Delaying first birth: an analysis of household survey data from rural Southern Tanzania.

BACKGROUND: Currently, family planning metrics derived from nationally-representative household surveys such as the Demographic and Health Surveys (DHS) categorise women into those desiring to space or limit (permanently stop) births, or according to their age in the case of young women. This conceptualisation potentially ignores a large and growing group of young women who desire to delay a first birth. This study uses household survey data to investigate the characteristics and needs for family planning of women who want to delay their first birth. METHODS: The research was conducted in two rural districts in southern Tanzania (Tandahimba and Newala), and nested within the Expanded Quality Management Using Information Power (EQUIP) study. Data were collected as part of a repeated cross sectional household survey conducted between September 2013 and April 2014. The socio-demographic characteristics, including parity, contraceptive practices and fertility intentions of 2128 women aged 13-49 were analysed. The association between women's life stages of reproduction (delayers of first birth, spacers of subsequent pregnancies and limiters of future birth) and selected contraceptive outcomes (current use, unmet need and demand for modern contraceptives) was assessed using the point estimates and 95% confidence intervals for each indicator, adjusted for the survey design. RESULTS: Overall, four percent of women surveyed were categorised as 'delayers of first birth', i.e. sexually active but not started childbearing. Among this group, the majority were younger than 20 years old (82%) and unmarried (88%). Fifty-nine percent were currently using a modern method of contraception and injectables dominated their contraceptive use. Unmet need for contraception was higher among delayers (41%; 95% CI 32-51) and limiters (41%; 95% CI 35-47) compared to spacers (19%; 95% CI 17-22). CONCLUSIONS: Delayers of first birth have very high unmet needs for modern contraceptives and they should be routinely and separately categorised and measured within nationally-representative surveys such as Demographic and Health Survey and Multiple Indicator Cluster surveys. Acknowledging their unique needs could help catalyse a programmatic response

Haematological consequences of acute uncomplicated falciparum malaria: a WorldWide Antimalarial Resistance Network pooled analysis of individual patient data

Background: Plasmodium falciparum malaria is associated with anaemia-related morbidity, attributable to host, parasite and drug factors. We quantified the haematological response following treatment of uncomplicated P. falciparum malaria to identify the factors associated with malarial anaemia. Methods: Individual patient data from eligible antimalarial efficacy studies of uncomplicated P. falciparum malaria, available through the WorldWide Antimalarial Resistance Network data repository prior to August 2015, were pooled using standardised methodology. The haematological response over time was quantified using a multivariable linear mixed effects model with nonlinear terms for time, and the model was then used to estimate the mean haemoglobin at day of nadir and day 7. Multivariable logistic regression quantified risk factors for moderately severe anaemia (haemoglobin < 7 g/dL) at day 0, day 3 and day 7 as well as a fractional fall ≥ 25% at day 3 and day 7. Results: A total of 70,226 patients, recruited into 200 studies between 1991 and 2013, were included in the analysis: 50,859 (72.4%) enrolled in Africa, 18,451 (26.3%) in Asia and 916 (1.3%) in South America. The median haemoglobin concentration at presentation was 9.9 g/dL (range 5.0–19.7 g/dL) in Africa, 11.6 g/dL (range 5.0–20.0 g/dL) in Asia and 12.3 g/dL (range 6.9–17.9 g/dL) in South America. Moderately severe anaemia (Hb < 7g/dl) was present in 8.4% (4284/50,859) of patients from Africa, 3.3% (606/18,451) from Asia and 0.1% (1/916) from South America. The nadir haemoglobin occurred on day 2 post treatment with a mean fall from baseline of 0.57 g/dL in Africa and 1.13 g/dL in Asia. Independent risk factors for moderately severe anaemia on day 7, in both Africa and Asia, included moderately severe anaemia at baseline (adjusted odds ratio (AOR) = 16.10 and AOR = 23.00, respectively), young age (age < 1 compared to ≥ 12 years AOR = 12.81 and AOR = 6.79, respectively), high parasitaemia (AOR = 1.78 and AOR = 1.58, respectively) and delayed parasite clearance (AOR = 2.44 and AOR = 2.59, respectively). In Asia, patients treated with an artemisinin-based regimen were at significantly greater risk of moderately severe anaemia on day 7 compared to those treated with a non-artemisinin-based regimen (AOR = 2.06 [95%CI 1.39–3.05], p < 0.001). Conclusions: In patients with uncomplicated P. falciparum malaria, the nadir haemoglobin occurs 2 days after starting treatment. Although artemisinin-based treatments increase the rate of parasite clearance, in Asia they are associated with a greater risk of anaemia during recovery

Health services provision to elderly people at Tandale dispensary, Kinondoni municipality, Dar es Salaam Tanzania

Background: Health services for the elderly are very crucial for these people have unique diseases which need special attention and treatmentObjectives: To study the awareness , acceptability and utilization of health services by the elderly people at Tandale Dispensary, Kinondoni Municipality, Dar es Salaam.Methods: This was a descriptive cross-sectional study whereby 154 persons aged 60 years and above , who attended Tandale Dispensaryin Tandale Ward, Dar es Salaam were interviewed in June 2012. At the same time, data was sought from 30 health workers of the facility and 16 Tandale community leaders through in depth interview and focus group discussionResults: Majority of the elderly (85%) had never had any free medical services at Tandale and (88%) were not covered by any health insurance scheme. Only 33% were aware of the National Aging Policy. The majority (84%) were unemployed, while 96% had no pension. A majority of health workers (93%) had not attended any training on managing special health problems of the elderly.Recommendations: The elderly should be made aware of their privileges according to the Aging Policy. Health service providers should be given appropriate education on special needs of the elderly and be empowered for the sam

Data for: "Delaying first birth: an analysis of household survey data from rural Southern Tanzania"

Family planning metrics derived from nationally-representative household surveys such as the Demographic and Health Surveys (DHS) currently categorise women into those desiring to space or limit (permanently stop) births, or according to their age in the case of young women. This conceptualisation potentially ignores a large and growing group of young women who desire to delay a first birth. This study uses household survey data to investigate the characteristics and needs for family planning of women who want to delay their first birth. Data was collected as part of a repeated cross sectional household survey conducted in Tandahimba and Newala, two rural districts in southern Tanzania, between September 2013 and April 2014, and nested within the Expanded Quality Management Using Information Power (EQUIP) study. Socio-demographic characteristics, including parity, contraceptive practices and fertility intentions of 2128 women aged 13–49 were analysed. The association between women’s life stages of reproduction (delayers of first birth, spacers of subsequent pregnancies and limiters of future birth) and selected contraceptive outcomes (current use, unmet need and demand for modern contraceptives) was assessed using the point estimates and 95% confidence intervals for each indicator, adjusted for the survey design

Pushing ‘Global Health’ out of its Comfort Zone: Lessons from the Depoliticization of AIDS Control in Africa

International audienceABSTRACT By affecting the lives and survival of numerous people, global health initiatives deeply alter local landscapes of inequality. They tackle some conditions at the origin of ill health while leaving others untouched, and they inevitably generate new inequalities. Yet, despite their inherently conflictual nature, global health players often minimize the political dimension of their interventions. Taking international AIDS control efforts in Tanzania as an example, this contribution discusses some modalities — and political causes — of the structural neglect of conflict in global health discourse and practice. It analyses how African HIV epidemics continue to be framed and managed in ways that obscure both the health inequalities at their origin, and those that result from efforts to control them. AIDS policy makers conceal inequalities by framing the epidemic as a problem of individual sexual behaviour, and by implicitly rationing access to HIV‐prevention and ‐treatment services. Furthermore, the imposition of disease hierarchies set by international fora excludes broader health‐related allocation decisions from domestic democratic debate. Drawing on a theoretical consideration of depoliticization as artificial deconflictualization, the article concludes by calling for a more open acknowledgement of conflict in global health policy making, and explores some analytical and practical implications of such a re‐politicization of public health.En affectant la vie et la survie de millions de personnes, les programmes de santé mondiale modifient profondément les inégalités internes aux pays "bénéficiaires". En s’attelant à lutter contre certains problèmes de santé tout en laissant d'autres de côté, ils génèrent inévitablement de nouvelles inégalités. Pourtant, malgré la nature intrinsèquement conflictuelle de ces programmes, les acteurs de la santé mondiale minimisent souvent la dimension politique de leurs interventions. En prenant comme exemple les efforts internationaux de lutte contre le sida en Tanzanie, cette contribution examine certaines modalités — et causes politiques — de la négation structurelle du conflit dans les discours et les pratiques en santé mondiale. Elle analyse comment les épidémies africaines du VIH continuent d'être présentées et gérées en faisant abstraction des inégalités de santé qui en sont à origine et de celles qui résultent des politiques de lutte contre le sida elles-mêmes. Les décideurs politiques de la lutte contre le sida dissimulent les inégalités en présentant l'épidémie comme un problème de comportement sexuel individuel, et en rationnant implicitement l'accès aux services de prévention et de traitement du VIH. De plus, l'imposition des hiérarchies de maladies fixées par les instances internationales exclut les décisions plus larges d'allocation de ressources en matière de santé du débat démocratique national. S'appuyant sur une approche théorique de la dépolitisation comme déconflictualisation artificielle, l'article conclut en appelant à une reconnaissance plus ouverte du conflit dans l'élaboration des politiques de santé mondiales, et explore certaines implications analytiques et pratiques d'une telle re-politisation de la santé publique

Gametocyte carriage in uncomplicated Plasmodium falciparum malaria following treatment with artemisinin combination therapy: a systematic review and meta-analysis of individual patient data

Background: Gametocytes are responsible for transmission of malaria from human to mosquito. Artemisinin combination therapy (ACT) reduces post-treatment gametocyte carriage, dependent upon host, parasite and pharmacodynamic factors. The gametocytocidal properties of antimalarial drugs are important for malaria elimination efforts. An individual patient clinical data meta-analysis was undertaken to identify the determinants of gametocyte carriage and the comparative effects of four ACTs: artemether-lumefantrine (AL), artesunate/amodiaquine (AS-AQ), artesunate/mefloquine (AS-MQ), and dihydroartemisinin-piperaquine (DP). Methods: Factors associated with gametocytaemia prior to, and following, ACT treatment were identified in multivariable logistic or Cox regression analysis with random effects. All relevant studies were identified through a systematic review of PubMed. Risk of bias was evaluated based on study design, methodology, and missing data. Results: The systematic review identified 169 published and 9 unpublished studies, 126 of which were shared with the WorldWide Antimalarial Resistance Network (WWARN) and 121 trials including 48,840 patients were included in the analysis. Prevalence of gametocytaemia by microscopy at enrolment was 12.1 % (5887/48,589), and increased with decreasing age, decreasing asexual parasite density and decreasing haemoglobin concentration, and was higher in patients without fever at presentation. After ACT treatment, gametocytaemia appeared in 1.9 % (95 % CI, 1.7-2.1) of patients. The appearance of gametocytaemia was lowest after AS-MQ and AL and significantly higher after DP (adjusted hazard ratio (AHR), 2.03; 95 % CI, 1.24-3.12; P = 0.005 compared to AL) and AS-AQ fixed dose combination (FDC) (AHR, 4.01; 95 % CI, 2.40-6.72; P <0.001 compared to AL). Among individuals who had gametocytaemia before treatment, gametocytaemia clearance was significantly faster with AS-MQ (AHR, 1.26; 95 % CI, 1.00-1.60; P = 0.054) and slower with DP (AHR, 0.74; 95 % CI, 0.63-0.88; P = 0.001) compared to AL. Both recrudescent (adjusted odds ratio (AOR), 9.05; 95 % CI, 3.74-21.90; P <0.001) and new (AOR, 3.03; 95 % CI, 1.66-5.54; P <0.001) infections with asexual-stage parasites were strongly associated with development of gametocytaemia after day 7. Conclusions: AS-MQ and AL are more effective than DP and AS-AQ FDC in preventing gametocytaemia shortly after treatment, suggesting that then on-artemisinin partner drug or the timing of artemisinin dosing are important determinants of post-treatment gametocyte dynamic