The Regression Model of Risk Factors Associated with Maternal Mortality in Tanzania

Maternal mortality is one of the statistics showing the largest degree of disparity between the developed and developing countries. According to literature up to 2016 Tanzania was among the countries with unacceptably maternal mortality ratio and claimed to be still very far from reaching the Millennium developing goals. This study aimed at modeling of risk factors for   maternal mortality using pre collected data Based on Tanzania Demographic Health Survey (TDH 2015 -16.  Therefore secondary data were used to build the model. Data were reanalyzed by descriptive statistics using statistical software package STATA version 13. Based on data the result indicates that mortality was about 345 per 100,000 live births. The contributing factor was identified as education [OR= 0.81), Age group between 20 to 24 (OR = 2.84), distance to the health center (OR = 0.89), Marital status (OR = 1.39). It is concluded that, the risk factor of maternal death is age groups 20 – 24 and 25 – 29 years especially in the mainland rural. Keywords : Martenal Motility, Regression model, Prevalence on maternal DOI: 10.7176/JHMN/67-06 Publication date:October 31st 201

Effectiveness of a multivitamin supplementation program among HIV-infected adults in Tanzania

Objective: The objective of this study was to assess the effectiveness of a routine multivitamin supplementation program for adults living with HIV in Tanzania. Design: We conducted a retrospective cohort study of 67,707 adults enrolled in the Dar es Salaam HIV care and treatment program during 2004-2012. Methods: The Dar es Salaam HIV care and treatment program intended to provide all adult patients with multivitamin supplements (vitamins B-complex, C, and E) free of charge; however, intermittent stockouts and other implementation issues did not afford universal coverage. We use Cox proportional hazard models to assess the time-varying association of multivitamin supplementation with mortality and clinical outcomes. Results: The study cohort contributed 41,540 and 129,315 person-years of follow-up time to the ART-naïve and ART-experienced analyses, respectively. Among 48,207 ART-naïve adults, provision of multivitamins reduced the risk of mortality (adjusted hazard ratio (aHR): 0.69; 95% CI: 0.59-0.81), incident tuberculosis (TB) (aHR: 0.83; 0.76-0.91), and meeting ART eligibility criteria (aHR: 0.78; 95% CI: 0.73-0.83) after adjustment for time-varying confounding. Among 46,977 ART-experienced patients, multivitamins reduced mortality (HR: 0.86; 95% CI: 0.80-0.92), incident TB (aHR: 0.78; 95% CI: 0.73-0.84), and immunologic failure (aHR: 0.70; 95% CI: 0.67-0.73). The survival benefits associated with provision multivitamins appeared to be greatest during the first year of ART and declined over time (p-value \u3c0.001). Conclusion: Multivitamin supplementation appears to be a simple, effective, safe, and scalable program to improve survival, reduce incidence of TB, and improve treatment outcomes for adult HIV patients in Tanzania

Patients’ and providers’ perceptions of the Swahili words of msongo (stress) and sonona (depression): implications for treating mood disorders among people living with HIV/AIDS, Dar Es Salaam, Tanzania

Objectives: People living with HIV/AIDS (PLH) in resource-limited settings have high and often unrecognized prevalence of mood disorders, with adverse implications for medication adherence and engagement in transmission risk reduction behaviors. Working in HIV treatment and care provision, we observed lack of common understandings between PLH and health care workers (HW) of the words msongo and sonona (Swahili) intended to mean stress and depression, respectively. This gap in psychosocial health communication may result in missed opportunities for depression management, which can contribute to altered immune functioning, poor self-care practices, accelerated HIV disease progression, and poor clinical outcomes among PLH. We explored perceptions and experiences in use of the terms msongo and sonona among PLH, to better inform the management of mood disorders among PLHMethods: A two-phased study which included exploratory mixed methods study including focus group discussions (FGDs), indepth interviews (IDIs) with PLH and HW, and a cross-sectional pilot survey with PLH in Dar es Salaam, Tanzania was conducted from 2012 to 2013. Only the data for phase I was included in this manuscript. Thematic analysis of qualitative data from 86 participants explored PLH and HW experiences with the use of terms msongo and sonona. From these findings, we developed scale items based on PLH’s descriptive idioms for a structured survey questionnaire administered to 318 PLH. Through Principal Component Analysis (PCA) we identified meaningful dimensions for the msongo and sonona scalesResults: Predominant meanings for PLH with mood disorder of the terms included troubling thoughts, emotional and physical symptoms. There were gender and age differences in meanings given to both words. For older PLH, msongo and sonona had similar meanings; the former representing higher severity of sonona. In contrast, younger women perceived sonona as a worse form of msongo, while for some young men sonona was understood as kisonono (gonorrhea). Among PLH with mood disorder, 60% and 80% requested help from a health worker for managing sonona and msongo, respectively. PLH without a mood disorder articulated msongo as normal thoughts not requiring hospital treatment; while sonona was a new word, the meaning of which they did not know. This group reported they did not seek care from a health worker for these concerns. The HW interchanged meanings and symptoms of msongo and sonona, while some thought sonona was a type of psychosis. PCA of the data from PLH revealed five dimensions for the combined sonona and msongo scale, with Cronbach’s alpha estimates of 0.92, a unidimensional msongo scale with Cronbach’s alpha estimates of 0.77 and four dimensions for the sonona scale with Cronbach’s alpha estimates of 0.90Conclusions: Though PLH overall had a limited understanding of the psychological health implications of msongo and sonona, those with mood disorders understood these words as meaning stress and depression, respectively. HW should raise their awareness and be alerted to possibilities of depressive disorders when PLH express concerns about msongo or sonona or have symptoms in order to facilitate the identification and management of depression in such settingsKeywords: HIV, PLH, msongo, sonona, depression, stress scale, Swahili, Tanzani

High magnitude of under nutrition among HIV infected adults who have not started ART in Tanzania – a call to include nutrition care and treatment in the test and treat model

BACKGROUND: Undernutrition among people living with HIV (PLWHIV) can be ameliorated if nutrition specific and sensitive interventions are integrated into their HIV care and treatment centers (CTC). Integrated care is lacking despite expansion of antiretroviral therapy (ART) coverage, representing a substantial missed opportunity. This research aims to examine nutritional status and associated risk factors among HIV-positive adults prior to ART initiation in Tanzania in order to characterize existing gaps and inform early integration of nutrition care into CTC. METHODS: We analyzed data from 3993 pre-ART adults living with HIV enrolled in CTCs within the Trial of Vitamin (TOV3) and progression of HIV/AIDS study in Dar es salaam, Tanzania. The primary outcome for this analysis was undernutrition, measured as body mass index (BMI) below 18.5 kg/m2. We conducted descriptive analyses of baseline characteristics and utilized multiple logistic regression to determine independent factors associated with pre-ART undernutrition. RESULTS: Undernutrition was prevalent in about 27.7% of pre-ART adults, with a significantly higher magnitude among males compared to females (30% vs. 26.6%, p < 0.025). Severe undernutrition (BMI < 16.0 kg/m2) was prevalent in one in four persons, with a trend toward higher magnitudes among females (26.2% vs. 21.1% p = 0.123). Undernutrition was also more prevalent among younger adults (p < 0.001), those with lower wealth quintiles (p = 0.003), and those with advanced HIV clinical stage (p < 0.001). Pre-ART adults presented with poor feeding practices, hallmarked by low dietary diversity scores and infrequent consumption of proteins, vegetables, and fruits. After adjusting for confounders and important co-variates, pre-ART undernutrition was associated with younger age, low wealth indices, advanced clinical stage, and low dietary diversity. CONCLUSIONS: One in every four pre-ART PLWHIV presented with undernutrition in Dar es salaam, Tanzania. Risk factors for undernourishment included younger age, lower household income, advanced HIV clinical stage, and lower dietary diversity score. Knowledge of the prevalence and prevailing risk factors for undernutrition among pre-ART PLWHIV should guide targeted, early integration of nutrition interventions into routine HIV care and treatment in high-prevalence, low-income settings such as Tanzania

Who are they? Identifying risk factors of loss to follow up among HIV+ patients on care and treatment in Dar es Salaam

Loss to follow up (LTFU) is a challenge in care and treatment programs in Sub Saharan Africa, Tanzania included. We analyzed risk factors LTFU among HIV+ patients receiving care and treatment in Dar es Salaam, Tanzania in order to inform strategies to retain patients in care and treatment services

CLINICAL outcomes and loss to follow-up among people living with HIV participating in the NAMWEZA intervention in Dar es Salaam, Tanzania: a prospective cohort study

Background: Psychosocial factors have been linked with loss to follow-up (LTFU) and clinical outcomes among people living with HIV (PLH), however little is known about the effect of psychosocial support on LTFU among PLH in treatment and care. The purpose of this study was to explore the effect of NAMWEZA (“Yes, together we can”) friends’ psychosocial support intervention on clinical outcomes and LTFU among PLH. NAMWEZA is based on a novel program using “appreciative inquiry”, positive psychology approaches to empower, promote positive attitudes and foster hope. Methods: PLH participating in the NAMWEZA intervention in HIV care clinics in Dar es Salaam Tanzania were compared with non-exposed PLH obtained from facilities that routinely collect clinical information and both followed longitudinally for 24 months. Baseline sociodemographic, clinical measures (CD4 cell count, hemoglobin (HGB), weight), and LTFU measures were collected. Chi square, Fisher’s exact tests, and t-tests were used to compare the frequencies for categorical variables and the means of continuous variables from the intervention and the comparison groups to identify variables that were significantly different across the two groups. Random effects models were performed to examine the bivariate associations between the intervention status and clinical outcomes. Results: At the end of 24 months of follow-up mean CD4 count and HGB levels increased significantly in both intervention and comparison groups (p = 0.009 and p < 0.0001, respectively). Weight increased significantly only in the intervention group (p = 0.003). Cumulative LTFU was three times higher in the comparison compared to the intervention (p < 0.001) group. Having a low CD4 count, extremes of weight, low HGB, younger age, and male gender were significantly associated with LTFU among the unexposed group, while being on ART for duration of 12 months or more was protective against LTFU in those intervened. Conclusion: Among PLH on ART, exposed or not exposed to NAMWEZA intervention, clinical care outcomes improved over time. LTFU was much higher in the comparison group with factors commonly known to predict LTFU only apparent in the comparison group. NAMWEZA could be a promising peer-facilitated model to reduce LTFU among PLH in care that can be integrated in ART services; however, more research is needed to evaluate its longer term effects

Barriers to viral load suppression among adolescents living with HIV on anti-retroviral therapy: a retrospective study in Tanga, Tanzania

Abstract Background Despite the decreased incidence of the human immunodeficiency virus (HIV) in Tanzania, the number of adolescents living with HIV is increasing. This study aimed to describe factors independently associated with viral load non-suppression among adolescents living with HIV (ALHIV) on ART in the Tanga region. Methods We conducted a retrospective study of routinely collected data from ALHIV on ART from October 2018 to April 2022. We extracted data from the Care and Treatment Clinics form number 2 (CTC2) database that included age, sex, BMI, World Health Organization HIV clinical disease stage, marital status, ART duration, viral load suppression, facility level, and Dolutegravir (DTG)-based regimen. We did descriptive analysis using frequencies to describe the study participants’ socio-demographic and clinical characteristics. The Cox proportional hazard regression model was used to identify factors associated with viral load non-suppression (VLS). Viral load non-suppression was defined as viral load ≥ 1000 copies/ml. A total of 4735 ALHIV on ART were extracted from CTC2, then 2485 were excluded (2186 missed viral load results, 246 were lost to follow-up, and 53 deaths). Results 2250 ALHIV on ART were tested for viral load, of whom 2216 (98.62%) adolescents were on first-line ART, and 2024 (89.96%) participants were virally suppressed, while 226 (10.04%) were virally non-suppressed. In addition, 2131 (94.71%) of participants were using a DTG-based regimen; of them, 1969 (92.40%) were virally suppressed. Not using a DTG-based regimen (HR: 9.36, 95% CI 3.41–15.31) and dispensary facility level (HR: 3.61, 95% CI 1.44–7.03) were independently associated with increased hazard for viral load non-suppression. In addition, adolescents aged between 15 and 19 years are less likely to be virally suppressed (HR: 0.55, 95% CI 0.30–0.99). Conclusions The dispensary facility level and not using a DTG-based regimen were significantly associated with viral load non-suppression. HIV intervention strategies should ensure a DTG-based regimen utilization in all adolescents living with HIV, and techniques used by higher-level health facilities should be disseminated to lower-level facilities

Infant Nutritional Status and Markers of Environmental Enteric Dysfunction are Associated with Midchildhood Anthropometry and Blood Pressure in Tanzania

Objective: To assess whether growth and biomarkers of environmental enteric dysfunction in infancy are related to health outcomes in midchildhood in Tanzania. Study design Children who participated in 2 randomized trials of micronutrient supplements in infancy were followed up in midchildhood (4.6-9.8 years of age). Anthropometry was measured at age 6 and 52 weeks in both trials, and blood samples were available from children at 6 weeks and 6 months from 1 trial. Linear regression was used for height-for-age z-score, body mass index-for-age z-score, and weight for age z-score, and blood pressure analyses; log-binomial models were used to estimate risk of overweight, obesity, and stunting in midchildhood. Results: One hundred thirteen children were followed-up. Length-for-age z-score at 6 weeks and delta length-for-age z-score from 6 to 52 weeks were associated independently and positively with height-for-age z-score and inversely associated with stunting in midchildhood. Delta weight-for-length and weight-for-age z-score were also positively associated with midchildhood height-for-age z-score. The 6-week and delta weight-for-length z-scores were associated independently and positively with midchildhood body mass index-for-age z-score and overweight, as was the 6-week and delta weight-for-age z-score. Delta length-for-age z-score was also associated with an increased risk of overweight in midchildhood. Body mass index-for-age z-score in midchildhood was associated positively with systolic blood pressure. Serum anti-flagellin IgA concentration at 6 weeks was also associated with increased blood pressure in midchildhood. Conclusions: Anthropometry at 6 weeks and growth in infancy independently predict size in midchildhood, while anti-flagellin IgA, a biomarker of environmental enteric dysfunction, in early infancy is associated with increased blood pressure in midchildhood. Interventions in early life should focus on optimizing linear growth while minimizing excess weight gain and environmental enteric dysfunction. Trial registration ClinicalTrials.gov: NCT00197730 and NCT00421668

Interruptions in treatment among adults on anti-retroviral therapy before and after test-and-treat policy in Tanzania.

IntroductionThe World Health Organization recommended the initiation of antiretroviral therapy (ART) for people living with HIV (PLHIV) regardless of CD4 cell counts. Tanzania adopted this recommendation known as test-and-treat policy in 2016. However, programmatic implementation of this policy has not been assessed since its initiation. The objective of the study was to assess the impact of this policy in Tanzania.MethodsThis was a cross-sectional study among PLHIV aged 15 years and older using routinely collected program data. The dependent variable was interruption in treatment (IIT), defined as no clinical contact for at least 90 days after the last clinical appointment. The main independent variable was test-and-treat policy status which categorized PLHIV into the before and after groups. Co-variates were age, sex, facility type, clinical stage, CD4 count, ART duration, and body mass index. The associations were assessed using the generalized estimating equation with inverse probability weighting.ResultsThe study involved 33,979 PLHIV-14,442 (42.5%) and 19,537 (57.5%) were in the before and after the policy groups, respectively. Among those who experienced IIT, 4,219 (29%) and 7,322 (38%) were in the before and after the policy groups respectively. Multivariable analysis showed PLHIV after the policy was instated had twice [AOR 2.03; 95%CI 1.74-2.38] the odds of experiencing IIT than those before the policy was adopted. Additionally, higher odds of experiencing IIT were observed among younger adults, males, and those with advanced HIV disease.ConclusionDemographic and clinical status variables were associated with IIT, as well as the test-and-treat policy. To achieve epidemic control, programmatic adjustments on continuity of treatment may are needed to complement the programmatic implementation of the policy