RECONCILING ATTITUDES AND BEHAVIOR IN ORGANIC FOOD RETAILING

For organic food to reach the average consumer will require greater penetration into conventional supermarkets. Product placement can be expanded into more stores by altering attitudes that lower the probability of selling organic foods. This study identified significant factors in the retail decision to sell organic foods and quantifies the effects of retailer attitudes on behavior. We used a probit model to quantify the effect of customer demographics, store characteristics, manager characteristics, and profitability of organic retailing on the decision to sell organic foods. The model was based on interview data collected in Atlanta, Georgia from 66 retailers who sell organic foods and 21 who do not. Our research indicates that organic education programs can be a cost-effective way to expand market penetration without requiring changes in price or cost premiums. If properly composed and targeted, such programs can alter underlying attitudes and increase the probability of selling organic foods.Marketing,

The impact of adult deaths on children's health in Northwestern Tanzania

The AIDS epidemic is dramatically increasing mortality of adults in many Sub-Saharan African countries, with potentially severe consequences for surviving family members. Until now, most of these impacts had not been quantified. The authors examine the impact of adult mortality in Tanzania on three measures of health among children under five: morbidity, height for age, and weight for height. The children hit hardest by the death of a parent or other adult are those in the poorest households, those with uneducated parents, and those with the least access to health care. The authors also show how much three important health interventions-immunization against measles, and rehydration salts, and access to health care-can do to mitigate the impact of adult mortality. These programs disproportionately improve health outcomes among the poorest children and, within that group, among children affected by adult mortality. In Tanzania there is so much poverty, and child health indicators are so low that these interventions should be targeted as much as possible to the poorest households, where the children hit hardest by adult mortality are most likely to be found. (Conceivably, the targeting strategy for middle-income countries with severe AIDS epidemics, such as Thailand, or countries with less poverty and better child health indicators might be different.)Health Monitoring&Evaluation,Early Child and Children's Health,Disease Control&Prevention,Early Childhood Development,Public Health Promotion,Adolescent Health,Early Child and Children's Health,Health Monitoring&Evaluation,Street Children,Youth and Governance

Understanding Stakeholders’ Roles in Health Sector Reform Process in Tanzania: The Case of Decentralizing the Immunization Program.

The current need and enthusiasm for health reforms open an important arena for deeper analysis of the policy process with a view to understanding the political determinants of reforms and strengthening implementation. The studies described in this thesis analyse positions of different actors in the reform process, their actions in support or opposition of the process, and their impact on the health sector reform process. Globally and especially in developing countries health sector reforms have been implemented over long periods. Although there have been improvements in health, the remaining burden of disease in many countries is still very high. Reasons for the high burden of disease have been classified into lack of resources and poor organizational and managerial capacity. Good stewardship was needed to facilitate improvement in the performance of health systems. Stakeholders’ alignment and support was one of the most important components of good stewardship. However, stakeholder analysis had not been a common undertaking in developing countries despite the reforms that were being implemented in most of them. It was the aim of this study to answer the question: What has been the role and importance of stakeholders in supporting or opposing the health sector reform process? The study was conducted in Tanzania as one of the poorest countries in Africa, using the decentralization of the Expanded Programme on Immunization (EPI) as a case reference. The study units were the Ministry of Health Headquarters, Medical Stores Department, Expanded Programme on Immunization, national archives, regions and districts. At district level the study units were District Council, Council Health Management Team, EPI managers at regional and district levels, ward and village authorities, health facility, facility providers and households. Qualitative and quantitative methods were used to collect data from January 2000 to June 2002. Relevant data collection instruments were prepared and pre-tested. The qualitative data collection methods included document review, in-depth interviews, key informants interviews and observations. Quantitative methods involved retrieval of secondary data, health facility survey and household surveys. Regular discussions with key informants and data collectors were held to verify the findings. Qualitative data was analysed manually. Quantitative data was captured and analysed using Epi Info version 6.1 and STATA version 6.0. The study involved answering five main questions. The first question was: Do reforms learn from history? Analysis of the waves of health reforms prior to the current reforms from 1926 was done to answer the question. The main stakeholders in the reforms were the political party in power, the government and donors who supported the reforms each time. Each wave of health sector reforms provided information on health provision, financing and resource generation. Due to the political contexts, information on failures of health financing did not provide lessons for succeeding reforms of the health sector. Stakeholders’ political interests opposed lessons that did not match the political ideology at the time i.e. free public services versus privatization and paying for social services. Lessons from previous health reforms were selective, and did not consider health-financing needs among others. The ongoing health reforms needed to use information from all functional aspects of the health system to provide lessons for improving the health system. The second question was: Who were the stakeholders in the current health reforms and what were their interests and reactions? The main stakeholders were donors, and the government. The two had a very high support for the reforms evidenced by their participation in problem identification, justification, reform design, planning and implementation. The health sector reforms thus had high political support at central level. In the implementation process, issues that triggered stakeholders’ reaction included sectoral versus local government decentralization. Another issue was the donor modality in financing the health sector and need for adopting new financial management systems. Among the donors there was hesitancy to join the common financing modalities that included a Sector Wide Approach (SWAp) and Basket Funding. As a result, there was delay in the process in order to reach better consensus. The third question was: What was the impact of stakeholders in the process of reforming a vertical programme like EPI? Health Sector Reforms in EPI included integration of generic functions, for example, vaccine procurement to medical stores department. Qualitative and quantitative data was collected and analysed from the Ministry of Health, EPI management unit. This again revealed that EPI reforms were well supported by the government and donors centrally. EPI managers at both district and regional levels opposed some of the EPI reforms. They argued that coverage was falling due to the reforms. However, there was no concrete evidence relating reforms in the EPI programme and falling coverage. The primary aim of certain actors was to make sure that they continued receiving extra income from EPI functions. One of the effects of stakeholders’ reaction was reversal of reforms (recentralization) and return to the status quo. The fourth question was: What was the immediate reaction of stakeholders to decentralization at district level and how might it have affected performance of EPI functions and the challenges? The immediate reaction of stakeholders was reduced cooperation between the Council Health Management Team (CHMT) and the District Council who were politically supreme in the district. Within the Council Health Management Team there was inadequate communication, which led to poor teamwork. The result of this was reduced supervisory visits to peripheral health facilities. The EPI coverage in the study district was 52.8 per cent, which was well below the previous national average (80 per cent). A logistic regression model for EPI service quality variables on children between 12 months and 23 months who had completed vaccination was applied. Certain EPI quality of service variables predicted significant changes in the odds ratio for completing vaccination. It was then suggested that strategies were needed to improve management skills among the CHMT and District Council members. Also there was a need of hastening the process of increasing remuneration and motivation of peripheral health workers. The fifth and final question was: What was the interest of the stakeholders and prospects of increasing EPI coverage at district level? Decentralization and integration of EPI functions were among the reforms at district level. The analysis revealed that active stakeholders at district level were the Ministry of Health, CHMT, EPI managers at district and regional levels and facility providers. The Ministry of Health opposed integration of EPI at district level by issuing the directive that DCCOs and MCHCOs (EPI manager at district level) should resume their tasks. However, the CHMT had no option but to comply. This action reversed some of the health reforms at district level. Analysis of the importance the community attached to EPI, using willingness to pay for EPI cold chain kerosene, was done. The support was low (48.7 per cent). EPI service quality variables were significantly negatively associated with odds ratio for willingness to pay for EPI input. Simulation with Policy Maker computer software predicted that an increased number of stakeholders through community participation would significantly improve the current low level of EPI coverage. It was then proposed to do a similar analysis in other vertical programmes and implement on a trial basis the results of the simulation. In conclusion, stakeholders were found to be active and influential in the health sectors of developing countries like Tanzania but poorly considered in implementation of reforms. Stakeholders are important since some strongly support while others oppose the reforms. The reaction of stakeholders is evident through deployment or non-deployment of information depending on interest and context. This would result in poor management leading to inefficiency in resource use, which would then be followed by poor quality of services, poor support by communities and consequently poor utilization of health services. It is suggested that stakeholder analysis be conducted in other vertical programmes in the process of integration. Promotion of stakeholder analysis and also Policy Maker as a tool to manage stakeholders will facilitate the management of reforms in the health sector

Factors Affecting the Utilisation of Improved Ventilated Latrines Among Communities in Mtwara Rural District, Tanzania.

The Tanzania government, working in partnership with other stakeholders implemented a community-based project aimed at increasing access to clean and safe water basic sanitation and promotion of personal hygiene in Mtwara Rural District. Mid-term evaluation revealed that progress had been made towards improved ventilated latrines; however, there was no adequate information on utilisation of these latrines and associated factors. This study was therefore conducted to establish the factors influencing the utilisation of these latrines. A cross-sectional study was conducted among 375 randomly selected households using a pre-tested questionnaire to determine whether the households owned improved ventilated latrines and how they utilised them. RESULS: About half (50.5%) of the households had an improved ventilated latrine and households with earnings of more than 50,000 Tanzanian Shillings were two times more likely to own an improved latrine than those that earned less (AOR 2.1, 95% CI=1.1-4.0, p= 0.034). The likelihood of owning an improved latrine was reduced by more than 60 percent for female-headed households (AOR=0.38; 95% CI=0.20-0.71; p=0.002). Furthermore, it was established that all members of a household were more likely to use a latrine if it was an improved ventilated latrine (AOR=2.4; 95% CI=1.1-5.1; p= 0.024). Findings suggest adoption of strategies to improve the wellbeing of households and deploying those who had acquired improved ventilated latrines as resource persons to help train others. Furthermore, efforts are needed to increase access to soft loans for disadvantaged members and increasing community participation

The primacy of trust in the social networks and livelihoods of women agro-entrepreneurs in Northern Tanzania

This paper describes the primacy of trust in the social networks and livelihoods of rural Tanzanian women engaged in agro-entrepreneurial activity. The importance of trust emerged from a study of the “who you know” social and economic network knowledge systems of these enterprising women in Moshi, Tanzania and the role cell phones play within their networks. The nature of the women’s agricultural businessesand their perceptions of the characteristics of women business leaders and cooperative group members were also studied. The objective of the study was to identify opportunities for developing innovative cellphone-based applications that link smallscale farmers and other entrepreneurs to markets, thus enabling these entrepreneurs to utilize, strengthen and expand their social and economic networks. A complementary goal was to identify the characteristics of women who are likely to successfully champion new entrepreneurial ventures. Three data collection techniques were employed: (1) a Personal Digital Assistant (PDA) survey, (2) structured interviews; and (3) focus group interviews. There were 26 women participants in this network study - all living in multi-ethnic areas in, or near, the town of Moshi. Each participant was the proprietor of a stall selling agricultural products in one of the three town markets. A total of 92 relationships were described by these 26 women. The majority of the women primarily used cell phones in their business communication andconsidered cell phones crucial to their businesses. The women valued long-term relationships with over 70% of the business relationships described by the women having lasted for more than one year. The study revealed that these relationships were based very strongly on trust and respect. This primacy of trust in these networks was further validated by the individual interviews and focus group discussions. Loyalty and the maintenance of inter-personal relationships are more important than price in these women’s business-related decision-making. The findings suggest the importance of building trust while expanding “who you know” networks to create social and economic capital in rural African communities. The pervasiveness and importance of cell phones in these communities raises the possibility of employing this technology to create value by harnessing social capital and expanding social networks. An entrepreneurial venture called WishVast emerged from this study and is described in this paper. WishVast is a cellphone-based system that allows individuals to interact within an expanded, geographically dispersed social network – and as aresult, it enables traditionally isolated individuals to connect, communicate and coordinate with a large number of potential clients

Comparison of MIL-101(Cr) metal-organic framework and 13X zeolite monoliths for CO2 capture

A comparative study was conducted to determine the pore properties and adsorptive performance of monoliths containing either the MIL-101(Cr) metal-organic framework or 13X zeolite for carbon dioxide (CO2) capture. Although there has been a great deal of previous work on CO2 adsorption onto zeolites and MOFs, there has been far fewer studies on structured adsorbents such as monoliths. The results indicate that MIL-101(Cr) monoliths have 1.3 times higher porosity than 13X zeolite monoliths. Increasing CO2 partial pressure in the gas mixture shortens breakthrough and equilibrium times and increases their breakthrough and equilibrium adsorption capacities of CO2. MIL-101(Cr) monoliths show better mass transfer of CO2 in the adsorbent bed with shorter breakthrough and equilibrium times of about 20% and 35%, respectively, than 13X zeolite monoliths. The adsorption capacity of CO2 on MIL-101(Cr) monoliths is higher by about 37% (based on weight in mmol/g) at breakthrough and slightly lower by about 7% at equilibrium when compared to 13X zeolite monoliths. MIL-101(Cr) monoliths were found to be 1.5 times more efficient for CO2 adsorption than 13X zeolite monoliths. The effects of regeneration temperature after CO2 adsorption on MIL-101(Cr) and 13X zeolite monoliths were studied and results showed an increase in CO2 adsorption capacity as the regeneration temperature was increased. In summary, the study showed MIL-101(Cr) monoliths have better CO2 adsorption properties than 13X zeolite monoliths

Complications of ventriculoperitoneal shunts in children in Dar es Salaam

Background: From the few reports available, VP shunt surgery in sub- Saharan Africa is associated with significant complications. This study was aimed at establishing the pattern, causes and frequency of complications of VPS in Tanzania.Methods: Sixty five of the 102 children with hydrocephalus treated with ventriculoperitoneal shunts between January 1996 and January 1999 were studied prospectively. The first follow-up was at 2 weeks postoperative when the wounds were evaluated and occipitofrontal circumference measured. Further follow-ups were at 4 weeks and at three months. Collaborating staff of the Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) thereafter regularly followed up the children at home.Results: The male to female ratio was 1.8 to 1. Forty-seven of the children (72%) were less than 12 months old but no patient was under 1 month of age at operation. The mean occipitofrontal circumference was 50.7cm. Shunt blockage was the commonest complication (32.3%) followed by infection (24.6%). The combined complication rate of shunt infection and wound infection was 46.1%. Shunt-related mortality was 13 (20.0%). There was no statistically significant correlation between the occipitofrontal circumference and type of complication or mortality. The mean age among the patients showing disconnection was 21.3 months compared to a mean age of 8.1 months for those not having this complication (P-value=0.04)Conclusion: The complication rates were higher than those in Western series but compared well with findings from sub Saharan Africa other studies

Community vaccine perceptions and its role on vaccination uptake among children aged 12-23 months in the Ileje District, Tanzania: a cross section study

Introduction: Underutilization of vaccines still remains a challenge in many regions across the world. Ileje district is one of the districts in Tanzania with consistently low pentavalent vaccine uptake (69%) and with drop out of 15%. We determined the vaccination completion with regard to Oral Polio virus, Measles, Bacillus Calmette-Guérin, and pentavalent vaccines and its association with community perceptions on vaccines. Methods: We conducted a cross sectional study in Ileje district from October to December 2013. We sampled 380 mothers using a multistage random sampling technique. We analysed data using EPI INFO. We summarized descriptive variables using mean and standard deviation and categorical variables using proportions. We conducted bivariate and multivariate logistic regression to identify factors influencing vaccination uptake, statistical significance was assessed at 95% confidence interval. Results: Mean age of the mothers was 27 years (SD 6.5 years) while that of their children was 16 months (SD 3.6 months). Fully vaccinated children were 71.1% and partially vaccinated were 28.9%, 99.2% were vaccinated with BCG vaccine and 73.4% were vaccinated with all OPV vaccine. Predictors of vaccination completion included negative perception on the vaccine provider-client relationship (AOR 1.86, 95%CI1.03-3.35), Perceived satisfaction with vaccination services (AOR 2.63, 95%CI 1.1 - 6.3). Others include child being born in the health facility (AOR 13.8 95% CI 8.04-25.8) and younger age of a child (AOR 0.51, 95%CI 0.29-0.9). Conclusion: improving quality of vaccination services, promoting health education and sensitizing community on health facility delivery will improve child vaccination completion in the districtPan African Medical Journal 2016; 2

Food insecurity and coping strategies among people living with HIV in Dar es Salaam, Tanzania

Food insecurity and malnutrition seriously impedes efforts to control HIV/AIDS in resource poor countries. This study was carried out to assess food security, and coping strategies among people living with HIV/AIDS (PLHIV) attending Care and Treatment Centre (CTC) in Dar es Salaam, Tanzania. A structured questionnaire was used to interview randomly selected adults (≥18 years) who were HIV positive who have just been eligible for anti-retroviral treatment (ART) in a CTC or one who has started ART but not more than four weeks has elapsed. A total of 446 (females=67.9%; males= 32.1%) people living with HIV/AIDS attending CTC were interviewed. About three quarters (73.1%) of the respondents were 25-44 years old and most (43.9%) were married. Two thirds (66.7%) of the respondents had primary school education. Seventy percent reported to have a regular income and 63.7% with a monthly income of less than US$154. More than half (52.2$154) (OR=0.10; 95%CI, 0.01–0.67). Reporting two or less meals increased the likelihood of food insecurity (OR=4.2; 95% CI1.7-9.8). Low frequency of meals was significantly more prevalent (18.6%) among those ≥45 years than among 35–44 years old respondents (6.7%) (P=0.04). Borrowing money (55.8%) and taking less preferred foods (53.3%) were the most common coping strategies. In conclusion, food insecurity is a significant problem among people living with HIV in Dar es Salaam which might significantly affect compliance to care and support. The study suggests that counselling of PLHIV before anti-retroviral treatment programmes should devise special strategies targeting those with low education, low income and low frequency of meals

Factors associated with HIV testing and receiving results during antenatal care in Tanzania

Mother to child transmission of HIV (MTCT) control goal is achievable when all pregnant mothers test for HIV and collect the results enabling timely eligibility and access to anti-retroviral therapy (ART). This study aimed to determine factors associated with uptake of HIV testing during antenatal care in Tanzania. Using 2011-2012 Tanzania HIV and Malaria Indicator Survey data, 3555 women who attended antenatal clinic and delivered in the last two years were analyzed. One was considered HIV tested if she took HIV test and collected results. Bivariate and multivariate analysis was done using STATA version 12. High proportion (76%) tested for HIV during antenatal care, factors significantly associated (p<0.05) with testing included receiving information on HIV testing during antenatal care, age, education and wealth. Proportion taking HIV test was high, prevention of MTCT (PMTCT) strategies should focus on increasing information on testing during antenatal care (ANC), targeting the young, less educated and poor