Tanzania Journal of Health Research

Socio-cultural and religious factors influencing menstrual hygiene management among schoolgirls in Tanzania: A literature survey

Yolanda Joseph Mbatia — 2024-09-27

Background: Menstruation is a natural phenomenon to adolescent girls and women as part of their reproductive life. It is associated with social and cultural values among schoolgirls and women. The purpose of this study was to identify and discuss several socio-cultural and religious elements that influence menstruation among Tanzanian schoolgirls.

Methods: The study is a literature survey based on the relevant papers published in Tanzania. A literature survey was conducted utilising a seven-step methodology, in which relevant themes from several prospective bibliographic databases such as Google Scholar, PubMed, and institutional repositories were methodically identified, collated, and analysed using descriptive methods.

Results: The survey found sociocultural and traditional factors influencing menstrual hygiene management among Tanzanian schoolgirls. These elements include religious beliefs, impurity, witchcraft, local superstitions, limitations on menstruation, menstruation's association with fear, shame, and secrecy, male involvement, awareness, knowledge, and abilities, and relationships with family, teachers, and peers.

Conclusion: The government and other stakeholders should work together to address the socio-cultural and religious concerns that affect menstrual hygiene management among schoolgirls in the country.

Review on Genetic Insights into Abnormal Uterine Bleeding and Leiomyoma Developmentment

Kruthica JG — 2024-09-27

Background: Abnormal uterine bleeding is a prevalent issue among women of reproductive age, primarily stemming from hormonal imbalances. It is characterized by flow volume, duration, and frequency variations outside of pregnancy. Occurring frequently during perimenopause and menstruation, abnormal uterine bleeding is associated with several benign tumors within the female reproductive system, including leiomyomas and endometriomas. Leiomyomas, composed of smooth muscle cells originating from the uterine wall, are influenced by genetic and environmental factors.

Objective: This review explored the complications linked with abnormal uterine bleeding and identified crucial genes involved in developing leiomyomas.

Methods: The International Federation of Gynecology and Obstetrics (FIGO) has established a classification and terminology system for the causes of abnormal uterine bleeding (AUB). This standardization aims to enhance research efficiency, facilitate diagnosis, and improve the management of clinical cases. Articles in English were searched in the PubMed, Embase, Scopus, ScienceDirect, and MEDLINE databases using the terms abnormal uterine bleeding, leiomyomas, and genes. The selection included systematic reviews, meta-analyses, randomized controlled trials, and reviews. Data were searched from 2016 to May 2023.

Results: The research reveals that uterine leiomyomas affect a substantial percentage of females by age 50, underlining the need for a comprehensive understanding of their genetic underpinnings. The knowledge gained from this study contributes to the potential development of more targeted and efficient treatments for leiomyomas, offering hope for improved outcomes in managing these common gynecological disorders.

Conclusion

The findings underscore the complexity of abnormal uterine bleeding, emphasizing its connection with leiomyomas and the genetic factors influencing their development. By employing the FIGO classification system, researchers and clinicians can standardize their approach to diagnosis and management, paving the way for more efficient future research and diagnostics. Identifying critical genes associated with leiomyomas provides insights into the underlying mechanisms, particularly the involvement of hormones and genetic pathways.

Needs for Establishment and Adoption of Regional One Health Approach for Preparedness and Response to Public Health Threats in the East African Community

John Stephen Kunda — 2024-09-27

Introduction: One Health approach integrates human, animal, and environmental health, recognizing their intricate relationship. It is an important approach to address complex public health challenges such as zoonoses, anti-microbial resistance (AMR), food safety and security, the impact of climate change, biodiversity degradation and many other health challenges that require collaborative efforts. East African Community (EAC) is among the regions that face such challenges. Hence, there is a dire need to adopt the One Health approach to prevent and control many of the public health threats.

Aim and objectives: To develop and implement a comprehensive regional One Health approach for the East African Community (EAC) that enhances collaborative efforts in addressing public health threats through an integrated approach to human, animal, and environmental health. The objectives of the work were to assess and strengthen current One Health initiatives, to assess the status of One Health implementation in the region and to recommend the best approach to develop a Regional One Health Strategy that would enhance the sustainable One Health approach in the EAC.

Data Collection: Data was collected through consultations with sector representatives from the EAC Partner States, the EAC Secretariat, and the EAC Expert Working Group (EWG). Between October 2020 and May 2022, documents and reports from the EAC secretariat and Partner States were also extensively reviewed.

Findings: The EAC has been facing numerous public health threats due to several factors, including its geographical location, high population density and movements, limited access to healthcare, limited disease surveillance and control, etc. Although a formal regional One Health strategy was lacking during the time of the data collection exercise, key initiatives like contingency plans development, risk analysis and communication, development of Standard Operating Procedures (SOPs) as well as capacity-building efforts for various health risks had been carried out, all under the umbrella of One Health. Some EAC Partner States have developed national One Health strategies and created multi-sectoral platforms to address public health challenges. Including the Democratic Republic of Congo (DRC) in the EAC region in April 2023 emphasized the need for a more comprehensive regional approach due to the DRC's vast tropical forests and history of infectious disease outbreaks.

Conclusion: Most public health threats do not recognize borders. Hence, there is a need to unify EAC Partner States’ efforts to effectively and efficiently address regionally evolving public health threats. This requires implementing a One Health approach, thereby emphasizing the significance of a regional One Health strategy. The unified approach will safeguard the well-being of human and animal health, the ecosystems in the region, and the socio-economy. Challenges may include securing adequate, sustainable resources, harmonizing efforts among Partner States, and aligning regulatory frameworks and resource capacities.

Impact of interventions on mosquitoes resting behaviour and species composition in Lugeye village in Magu district, Northwestern Tanzania

Eliningaya Kweka — 2024-09-27

Background: Understanding the impact of intervention tools on vector behaviour, host preference, resting, and infectivity rates is paramount in malaria control planning. Magu district was one of the districts in lake zone regions in northwestern Tanzania covered with indoor residual spray and long-lasting insecticidal nets in the main malaria control campaign. After interventions, this study evaluated the mosquito's host preference and resting behaviour in Lugeye village in rainy and dry seasons.

Methods: Mosquitoes were collected both indoors and outdoors using the rest pots. The collection was done in both rainy and dry seasons. The samples were collected bi-weekly for three months each season.

Results: A total of 254 mosquitoes were collected in both dry and rainy seasons, indoors and outdoors. The most abundant species were Anopheles funestus s.s. and An.arabiensis. Most blood meals from bovines rested outdoors, while human blood meal sources rested outdoors. Sporozoite-positive mosquitoes were found only during the dry season.

Conclusion: This study's findings have shown that implementing IRS and LLIN interventions has led to a species shift from An.gambiae s.s. to An.funestus and An.arabiensis. The inclusion of vector insecticide resistance information can be of paramount importance in appropriate intervention tool selection.

Awareness of Type 2 Diabetes Mellitus and Hypertension among Secondary School Adolescents in Morogoro Region, Tanzania

Khadija Ahmed Makbel — 2024-09-27

Background: Several studies have consistently shown that adolescents' awareness of diabetes mellitus and hypertension is inadequate. The main objective was to assess adolescents' awareness of type 2 diabetes and hypertension and identify areas for improvement.

Methods: A cross-sectional survey was conducted with 384 secondary school students from public and private day schools in Kilosa and Morogoro urban. Face-to-face interviews were undertaken to collect data on awareness of type 2 diabetes and hypertension. Data were analyzed using IBM Statistical Packages for Social Sciences (SPSS version 21), and total awareness scores for various sections were calculated by adding the results from all 34 questions and assigning a score of 1 for a yes response and a score of 0 for a no response or a don't know response.

Results: The main awareness scores for hypertension and diabetes mellitus were 51.4% and 50.2%, respectively, of the possible total score. The scores for general diabetes awareness and hypertension were 53.5% and 42.6%, respectively. Other scores for type 2 diabetes and hypertension were 32.1% vs 42.6% on the "Awareness of Risk Factors" section, 49.5% vs 46% on the "Awareness of Symptoms and Complications" section, 54.1% vs 52.9% on the "Awareness of Treatment and Available Medication Section" section; and 67.6% vs 66.9% on the "Awareness of Lifestyle Changes and Management Section".

Conclusion: Except for a few areas, such as risk factors, symptoms, and complications that necessitate intervention, adolescents exhibited an average level of information regarding Type 2 Diabetes Mellitus and hypertension. Non-communicable disease risk factors, symptoms, and complications should be taught in schools at a young age to improve primary prevention.

Asymptomatic Bacteriuria and Its Determinants Among Pregnant Women In Rural Southwestern Nigeria

Azeez Oyemomi Ibrahim — 2024-09-27

Background: The occurrence of asymptomatic bacteriuria in pregnancy has been associated with adverse maternal and fetal outcomes.

Objective: This study determined the prevalence of asymptomatic bacteriuria and its determinants among pregnant women in rural Southwestern Nigeria.

Methods: A hospital-based cross-sectional study was conducted between June 2021 and May 2023 among 400 pregnant women with no signs or symptoms of urinary tract infection. Demographic and clinical data were collected using structured questionnaires. Mid-urine samples were cultured using standard laboratory procedures. Bacterial colonies were isolated, and antimicrobial sensitivity was measured using the disc diffusion technique. Data were analyzed using SPSS version 22. The determinants of asymptomatic bacteriuria were measured using odds ratio and 95% confidence Interval (CI) with significant level ( p-value <0.05).

Results: The prevalence of asymptomatic bacteriuria was 24.0% (95% CI = 18.2% - 30.5%). The determinants of asymptomatic bacteriuria were the absence of post-coital urination (AOR, 4.433; 95%CI: 1.462-7.116), diabetes mellitus (AOR, 2.468; 95% CI: 1.300 – 4.684), and anaemia (AOR, 2.699; 95%CI: 1.042 – 6.729). The most detected asymptomatic bacteriuria was E. coli 52/96 (54.2%). The cultured isolates were 100.0% sensitive to ceftriaxone and ceftazidine but were 100.0% resistant to ampicillin and erythromycin.

Conclusion: Based on the urine culture and sensitivity results, the study suggests using ceftriaxone or ceftazidine as an empirical treatment for asymptomatic bacteriuria.

A qualitative exploration of nurses’ and midwives’ experiences in designated COVID-19 healthcare facilities in rural and urban Tanzania

Kahabi Ganka Isangula — 2024-09-27

Background: Frontline healthcare providers, particularly nurses and midwives, are at higher risk of COVID-19 infection due to frequent patient contact. However, studies examining their experiences, particularly in low-income countries like Tanzania, are limited.

Objective: This study aimed to explore the experiences of nurses and midwives providing care in COVID-19-designated healthcare facilities in selected regions of Tanzania.

Methods: A qualitative descriptive approach was used to investigate the experiences of nurses and midwives in COVID-19 care. In-depth interviews were conducted with 20 purposefully selected participants from Dar es Salaam, Shinyanga, and Pwani regions. Data were coded with NVivo 12 software and analyzed using a descriptive phenomenology approach.

Results: Nurses and midwives in urban areas reported managing more patients and experiencing more deaths than peers in rural settings. Urban and rural participants demonstrated strong knowledge of COVID-19, including its symptoms, management, and preventive measures. Selection for COVID-19 care was based on Ministry of Health guidelines, prioritizing leadership and emergency care experience. Their roles included patient isolation, routine and specialized care, psychological support, health education, and post-mortem care. Despite this, most nurses and midwives reported feeling underprepared due to insufficient training, a lack of personal protective equipment, and limited medical supplies. Additionally, no risk allowances were provided. Nurses and midwives experienced key challenges such as patient stigmatization, abandonment by families, deaths resulting from oxygen shortages, burnout, and personal infection. Nurses and midwives recommended strengthening the healthcare system, providing ongoing training, offering risk allowances, and promoting community education and sensitization to improve future pandemic preparedness.

Conclusion: Nurses' and midwives' experiences in COVID-19 care facilities were surrounded by inadequate preparations, with health system deficiencies and societal fears significantly impacting their ability to provide effective care. Strengthening health sector readiness, including training and resource allocation, is essential for future pandemic and disaster response efforts.

Mothers’ Knowledge and Practices Towards Pneumonia to Children Under Five Years of Age in Makambako Town-Njombe

Erasto Kinemelo — 2024-09-27

Background: Pneumonia is an acute respiratory infection caused by several infectious agents, such as viruses, bacteria, and fungi. It affects the lungs. This study aimed to assess mothers’ knowledge and practices regarding pneumonia in children under five years of age in Makambako town. The study focused on exploring knowledge, awareness, practices, and the extent to which mothers understand the disease and measures taken to protect children to prevent and reduce the disease prevalence.

Methodology: A community-based descriptive cross-sectional study design was used, employing random and purposive sampling techniques to obtain 106 respondents in the study area who filled out the structured questionnaires. All questionnaires were checked for completeness and then entered into SPSS for analysis. The prevalence is high, as there were 2647 cases of pneumonia in 2017 compared to 1938 cases in 2016.

Results: Based on the study findings, the high prevalence of childhood pneumonia in Makambako town council is caused by low knowledge and poor practices of mothers concerning childhood pneumonia, as 70.8% of mothers do not know what pneumonia is about, 72.6% of mothers do not know health risk factors associated with childhood pneumonia, and 77.3% do not know how pneumonia is transmitted. Some mothers perform cultural and traditional beliefs, while others perform self-medication and take a child to the hospital when the conditions worsen. Most do not know if proper nutrition and immunization, as signified by 99% and 81%, respectively, are the most effective ways to protect a child against pneumonia.

Conclusion and recommendations: The study concludes that mothers' knowledge and practices associated with improper nutrition and immunization contribute much to children’s pneumonia. Therefore, the study suggests proper nutrition and immunization education should be done appropriately to protect children from pneumonia.

Secondary School Food Environment and Purchase Choices of Adolescents in Mbeya City

Mercy Kamwela — 2024-09-27

Background: Increasing levels of overweight and obesity among adolescents are quite alarming worldwide. Among the depicted causes is poor diet, in which the food environment plays a major role in contributing. Still, little is known about adolescents and the school food environment they are exposed to in Tanzania.

Objective: This study aimed to explore the secondary school food environment and document food and drink mostly purchased by secondary school adolescents

Methodology: This cross-sectional study involved 8 secondary schools in Mbeya City, 384 secondary school adolescents and 35 food outlets. Aspects of the food environment studied were under the external domain, food availability, price and promotion and policy and guideline. Personal domain: accessibility, affordability and desirability. Direct observation was used in food outlets with the help of an observation tool adopted from the Nutrition Environment Measure Survey. Structured interviews were done with the school administrators or teachers responsible for nutrition issues in school with the help of a questionnaire designed based on WHO Nutrition Friendly Schools Initiative. Also, a student purchased a recall questionnaire designed based on the Nutrition Environment Measure Survey, which also helped identify the adolescents' demographic characteristics. Descriptive statistics and ordinal logistic regression were used to establish prevalences and associations between variables.

Results: Most available food outlets outside the school were retail shops and canteens inside the schools. The foods most purchased by adolescents are sweets, fried snacks, and sugar-sweetened beverages. Most adolescents purchase their food and drinks in school shops and canteens. Cereal-based foods are most available, while fruit and vegetables are least available inside and outside school. Adolescents care most about taste and least about nutrition and weight control while purchasing food and drinks. Demographic characteristics like age, level of education, and the type of school adolescents attend are associated with purchasing certain foods.

Conclusion: Secondary schools have weak policies and guidelines on the food environment, and they are filled with ultra-processed foods, fried snacks, and sugar-sweetened beverages. Adolescents respond to their environment by purchasing what is most available. Adolescents’ responses depend on their age and the school type, either public or private. This situation calls for effective planning and interventions from the national to the institutional/school levels to ensure a nutrition-enabling environment is created in secondary schools.

Antibacterial Activity and Synergism of Sapium ellipticum (Hochst.) Pax and Harungana madagascariensis (Lam. Ex Poir) Stem bark Extract against Methicillin Resistant Staphylococcus aureusarscariensis (Lam. Ex Poir) Stem Bark Extracts Against Methicillin resistant Staphylococcus aureus

Kulwa Mtani — 2024-09-27

Background: The increase in infections involving anti-microbial resistant (AMR) bacteria like Methicillin-resistant Staphylococcus aureus (MRSA) has limited therapeutic options and has been consistently found to be among the top causes of threats to global health. Combining antibacterial agents and/or medicinal plants has minimized this AMR crisis worldwide.

Aim: This study aimed to investigate in vitro synergistic antibacterial activity of Sapium ellipticum (Hochst.) Pax and Harungana madagascariensis (Lam. Ex Poir) stem bark extracts against Methicillin resistant Staphylococcus aureus (MRSA).

Methods: The MRSA clinical isolates were identified phenotypically and genotypically before being used as test microorganisms. Stem bark plant extracts of S. ellipticum and H. madagascariensis were prepared using methanol and dichloromethane solvents. Screening of antibacterial activities of plant extracts was done using the agar-well diffusion method, and minimum inhibitory concentration (MIC) determination was done by serial microdilution technique.

Results: The MIC for individual extracts ranged from 1.56 - 6.25 mg/mL, while MIC for combined extracts ranged from 0.2 - 0.8 mg/mL. Combined extracts were significantly more active than individual extracts. The study discovered synergistic interaction when combining methanol or dichloromethane extracts of S. ellipticum and H. madagascariensis against MRSA isolates. The suitable combination ratio for methanol and dichloromethane extracts was 1:1, though a 3:1 ratio also resulted in synergistic interaction in the methanolic combination.

Conclusion: The differences in MIC range between the individual and combined extracts might be attributed to the concentration and composition of the extracts. These results provide promising information for using methanol or dichloromethane crude extracts of S. ellipticum and H. madagarscariensis stem barks in synergism against MRSA isolates.

Indonesia Measles Immunization Program Monitoring: An Analysis of 5 Years Measles Surveillance Data

Vivi Setiawaty — 2024-09-27

Background: Measles remains a leading cause of death among young children. Maintaining high coverage of routine immunization should be a top priority to achieve the elimination target in 2020. This study aims to determine the progress of the national measles immunization program.

Method: We analyzed the measles surveillance data from January 2008 to December 2013. A measles case is a clinical measles case with a positive measles virus infection through a serology test (measles IgM positive) and no measles vaccination 4-6 weeks before the rash appears.

Results: We found that 115,105 measles cases were reported. During that period, a series of measles immunization campaigns were conducted from 2009 – to 2011. There was a decrease in laboratory-confirmed measles cases, from 10 per 100,000 population in 2008 to 4.6 in 2013. From 2010 to 2013, the proportion of suspect measles cases tested in the laboratory increased from 16 to 37% of the total suspect cases. Among those tested specimens, we found the increasing number ranged from 12 to 26% measles positive and 24 to 44% rubella positive.

Conclusion: These findings indicate that the measles immunization program in Indonesia has effectively reduced the number of measles cases.

Factors related to attitude-associated stigma among caregivers of mentally ill patients in Tanzania

Clavery Lyela — 2024-09-27

Background: Attitude-associated stigmas towards patients with mental illness affect most patients. However, the factors related to attitude-associated stigma among caregivers remain unknown. This might lead to the disruption of family relationships, low self-esteem, lack of socialization and other adverse effects. Therefore, the current study aimed to determine the associated stigma among caregivers of a patient with a mental illness

Methods: A quantitative approach, with a cross-sectional study design, was used, involving two standardized questionnaires: Community Attitudes Towards the Mentally Ill (CAMI) Scale and Modified Consumer Experiences of Stigma Questionnaire (MCESQ), which were used to measure attitudes associated with stigma towards mentally ill patients, experienced stigma and discriminations among caregivers of patient with mental illness. Data were analyzed using SPSS version 20, and descriptive and appropriate inferential statistics such as Chi-square test, Pearson correction and logistic regression were used.

Results: 422 caregivers living with mentally ill people attending Mirembe National Mental Hospital participated in the study. The overall prevalence of attitude-associated stigma towards mentally ill patients among caregivers was 95.3% in all four dimensions. However, in those who experienced stigma and discrimination, the overall prevalence was 63.3%. Factors that were statistically significantly associated with experiencing stigma and discrimination against mental disorders were age, education, occupation, place of residence, relationship and frequency of admission.

Conclusion: Attitudes associated with stigma towards mentally ill patients among caregivers are associated with admissions, relationships and some demographic characteristics. Thus, the current study suggests that social support should be provided to caregivers with a family member having a mental illness. However, future studies with longitudinal study design might provide the risk factors that predispose caregivers to attitude-associated stigma.

Barriers to HIV prevention among adolescents in Njombe, Tanzania: Knowledge gaps and accessibility of sexual and reproductive health services

Joseph Swilla — 2024-09-27

Background: HIV remains a significant global public health issue, claiming 36.3 million lives worldwide. In 2020, approximately 1.75 million adolescents aged 10-19 were living with HIV globally, with sub-Saharan Africa accounting for 88% of these cases. Tanzania has a national HIV prevalence of 4.8% among individuals aged 15-49, with the Njombe region reporting the highest prevalence at 11.4%. Despite efforts to combat HIV, adolescents often receive less focus in intervention programs, resulting in inadequate adolescent-friendly services and low HIV testing coverage. This study aimed to assess the barriers to HIV prevention among adolescents in Njombe, focusing on their knowledge and access to Sexual and Reproductive Health Rights (SRHR) services

Methods: A descriptive research approach was used, targeting adolescents aged 15-19 from Agnes Trust and Mpechi secondary schools in Ramadhani and Mji Mwema wards. A total of 155 students were selected through purposive sampling. Data was collected using structured questionnaires and analyzed using STATA version 17.

Results: The study revealed that 67.1% of adolescents had good knowledge of HIV prevention, with females demonstrating slightly better knowledge (70.11%) compared to males (63.24%). However, only 69.68% had access to SRHR services, with counseling and testing (31.61%) and health education (30.97%) being the most common services received. Despite this, condom use remained low, with only 3.7% taking condoms during SRHR service participation.

Conclusion: While adolescents in Njombe have a good understanding of HIV prevention, there are significant gaps in the consistent use of preventive measures like condoms. Enhanced community awareness, better access to SRHR services, and targeted interventions for male adolescents are recommended to address these gaps and reduce HIV prevalence among adolescents in the region. Further research is needed to explore additional factors contributing to the high HIV prevalence in Njombe.

Understanding Practice and Associated Factors of Implementers on Fidelity Implementation of Prime Vendor System: A Case Study of Tanzania Mainland

Mathew Mganga — 2024-09-27

The practice of Supply Chain Management is an application of the process view, focusing on delivering health commodities to clients and transitioning from functions to processes. The Prime Vendor system has been implemented through the existing institutional structures at various levels of government and funded exclusively by complementary funds. The availability of quality medicines in low-income and middle-income countries is often limited, especially in peripheral health facilities. This study provides a comprehensive understanding of the actual practice and associated factors of implementers on fidelity implementation of the prime vendor system.

Materials and Methods: Data was collected from June to September 2023 using the ODK application from 356 respondents in the Dodoma, Morogoro, Mtwara, and Mwanza regions in Tanzania. They were analysed using SAS version 9.4. Statistical significance was determined at a 95% confidence level."5% confidence level.

Results: In the study, 98.60% of health facility respondents reported procuring health commodities from prime vendors only when they received out-of-stock notifications from the Medical Stores Department. However, 85.67% disagreed with the practice of quarterly procurement. Additionally, 50.56% of respondents agreed they incurred costs upon consignment receipt, and 58.15% disagreed with health facility overseers being responsible for prime vendor preparation. The study revealed that 90.45% of respondents acknowledged the Health Facility Governing Committee/Medicine and Therapeutic Committee's role in approving orders and funds for health commodities procurement through the prime vendor system. Regarding payment timelines, 65.17% of respondents were uncertain about settling invoices within seven days. Most respondents (86.80%) disagreed with using online payment platforms when traditional banking services were unavailable. Furthermore, 88.76% relied on supplementary funds for procurement, while 73.60% disagreed with using in-kind receipts as a source of funds in implementing the prime vendor system. Regarding order submission and delivery, 73.60% did not support health facilities directly submitting their orders to prime vendors, and 56.18% were unaware of the delivery timelines used by the prime vendor to supply various destinations.

Conclusion: The study elucidates the issues surrounding the procurement practices and procedures of health commodities through the prime vendor system, revealing significant variations in implementation fidelity among respondents. Factors influencing implementers' practices underscore the complex interplay between individual characteristics and systemic factors. Addressing these challenges requires targeted interventions, which are essential in enhancing smooth and consistent fidelity in the implementation of the prime vendor system, which will ensure equitable access to health commodities across healthcare facilities.

Perceived COVID-19 Vaccine Uptake and Effect on Delivery of Health Services in Tanzania: A Qualitative Study of Community and Health Workers

Gladys Mahiti — 2024-09-30

Background: The World Health Organization (WHO) declared the novel coronavirus a worldwide pandemic in March 2020. Since the coronavirus (COVID-19) is highly contagious, the number of confirmed cases and death rates has increased dramatically. The COVID-19 pandemic has caused significant morbidity and mortality throughout the world, as well as major social, educational and economic disruptions. Studies conducted in other low- and middle-income countries showed that health workers perceived the vaccine as beneficial; the benefits include preventing infection and limiting the severity of the disease. Despite myths and misconceptions which are reported to contribute significantly towards vaccine hesitancy in several African countries, there is a scarcity of systematic documentation of health workers and community perceptions on how the COVID-19 vaccine impacted the delivery and uptake of other services in Tanzania.

Objective: This study assessed and documented health workers’ and community perceived uptake and impact of COVID-19 vaccination on the delivery of other services in Tanzania.

Methods: A phenomenological cross-sectional study among 632 healthcare workers at all levels and community leaders was conducted using interview guides for key informants, in-depth interviews, and Focus Group Discussions (FGDs). The collected data were analyzed using a thematic analysis approach.

Results: In this study, six themes emerged, namely COVID-19 vaccine uptake, hesitation and awareness, COVID-19 transmission and prevention, and the effect of COVID-19 vaccination on the delivery and uptake of other services. Most study participants indicated that they were aware of COVID-19 and could understand the mode of COVID-19 transmission. Participants identified several factors that contribute to vaccine hesitation in the country. Such factors included receiving mixed information on the COVID-19 vaccine, family influence and secretive manner of vaccine delivery. Participants indicated that a shortage of resources affected the delivery of other services. Nevertheless, other participants indicated that the COVID-19 vaccination program did not affect the delivery of other health services. Based on the participants’ views, the country was unprepared to respond effectively to the pandemic.

Conclusion: The Ministry of Health, under the communication section, should continue to reinforce the increasing awareness of COVID-19 and its means of transmission. The Ministry of Health should increase COVID-19 and the means of transmission to top leaders. Furthermore, using community leaders and champions to deliver appropriate information on COVID-19 vaccination may help increase the uptake of the COVID-19 vaccine and prevent misconceptions among community members. To avoid disruption of delivery of other services, there is a need to strengthen the country’s capacity for preparedness and response to emergencies and pandemics.

Clinical Presentation and Outcomes of COVID-19 Patients Supplemented with Approved Herbal Preparations in Tanzania: A Cohort Study

Verdiana Byemelwa — 2024-09-27

Introduction: During the COVID-19 pandemic, there was no known specific treatment for coronavirus Disease. Because of this, different countries and institutions have used different regimens to manage disease symptoms. In Tanzania, well-known and long-used herbal preparations believed to have antiviral activities were used as supplements to standard care for COVID-19 management. This study assessed the clinical presentation and outcomes of hospitalized COVID-19 patients receiving standard care plus herbal preparations in Tanzania.

Methods: An observational cohort study was conducted between February and May 2021 at 12 health facilities. Sociodemographic information, clinical presentation, past medical history, baseline, and follow-up laboratory records were documented. Each study participant was followed up for 14 days from enrolment.

Results: 285 participants were enrolled; their mean age was 59.2 ± 16.5 years, and males constituted 56% of the study participants. Nearly 33% were aged 50 years and above. The majority (72%) reported having at least one form of co-morbidities (raised blood pressure, diabetes mellitus, asthma, Chronic Obstructive Pulmonary Diseases (COPD) and other forms of heart problems apart from hypertension). More than 60% of the study participants reported to have used at least one form of locally available herbal preparations. Symptoms and signs reported at enrolment subsided relatively faster among those supplemented with herbal preparations than among their counterparts. PCR results of nearly 66% of the study participants had converted to PCR negative at different rates by day 7 (61 vs 78%) and by day 14 (64.3% vs 36.4%) among herbal and non-herbal users, respectively. Overall, proportionally mortality was higher among those who used standard care alone (23.3% vs 16.9%) compared to those supplemented with herbal preparations.

Conclusion: The use of herbal preparations in addition to standard care treatment showed a positive effect in subsiding signs and symptoms and decreasing mortality among COVID-19 patients. The findings from this study call for further research, especially clinical trials, to ascertain these findings.

Role of Community Health Workers in early detection, reporting and response to infectious disease outbreaks: Experience from Marburg Outbreak Management in Kagera region, Northwestern Tanzania

Emmanuel Mnkeni — 2024-09-27

Background: Community health workers (CHWs) are involved in different segments of health promotion and surveillance systems to control the outbreak that occurred in March 2023. CHW initially detected and reported deaths of unknown causes through an established community electronic event-based surveillance. Later, it was confirmed to be MVD; until the end of the outbreak, a total of nine people were confirmed with Marburg viruses, and six of them died, making a case fatality rate of 66.7%.

Involvement of Community Health Workers in Response to Marburg Virus Disease: CHWs from the high-risk areas were oriented to the disease and appropriate control measures. They were guided on the necessary precautions to ensure their safety while working and equipped with infection protection equipment. CHWs were in a frontline position to support the mobilization of community members, awareness creation, provision of public health education, and psychosocial support. Reached the community members by visiting households, public places, schools, and worship places. They received monetary remuneration to commit outstanding time to the outbreak control efforts.

Conclusion: The lesson learnt is that trained CHWs adequately equipped with working tools, protective equipment and remuneration can contribute substantially to outbreak detection and response initiatives. We advocate for their involvement in future outbreak preparedness and response because of their centric position in communities where traditional outbreaks start. Recommend adopting policy and practice strategies that promote their integration and recognition by health systems as a paid cadre to sustain and enhance their efficiency.

Missed Advanced Abdominal Pregnancy: A Case Report

Mwajabu Mmbaga — 2024-09-27

Early diagnosis of an abdominal pregnancy is difficult since it is associated with a wide range of signs and symptoms. However, ultrasound is the most effective method for diagnosing an abdominal ectopic pregnancy. We present a case of advanced abdominal ectopic pregnancy, which progressed to the second trimester and ended up with fetal death. Despite having repeated ultrasound scanning, the diagnosis was missed. This case report emphasizes the need for a high index of suspicion and correlation of the patient’s signs and symptoms with ultrasound findings to make an early diagnosis of abdominal ectopic pregnancy.

Determinants of Hospital Performance under Variable Ownership Pattern: A Two-Stage Analysis

Somnath Chatterjee — 2024-09-27

This study aims to insight the performance of three distinct categories of hospitals according to their ownership pattern in the form of their relative efficiency in the districts of East and West Bardhaman, West Bengal, India. It assesses whether the differences in performances among these hospitals are significant or not. The study also investigates the determinants of the performance of hospitals. Data envelopment analysis is used to measure the performance of hospitals under three distinct ownership categories. The Mann Whitney U Test is employed to examine whether the differences in performances among these hospitals are significant or not. Finally, Censored Tobit Analysis is used to insight the determinants of their performance. Hospitals are categorized according to their ownership pattern, namely, government hospitals owned by state government (H_GOV), public hospitals owned by public sector undertakings (H_PSU), hospitals owned by private authorities (H_PVT). Considering the input-output variables, relative performances have been measured, where the hospitals under government ownership shows best performance, followed by H_PSU and H_PVT. This performance level has significant determinants like size of the hospital, bed occupancy rate and also the management and authority of the hospitals. In a developing or under developed nation, all alternative healthcare providers need to be efficient enough for the rationale of mass health profit. The vision of ‘health for all’ can be reached through the mission of ‘healthcare inclusion’ strategy by including all hospitals in the supply side regardless of their motive, ownership pattern or any other phenomenon.

Oral Prosthesis Cleaning Practice and Oral Health Status of Removable Oral Prosthesis Wearers who attended Kilimanjaro Christian Medical Centre, Moshi, Tanzania

Ruchius Philbert — 2024-10-01

Background: Maintaining good oral health and extending the lifespan of prostheses require effective and routine cleaning procedures for complete and partially removable appliances. Removable oral prostheses should be cleaned daily to remove bacterial plaque and prevent infections, such as Candida albicans and denture stomatitis. Patients with affected prostheses must practice good oral hygiene for the rest of their lives. This study aims to assess the Oral prosthesis cleaning practice and oral health status of Removable Oral Prosthesis Wearers who attended Kilimanjaro Christian Medical Centre, Moshi, Tanzania.

Materials and methods: The sample size was calculated using the formula for cross-sectional studies developed by Kish and Leslie (1965), and convenience sampling was employed. This hospital-based descriptive cross-sectional study involved 200 patients who attended the Kilimanjaro Christian Medical Centre dental clinic in Moshi, Tanzania. A closed-ended tool and a self-administered questionnaire were used to assess the oral prosthesis cleaning practices and oral health status of removable oral prosthesis wearers. Descriptive and logistic regression analyses were then conducted using STATA software version 15.0. A p-value of less than 5% was considered statistically significant.

Results: The average age of the participants was 57 years, with 56% female. This study revealed that the majority, 44%, had good denture hygiene. It also found that 49.5% of patients over 60 had poor hygiene habits. Additionally, 64.0% of the participants did not sleep with their dentures, and 27.0% cleaned them more than twice daily. Only 9.5% of the participants received annual examinations for their dentures, and 25.95% had inflammation on the denture's fit surface. The independent predictors of good oral hygiene were age, frequency of denture check-ups, frequency of denture cleaning, and palatal erythema.

Conclusions: The study found that the hygiene practices for removable dentures were unfavourable. Most patients sleep with dentures in place; the preferred cleaning method is water and toothpaste. Therefore, dentists should instruct patients on proper denture care to prevent oral cavity infections.

Awareness and availability of micronutrients powders among mothers and caregivers of children aged 6 - 59 months in Zanzibar City

Rania Nahdi — 2024-09-27

Background: Micronutrient powders (MNP) are designed to supplement micronutrients in foods consumed by children or pregnant women in settings where micronutrient deficiencies are prevalent. Organisations, including humanitarian agencies, the Ministry of Health, and non-governmental organisations distribute them. This study aimed to assess the awareness and availability of micronutrient powders (MNPs) among mothers and caregivers in Zanzibar City. The study specifically aimed to assess the understanding of MNPs among mothers and caregivers and to assess the use of MNPs among children in Zanzibar.

Methods: The study employed a longitudinal design, whereby data were collected at a single point in time over two months. A combination of qualitative and quantitative approaches was employed. Purposive sampling was used to identify sellers of MNPs sachets. A total of 365 respondents were surveyed, comprising two MNPs sellers in Zanzibar and 263 caregivers and mothers in Zanzibar. The former was interviewed face-to-face, while the latter completed a pre-tested questionnaire and checklists. However, the study involved three focus group discussions with customers of MNPs, namely mothers and caregivers, to collect data.

Results: The results indicated that most mothers and caregivers were unaware of the MNPs. The product was not readily available or used during the study period. Furthermore, there was a lack of clarity regarding the product among mothers and caregivers. The mothers and caregivers believed that the MNPs were a strategy for vaccinating their children and/or making them infertile.

Conclusions: Community health workers needed training to counsel mothers and caregivers appropriately. Further research is required to ascertain the beliefs and social norms regarding MNPs among parents of children under five in Zanzibar.

Magnitude of Repeat Use of Emergency Contraceptives Among Women of Reproductive Age in Tanzania

Kijakazi Obed Mashoto — 2024-10-08

Background: Emergency contraceptives are intended to mitigate the risk of conceiving unwanted pregnancies following unprotected sexual intercourse. However, there is concern about the increasing repeated use of emergency contraceptive pills among women of reproductive age.

Objectives: This study aimed to determine the use and magnitude of repeated use of emergency contraceptive pills and associated factors among women of reproductive age.

Methods: A cross-sectional study was conducted in six out of twenty-six administrative regions of mainland Tanzania. A total of 1,284 women of reproductive age were interviewed using a structured questionnaire.

Results: The rate of ever use of emergency contraceptives was 17.4%. One out of 10 women of reproductive age have used emergency contraceptive pills in the previous 12 months. Nearly half of clients of emergency contraceptive pills were prevented by their spouses or partners from using regular family planning methods. Of the 224 users of emergency contraceptives, 198 (88.4%) affirmed that they had used the pills more than once. Of those, 159 (80.3%) reported to have used emergency contraceptive pills several times (more than three times). Knowledge of the use of emergency contraceptive pills varied with education, marital status, geographical location, age, and wealth index. Most women of reproductive age (82.9%) do not know the appropriate use of emergency contraceptive pills, particularly in Mbeya and Mwanza, where all interviewed women of reproductive age were not aware that emergency contraceptive pills are used to avoid unwanted pregnancy in emergencies only. A significantly low proportion of women of reproductive age in Mbeya (6.7%), adolescent girls (34.6%), slightly over one-third of married and unmarried women, and those in middle and lower wealth index knew the right time to take emergency contraceptive pills. A significantly low proportion of women of reproductive age in Mbeya (36.7%) agreed that emergency contraceptive pills are safe for use and that they can be recommended to a friend. Nearly one-third of women of reproductive age in Mwanza (27.3%), one-fifth of women of reproductive age with tertiary education (21.6%), and almost a quarter of employed women of reproductive age (24%) had a negative perception of the use of emergency contraceptive pills. Repeated use of emergency contraceptive pills was associated with the region of residence, the status of the use of regular FP methods, education, knowledge of indication and appropriate time to take emergency contraceptive pills, and perceived safety of emergency contraceptive pills.

Conclusion: Although the use of emergency contraceptives is still modest, the proportion of women of reproductive age who reported several repeated uses of emergency contraceptive pills is high, particularly so among women of reproductive age in Mwanza and Mtwara, those with tertiary education and those who do not know that prescription is not required to get emergency contraceptive pills. Interventions to educate women of reproductive age on indication and appropriate use of emergency contraceptives are required.

Prevalence and risk factors for depression among patients with spinal cord injury attended at Kilimanjaro Christian Medical Centre from August 2021 to May 2022

Said Rashid — 2024-09-27

Background: Depression after SCI inhibits physical rehabilitation and exacerbates physical health complications, which results in more extended lengths of stay for inpatient care, less independence following discharge, poor compliance with self-care, higher medical expenses, and increased risk of suicide.

Objective: To determine the prevalence and risk of depression among patients with SCI who attended Kilimanjaro Christian Medical Center from August 2021 to June 2022.

Methodology: This is a hospital-based analytical cross-sectional study conducted at KCMC orthopedic and physiotherapy departments whereby 129 patients with SCI were captured, and those who were below 18 years, with less than 2 weeks of history of spinal cord injury, polytrauma patients, patients with a history of psychiatric illness and SCI patients with cognitive speech problems were excluded from the study .74 patients were interviewed using questionnaire and Swahili version of PHQ-9 depression assessment questionnaire. The associations were measured using the Fischer exact test and Odds ratio with 95% CI with a significance level set at p<0.05.

Results: 74 participants were included in this study, the median age of the study participants being 36 years, ranging (from 21 to 74) years, and predominantly males being 55 (74.3%). The prevalence of Depression after SCI was found to be 35.1%. Factors such as SCI duration of ≥ 6 months (OR=3.50, 95% CI: 2.44 – 28.0, p=0.001), having pressure sore (OR=8.40, 95% CI: 1.02 – 6.92, p<0.001), having bowel dysfunction (OR= 3.20, 95% CI: 2.02 – 6.75, p=0.001), having sexual dysfunction (OR=3.80, 95% CI: 3.50 – 4.80, p=0.001) and non-surgical management of SCI (OR=11.40, 95% CI: 1.41 – 91.86, p=0.023), have more odds of developing depression after SCI and were statistically significance.

Conclusion: More than a third of patients with SCI had depression. The risk factors of depression after SCI included patients with Complete SCI (ASIA A), Cervical spine injury, patients managed conservatively, those with prolonged hospital stay, patients without health insurance and patients with complications after SCI such as pressure ulcers, neurogenic bowel, neurogenic bladder, and sexual dysfunction.

Effectiveness of a preoperative checklist in reducing surgery cancellations in a tertiary hospital in a low-income country

Emmanuel Henry Suluba — 2024-09-27

Background: A high surgery cancellation rate has been a problem at Muhimbili National Hospital for a decade, ranging from 16% to 29%, with patient factors accounting for up to 40% of cancelled surgeries. One critical aspect of addressing the problem was the implementation of a preoperative checklist to double-check the preoperative workup and reduce cancellations due to patient factors. This paper aimed to determine the effectiveness of a preoperative checklist in reducing the cancellation rate of planned surgeries.

Methods: A 6-month quasi-experimental study was conducted at Muhimbili National Hospital. We enrolled 298 and 300 patients in the control and interventional phases, respectively. The data was gathered using a pre-tested checklist, coded, entered, and analysed using SPSS version 22.0.

Results: The checklist implementation reduced the cancellation rate from 19.1% to 16.3%, with patients' factors significantly decreasing from 46 (15.4%) in the control group to 14 (4.7%). p=0.000.

Conclusions: A preoperative checklist reduces cancellations due to patient factors and is a promising tool for reducing surgery cancellations. It is recommended that the preoperative checklist be used regularly at MNH to reduce surgical cancellations.