Antiretroviral therapy clinic attendance among children aged 0-14 years in Kahama district, Tanzania: a cross-sectional study

Background: Efforts made to scale up care and treatment for HIV in Tanzania have started to pay off. The number of people living with HIV (PLHIV) who are on antiretroviral therapy (ART) has massively increased owing to an increase in investment made. However, this is not reflected in all populations, especially children living with HIV. This study, therefore, aims to determine the magnitude and factors associated with ART uptake among children living with HIV in Kahama district, Tanzania.Methods: This cross-sectional study was conducted among pairs of children aged 0-14 years and their caregivers. A total of 423 randomly selected caregivers of HIV-positive children were interviewed using a structured questionnaire. The outcome variable was ART uptake while independent variables constituted of socio-demographic, health facility, and systemic factors.Results: A total of 132 (31%) of all caregivers reported to have missed at least one clinic visit for their children during a period of three months before the survey. Of them, one in four missed at least two clinics. Caregivers cited factors such as lack of transport fare and distance to the health facility as barriers to attend the planned clinics. After adjusting for the important confounders and other covariates, factors associated with ART uptake were being divorced/widowed (AOR= 0.57, 95% CI; 0.33-0.97) and having primary education or more (AOR 0.30, 95% CI 0.11-0, 82).Conclusion: One in every three HIV-positive children miss their scheduled routine ART clinics in Kahama, Shinyanga. Tailored interventions should target caregivers of such children who are divorced or widowed and those with low or no education while addressing distance and transportation challenges in this and other areas with similar contexts. 

Factors for change in maternal and perinatal audit systems in Dar es Salaam hospitals, Tanzania

<p>Abstract</p> <p>Background</p> <p>Effective maternal and perinatal audits are associated with improved quality of care and reduction of severe adverse outcome. Although audits at the level of care were formally introduced in Tanzania around 25 years ago, little information is available about their existence, performance, and practical barriers to their implementation. This study assessed the structure, process and impacts of maternal and perinatal death audit systems in clinical practice and presents a detailed account on how they could be improved.</p> <p>Methods</p> <p>A cross sectional descriptive study was conducted in eight major hospitals in Dar es Salaam in January 2009. An in-depth interview guide was used for 29 health managers and members of the audit committees to investigate the existence, structure, process and outcome of such audits in clinical practice. A semi-structured questionnaire was used to interview 30 health care providers in the maternity wards to assess their awareness, attitude and practice towards audit systems. The 2007 institutional pregnancy outcome records were reviewed.</p> <p>Results</p> <p>Overall hospital based maternal mortality ratio was 218/100,000 live births (range: 0 - 385) and perinatal mortality rate was 44/1000 births (range: 17 - 147). Maternal and perinatal audit systems existed only in 4 and 3 hospitals respectively, and key decision makers did not take part in audit committees. Sixty percent of care providers were not aware of even a single action which had ever been implemented in their hospitals because of audit recommendations. There were neither records of the key decision points, action plan, nor regular analysis of the audit reports in any of the facilities where such audit systems existed.</p> <p>Conclusions</p> <p>Maternal and perinatal audit systems in these institutions are poorly established in structure and process; and are less effective to improve the quality of care. Fundamental changes are urgently needed for successful audit systems in these institutions.</p

Levels and causes of adult mortality in rural Tanzania with special reference to HIV/AIDS

Data from a longitudinal study in northwest Tanzania were used to assess the levels of adult mortality and the leading causes of death. Adult mortality in this rural area was high and 42 per cent of persons aged 15 will die before their sixtieth birthday at current mortality rates. Mortality in this population with an HIV prevalence of about six per cent in 1994-95, has increased by about one-third because of HIV/AIDS, and further increase is likely. Other infectious diseases cause nearly a quarter of deaths and non-communicable diseases are still a relatively minor cause. The occurrence of the AIDS epidemic may have further delayed the onset of the epidemiological transition in many parts of Africa

Integrating reproductive and child health and HIV services in Tanzania: Implication to policy, systems and services

In Tanzania, reproductive health and HIV services are coordinated by the Ministry of Health and Social Welfare in two separate units namely Reproductive and Child Health Section and the National AIDS Control Programme. The importance of integrating the two services that are vertically run is expected to improve access to and uptake of key essential services and extend coverage to underserved and vulnerable populations and thus minimizing missed opportunities. Experts around the world recognize the central role of Sexual and Reproductive Health (SRH) services in preventing HIV infection. Evidence suggests that improving access to contraception for women to prevent pregnancy is an important and cost-effective way to prevent HIV-positive births. Integrating SRH and HIV services therefore verifies its importance for improving maternal and child health as well as leading to prevention of HIV infection.  The primary objective of this review was to gain an understanding of the current linkages between SRH and HIV within Tanzania’s policies, programmes, systems and services. Policy documents, guidelines, national laws, and published reports on SRH and HIV were reviewed.  The majority of the reviewed documents mentioned fundamentals of integration between SRH and HIV. Majority of policies and guidelines both in family planning (FP) and HIV documents mandate bi-directional linkages. This review suggests that there are linkages between the two services and can be operationalised together. However, policies and guidelines only specify services to be integrated without due consideration of resources and structural orientation for linked services

Rain-Fed Farming System at a Crossroads in Semi-Arid Areas of Tanzania: What Roles do Climate Variability and Change Play?

Positive changes, like adopting drought resistant crop varieties, in the rain-fed farming system (RFFS) in response to climate variability and change enhance system’s ability to support people’s living as opposed to negative changes, like lack of pastures, which put the system at risk of failure in supporting the living. Using participatory rural appraisal (PRA) and household survey, this paper examined the roles of climate variability and change in triggering changes in RFFS. Specifically, the paper: (i) assessed dominant crop and livestock farming system; (ii) assessed the change element of crop and livestock production systems; and (iii) examined factors for the changes in RFFS. A random sample of 388 households was used. Qualitative data analysis was done through content analysis. Binary logistic regression was used to assess factors that explain changes on RFFS. The results showed that dominant crops were different in each village. Secondly, some changes in crop varieties and in livestock grazing arrangements were noted in response to climate variability and change. Unlike the hypothesis (P&gt;0.05), the results demonstrated that warming (ß = -10.61, Wald = 36.26, P ? 0.001) showed highest significant impact on likelihood of adopting new crop varieties relative to other factors. Similarly, drought (ß = 2.16, Wald = 6.82, P ? 0.009) showed highest impact on the likelihood of changing a grazing place. Yet, the changes were constrained by factors like natural resources protective policies, failure of crop varieties to withstand warming and drought, and poor land use management. Therefore, the RFFS was at a crossroads with implications on system sustainability and livelihoods. The government and private interventions should support farmers and agro-pastoralists to manage risks related to the changes in RFFS in response to climate variability and change. Keywords: Climate change, agro-pastoralism, livelihoods, semi-arid, Tanzani

Patterns of sexually transmitted infections in adolescents and youth in Dar es Salaam, Tanzania

BACKGROUND: Syndromic management of STIs has been advocated as simplified and cheap approach. Youth have been reported to be at increased risk of acquiring STIs which can facilitate HIV transmission. We have investigated the relationship between the syndromic management and specific aetiology diagnosis and its relationship with HIV infection and health seeking behaviour among youth attending a reproductive health clinic in Dar es Salaam, Tanzania. METHODS: Between September 1998 and February 1999 among 1895 adolescents and youth below 25 years seen in the clinic 199 (10.5%) were randomly selected and consented to participate in the study. A standard questionnaire was administered. Blood and vaginal or urethral specimens were taken and investigated for STI causative agents. RESULTS: Among a total of 199 studied adolescents and youth 22.6 % were teenagers, with fewer females 17.8% than males; 27.5% (p < 0.018). 20.8% of the females compared to 11.5% in males were HIV infected. Genital discharge was the most common complaint which was reported in 54.1% of male and 63.4 % of female patients. All males with gonorrhoea and four out of five with Chlamydia were given appropriate treatment with syndromic management, while 28% women with gonorrhoea or Chlamydia received appropriate treatment by syndromic management. All patients found with active syphilis by serology had not complained of genital ulcers and would not have been assigned to syndromic treatment for syphilis at the initial visit. CONCLUSION: The burden of STIs in this youth population is large indicating that youth are at increased risk of STIs and will certainly require youth friendly clinics. There is a need to refine the current syndromic management guidelines

The impacts of COVID-19 and its policy response on access and utilization of maternal and child health services in Tanzania: A mixed methods study.

The SARS-Cov-2 virus (COVID-19) has had a global social and economic impact. Despite the growing evidence, its effects on access and delivery of maternal and child health services in low-income countries are still unclear. This cross-sectional case study was conducted in Mjini Magharibi, Chake Chake, and Ilala districts in Tanzania to help fill this gap. The study combined qualitative and quantitative data collection methods, providing an account of the evolution of the pandemic and the associated control measures in Tanzania. We drew from 34 in-depth interviews, 60 semi-structured interviews, and 14 focus group discussions with key informants, patients, and health providers, and complemented the findings with a review of pandemic reports and health facility records. We followed the Standards for Reporting Qualitative Research (SRQR) to provide an account of the findings. Our account of the pandemic shows that there was at times an inconsistent policy response in Tanzania, with diverse control measures adopted at various stages of the epidemic. There was a perception that COVID-19 services were prioritized during the epidemic at the expense of regular ones. There were reports of reorganisation of health facilities, reallocation of staff, rescheduled antenatal and postnatal clinics, and reduced time for health education and child monitoring. Scarcity of essential commodities was reported, such as vaccines, equipment, and medical supplies. Such perceptions were in part supported by the routine utilization evidence in the three districts, showing a lower uptake of antenatal, postnatal, family planning, and immunization services, as well as fewer institutional deliveries. Our findings suggest that, although the policy response in Tanzania was erratic, it was rather fear of the pandemic itself and diversion of resources to control COVID-19, that may have contributed most to lower the utilization of mother and child services. For future emergencies, it will be crucial to ensure the policy response does not weaken the population's demand for services

Cholera outbreak in southern Tanzania: risk factors and patterns of transmission.

To identify risk factors and describe the pattern of spread of the 1997 cholera epidemic in a rural area (Ifakara) in southern Tanzania, we conducted a prospective hospital-based, matched case- control study, with analysis based on the first 180 cases and 360 matched controls. Bathing in the river, long distance to water source, and eating dried fish were significantly associated with risk for cholera. Toxigenic Vibrio cholerae O1, biotype El Tor, serotype Ogawa, was isolated in samples from Ifakara's main water source and patients' stools. DNA molecular analyses showed identical patterns for all isolates

The quality of antenatal care in rural Tanzania: what is behind the number of visits?

Background: Antenatal care (ANC) provides an important opportunity for pregnant women with a wide range of interventions and is considered as an important basic component of reproductive health care.Methods: In 2008, severe maternal morbidity audit was established at Saint Francis Designated District Hospital (SFDDH), in Kilombero district in Tanzania, to ascertain substandard care and implement interventions. In addition, a cross-sectional descriptive study was carried out in 11 health facilities within the district to assess the quality of ANC and underlying factors in a broader view.Results: Of 363 severe maternal morbidities audited, only 263 (72%) ANC cards were identified. Additionally, 121 cards (with 299 ANC visits) from 11 facilities were also reviewed. Hemoglobin and urine albumin were assessed in 22% - 37% and blood pressure in 69% - 87% of all visits. Fifty two (20%) severe maternal morbidities were attributed to substandard ANC, of these 39 had severe anemia and eclampsia combined. Substandard ANC was mainly attributed to shortage of staff, equipment and consumables. There was no significant relationship between assessment of essential parameters at first ANC visit and total number of visits made (Spearman correlation coefficient, r = 0.09; p = 0.13). Several interventions were implemented and others were proposed to those in control of the health system.Conclusions: This article reflects a worrisome state of substandard ANC in rural Tanzania resulting from inadequate human workforce and material resources for maternal health, and its adverse impacts on maternal wellbeing. These results suggest urgent response from those in control of the health system to invest more resources to avert the situation in order to enhance maternal health in this country. © 2012 Nyamtema et al.;