Tanzania HIV/AIDS Indicator Survey 2003-04

The Tanzania Commission for AIDS (TACAIDS) authorised the National Bureau of Statistics\ud (NBS) to conduct the THIS. The THIS is the first household survey of its kind to be conducted in Tanzania.\ud The survey covered the Tanzania Mainland only.The main objective of the survey was to provide HIV/AIDS programme managers and policymakerswith information needed to guide planning and implementation of interventions, including resource mobilization and allocation, monitoring and evaluation of existing programmes, and designing new and effective strategies for combating the epidemic.\ud Before this survey, national HIV prevalence estimates depended entirely on data derived from\ud blood donors and pregnant women seeking antenatal care. Although this information from the surveillance system has been useful for monitoring the trends of HIV in Tanzania, the inclusion of HIV testingin the THIS offers the opportunity to better understand the magnitude and pattern of infection in the generalreproductive-age population in Tanzania. The THIS results are in turn expected to improve the calibrationof the annual sentinel surveillance data, so that trends in HIV infection can be more accurately\ud measured in the intervals between household surveys.\ud This report contains findings from the 2003-04 THIS collected from the households visited. The\ud survey was designed to produce regional estimates. The tables and text cover the most important indicatorsrelated to HIV/AIDS and should be of use to policymakers and programme administrators who needup-to-date data for evaluating their activities and planning future directions.\u

Tackling Child Undernutrition in India: Governance Challenges Need More Attention

This article puts a governance lens on India's current approach to tackling undernutrition through DFID's governance framework of state capability, accountability and responsiveness. State capability is analysed in terms of strength of political leadership to tackle undernutrition and to mobilise cross government actions. Accountability for results is assessed in the Integrated Child Development Scheme (ICDS) – India's foremost programme for children under six years of age with nutrition and health as one of the programme components. Finally, state responsiveness is assessed especially with respect to the Right?to?Food (RTF) campaign that has taken a legal route to advocacy by successfully petitioning the Supreme Court (SC) that has directed the Government of India (GoI) to improve the functioning of ICDS – with a special focus on the disadvantaged sections of the population

Geographical disparities in core population coverage indicators for roll back malaria in Malawi

BACKGROUND: Implementation of known effective interventions would necessitate the reduction of malaria burden by half by the year 2010. Identifying geographical disparities of coverage of these interventions at small area level is useful to inform where greatest scaling-up efforts should be concentrated. They also provide baseline data against which future scaling-up of interventions can be compared. However, population data are not always available at local level. This study applied spatial smoothing methods to generate maps at subdistrict level in Malawi to serve such purposes. METHODS: Data for the following responses from the 2000 Malawi Demographic and Health Survey (DHS) were aggregated at subdistrict level: (1) households possessing at least one bednet; (2) children under 5 years who slept under a bednet the night before the survey; (3) bednets retreated with insecticide within past 6-12 months preceding the survey; (4) children under 5 who had fever two weeks before the survey and received treatment within 24 hours from the onset of fever; and (5) women who received intermittent preventive treatment of malaria during their last pregnancy. Each response was geographically smoothed at subdistrict level by applying conditional autoregressive models using Markov Chain Monte Carlo simulation techniques. RESULTS: The underlying geographical patterns of coverage of indicators were more clear in the smoothed maps than in the original unsmoothed maps, with relatively high coverage in urban areas than in rural areas for all indicators. The percentage of households possessing at least one bednet was 19% (95% credible interval (CI): 16-21%), with 9% (95% CI: 7-11%) of children sleeping under a net, while 18% (95% CI: 16-19%) of households had retreated their nets within past 12 months prior to the survey. The northern region and lakeshore areas had high bednet coverage, but low usage and re-treatment rates. Coverage rate of children who received antimalarial treatment within 24 hours after onset of fever was consistently low for most parts of the country, with mean coverage of 4.8% (95% CI: 4.5-5.0%). About 48% (95% CI: 47-50%) of women received antimalarial prophylaxis during their pregnancy, with highest rates in the southern and northern areas. CONCLUSION: The striking geographical patterns, for example between predominantly urban and rural areas, may reflect spatial differences in provider compliance or coverage, and can partly be explained by socio-economic and cultural differences. The wide gap between high bed net coverage and low retreatment rates may reflect variation in perceptions about malaria, which may be addressed by implementing information, education and communication campaigns or introducing long lasting insecticide nets. Our results demonstrate that DHS data, with appropriate methodology, can provide acceptable estimates at sub-national level for monitoring and evaluation of malaria control goals

Determinants of fertility in rural Ethiopia: the case of Butajira Demographic Surveillance System (DSS)

<p>Abstract</p> <p>Background</p> <p>Fertility is high in rural Ethiopia. Women in the reproductive age group differed in various characteristics including access to food and encounter to drought which requisite the assessment of determinants of fertility.</p> <p>Methods</p> <p>Reproductive age women were recruited from a DSS, the Butajira DSS database. A DHS maternity history questionnaire was administered on 9996 participants. Data quality was assured besides ethical clearance. Poisson regression crude and adjusted Incidence Rate Ratio with 95 Confidence Interval were used to identify determinants of fertility.</p> <p>Results</p> <p>Delayed marriage, higher education, smaller family, absence of child death experience and living in food-secured households were associated with small number of children. Fertility was significantly higher among women with no child sex preference. However, migration status of women was not statistically significant.</p> <p>Conclusions</p> <p>Policy makers should focus on hoisting women secondary school enrollment and age at first marriage. The community should also be made aware on the negative impact of fertility on household economy, environmental degradation and the country's socio-economic development at large.</p

Measuring client satisfaction and the quality of family planning services: A comparative analysis of public and private health facilities in Tanzania, Kenya and Ghana

Public and private family planning providers face different incentive structures, which may affect overall quality and ultimately the acceptability of family planning for their intended clients. This analysis seeks to quantify differences in the quality of family planning (FP) services at public and private providers in three representative sub-Saharan African countries (Tanzania, Kenya and Ghana), to assess how these quality differentials impact upon FP clients' satisfaction, and to suggest how quality improvements can improve contraceptive continuation rates.\ud Indices of technical, structural and process measures of quality are constructed from Service Provision Assessments (SPAs) conducted in Tanzania (2006), Kenya (2004) and Ghana (2002) using direct observation of facility attributes and client-provider interactions. Marginal effects from multivariate regressions controlling for client characteristics and the multi-stage cluster sample design assess the relative importance of different measures of structural and process quality at public and private facilities on client satisfaction. Private health facilities appear to be of higher (interpersonal) process quality than public facilities but not necessarily higher technical quality in the three countries, though these differentials are considerably larger at lower level facilities (clinics, health centers, dispensaries) than at hospitals. Family planning client satisfaction, however, appears considerably higher at private facilities - both hospitals and clinics - most likely attributable to both process and structural factors such as shorter waiting times and fewer stockouts of methods and supplies. Because the public sector represents the major source of family planning services in developing countries, governments and Ministries of Health should continue to implement and to encourage incentives, perhaps performance-based, to improve quality at public sector health facilities, as well as to strengthen regulatory and monitoring structures to ensure quality at both public and private facilities. In the meantime, private providers appear to be fulfilling an important gap in the provision of FP services in these countries