Rural household livelihoods, crop production and well-being after a period of trade reforms: a case study of Rukwa, Tanzania

Production of staples occupies an important part in Sub-Saharan Africa‘s crop production, and maize is its single most important food staple. This thesis mainly examines the role of maize in farmers‘ livelihoods and wellbeing in Tanzania, in the context of a long period of reforms that have affected both the maize market, agriculture more widely. It does so by exploring the role of maize in household‘s on and off-farm diversification, the determinants of crop productivity, and the relationship between diversification, commercialisation and‘ well-being. A number of specific issues are explored including the importance of factors such as farm size and education, access to key inputs such as seeds, fertilizers and agricultural extension services. The thesis uses data collected from three districts of Rukwa, one of Tanzania‘s major maize producing regions, and some secondary agricultural data from official sources. The research found that households with more land were generally more diversified (both on-farm and off-farm) than those with less land, and they experienced higher levels of well-being as measured by a range of concepts of well-being, but that maize continues to play an important role households‘ livelihoods and well-being. The research also revealed low levels of use of important agricultural inputs such as modern fertilizers and extension services, which may explain the low yields observed in the region. Education emerged as an important factor in raising yields, increasing commercialisation and also well-being, suggesting that nonagriculture policies may also be important for improving productivity and welfare of farmers. Despite the importance of crop production to their‘ well-being, households face several constraints; these include access to fertilizers, improved seeds and other chemical inputs necessary for higher production, and extension services. These findings have important policy implications as many rural households continue to rely on agriculture, especially production of staples. Therefore, these results could help the central and local governments to formulate strategies geared towards improving rural well-being

Integration of Community Health Workers into a Formal Health System of Tanzania- Measuring satisfaction on the Training program using Kirk Patrick Model

This study aimed at assessing the satisfaction of Community Health Worker CHW -students with the training programme from Kahama and Shirati Health Institutes It employed Kirkpatrick s Model- focusing on Level 1 and a cross- sectional design The study sampled a total of 153 Community Health CHWs by Simple Random Sampling and a total of 14 tutors from Kahama and Shirati Health Institutes by purposively sampling Data were collected using i CHW survey-using questionnaire-Kirkpatrick tool ii Focus Group Discussion FGD - for the tutors Quantitative data were processed edited and descriptively analyzed using SPSS version 20 The Likert scale 1-5 was used for the computation of weighted scores The majority 66 weighted score 4 5 were strongly satisfied with the course content Call for curriculum review should go hand in hand with putting in place on job training programmes for tutors to enhance their teaching methodology skill

Determinants of the Use of Cell phones in Access to Beef Cattle Market Information for Smallholders in Mpwapwa District, Tanzania

Cell phone is said to be an innovative communication device which allows consumers, traders and farmers to search market appropriate information for timely decision-making to save time and travelling costs. However, determinants of using this technology in beef cattle market information seeking for smallholders in Tanzania - particularly in Mpwapwa District, are not well established. Thus, this study analysed the determinants of the use of cellphones in accessing beef cattle market information in Mpwapwa District. Data were collected from 120 respondents using a structured questionnaire and focus group discussion guide. The questionnaire-based data were analysed using theStatistical Package for Social Sciences in which the main analytical model was binary logistic regression. In the model, the dependent variable was access to beef cattle market information via cell phones with two options; did not access (0) and accessed (1). Research findings revealed that the nature of using cell phones in access to beef cattle market information was mostly determined by distance from home to the nearest cattle market; the variety of information demands; income earned per year; level of local network coverage and access to mobile financial services (M-Pesa). On the basis of these findings it is concluded that the smallholder beef cattle producers can use cell phone technology in market information sharing to enhance their marketing participation. Therefore, the study recommends that cell phones service providers should extend their services more in the rural areas of Mpwapwa District

The Burden of Rabies in Tanzania and Its Impact on Local\ud Communities

Rabies remains a major public health threat in many parts of the world and is responsible for an estimated 55,000 human deaths annually. The burden of rabies is estimated to be around US$20 million in Africa, with the highest financial expenditure being the cost of post-exposure prophylaxis (PEP). However, these calculations may be substantial underestimates because the costs to households of coping with endemic rabies have not been investigated. We therefore aimed to estimate the household costs, health-seeking behaviour, coping strategies, and outcomes of exposure to rabies in rural and urban communities in Tanzania. Extensive investigative interviews were used to estimate the incidence of human deaths and bite exposures. Questionnaires with bite victims and their families were used to investigate health-seeking behaviour and costs (medical and non-medical costs) associated with exposure to rabies. We calculated that an average patient in rural Tanzania, where most people live on less than US$1 per day, would need to spend over US$100 to complete WHO recommended PEP schedules. High costs and frequent shortages of PEP led to poor compliance with PEP regimens, delays in presentation to health facilities, and increased risk of death. The true costs of obtaining PEP were twice as high as those previously reported from Africa and should be considered in re-evaluations of the burden of rabies

School Based Reproductive Health Education and Teenage Pregnancy: A Case of Mtwara Region, Tanzania

Teenage pregnancy is one of the complex health and development problems facing the world. In Tanzania adolescent pregnancy has been identified as one of the reasons for girls dropping out of school. The purpose of this study was to determine the effectiveness of school based reproductive health education programmes on teenage pregnancy. The study adopted a cross-sectional explanatory design and was conducted in Mtwara Region, Tanzania covering four secondary schools. Respondents for the study were randomly selected. Data was collected using a pre-structured questionnaire, focus groups discussions and key informant interviews. A total of 156 individuals participated in the study. Findings from the study show that school based reproductive health education programmes were effective in terms of knowledge creation. Generally, the results show a significant (P≤ 0.001) difference in reproductive health education between intervention and non-interventions schools. In addition, significant differences were also observed between rural and urban non-intervention schools. It is therefore concluded that school based reproductive health education programmes are effective in knowledge creation among adolescent girls. Hence, it is recommended that a comprehensive school based reproductive health education programme (SBRHEP) be instituted in schools as a way of reducing teenage pregnancies and spread of sexually transmitted diseases (STI’s). However, for this to be more effective there is need for a standalone subject that only deals with reproductive health education rather than the status quo where it is offered under the biology subject. Keywords: School based Reproductive health education, Teenage pregnancy DOI: 10.7176/DCS/9-1-0

Access to Reproductive Health Services and Factors Contributing to Teenage Pregnancy in Mtwara Region, Tanzania

Generally, adolescents/teenagers sexual and reproductive health (SRH) needs are largely unmet in developing countries despite this group’s size. This paper examines teenage girls’ accessibility to reproductive health services and factors contributing to teenage pregnancy. The study on which the paper is based adopted a cross-sectional explanatory design and was conducted in Mtwara Region, Tanzania covering four secondary schools. Teenage girls in the four secondary schools were randomly selected to participate in the study. Data was collected using questionnaires, focus groups discussions and key informant interviews. A total of 156 people participated in the study. Quantitative data was analyzed using SPPS while qualitative data was analyzed using content analysis.  Generally, results show that teenage pregnancy is a major problem in Mtwara and the attributing factors include poverty, culture, desire for money, peer pressure, lack of education on reproductive health issues and poor parental support. Results also show that teenagers in Mtwara lack access to youth friendly reproductive health services. Additionally, the findings show a disparity in terms of access to reproductive health services (RHS) between rural and urban teenage girls: those in the urban area had relatively more access compared with their rural counterparts. It is therefore concluded that access to reproductive health services for teenage girls is a serious challenge in Mtwara region. It is hereby recommended it is recommended that households be empowered to earn sufficient income to provide for their families, particular emphasis should be put on non-farm income generating activities. It is also recommended that youth friendly SRH services be established in the study areas; doing so will improve youth’s access to the same. Keywords: Teenage, Teenage pregnancy, Youth friendly service

Vitamin D Status and TB Treatment Outcomes in Adult Patients in Tanzania: A Cohort Study.

Vitamin D is an immunomodulator and can alter response to tuberculosis (TB) treatment, though randomised trials have been inconclusive to date. We present one of the first comprehensive analysis of the associations between vitamin D status and TB treatment, T-cell counts and nutritional outcomes by HIV status. Cohort study. Outpatient clinics in Tanzania. 25-hydroxyvitamin D levels were assessed in a cohort of 677 patients with TB (344 HIV infected) initiating anti-TB treatment at enrolment in a multivitamin supplementation (excluding vitamin D) trial (Clinicaltrials.gov identifier: NCT00197704). Information on treatment outcomes such as failure and relapse, HIV disease progression, T-cell counts and anthropometry was collected routinely, with a median follow-up of 52 and 30 months for HIV-uninfected and HIV-infected patients, respectively. Cox and binomial regression, and generalised estimating equations were used to assess the association of vitamin D status with these outcomes. Mean 25-hydroxyvitamin D concentrations at enrolment were 69.8 (±21.5) nmol/L (27.9 (±8.6) ng/mL). Vitamin D insufficiency (<75 nmol/L) was associated with a 66% higher risk of relapse (95% CI 4% to 164%; 133% higher risk in HIV-uninfected patients). Each unit higher 25-hydroxyvitamin D levels at baseline were associated with a decrease of 3 (p=0.004) CD8 and 3 (p=0.01) CD3 T-cells/µL during follow-up in patients with HIV infection. Vitamin D insufficiency was also associated with a greater decrease of body mass index (BMI; -0.21 kg/m(2); 95% CI -0.39 to -0.02), during the first 8 months of follow-up. No association was observed for vitamin D status with mortality or HIV disease progression. Adequate vitamin D status is associated with a lower risk of relapse and with improved nutritional indicators such as BMI in patients with TB, with or without HIV infection. Further research is needed to determine the optimal dose of vitamin D and effectiveness of daily vitamin D supplementation among patients with TB

Knowledge, Attitudes and Practices (KAP) about rabies prevention and control: a community survey in Tanzania

BACKGROUND: Despite being entirely preventable,canine rabies still kills 55,000 people/year in developing countries. Information about local beliefs and practices can identify knowledge gaps that may affect prevention practices and lead to unnecessary deaths. METHODOLOGY/PRINCIPAL FINDINGS: We investigated knowledge, attitudes and practices related to rabies and its prevention and control amongst a cross-section of households (n = 5,141)in urban and rural areas of central, southern and northern Tanzania. Over 17% of respondents owned domestic dogs (average of 2.3 dogs/household), &gt;95% had heard about rabies, and &gt;80% knew that rabies is transmitted through dog bites. People who (1)had greater education,(2)originated from areas with a history of rabies interventions,(3)had experienced exposure by a suspect rabid animal,(4)were male and(5)owned dogs were more likely to have greater knowledge about the disease. Around 80% of respondents would seek hospital treatment after a suspect bite, but only 5% were aware of the need for prompt wound cleansing after a bite. Although &gt;65% of respondents knew of dog vaccination as a means to control rabies, only 51% vaccinated their dogs. Determinants of dog vaccination included(1)being a male-headed household,(2)presence of children,(3)low economic status,(4)residing in urban areas,(5)owning livestock,(6)originating from areas with rabies interventions and(7)having purchased a dog. The majority of dog-owning respondents were willing to contribute no more than US$0.31 towards veterinary services. CONCLUSIONS/SIGNIFICANCE: We identified important knowledge gaps related to, and factors influencing the prevention and control of rabies in Tanzania. Increasing knowledge regarding wound washing, seeking post-exposure prophylaxis and the need to vaccinate dogs are likely to result in more effective prevention of rabies; however, greater engagement of the veterinary and medical sectors is also needed to ensure the availability of preventative services