A counseling intervention to address HIV stigma at entry into antenatal care in Tanzania (Maisha): study protocol for a pilot randomized controlled trial.

BACKGROUND: HIV-related stigma significantly impacts HIV care engagement, including in prevention of mother-to-child transmission of HIV (PMTCT) programs. Maisha is a stigma-based counseling intervention delivered during the first antenatal care (ANC) visit, complementing routine HIV counseling and testing. The goal of Maisha is to promote readiness to initiate and sustain treatment among those who are HIV-positive, and to reduce HIV stigmatizing attitudes among those who test negative. METHODS: A pilot randomized control trial will assess the feasibility and acceptability of delivering Maisha in a clinical setting, and the potential efficacy of the intervention on HIV care engagement outcomes (for HIV-positive participants) and HIV stigma constructs (for all participants). A total of 1000 women and approximately 700 male partners will be recruited from two study clinics in the Moshi municipality of Tanzania. Participants will be enrolled at their first ANC visit, prior to HIV testing. It is estimated that 50 women (5%) will be identified as HIV-positive. Following consent and a baseline survey, participants will be randomly assigned to either the control (standard of care) or the Maisha intervention. The Maisha intervention includes a video and counseling session prior to HIV testing, and two additional counseling sessions if the participant tests positive for HIV or has an established HIV diagnosis. A subset of approximately 500 enrolled participants (all HIV-positive participants, and a random selection of HIV-negative participants who have elevated stigma attitude scores) will complete a follow-up assessment at 3 months. Measures will include health outcomes (care engagement, antiretroviral adherence, depression) and HIV stigma outcomes. Quality assurance data will be collected and the feasibility and acceptability of the intervention will be described. Statistical analysis will examine potential differences between conditions in health outcomes and stigma measures, stratified by HIV status. DISCUSSION: ANC provides a unique and important entry point to address HIV stigma. Interventions are needed to improve retention in PMTCT care and to improve community attitudes toward people living with HIV. Results of the Maisha pilot trial will be used to generate parameter estimates and potential ranges of values to estimate power for a full cluster-randomized trial in PMTCT settings, with extended follow-up and enhanced adherence measurement using a biomarker.

Patient and caregiver experiences of living with dementia in Tanzania

Introduction: Tanzania is a low-income country with an increasing prevalence of dementia, which provides challenges for the existing healthcare system. People with dementia often don’t receive a formal diagnosis, and with a lack of formal healthcare, are often predominantly supported by family relatives. There are very few published data relating to lived experiences of people with dementia in Tanzania. This study aimed to understand people with dementia, and their caregivers’ experiences of living with dementia in Tanzania and the perceived needs of people with dementia. Methods: Qualitative, semi-structured interviews were conducted with 14 people with dementia and 12 caregivers in Moshi, Tanzania. Interviews were audio-recorded, translated, transcribed and analysed using a Framework Analysis approach. Results: Three sub-themes were identified within data describing the experience of ‘Living with Dementia in Tanzania’: ‘Deteriorations in Health’, ‘Challenges to living with Dementia in Tanzanian Culture’, and ‘Lack of Support’: people with dementia faced challenges due to social isolation, stigmatisation, and lack of caregiver knowledge on how best to provide support. Collectively, these impacted on both the physical and mental health of people with dementia. Misconceptions about dementia aetiology related to age, stresses of daily life and other co-morbidities. People with dementia were motivated to access treatment, exhibiting pluralistic health-seeking behaviours. There was an overall preference for non-pharmacological interventions over medication, with high levels of trust in medical professional opinions. Conclusions: Living with dementia in Tanzania is influenced by both cultural and religious factors. More work is needed to target supplementary healthcare (with efforts to promote accessibility), support for caregivers and public health education about dementia to overcome existent misconceptions and stigma

Simulation-based education on initial neonatal care knowledge among nursing and midwifery students in Tanzania: Quasi experimental study

Background: Simulation-based education is an effective pedagogical method for improving nursing students’ knowledge and quality care. However, traditional methods of auditorium lectures are widely conducted in nursing education institutions in Tanzania. Such pedagogic provides students with theoretical knowledge with limited hands-on exposure for clinical competence, thus, affecting professional integration of students and quality care delivery. Therefore, this study assessed the effectiveness of simulation-based education on initial neonatal care knowledge among nursing students in Tanzania. Methods: A quasi-experimental with pre-post study design was employed. Ninety students from two nursing schools: forty-five students in urban school (intervention group), and forty-five in a rural school (control group) were purposively selected to participate in the study. The students received two different initial neonatal care scenarios: (1) initial neonatal care to a term normal healthy breathing neonate, (2) Initial neonatal care to neonates with difficulty breathing. The pre-post test data was collected using structured questionnaire between March and June 2023. Data was analysed using descriptive statistics, independent t-test, and multiple linear model. Results: The interventional group students showed a significant higher knowledge mean score on initial neonatal care aβC = 7.6(6.8–8.4), p- <0.001. The effect size of the intervention was statistically significant aDiD 3.0(1.8–4.1), p- value 0.001. Conclusion: Simulation-based education improved students’ knowledge in the interventional group compared to traditional lectures. This approach could enhance learning outcomes in Tanzania’s nursing education programs, addressing challenges related to the shortage of skilled healthcare providers and quality neonatal care

Postpartum depression among women who have experienced intimate partner violence:A prospective cohort study at Moshi, Tanzania

BACKGROUND: Post-partum depression (PPD) in many low-income countries, including Tanzania, is not well recognized, and the underlying predictors and causes of PPD remain unclear. Results from previous studies suggest that PPD is associated with intimate partner violence (IPV) experienced during the perinatal period. In the present study, we assessed the relationship between IPV and PPD among women attending antenatal services in Tanzania.METHODS: We conducted a prospective cohort study from March 1, 2014 to May 30, 2015, in Kilimanjaro Region, Tanzania, among pregnant women of less than 24 weeks gestation attending antenatal clinics in two primary level health facilities. Women were interviewed at four time points: 1) Socio-demographic and reproductive health characteristics were assessed at recruitment; 2) At 34 weeks gestational age we screened for depression using the Edinburgh Postpartum Depression Scale (EPDS) and self-reported IPV experiences were assessed using structured questions adopted from the WHO's Multi-country Study on Women's Health and Domestic Violence; 3) Assessment for postpartum depression using EPDS was repeated at 40 days post-partum. Data were analyzed using bivariate and multivariate analyses.RESULTS: A total of 1013 women were interviewed, of whom 304 (30.0%) reported being exposed to at least one type of IPV during their pregnancy and 122 (12.0%) had EPDS scores of 13 and more. Exposure to at least one type of IPV increased the odds of PPD more than three times (AOR=3.10; 95% CI: 2.04-4.40) as compared to those women who were not exposed to IPV during their pregnancy. Stratified analyses showed that this risk of PPD was highest among younger women (aged 18-24 years) who were exposed to physical violence (AOR=3.75; 95% CI: 1.21-11.67). Among women exposed to emotional violence, women with no previous history of depression were also at higher risk of developing postpartum depression as compared to women who were having previous history of depression (AOR=2.79; 95% CI: 1.76-4.42) and (AOR=0.89; 95% CI: 0.38-2.08).CONCLUSIONS: One out of every three pregnant women in the study population was exposed to IPV during pregnancy and these events were strongly associated with development of postpartum depression. Younger women and women with no prior history of depression were specifically prone to develop PPD when being exposed to IPV. These findings should help to inform targeted screening for PPD in the postnatal setting in Tanzania and other low-income countries in order to minimize complications suffered by mothers and their babies.</p