Tanzania HIV/AIDS and Malaria Indicator Survey 2011-12(Preliminary Results)

Preliminary results (tables only) for the malaria indicators and selected HIV indicators. The results were released by the National Bureau of Statistics on 11 October 2012. Full results of the survey are still being compiled and will be included in the final report

Sexual and reproductive health and HIV in border districts affected by migration and poverty in Tanzania

Objectives To assess HIV knowledge, attitudes, sexual practices and sexual and reproductive health ( SRH) service delivery in border areas of Tanzania, with a view to support the prioritisation of SRH interventions in border areas. Methods The target sample comprised randomly selected people living near the border, aged 15 to 49 years. To gather information, we utilised: (i) a standardised questionnaire (n = 86; 42 men and 44 women) previously used in national household surveys conducted by the Tanzanian government; (ii) focus group discussions (ten male groupsn = 47; ten female groups, n = 51); and (iii) semi- structured interviews with service providers (n = 37). Results The mean number of sexual partners, frequency of multiple concurrent partnerships and engagement in transactional sex were significantly higher in the border community than in the national population. Knowledge about HIV was comparable with that in the general population. Access to SRH services was limited in the border areas. Conclusion Efforts to reduce HIV transmission and to improve SRH in the border areas should focus on gaps in service delivery rather than education and information activities alone. In addition, multi-sectorial efforts spanning the health, social, legal and private sectors addressing gender imbalances and poverty alleviation are imperative for reducing poverty-driven unsafe transactional sex

Delivering at Home or in a Health Facility? Health-Seeking Behaviour of Women and the Role of Traditional birth attendants in Tanzania.

Traditional birth attendants retain an important role in reproductive and maternal health in Tanzania. The Tanzanian Government promotes TBAs in order to provide maternal and neonatal health counselling and initiating timely referral, however, their role officially does not include delivery attendance. Yet, experience illustrates that most TBAs still often handle complicated deliveries. Therefore, the objectives of this research were to describe (1) women's health-seeking behaviour and experiences regarding their use of antenatal (ANC) and postnatal care (PNC); (2) their rationale behind the choice of place and delivery; and to learn (3) about the use of traditional practices and resources applied by traditional birth attendants (TBAs) and how they can be linked to the bio-medical health system. Qualitative and quantitative interviews were conducted with over 270 individuals in Masasi District, Mtwara Region and Ilala Municipality, Dar es Salaam, Tanzania. The results from the urban site show that significant achievements have been made in terms of promoting pregnancy- and delivery-related services through skilled health workers. Pregnant women have a high level of awareness and clearly prefer to deliver at a health facility. The scenario is different in the rural site (Masasi District), where an adequately trained health workforce and well-equipped health facilities are not yet a reality, resulting in home deliveries with the assistance of either a TBA or a relative. Instead of focusing on the traditional sector, it is argued that more attention should be paid towards (1) improving access to as well as strengthening the health system to guarantee delivery by skilled health personnel; and (2) bridging the gaps between communities and the formal health sector through community-based counselling and health education, which is provided by well-trained and supervised village health workers who inform villagers about promotive and preventive health services, including maternal and neonatal health

Survival of neonates in rural Southern Tanzania: does place of delivery or continuum of care matter?

\ud The concept of continuum of care has recently been highlighted as a core principle of maternal, newborn and child health initiatives, and as a means to save lives. However, evidence has consistently revealed that access to care during and post delivery (intra and postpartum) remains a challenge in the continuum of care framework. In places where skilled delivery assistance is exclusively available in health facilities, access to health facilities is critical to the survival of the mother and her newborn. However, little is known about the association of place of delivery and survival of neonates. This paper uses longitudinal data generated in a Health and Demographic Surveillance System in rural Southern Tanzania to assess associations of neonatal mortality and place of delivery. Three cohorts of singleton births (born 2005, 2006 and 2007) were each followed up from birth to 28 days. Place of birth was classified as either "health facility" or "community". Neonatal mortality rates were produced for each year and by place of birth. Poisson regression was used to estimate crude relative risks of neonatal death by place of birth. Adjusted ratios were derived by controlling for maternal age, birth order, maternal schooling, sex of the child and wealth status of the maternal household. Neonatal mortality for health facility singleton deliveries in 2005 was 32.3 per 1000 live births while for those born in the community it was 29.7 per 1000 live births. In 2006, neonatal mortality rates were 28.9 and 26.9 per 1,000 live births for deliveries in health facilities and in the community respectively. In 2007 neonatal mortality rates were 33.2 and 27.0 per 1,000 live births for those born in health facilities and in the community respectively. Neonates born in a health facility had similar chances of dying as those born in the community in all the three years of study. Adjusted relative risks (ARR) for neonatal death born in a health facility in 2005, 2006 and 2007 were 0.99 (95% CI: 0.58 - 1.70), 0.98 (95% CI: 0.62 - 1.54) and 1.18 (95% CI: 0.76 - 1.85) respectively. We found no evidence to suggest that delivery in health facilities was associated with better survival chances of the neonates.\u

Intimate partner violence during pregnancy and associated mental health symptoms among pregnant women in Tanzania: a cross-sectional study.

OBJECTIVE: Violence against pregnant women is a prevalent issue with severe health implications, especially during pregnancy. This study seeks to determine the prevalence of intimate partner violence against women during pregnancy and its associated mental health symptoms. DESIGN: Cross-sectional survey conducted from December 2011 to April 2012. SETTING: Muhimbili National Hospital antenatal clinic in Dar es Salaam, Tanzania. SAMPLE: 1180 pregnant antenatal care patients. METHODS: Trained interviewers conducted face-to-face standardised interviews with the women in a private room prior to their antenatal care appointment. (PTSD), anxiety and depressive symptoms were assessed through the Conflict Tactics Scale, the John Hopkins Symptom Checklist (25) and the Posttraumatic Diagnostic Scale. MAIN OUTCOME MEASURES: The Conflict Tactics Scale, the John Hopkins Symptom Checklist (25) and the Posttraumatic Diagnostic Scale. RESULTS: Of the 1180 women who were interviewed, 27% reported experiencing both physical and sexual intimate partner violence in the index pregnancy, with 18% reporting physical violence and 20% reporting sexual violence. After adjusting for the sociodemographic characteristics of women, women who experienced physical and/or sexual intimate partner violence during pregnancy were significantly more likely to have moderate PTSD (AOR 2.94, 95% CI 1.71-5.06), anxiety (AOR 3.98, 95% CI 2.85-5.57) and depressive (AOR 3.31, 95% CI 2.39-4.593) symptoms than women who did not report physical and/or sexual intimate partner violence during pregnancy. CONCLUSIONS: About three out of ten women experienced physical or sexual intimate partner violence during pregnancy by an intimate partner, which was significantly associated with poor mental health symptoms. These rates are alarming, and justify training and education of antenatal care providers to raise awareness

Adolescent fertility and family planning in East Asia and the Pacific: a review of DHS reports

<p>Abstract</p> <p>Background</p> <p>Adolescent pregnancy has significant health and socio-economic consequences for women, their families and communities. Efforts to prevent too-early pregnancy rely on accurate information about adolescents' knowledge, behaviours and access to family planning, however available data are limited in some settings. Demographic and Health Survey (DHS) reports are recognised as providing nationally representative data that are accessible to policymakers and programmers. This paper reviews DHS reports for low and lower middle income countries in East Asia and the Pacific to determine what information regarding adolescent fertility and family planning is available, and summarises key findings.</p> <p>Methods</p> <p>The most recent DHS reports were sought for the 33 low and lower middle income countries in the East Asia and Pacific region as defined by UNICEF and World Bank. Age-disaggregated data for all indicators relevant to fertility and current use, knowledge and access to family planning information and services were sought to identify accessible information. Reported data were analysed using an Excel database to determine outcomes for adolescents and compare with adult women.</p> <p>Results</p> <p>DHS reports were available for eleven countries: Cambodia, Indonesia, Marshall Islands, Nauru, Papua New Guinea, Philippines, Samoa, Solomon Islands, Timor-Leste, Tuvalu and Vietnam. Twenty seven of 40 relevant DHS indicators reported outcomes for adolescent women aged 15-19 years. There were limited data for unmarried adolescents. A significant proportion of women commence sexual activity and childbearing during adolescence in the context of low contraceptive prevalence and high unmet need for contraception. Adolescent women have lower use of contraception, poorer knowledge of family planning and less access to information and services than adult women.</p> <p>Conclusion</p> <p>DHS reports provide useful and accessible data, however, they are limited by the failure to report data for unmarried adolescents and report age-disaggregated data for some indicators. Further research is required to better understand the barriers that both married and unmarried adolescents face accessing reproductive health information and services, and their information and service delivery preferences.</p

Why do women choose private over public facilities for family planning services? A qualitative study of post-partum women in an informal urban settlement in Kenya

BACKGROUND: Nearly 40 % of women in developing countries seek contraceptives services from the private sector. However, the reasons that contraceptive clients choose private or public providers are not well studied. METHODS: We conducted six focus groups discussions and 51 in-depth interviews with postpartum women (n = 61) to explore decision-making about contraceptive use after delivery, including facility choice. RESULTS: When seeking contraceptive services, women in this study preferred private over public facilities due to convenience and timeliness of services. Women avoided public facilities due to long waits and disrespectful providers. Study participants reported, however, that they felt more confident about the technical medical quality in public facilities than in private, and believed that private providers prioritized profit over safe medical practice. Women reported that public facilities offered comprehensive counseling and chose these facilities when they needed contraceptive decision-support. Provision of comprehensive counseling and screening, including side effects counseling and management, determined perception of quality. CONCLUSION: Women believed private providers offered the advantages of convenience, efficiency and privacy, though they did not consistently offer high-quality care. Quality-improvement of contraceptive care at private facilities could include technical standardization and accreditation. Development of support and training for side effect management may be an important intervention to improve perceived quality of care