Effect of Family Size and Sex Preference on Contraceptive Use Among Married Women in Morogoro Municipality

This study was conducted with the purpose of determining whether sonpreference exists in the study area as well as establishing the ideal family size among married women. These were correlated with contraceptive behaviour in order to establish their relationships. The study was conducted to a sample of 135 randomly selected married women aged between 15-49 years from Morogoro Municipality. Both a questionnaire and focus group interviews were used to collect the data. The results showed that mean ideal number of desired children was 4.2. When ideal family size was compared with contraceptive behavior results indicated the increase of current and intention to use contraceptive methods to women with more than two children. Majority of respondents did not show strong sex preference. When related with contraceptive use, current use of  contraceptive use was found to be high among respondents with children of both sexes and low for respondents with children of single sex. Looking into actual sex composition, 47.3% had more boys than girls. When actual family size was related to contraceptive use, it was observed that majority were currently using contraceptive (67%), the same pattern was noted with the intention to use contraceptives, which was high - especially to those respondents with one or two children. The study recommends that, although the current use and intention to use contraceptives was high in the study area, more effort is needed to make sure that continuation rate is also high.Key words: Contraceptives, family size, sex preference, married wome

The Role of Sexual Reproductive Health Education in Adolescents: Sexual Behaviours in Secondary Schools in Morogoro Municipality, Tanzania

HIV/AIDS, STD, unwanted pregnancies and abortion are indicators for the existence of adolescents’ sexual behaviours. Young people accounted for 40 per cent of new HIV infections in 2006 and about 6 millions of girls aged 15 to 19 years gave birth each year worldwide. The sexual and reproductive health education in secondary schools was a key strategy for promoting safe sexual behaviours among teenagers. This study examined the role of sexual and reproductive health education on adolescents' sexual behaviours. A cross sectional design was employed by using open and closed ended questionnaires, interview guides and focus group discussions (FGD). Data analysis was done using Statistical Package for Social Science (SPSS) software. Some adolescents, (28.8 %) in secondary schools in Morogoro Municipal were sexually active; they were involved in risky sexual behaviour such as having multiple partners, practising sex at early age as early as from 10-15 years,Lack use of condoms, engaging with sexual partners who were much older. Also adolescent students’ awareness of sexual and reproductive health matters was average. Moreover it was revealed that, students’ awareness on sexual and reproductive health had positive influence on students’ risky sexual behaviours i.e. students with high level of awareness were less likely to engage in risky sexual behaviour.Key words: Sexual behaviour, reproductive health, awareness and adolescent

Comparative Analysis of Youth Sexual Behaviour Risks for HIV and AIDS Infection in Mbulu and Mufindi Districts, Tanzania

The youth are among the vulnerable population for contracting Human Immune deficiency Virus (HIV) and Acquired Immuno deficiency Syndrome (AIDS), which are behavioural related problems.  This paper examines sexual behaviour risks for HIV and AIDS infection among youth.  A total of 232 youth both in and out of school aged 15-35 years were involved in the study.  A cross sectional study design was adopted and data was collected through questionnaire, Non participant observation and documentary review.  The study used descriptive statistics to determine frequency, percentages and the mean scores for sexual behaviour risks among the youth in the study areas.  The findings showed that more than a half of the sexually active youth had had sexual intercourse and among the youth who had already had sexual intercourse, a half of them did not use condoms.  The results showed significant differences in sexual behaviour risks among youth in the study areas (p < 0.05).  Youth in Mufindi were at a higher risk than was the case with their counterparts in Mbulu. The study call for creation of youth programmes that will focus on reduction of sexual behaviour risks among the youth.  Programmes for youth can focus on a range of services including prevention strategies, risk reduction, and behaviour change. Keywords: Youth, Sexual behaviour risks, HIV and AIDS, Infection, prevention, Tanzania DOI: 10.7176/DCS/9-5-06 Publication date:May 31st 201

Relationship Between Household Socio-Economic Status and under-five Mortality in Rufiji DSS, Tanzania.

Disparities in health outcomes between the poor and the better off are increasingly attracting attention from researchers and policy makers. However, policies aimed at reducing inequity need to be based on evidence of their nature, magnitude, and determinants. The study aims to investigate the relationship between household socio-economic status (SES) and under-five mortality, and to measure health inequality by comparing poorest/least poor quintile mortality rate ratio and the use of a mortality concentration index. It also aims to describe the risk factors associated with under-five mortality at Rufiji Demographic Surveillance Site (RDSS), Tanzania. This analytical cross sectional study included 11,189 children under-five residing in 7,298 households in RDSS in 2005. Principal component analysis was used to construct household SES. Kaplan-Meier survival incidence estimates were used for mortality rates. Health inequality was measured by calculating and comparing mortality rates between the poorest and least poor wealth quintile. We also computed a mortality concentration index. Risk factors of child mortality were assessed using Poisson regression taking into account potential confounders. Under-five mortality was 26.9 per 1,000 person-years [95% confidence interval (CI) (23.7-30.4)]. The poorest were 2.4 times more likely to die compared to the least poor. Our mortality concentration index [-0.16; 95% CI (-0.24, -0.08)] indicated considerable health inequality. Least poor households had a 52% reduced mortality risk [incidence rate ratio (IRR) = 0.48; 95% CI 0.30-0.80]. Furthermore, children with mothers who had attained secondary education had a 70% reduced risk of dying compared to mothers with no education [IRR = 0.30; 95% CI (0.22-0.88)]. Household socio-economic inequality and maternal education were associated with under-five mortality in the RDSS. Targeted interventions to address these factors may contribute towards accelerating the reduction of child mortality in rural Tanzania

Clustering of under-five mortality in Rufiji Health and Demographic Surveillance System in rural Tanzania

BACKGROUND\ud \ud Less than 5 years remain before the 2015 mark when countries will be evaluated on their achievements for the Millennium Development Goals (MDGs). The MDG 4 and 6 call for a reduction of child mortality by two-thirds and combating malaria, HIV/AIDS, TB, and other diseases, respectively. To accelerate the achievement of these goals, focused allocation of resources and high deployment of cost-effective interventions is paramount. The knowledge of spatial and temporal distribution of diseases is important for health authorities to prioritize and allocate resources.\ud \ud METHODS\ud \ud To identify possible significant clusters, we used SatTScan software, and analyzed 2,745 cases of under-five with 134,099 person-years for the period between 1999and 2008. Mortality rates for every year were calculated, likewise a spatial scan statistic was used to test for clusters of total under-five mortalities in both space and time.\ud \ud RESULTS\ud \ud A number of significant clusters from space, time, and space-time analysis were identified in several locations for a period of 10 years in the Rufiji Demographic Surveillance Site (RDSS). These locations show that villages within the clusters have an elevated risk of under-five deaths. The spatial analysis identified three significant clusters. The first cluster had only one village, Kibiti A (p < 0.05, the second cluster involved five villages (Mtawanya, Pagae, Kibiti A, Machepe, and Kibiti B; p < 0.05), the third cluster involved one village, Jaribu Mpakani (p < 0.05). A space-time cluster of 10 villages for the period between 1999 and 2002 with a radius of 14.73 km was discovered with the highest risk (RR 1.6, p < 0.001). The mortality rates were very high for the years 1999-2002 according to the analysis. The death rates were 33.5, 26.4, 24.1, and 24.9, respectively. Total childhood mortality rates calculated for the period of 10 years were 21.0 per 1,000 person-years.\ud \ud CONCLUSION\ud \ud During the 10 years of analysis, mortality seemed to decrease in RDSS. The mortality decline should be taken with caution because the Demographic Surveillance System is not statistically representative of the whole population; therefore, inference should not be made to the general population of Tanzania. The pattern observed could be attributed to demographic and weather characteristics of RDSS. This should provide new insights for further studies and interventions toward reducing under-five mortality

Health and survival of young children in southern Tanzania

With a view to developing health systems strategies to improve reach to high-risk groups, we present information on health and survival from household and health facility perspectives in five districts of southern Tanzania. We documented availability of health workers, vaccines, drugs, supplies and services essential for child health through a survey of all health facilities in the area. We did a representative cluster sample survey of 21,600 households using a modular questionnaire including household assets, birth histories, and antenatal care in currently pregnant women. In a subsample of households we asked about health of all children under two years, including breastfeeding, mosquito net use, vaccination, vitamin A, and care-seeking for recent illness, and measured haemoglobin and malaria parasitaemia. In the health facility survey, a prescriber or nurse was present on the day of the survey in about 40% of 114 dispensaries. Less than half of health facilities had all seven 'essential oral treatments', and water was available in only 22%. In the household survey, antenatal attendance (88%) and DPT-HepB3 vaccine coverage in children (81%) were high. Neonatal and infant mortality were 43.2 and 76.4 per 1000 live births respectively. Infant mortality was 40% higher for teenage mothers than older women (RR 1.4, 95% confidence interval (CI) 1.1 - 1.7), and 20% higher for mothers with no formal education than those who had been to school (RR 1.2, CI 1.0 - 1.4). The benefits of education on survival were apparently restricted to post-neonatal infants. There was no evidence of inequality in infant mortality by socio-economic status. Vaccine coverage, net use, anaemia and parasitaemia were inequitable: the least poor had a consistent advantage over children from the poorest families. Infant mortality was higher in families living over 5 km from their nearest health facility compared to those living closer (RR 1.25, CI 1.0 - 1.5): 75% of households live within this distance. Relatively short distances to health facilities, high antenatal and vaccine coverage show that peripheral health facilities have huge potential to make a difference to health and survival at household level in rural Tanzania, even with current human resources

Dynamics of Socioeconomic Risk Factors for Neglected Tropical Diseases and Malaria in an Armed Conflict

Armed conflict and war and infectious diseases are globally among the leading causes of human suffering and premature death. Moreover, they are closely interlinked, as an adverse public health situation may spur violent conflict, and violent conflict may favor the spread of infectious diseases. The consequences of this vicious cycle are increasingly borne by civilians, often as a hidden and hence neglected burden. We analyzed household data that were collected before and after an armed conflict in a rural part of western Côte d'Ivoire, and investigated the dynamics of socioeconomic risk factors for neglected tropical diseases (NTDs) and malaria. We identified a worsening of the sanitation infrastructure, decreasing use of protective measures against mosquito bites, and increasing difficulties to reach public health care infrastructure. In contrast, household crowding, the availability of soap, and the accessibility of comparatively simple means of health care provision (e.g., traditional healers and community health workers) seemed to be more stable. Knowledge about such dynamics may help to increase crisis-proofness of critical infrastructure and public health systems, and hence mitigate human suffering due to armed conflict and war

Implementation of an insecticide-treated net subsidy scheme under a public-private partnership for malaria control in Tanzania – challenges in implementation

BACKGROUND: In the past decade there has been increasing visibility of malaria control efforts at the national and international levels. The factors that have enhanced this scenario are the availability of proven interventions such as artemisinin-based combination therapy, the wide scale use of insecticide-treated nets (ITNs) and a renewed emphasis in indoor residual house-spraying. Concurrently, there has been a window of opportunity of financial commitments from organizations such as the Global Fund for HIV/AIDS, Tuberculosis and Malaria (GFATM), the President's Malaria Initiative and the World Bank Booster programme. METHODS: The case study uses the health policy analysis framework to analyse the implementation of a public-private partnership approach embarked upon by the government of Tanzania in malaria control - 'The Tanzania National Voucher Scheme'- and in this synthesis, emphasis is on the challenges faced by the scheme during the pre-implementation (2001 - 2004) and implementation phases (2004 - 2005). Qualitative research tools used include: document review, interview with key informants, stakeholder's analysis, force-field analysis, time line of events, policy characteristic analysis and focus group discussions. The study is also complemented by a cross-sectional survey, which was conducted at the Rufiji Health Demographic Surveillance Site, where a cohort of women of child-bearing age were followed up regarding access and use of ITNs. RESULTS: The major challenges observed include: the re-introduction of taxes on mosquito nets and related products, procurement and tendering procedures in the implementation of the GFATM, and organizational arrangements and free delivery of mosquito nets through a Presidential initiative. CONCLUSION: The lessons gleaned from this synthesis include: (a) the consistency of the stakeholders with a common vision, was an important strength in overcoming obstacles, (b) senior politicians often steered the policy agenda when the policy in question was a 'crisis event', the stakes and the visibility were high, (c) national stakeholders in policy making have an advantage in strengthening alliances with international organizations, where the latter can become extremely influential in solving bottlenecks as the need arises, and (d) conflict can be turned into an opportunity, for example the Presidential initiative has inadvertently provided Tanzania with important lessons in the organization of 'catch-up' campaigns