Readiness of public healthcare facilities on the management and referral of pre-eclampsia in Zanzibar

Background: Proper management of pre-eclampsia/eclampsia depends on the availability of well-functioning healthcare facilities. A significant number of women with pre-eclampsia in Zanzibar are referred late and most end up with eclampsia or even death. This raised a concern about whether healthcare facilities are prepared enough for the management of pre-eclampsia/eclampsia. Objectives: To assess the readiness of public healthcare facilities for the management and referral of pre-eclampsia/eclampsia. Methods: A descriptive cross-sectional study was conducted in Zanzibar targeting all public healthcare facilities. A sample of 54 healthcare facilities of all levels was randomly selected. Physical observation, questionnaire and review of hospital records were used for data collection. Descriptive statistics were used for analysis. Results: National, regional and district hospitals have all the required equipment, supplies and drugs by 100% compared to primary healthcare units where a significant shortage was observed in equipment [working oxygen cylinder 1(2.1%), strips for proteinuria 25(54.3%)], drugs [diazepam 11(23.9%) and magnesium sulphate 14(30.4%)], test [urine for protein test 29(63%)], knowledgeable healthcare providers 46(38.8%) and skilled healthcare providers 47(39.8%). All primary health care units had clear criteria for referring a patient with pre-eclampsia, but only 19(41.3%) provide pre-referral treatment and only 17(36.9%) had vehicles for transporting the referred patient. Conclusion: There is a huge shortage of resources in lower healthcare facility levels where most pregnant women have their initial contact. Necessary measures should be taken to well-equip primary healthcare units to improve their capability to proper diagnosis, manage and timely referral of patients with pre-eclampsia

Prevalence and Predictor of Exclusive Breastfeeding among Mothers of 0 to 6 months Infants from Pastoralists and Hunters’ Community in Tanzania; A Community Based Cross-Sectional Study

Background: Initiating breastfeeding during the first hour after birth and continuing breastfeeding exclusively for 6 months prevents childhood infections such as diarrhoea. Exclusive breastfeeding (EBF) for the first 6 months of life of the baby is recognised globally as the best and the most effective intervention to ensure the survival of babies. The aim of this study was to determine the prevalence of EBF and its predictors among mothers of 0 to 6 months infants from pastoralists and hunters’ community in Manyara region-Tanzania. Methods: This was a community-based analytical cross-sectional study that involved 342 mothers of 0 to 6 months infants who were randomly selected through 4 stage multistage sampling technique. Data was collected using an intervieweradministered questionnaire. Collected data was analysed using Statistical Package for Social Sciences (SPSS) version 20. Binary Logistic Regression analysis was used to establish factors associated with EBF practices. Results: The prevalence of EBF among postnatal women from hunters and pastoralists societies was 47.1% at 95% CI=41.7%-52.5%. After adjusted for confounders, the predictors of EBF practice were age of infants (0-1 months, AOR= 2.838 at 95% CI = 1.326-6.075, p=.007), age of mothers (26-35 years, AOR=1.851 at 95% CI= 1.059-3.234, p=.031), Level of education of infants’ mothers (primary education, AOR= 2.374 at 95% CI= 1.321-4.265, p=.004) and knowledge on exclusive breast feeding, AOR=2.51 at 95% CI= 1.435-4.393, p=.001. Conclusion: Majority of mothers from pastoralists’ and hunters’ societies were not practising EBF. Predictors of EBF practice were; the age of infants, maternal age, level of education of the mother and knowledge on exclusive breastfeeding. Poor EBF practice was mainly contributed to low level of knowledge about the EBF. The low level of knowledge could have been contributed by poor access to maternal services. Nature of living (lack of permanent settlement) of the study population could have contributed to low access to maternal  services. An innovative interventional study is highly recommended to come up with strategies that will improve knowledge on EBF and practice of EB

The influence of home environment and wound care practice on surgical site infection among post cesarean section women in Dodoma- Tanzania

Background: Post caesarean section surgical site infections continue to be the problem of wound management that contribute to high maternal morbidity. This study assessed the prevalence of post caesarean section surgical site infections and the influence of home environment and wound care practices at home on surgical site infections among post cesarean section women in Dodoma region-Tanzania. Methods: This was a hospital-based analytical cross-sectional study involved 183 randomly selected post caesarean section women during postnatal clinic visit within two weeks post discharge. Wound assessment and isolation of microbes were used to confirm the infection, while questionnaire was used to assess the wound care practices and characteristics of home environment. Logistic regression models were employed, and the level of significance was set at p ≤ 0.05. Results: The prevalence of post caesarean surgical site infections was 20.8 %, and the common isolated microbes were Staphylococcus aureus (52.6 %). Most isolates were sensitive to ciprofloxacin (81.5 %). Women with poor wound care practices had 6 times greater odds of developing surgical site infections (AOR = 5.95; p-value 0.004). The home environment condition did not influence the development of surgical site infections but it was related with good wound care practices. Conclusion: The post cesarean section surgical site infections rate after being discharged is high in Dodoma and it is directly influenced by the poor wound care practices and indirectly by the unconducive home environment. Efforts need to be directed to ensure women adhere to infection prevention measures when caring for their wound at home while taking into consideration their physical home environment they are living in

Knowledge and skills of pre-eclampsia management among healthcare providers working in antenatal clinics in Zanzibar

Abstract Background Pre-eclampsia and eclampsia are the leading causes of perinatal morbidity and mortality worldwide. Early detection and treatment of preeclampsia is lifesaving; however, evidence suggests that the majority of women in low and middle income-countries are not routinely screened for high blood pressure during antenatal care, that those with severe and mild pre-eclampsia are not monitored for blood pressure and proteinuria as needed, and the magnesium sulphate is not administered as needed. The purpose of this study was therefore to assess knowledge and skills in pre-eclampsia and eclampsia management and their associated factors among healthcare providers working in antenatal clinics in Zanzibar. Methods This was a cross-sectional analytical study conducted in all levels of healthcare facilities in Zanzibar. The study involved 176 healthcare providers (nurses and doctors) who were randomly selected. A self-administered questionnaire was used to collect data and descriptive and inferential statistics were used in the analysis whereby logistic regression models were employed. The Chi-square coefficient, odds ratio, and 95% confidence intervals were reported, and the level of significance was set at p < 0.05. Results The mean age of healthcare providers was 35.94 (SD ± 7.83) years. The proportion of healthcare providers with adequate knowledge was 49.0%, and 47% had adequate skills. Knowledge level was predicted by working in higher healthcare facility levels (AOR: 3.28, 95% CI: 1.29–8.29), and having attended on-the-job training on pre-eclampsia (AOR: 7.8, 95% CI: 2.74 − 22.75). Skills were predicted by having attended on-job training (AOR: 8.6, 95% CI: 2.45 − 30.16), having working experience of five years or above in antenatal care units (AOR: 27.89, 95% CI: 5.28 − 148.89) and being a medical doctor or assistant medical doctor (AOR: 18.9, 95% CI: 2.1–166). Conclusion Approximately half of Zanzibar’s ANC healthcare workers demonstrated inadequate knowledge and skills in preeclampsia care, indicating a critical need for targeted interventions to reduce maternal morbidity and mortality. Knowledge is predicted by attending on-the-job training and working in higher healthcare facility level, while skills is predicted by attending on job training, more years of working experience in antenatal care units and being a medical doctor or assistant medical doctor The study recommends the healthcare facility institutions to provide on-the-job training to for the healthcare providers working in lower healthcare facility levels

Caretaker-Adolescent Communication on Sexuality and Reproductive Health: My Perceptions Matter; A Qualitative Study on Adolescents’ Perspectives in Unguja-Zanzibar

This study was conducted to explore the perceptions of adolescents on caretaker-adolescent communication on sexuality. Using an Information-Motivation-Behavioural Skills model, this ar-ticle highlights areas to emphasise when planning strategies to improve caretaker-adolescent communication on sexuality. Twelve focus group discussions were held with adolescents aged between 15 and 19 years, and data were analysed using content analysis. The participants found it important for caretakers to communicate with adolescents about sexuality to avoid sexual and related health risks. Caretakers were the most preferred communicators, by adolescents, on sex-uality matters. It became apparent that information about the use of condoms was the most un-popular topic during the discussions, while information about the use of contraceptives seemed to be more interesting to the majority of the participants. From the adolescents ’ point of view, the barriers to communication about sexuality on the caretakers ’ side, include, the belief that such information might encourage promiscuity; some caretakers do not find it easy to discuss matters related to sexuality with their children; and others feel that some adolescents know more about sexuality than themselves. On the other hand, barriers on adolescents ’ side include, “fear ” of th

Caretaker-adolescent communication on sexual and reproductive health: a cross-sectional study in Unguja-Tanzania Zanzibar

Abstract Background Caretakers/parents/caregivers/guardians play important roles in improving Sexual and Reproductive Health (SRH) of adolescents. Caretaker-adolescent sexual communication suggested to influence young people’s sexual behaviours. Despite this significance, the communication is believed to be low in Unguja due to the increase of risky sexual behaviours among adolescents. This study assessed the pattern of such communication using IMB model as a framework. Methods This is a cross-sectional study targeted caretakers of adolescents aged 15–19. One thousand caretakers of adolescents were interviewed using structured questionnaire. Comparison between male and female caretakers on discussing different SRH topics to both sexes of adolescents was made. The mean-score difference of overall communication was examined using Univariate analysis of variance (ANOVA). Bivariate correlation and simple path analysis via regression was conducted to determine the association of IMB variables in relation to communication practice. Results This study finds 40.7% of caretakers had ever communicated with their adolescents on SRH matters and 9.2% reported to have had communicated in the past 30 days. The weighted topic measure revealed only 26.5% of caretakers communicated with their adolescents. Both caretakers communicated more with their female adolescents. The communication was more common between same sex and between caretakers and their biological adolescents (p < 0.000). Both male and female caretakers mostly discussed sexual abstinence to female adolescents while to male adolescents, HIV/STIs was mostly discussed by female caretakers and pregnancy by male caretakers. The least discussed topics to both sexes are safer sex and other contraceptives use. The bivariate correlations suggested that IMB constructs were inter-related and associated with communication practice. Conclusion Caretakers-adolescents communication on SRH in Unguja is low and it is not comprehensive. Caretakers fail to communicate with their adolescents on sensitive issues but do so on less sensitive ones. The pattern of communication found to vary across gender of caretaker and that of adolescent and depends on the nature of relationship between caretaker and adolescent. There is gender differences in selecting SRH topics of discussion. Interventions programmes have to include strategies that enhance caretaker’s information, motivation and skills so as to improve SRH communication between caretakers and adolescent

Enhancing nursing student presentation competences using Facilitatory Pecha kucha presentation pedagogy: a quasi-experimental study protocol in Tanzania

Abstract Introduction With an increasing number of nursing students in higher education institutions in Tanzania, traditional student presentation pedagogies are insufficient to enhance effective learning. Pecha Kucha presentation is a new promising approach that can improve students’ speaking skills, learning process, creativity, and students’ engagement in learning. It involves the use of 20 slides where each covers 20 s, thus making a total of 6 min and 40 s. The current study will assess the effect of Pecha Kucha’s presentation on presentation knowledge, skills, and learning satisfaction among nursing students in Tanzania. Objectives The objectives of this study aimed to determine the baseline and end-line of Pecha Kucha Presentation knowledge, skills, and learning satisfaction among nursing students. Methods This study protocol proposes to employ an uncontrolled quasi-experimental study design with a quantitative approach among 230 university nursing students in Dodoma Region using simple and stratified sampling techniques. It proposes to employ the researcher-administered questionnaire to assess study variables that arise as students use the Pecha Kucha presentation format to prepare and present their assignments. The study will involve training of research assistants, pre-assessment of study variables, and training, and demonstration of Pecha Kucha presentations format among study participants. It will also involve assigning topics to study participants, submission and evaluation of the prepared assignments, participants’ presentations in the classroom, post-intervention assessment, data analysis, reporting and dissemination of the study findings. Conclusion This study will address and complement the global need to invest in nursing in an attempt to prepare competent nurses who are capable of solving complex health challenges through critical thinking, analysis, collaboration, and effective communication. The study will inform policymakers, health training institutions, and educators about a new engaging, and innovative nursing student presentation approach that enhances students’ creativity, critical thinking skills, and meaningful learning. The referred nursing students’ presentation approach intends to equip the students with survival and life skills in the 21st century in an attempt to meet the global economy and job opportunities. Trial registration It is not applicable as this is not a trial

HIV viral suppression in Oman: Encouraging progress toward achieving the United Nations ‘third 90’

Objective: To assess the impact of capacity-building interventions introduced by the Oman National AIDS Programme on the quality of HIV care in the country. Methods: HIV viral load (VL) suppression and loss to follow-up (LTFU) rates were calculated for the period before (in December 2015; n = 1098) and after (in June 2017; n = 1185) the introduction of the interventions: training, support, and care pathway development. Three HIV VL cuts-offs at last measurement in the year of interest were used to define VL suppression. Results: In the intention-to-treat (ITT) analysis, rates of VL <200 copies/ml and <1000 copies/ml increased from 51.9% in 2015 to 65.5% in 2017 (relative risk (RR) 1.26, 95% confidence interval (CI) 1.17–1.36) and from 58.1% in 2015 to 70.9% in 2017 (RR 1.22, 95% CI 1.14–1.30), respectively; p < 0.0001 for both. Similarly, in the on-treatment analysis, rates of VL <200 copies/ml and <1000 copies/ml increased from 64.2% in 2015 to 76.9% in 2017 (RR 1.20, 95% CI 1.12–1.28) and from 71.9% in 2015 to 83.2% in 2017 (RR 1.16, 95% CI 1.10–1.22), respectively. Fewer patients were LTFU in 2017 than in 2015 (14.7% (157/1061) vs. 19.2% (188/981); RR 0.77, 95% CI 0.64–0.94). Conclusions: Achieving the UNAIDS target of 90% of HIV patients on treatment having VL suppression by 2020 is feasible in Oman

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

OBJECTIVES: Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs. DESIGN: A multicentre, international, collaborative cohort study. SETTING: 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020. PARTICIPANTS: Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, Wilms' tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer. MAIN OUTCOME MEASURE: All-cause mortality at 30 days and 90 days. RESULTS: 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001). CONCLUSIONS: The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally

Abstracts of Tanzania Health Summit 2020

This book contains the abstracts of the papers/posters presented at the Tanzania Health Summit 2020 (THS-2020) Organized by the Ministry of Health Community Development, Gender, Elderly and Children (MoHCDGEC); President Office Regional Administration and Local Government (PORALG); Ministry of Health, Social Welfare, Elderly, Gender, and Children Zanzibar; Association of Private Health Facilities in Tanzania (APHFTA); National Muslim Council of Tanzania (BAKWATA); Christian Social Services Commission (CSSC); &amp; Tindwa Medical and Health Services (TMHS) held on 25–26 November 2020. The Tanzania Health Summit is the annual largest healthcare platform in Tanzania that attracts more than 1000 participants, national and international experts, from policymakers, health researchers, public health professionals, health insurers, medical doctors, nurses, pharmacists, private health investors, supply chain experts, and the civil society. During the three-day summit, stakeholders and decision-makers from every field in healthcare work together to find solutions to the country’s and regional health challenges and set the agenda for a healthier future. Summit Title: Tanzania Health SummitSummit Acronym: THS-2020Summit Date: 25–26 November 2020Summit Location: St. Gasper Hotel and Conference Centre in Dodoma, TanzaniaSummit Organizers: Ministry of Health Community Development, Gender, Elderly and Children (MoHCDGEC); President Office Regional Administration and Local Government (PORALG); Ministry of Health, Social Welfare, Elderly, Gender and Children Zanzibar; Association of Private Health Facilities in Tanzania (APHFTA); National Muslim Council of Tanzania (BAKWATA); Christian Social Services Commission (CSSC); &amp; Tindwa Medical and Health Services (TMHS)