures. The left half carcasses were jointed into eight wholesale joints, and dissected into muscles, fat and bone, which were weighed separately. Sheep had greater (p<0.05) slaughter BW (22.29 kg vs 20.50 kg) and empty BW (20.17 kg vs 18.67 kg) than goats (p<0.05). Dressing percentages were lower (p<0.001) in sheep than goats when carcass weight was expressed as percentage of slaughter BW (42.31% and 47.15%) and empty BW (46.75% and 51.79%). Sheep carcasses had lower (p<0.001) proportion (66.18% vs 71.64%) of muscles and higher (p<0.001) proportion of fat (7.41% vs 3.44%) than goat carcasses. Sheep had proportionally lighter (p<0.001) shoulder (18.89% vs 22.68%) and heavier (p<0.05) proportion of chump (7.916% vs 6.76%) and main rib (8.12% vs 7.07%). Sheep had more (p<0.001) muscles in the leg (28.83% vs 27.08%) and main rib (7.62% vs 6.36%) than goats. Sheep had less (p<0.001) muscles (20.28% vs 23.56%) in shoulder joints when expressed as percentage of total muscle of carcasses. It is concluded that there are differences in sheep and goat both in terms of carcass and joint yields and composition. The present study also implies that there is need to consider setting different meat cuts and prices for these cuts when one takes into account the differences in muscle distribution within joints in sheep and goats

Engaging diverse communities participating in clinical trials: case examples from across Africa

<p>Abstract</p> <p>Background</p> <p>In the advent of increasing international collaborative research involving participants drawn from populations with diverse cultural backgrounds, community engagement becomes very critical for the smooth conduction of the research. The African Malaria Network Trust (AMANET) is a pan-African non-governmental organization that sponsors and technically supports malaria vaccine trials in various African countries.</p> <p>Case description</p> <p>AMANET sponsored phase Ib or IIb clinical trials of several malaria vaccine candidates in various Africa countries. In Burkina Faso, Mali and Tanzania trials of the merozoite surface protein 3 -- in its Long Synthetic Peptide configuration (MSP3 LSP) -- were conducted. In Mali, the apical membrane antigen 1 (AMA1) was tested, while a hybrid of glutamate rich protein (GLURP) and MSP3 (GMZ2) was tested in Gabon. AMANET recognizes the importance of engaging with the communities from which trial participants are drawn, hence community engagement was given priority in all project activities conducted in the various countries.</p> <p>Discussion and evaluation</p> <p>Existing local social systems were used to engage the communities from which clinical trial participants were drawn. This article focuses on community engagement activities employed at various AMANET-supported clinical trial sites in different countries, highlighting subtle differences in the approaches used. The paper also gives some general pros and cons of community engagement.</p> <p>Conclusions</p> <p>Community engagement enables two-way sharing of accurate information and ideas between researchers and researched communities, which helps to create an environment conducive to smooth research activities with enhanced sense of research ownership by the communities.</p

Prevalence and correlates of partner violence among adolescent girls and young women: Evidence from baseline data of a cluster randomised trial in Tanzania.

BACKGROUND: Little has been documented about partner violence among adolescent girls and young women (AGYW) who are out of school, a factor associated with HIV acquisition. To understand areas for prioritising HIV prevention intervention efforts, we explored the prevalence and correlates of partner violence among out of school AGYW in Shinyanga, Tanzania. METHODS: A cross-sectional analysis of data from AGYW aged 15-23 years recruited in a cluster randomised trial conducted between October and December 2017 was used to examine correlates of partner violence. Data were collected through an Audio Computer-Assisted Self-interview. Multivariate logistic regression analysis was used to evaluate the association. RESULTS: 2276 (75.5%) AGYW were sexually active. Of these, 816 (35.9%) reported having experienced violence from partners in the last six months. After adjusting for other covariates, being formerly married (AOR = 1.55, 95% CI:1.02, 2.37), having children (AOR = 1.79, 95% CI:1.47, 2.16), anxiety and depression symptoms (AOR = 3.27, 95%CI: 2.15, 4.96), having engaged in sex work in the past six months (AOR = 1.92, 95% CI: 1.45, 2.53) and economic deprivation (AOR = 1.61, 95% CI: 1.34,1.92) were significantly associated with partner violence. CONCLUSIONS: Almost one in three sexually active AGYW had experienced partner violence in the 6 months preceding the survey. The findings underscore the need for future research to focus on understanding the reasons and dynamics underlying high level of partner violence among AGYW. Furthermore, there is a need for implementing intervention programs that aim to reduce economic deprivation among AGYWs and address social norms and structures perpetuating violence against AGYW. TRIAL REGISTRATION: ClinicalTrials.gov-ID NCT03597243