Prevalence of HIV and associated risk factors among street-connected children in Mwanza city

While on the street, HIV infection among street-connected children is a challenging issue due to the nature of transmission, distribution, and prevention. Lack of proper care and protection, insufficient knowledge of the danger of acquiring HIV, and insufficient or absence of health facilities serving street-connected children have left this vulnerable group engaging in high-risk behaviors exposing them to acquiring HIV. This cross-sectional study aimed at estimating the prevalence of HIV infection and its associated risk factors among street-connected children aged between 10 to17 years in Mwanza City. The study was granted ethical clearance all permissions and restrictions to work with street-connected children were adhered to. A total of 131 participants aged 10-17 years were recruited for interviews and HIV testing. Exact logistic regression was used to determine factors associated with having HIV. A total of 111 (85.0%) boys and 20 (15.0%) girls responded to the questionnaire, with the median age being 15years. The overall HIV prevalence was 12.2% (16/131). Street-children using condoms were less likely to be affected by HIV compared to those who were not using (OR = 0.24; 95% CI 0.04-0.97). Females had higher odds of HIV infection compared to males (OR = 5.24; 95% CI of 1.24-24.65). The study shows a significantly higher prevalence of HIV among street-connected children as compared to the general population. Therefore, there should be tailored reproductive and sexual health programs, with the provision of protective materials like condoms

Attendance of male partners to different reproductive health services in Shinyanga District, North western Tanzania

Background: Male involvement in reproductive health (RH) services in Africa has been associated with improved maternal and child health outcomes. The objective of this study was to determine the prevalence and factors affecting male partner attendance to available reproductive health services in Shinyanga district, north-western Tanzania.Methods: A house to house survey using a structured questionnaire was conducted among randomly selected married men. Additional in-depth interviews were conducted among married men found attending RH services. Factors that motivates the uptake of locally available RH services together with their partners were explored.Results: A total of 204 men participated in the study, 94.4 % (193/204) of them reported to have ever attended the RH service with their female partners at least once whereas 50.6% (103/204) of them attended at least thrice. Three quarters (154/204) attended HIV counselling and testing (VCT) and 63% (129/204) attended antenatal services (ANC). Reported attendance to sexually transmitted infections (STIs/STDs), prevention of HIV transmission from mother to child (PMTCT), and reproductive health cancer services were all less than 13%.  The male partners age group (25-34 years; χ2=9.347, df =3 p-value < 0.001), female partner invitation to HR services (χ2= 29.901, df=1, p-value <0.001) and having less than 2 children (χ2= 6.201, df= 2, p-value < 0.05) were associated with higher RH service attendance. Only 20% (4/20) of married men attended RH because they expected better health outcomes in their presence whilst majority attended because they were summoned or just happen to be at the clinic for other purposes.Conclusion: The male attendance to RH services together with their female partners’ in rural Shinyanga was mainly focused ANC and VCT. Most of men attended because were verbally invited by their partners. Education on couple communication empowerment among women attending RH clinics could sustainably improve attendance to all RH services.

Twelve-year persistence of inequalities in antenatal care utilisation among women in Tanzania: a decomposition analysis of population-based cross-sectional surveys

Objective This study was undertaken to assess the trend and contributors of socioeconomic inequalities in antenatal care (ANC) utilisation among women of reproductive age in Tanzania from 2004 to 2016.Design Population-based cross-sectional surveys.Setting This study analysed nationally representative data for women of reproductive age obtained from the 2004–2016 Tanzania Demographic Health Surveys.Primary outcome measure The outcome variables analysed in this study are: (1) attendance of ANC and (2) accessing adequate antenatal care.Analytical methods The concentration curve and the concentration index were used to measure socioeconomic inequality in attending and accessing adequate ANC. The concentration index was decomposed to identify the factors explaining the observed socioeconomic inequality of these two outcomes.Results The concentration index for attending at least four ANC visits increased from 0.169 in 2004 to 0.243 in 2016 (p<0.01). Similarly, for accessing adequate care, the index increased from 0.147 in 2004 to 0.355 in 2016 (p<0.01). This indicates the significant increase in socioeconomic inequalities (favouring wealthier women) for these two outcomes over time. Furthermore, the results show that wealth status was the largest contributor to inequality in both attending at least four visits (71%, 50% and 70%) and accessing adequate ANC (50%, 42% and 51%) in 2004, 2010 and 2016, respectively, in favour of wealthier women (p<0.05). The other contributors to socioeconomic inequalities in ANC utilisation were maternal education and type of residence.Conclusion Over the 12 years of surveys, there was no reduction in socioeconomic inequalities in ANC utilisation in Tanzania. Therefore, the efforts of achieving universal health coverage should focus on reducing wealth-related inequality and improving women’s education from poor households

Perceived usefulness of Contraceptives among Married Individuals in Rorya District

The increasing use of contraception methods worldwide has allowed couples to choose the number and spacing of their children. Despite impressive achievements, contraceptive use remains low while the need for contraception is high in some of the world\u27s poorest and most populous places. Little is known about the factors contributing to the low utilisation of contraceptives in the Rorya district, particularly among married individuals where the prevalence of contraceptive use was only 28%. A qualitative design was used for six focus group discussions and six in-depth interviews conducted with married individuals to understand the perception of the use of contraceptives in the Rorya District. Respondents believe that contraception is important in reducing the number of pregnancies and improving health, as well as in limiting family size. Interviewees emphasised the need for more accessible outlets for contraceptives. Religious beliefs and myths about contraceptive side effects have been reported to influence contraceptive choice and use. Respondents are aware of the health benefits of contraception for themselves and their children. Limited access, Myth, and religious beliefs continue to influence contraceptive use. Strategies to improve contraceptive use should ensure the availability and accessibility of contraceptives and tailored BCC, especially in low uptake areas

Provision of inadequate information on postnatal care and services during antenatal visits in Busega, Northwest Tanzania: a simulated client study

Abstract Background Most (94%) of global maternal deaths occur in low- and middle-income countries due to preventable causes. Maternal health care remains a key pillar in improving survival. Antenatal care (ANC) guidelines recommend that pregnant women should be provided with information about postnatal care in the third trimester. However, the utilization of postnatal care services is limited in developing countries including Tanzania. The aim of this study was to investigate the practice of health care workers in providing information on postnatal care to pregnant women during antenatal care visits. Methods A cross sectional study was conducted among health care workers from 27 health facilities that offer reproductive and child health services in Busega district Northwest Tanzania. A simulated client approach was utilized to observe quality of practice among health care workers with minimal reporting bias (i.e., the approach allows observing participants at their routine practices without pretending). Selected pregnant women who were trained to be simulated clients from the community within facility catchment area attended antenatal care sessions and observed 81 of 103 health care workers. Data analyses were carried out using STATA 13. Results Only 38.73% (95% CI; 28.18–49.49%) of health care workers were observed discussing subtopics related to postnatal care during the ANC visit. Few health care workers (19.35%), covered all eight subtopics recommended in the ANC guidelines. Postnatal danger signs (33.33%) and exclusive breast feeding (33.33%) were mostly discussed subtopics by health care workers. Being a doctor/nurse/clinical officer is associated by provision of postnatal education compared to medical attendant, aOR = 3.65 (95% CI; 1.21–12.14). Conclusion The provision of postnatal education during ANC visits by health care workers in this district was limited. This situation could contribute to the low utilization of postnatal care services. Health care workers need to be reminded on the importance of delivering postnatal education to pregnant women attending ANC clinic visits. On job training can be used to empower health care workers of different cadres to deliver postnatal health education during ANC visits. These efforts could increase women’s utilization of postnatal care and improve outcomes for mothers and newborns

Low adherence to Option B+ antiretroviral therapy among pregnant women and lactating mothers in eastern Tanzania.

BackgroundAdherence to option B+ antiretroviral treatment (ART) is vital to a successful implementation of Prevention of Mother to Child Transmission (PMTCT) program. Further studies show that optimal viral suppression is also crucial for a successful PMTCT program, however barriers to adherence exist and differ among populations and particularly within few years of its adoption in Tanzania. This study therefore aimed at investigating the level and predictors of adherence to ART option B+ among pregnant and lactating women in rural and urban settings of eastern Tanzania.MethodologyA cross-sectional study was conducted among 305 pregnant women and lactating mothers on Option B+ regime from six health facilities located in rural and urban settings in Morogoro region in eastern Tanzania. Data were collected using a structured questionnaire. Data analysis was performed using descriptive statistics, as well as bivariate and multivariate logistic regression.ResultsGood adherence to option B+ PMTCT drugs was 26.3% and 61.1% among respondents residing in urban and rural areas respectively. The rural residents were 4.86 times more likely to adhere compared to their counterparts in an urban area (aOR = 4.86; 95% CI = 2.91-8.13). Similarly, women with male partners' support in PMTCT were 3.51 times more likely to have good adherence than those without (aOR = 3.51, 95% CI = 1.21-10.15). Moreover, there was a significantly lower odds of adherence to option B+ among those who had been on treatment between one to two years as compared to those had less than one year of treatment (aOR = 0.45; 95%CI = 0.22-0.93).ConclusionAdherence to PMTCT option B+ antiretroviral drugs treatment among pregnant women and breastfeeding mothers was low and much lower among urban residents. Adherence was significantly predicted by rural residence, male partner support and short duration on ART. Efforts to improve adherence should focus on increasing male participation on PMTCT, tailored interventions to urban residents and those who have been on ART for a long duration

Prevalence of HIV infection and uptake of HIV/AIDS services among fisherfolk in landing Islands of Lake Victoria, north western Tanzania

Abstract Background New HIV infections in Tanzania have been decreasing, however some populations remain at higher risk. Despite of that, evidence on the magnitude of HIV infection and the associated factors and HIV/AIDS services uptake among fisherfolk in Tanzania are inadequately explored. This study therefore aimed at determining prevalence of HIV infection and utilization of HIV/AIDS services among fishfolk in selected Islands of Lake Victoria for evidence-based interventions. Methods Cross-sectional study determining status of HIV infection among fisherfolk (n = 456) and retrospective review of voluntary counselling and testing (VCT) registry (n = 1744) were done in Buchosa and Muleba districts. Structured questionnaire and HIV rapid test kits with the standard testing protocol were used as research tools. Results A total of 269 (58.9%) male and 187 (41.1%) female fisherfolk were recruited during the community survey. Prevalence of HIV infection was 14% in all surveyed landing sites with a site variation from as low as 7.2% to as high as 23.8%. Participants employed in fishing related employment had higher odds of being HIV infected (5.4 times) than those who practiced fishing and partly farming [OR = 5.40; 95%CI 1.88–15.61; p < 0.001]. Participants employed in fishing related employment had higher odds of being HIV infected (5.4 times) than those practiced fishing and farming [OR = 5.40; 95%CI 1.88–15.61; P < 0.001]. Lack of formal education [aOR = 3.37; 95%CI 1.64–6.92; p < 0.001], being older [aOR = 1.06; 95%CI 1.03–1.09] and using alcohol [aOR = 2.26; 95%CI 1.23–4.15] predicted the likelihood of contracting HIV infection. Approximately three quarters (76%) of respondents had ever tested for HIV infection within past 1 year. Moreover, about half of the study participants had used condom inconsistently and 5 out of 14 (37.5%) of participants who knew their status had never started treatment. Despite the low uptake of most HIV preventive services, majority (88%) of male fisherfolk were circumcised. Conclusion The magnitude of HIV infection among fisherfolk was up to 3 times higher than that of the general populations in Muleba and Buchosa districts. Higher age, using alcohol and lack of formal education predicted increased likelihood of HIV infection. The uptake of key HIV/AIDS curative and preventive services was generally low

High Prevalence of Anemia and Poor Compliance with Preventive Strategies among Pregnant Women in Mwanza City, Northwest Tanzania: A Hospital-Based Cross-Sectional Study

Anemia in pregnancy is prevalent in Tanzania despite the implementation of existing prevention strategies. This study aims to determine the level of compliance with anemia preventive strategies among pregnant women and the factors associated with poor compliance. A cross sectional study was conducted among 768 pregnant women who attended the Bugando Medical Center, Sekou-Toure Regional Hospital, Nyamagana District Hospital, and Buzuruga Health Center in Mwanza, Northwest Tanzania. The prevalence of anemia at term was 68.8% (95% CI, 65.5&ndash;72.0%). The average hemoglobin level at term was 10.0 g/dL (95% CI, 9.8&ndash;10.1). Only 10.9% of pregnant women complied fully with anemia-preventive strategies. A decrease in mean hemoglobin level was observed across levels of compliance, with women who were non-compliant displaying a significantly lower mean hemoglobin level (8.3 g/dL) compared to women who were fully compliant (11.0 g/dL). Poor compliance was associated with no formal or primary education and initiating antenatal care in the 2nd or 3rd trimester. Anemia in pregnancy was commonly associated with lack of compliance with preventive strategies among participants. There is a need for community-based health education on the importance of complying with anemia-preventive strategies in order to reduce the burden during pregnancy and the consequences of anemia to the unborn baby

Antenatal care and opportunities for quality improvement of service provision in resource limited settings: A mixed methods study

Antenatal care is essential to improve maternal and newborn health and wellbeing. The majority of pregnant women in Tanzania attend at least one visit. Since implementation of the focused antenatal care model, quality of care assessments have mostly focused on utilization and coverage of routine interventions for antenatal care. This study aims to assess the quality of antenatal care provision from a holistic perspective in a rural district in Tanzania. Structure, process and outcome components of quality are explored. This paper reports on data collected over several periods from 2012 to 2015 through facility audits of supplies and services, ANC observations and exit interviews with pregnant women. Additional qualitative methods were used such as interviews, focus group observations and participant observations. Findings indicate variable performance of routine ANC services, partly explained by insufficient resources. Poor performance was also observed for appropriate history taking, attention for client's wellbeing, basic physical examination and adequate counseling and education. Achieving quality improvement for ANC requires increased attention for the process of care provision beyond coverage, including attention for response-based services, which should be assessed based on locally determined criteria

Migration Behavior of Low-Density Particles in Lab-on-a-Disc Devices: Effect of Walls

The effect of the lateral walls of a Lab-On-a-Disc device on the dynamics of a model system of particles with a density lower than that of the solvent (modelling parasites eggs) is analyzed theoretically and experimentally. In the absence of lateral walls, a particle always moves in the direction of the centrifugal force, while its trajectory is deflected in the tangential direction by the inertial Coriolis and Euler forces. Lateral walls, depending on the angle forming with the radial direction, can guide the particle either in the same or in the opposite direction to the centrifugal force, thus resulting in unusual particle trajectories including zig-zag or backwards particle motion. The effect is pronounced in the case of short operation times when the acceleration of the angular rotation, and thus the Euler force, is considerable. The predicted unusual motion is demonstrated by numerically solving the equation of motion in the presence of lateral walls and verified in the experiment with particles of density lower than that of the solvent. Our analysis is useful for design and operational considerations of Lab-On-a-Disc devices aiming for or involving (bio)particle handling