Kauzeni, A.S.; Masao, H.P.; Sawe, E.N.; Shechambo, F.C. [Dar Es Salaam Univ. (Tanzania). Inst. of Resource Assessment; Ellegaard, A. [Stockholm Environment Inst. (Sweden)
In Tanzania, like in many other developing countries in Southern and Eastern Africa, bioenergy planning has received relatively little attention, compared to planning for `modern` energy sources, although it accounts for about 90% of the country`s energy supply. As a result there is less understanding of the complexity and diversity of bioenergy systems. There is a lack of reliable data and information on bio-resources, their consumption and interaction with social, economic, institutional and environmental factors. This is largely due to lack of adequately developed and easily understood methods of data and information development, analysis and methods of evaluating available bioenergy options. In order to address the above constraints a project was initiated where the general objective was to develop and test a multi-disciplinary research method for identifying bioenergy options that can contribute to satisfying the energy needs of the rural household, agricultural and small scale industrial sectors, promote growth and facilitate sustainable development. The decision on the development and testing of a multidisciplinary research method was based on the fact that in Tanzania several bioenergy programmes have been introduced e.g. tree planting, improved cookstoves, biogas, improved charcoal making kilns etc. for various purposes including combating deforestation; promoting economic growth, substitution of imported petroleum fuels, health improvement, and raising standards of living. However efforts made in introducing these programmes or interventions have met with limited success. This situation prevails because developed bioenergy technologies are not being adopted in adequate numbers by the target groups. There are some indications from the study that some of the real barriers to effective bioenergy interventions or adoption of bioenergy technologies lie at the policy level and not at the project level. After the development and testing of the methodology
Rasch, Vibeke; Kipingili, Rose
OBJECTIVE: To describe unsafe abortion methods and associated health consequences in Tanzania, where induced abortion is restricted by law but common and known to account for a disproportionate share of hospital admissions. METHOD: Cross-sectional study of women admitted with alleged miscarriage:...
Rasch, Vibeke; Yambesi, Fortunata; Kipingili, Rose
Tanzania and 42% in rural Tanzania stated that their pregnancy was unwanted. Contraceptive acceptance among women with unwanted pregnancies was high; 93% in urban Tanzania and 71% in rural Tanzania left with a contraceptive method. CONCLUSION: The high proportion of women with unwanted pregnancies in urban...... and rural Tanzania underlines the need of scaling up postabortion contraceptive service....
Mwanri, A.W.; Kinabo, J.; Ramaiya, K.; Feskens, E.J.M.
Aim - To estimate prevalence of gestational diabetes mellitus (GDM) and associated determinants in urban and rural Tanzania. Methods - A cross-sectional study was conducted from 2011 through 2012 in selected urban and rural communities. Pregnant women (609 urban, 301 rural), who were not previously
Mbogo, Shaaban Aman
It is estimated that one billion people worldwide do not have access to treated drinking water. This paper reports on an investigation into the potential of indigenous or natural water treatment methods as alternatives to conventional chemical water treatment methods. The seeds of five natural plant species--Vigna unguiculata, Phaseolus mungo, Glycine max, Pisum sativam, and Arachis hypogea--were evaluated for the removal of turbidity, and their efficiency was compared with that of alum. The use of a solar energy-saving method to disinfect drinking water--leaving it to heat under the sun to reduce bacteria colonies--also was evaluated, The study revealed that for raw water with turbidity of 482 nephelometric turbidity units, coagulation with seed extracts from natural plant species reduced natural turbidity by 96.7 to 100 percent when the seed extract was used as the primary coagulant and by 100 percent when it was used as a coagulant aid. The study showed further that natural coagulants were as effective as commercial alum [Al2(SO4)3] and even superior for clarification because the optimum dosage was low compared with that of alum. Leaving samples of water clarified by natural coagulants on a black-painted roof for 8 hours achieved up to 100 percent bacteria kill.
Mrisho, Mwifadhi; Schellenberg, Joanna A; Mushi, Adiel K.; Obrist, Brigit; Mshinda, Hassan; Tanner, Marcel; Schellenberg, David
BACKGROUND Studies of factors affecting place of delivery have rarely considered the influence of gender roles and relations within the household. This study combines an understanding of gender issues relating to health and help-seeking behaviour with epidemiological knowledge concerning place of delivery. METHODS In-depth interviews, focus group discussions and participant observation were used to explore determinants of home delivery in southern Tanzania. Quantitative data were ...
Masanyiwa, Z.S.; Niehof, A.; Termeer, C.J.A.M.
This article examines the impact of decentralization reforms on improving access to domestic water supply in the rural districts of Kondoa and Kongwa, Tanzania, using a users' and a gender perspective. The article addresses the question whether and to what extent the delivery of gender-sensitive wat
Kondylis, Florence; Manacorda, Marco
Is improved school accessibility an effective policy tool for reducing child labor in developing countries? We address this question using microdata from rural Tanzania and a regression strategy that attempts to control for nonrandom location of households around schools as well as classical and nonclassical measurement error in self-reported…
Kondylis, Florence; Manacorda, Marco
Is improved school accessibility an effective policy tool for reducing child labor in developing countries? We address this question using microdata from rural Tanzania and a regression strategy that attempts to control for nonrandom location of households around schools as well as classical and nonclassical measurement error in self-reported…
Masanyiwa, Z.S.; Niehof, A.; Termeer, C.J.A.M.
This article examines the impact of decentralization reforms on improving access to domestic water supply in the rural districts of Kondoa and Kongwa, Tanzania, using a users' and a gender perspective. The article addresses the question whether and to what extent the delivery of gender-sensitive wat
Gundersen Svein G
Full Text Available Abstract Background HIV-associated anemia is common and associated with poor prognosis. However, its response to antiretroviral treatment (ART in rural Africa is poorly understood. Methods HIV-infected adults (≥15 years who enrolled in HIV care at Haydom Lutheran Hospital in northern Tanzania were included in the study. The effect of ART (zidovudine/stavudine + lamivudine + efavirenz/nevirapine on HIV-associated anemia was studied in a subset of patients who were anemic at the time they started ART and had a follow-up hemoglobin measurement 12 months later. Pregnant women were excluded from the study, as were women who had given birth within the past 6 weeks. Anemia was defined as hemoglobin Results At enrollment, mean hemoglobin was 10.3 g/dL, and 649 of 838 patients (77.4% were anemic. Of the anemic patients, 254 (39.1% had microcytosis and hypochromia. Among 102 patients who were anemic at ART initiation and had a follow-up hemoglobin measurement after 12 months, the mean hemoglobin increased by 2.5 g/dL (P Conclusions Most patients had anemia at enrollment, of whom nearly 40% had microcytosis and hypochromia suggestive of iron deficiency. The mean hemoglobin increased significantly in patients who received ART, but one third were still anemic 12 months after ART initiation indicating that additional interventions to treat HIV-associated anemia in rural Africa might be warranted, particularly in patients with microcytosis and those treated with zidovudine.
Kondylis, Florence; Manacorda, Marco
Is improved school accessibility an effective policy tool for reducing child labor in developing countries? We address this question using micro data from rural Tanzania and a regression strategy that attempts to control for non-random location of households around schools as well as classical and nonclassical measurement error in self-reported distance to school. Consistent with a simple model of child labor supply, but contrary to what appears to be a widespread perception, our analysis sho...
Mtenga, S.; Shamba, D.; Wamoyi, J.; Kakoko, D.; Haafkens, J.; Mongi, A.; Kapiga, S.; Geubbels, E.
Objective: To explore ideas of truck drivers and villagers from rural Tanzania about heterosexual anal sex (HAS) and the associated health risks. Methods: Qualitative study using 8 in-depth interviews (IDIs) and 2 focus group discussions (FGDs) with truck drivers and 16 IDIs and 4 FGDs with villager
Keywords: Central Tanzania, rural poultry, scavengeable feed resources, nutrient composition, crop contents, season, farming system, chemical composition, supplementary feeding, weaning, egg production, growth rate, survival rate, laying management, indigenous chickens The main objective of the
Ilskog, Elisabeth E-mail: firstname.lastname@example.org; Kjellstroem, B. E-mail: email@example.com; Gullberg, Monica E-mail: firstname.lastname@example.org; Katyega, Maneno E-mail: email@example.com; Chambala, William E-mail: firstname.lastname@example.org
One possibility to accelerate the progress of rural electrification in developing countries could be to form independent electrification co-operatives that are allowed to generate and distribute electric power and set their own tariffs. This approach has been successfully tried in the village Urambo, located about 80 km west of Tabora in Tanzania. The co-operative was formed in 1993 and started regular operation in 1994 with 67 consumers. The co-operative received initial financial support for rehabilitation of a diesel power plant and some other investments. The national utility TANESCO has provided technical support and training for operators and an accountant. Despite a tariff more than 15 times higher than in the nearby town Tabora that is served by TANESCO, the number of consumers in Urambo has been growing and reached 241 in October 2002. About 70% of the supplied electricity in 2002 was used by households, 15% in businesses, 12% in institutions and public buildings and approximately 3% for street lighting. The reliability of the supply has improved from 80% in 1994, to 97% during 2002. The experiences must be considered as very promising. Several more electrification co-operatives have been formed in Tanzania and are looking for financing for the necessary initial investments.
Full Text Available Diarrheal diseases account for 7% of deaths in children under five years of age in Tanzania. Improving sanitation is an essential step towards reducing these deaths. This secondary analysis examined rural Tanzanian households’ sanitation behaviors and attitudes in order to identify barriers and drivers to latrine adoption. The analysis was conducted using results from a cross-sectional study of 1000 households in five rural districts of Tanzania. Motivating factors, perceptions, and constraints surrounding open defecation and latrine adoption were assessed using behavioral change theory. Results showed a significant association between use of improved sanitation and satisfaction with current sanitation facility (OR: 5.91; CI: 2.95–11.85; p = 0.008. Livestock-keeping was strongly associated with practicing open defecation (OR: 0.22; CI 0.063–0.75; p < 0.001. Of the 93 total households that practiced open defecation, 79 (85% were dissatisfied with the practice, 62 (67% had plans to build a latrine and 17 (18% had started saving for a latrine. Among households that planned to build a latrine, health was the primary reason stated (60%. The inability to pay for upgrading sanitation infrastructure was commonly reported among the households. Future efforts should consider methods to reduce costs and ease payments for households to upgrade sanitation infrastructure. Messages to increase demand for latrine adoption in rural Tanzania should integrate themes of privacy, safety, prestige and health. Findings indicate a need for lower cost sanitation options and financing strategies to increase household ability to adopt sanitation facilities.
Sara, Stephen; Graham, Jay
Diarrheal diseases account for 7% of deaths in children under five years of age in Tanzania. Improving sanitation is an essential step towards reducing these deaths. This secondary analysis examined rural Tanzanian households’ sanitation behaviors and attitudes in order to identify barriers and drivers to latrine adoption. The analysis was conducted using results from a cross-sectional study of 1000 households in five rural districts of Tanzania. Motivating factors, perceptions, and constraints surrounding open defecation and latrine adoption were assessed using behavioral change theory. Results showed a significant association between use of improved sanitation and satisfaction with current sanitation facility (OR: 5.91; CI: 2.95–11.85; p = 0.008). Livestock-keeping was strongly associated with practicing open defecation (OR: 0.22; CI 0.063–0.75; p < 0.001). Of the 93 total households that practiced open defecation, 79 (85%) were dissatisfied with the practice, 62 (67%) had plans to build a latrine and 17 (18%) had started saving for a latrine. Among households that planned to build a latrine, health was the primary reason stated (60%). The inability to pay for upgrading sanitation infrastructure was commonly reported among the households. Future efforts should consider methods to reduce costs and ease payments for households to upgrade sanitation infrastructure. Messages to increase demand for latrine adoption in rural Tanzania should integrate themes of privacy, safety, prestige and health. Findings indicate a need for lower cost sanitation options and financing strategies to increase household ability to adopt sanitation facilities. PMID:25247427
Full Text Available Abstract Background Brucellosis is known to cause debilitating conditions if not promptly treated. In some rural areas of Tanzania however, practitioners give evidence of seeing brucellosis cases with symptoms of long duration. The purpose of this study was to establish health-seeking behaviour of human brucellosis cases in rural Tanzania and explore the most feasible ways to improve it. Methods This was designed as a longitudinal study. Socio-demographic, clinical and laboratory data were collected from patients who reported to selected hospitals in rural northern Tanzania between June 2002 and April 2003. All patients with conditions suspicious of brucellosis on the basis of preliminary clinical examination and history were enrolled into the study as brucellosis suspects. Blood samples were taken and tested for brucellosis using the Rose-Bengal Plate Test (RBPT and other agglutination tests available at the health facilities and the competitive ELISA (c-ELISA test at the Veterinary Laboratory Agencies (VLA in the UK. All suspects who tested positive with the c-ELISA test were regarded as brucellosis cases. A follow-up of 49 cases was made to collect data on health-seeking behaviour of human brucellosis cases. Results The majority of cases 87.7% gave a history of going to hospital as the first point of care, 10.2% purchased drugs from a nearby drug shop before going to hospital and 2% went to a local traditional healer first. Brucellosis cases delayed going to hospital with a median delay time of 90 days, and with 20% of the cases presenting to hospitals more than a year after the onset of symptoms. Distance to the hospital, keeping animals and knowledge of brucellosis were significantly associated with patient delay to present to hospital. Conclusion More efforts need to be put on improving the accessibility of health facilities to the rural poor people who succumb to most of the diseases including zoonoses. Health education on brucellosis in
Full Text Available Abstract Background Injuries are becoming a major health problem in developing countries. Few population based studies have been carried out in African countries. We examined the pattern of nonfatal injuries and associated risk factors in an urban and rural setting of Tanzania. Methods A population-based household survey was conducted in 2002. Participants were selected by cluster sampling. A total of 8,188 urban and 7,035 rural residents of all ages participated in the survey. All injuries reported among all household members in the year preceding the interview and resulting in one or more days of restricted activity were included in the analyis. Results A total of 206 (2.5% and 303 (4.3% persons reported to have been injured in the urban and rural area respectively. Although the overall incidence was higher in the rural area, the incidence of major injuries (≥ 30 disability days was similar in both areas. Males were at a higher risk of having an injury than females. Rural residents were more likely to experience injuries due to falls (OR = 1.6; 95% CI = 1.1 – 2.3 and cuts (OR = 4.3; 95% CI = 3.0 – 6.2 but had a lower risk of transport injuries. The most common causes of injury in the urban area were transport injuries and falls. In the rural area, cuts and stabs, of which two thirds were related to agriculture, formed the most common cause. Age was an important risk factor for certain types of injuries. Poverty levels were not significantly associated with experiencing a nonfatal injury. Conclusion The patterns of injury differ in urban and rural areas partly as a reflection of livelihoods and infrastructure. Rural residents are at a higher overall injury risk than urban residents. This may be important in the development of injury prevention strategies.
Kavana, Nicholas; Sonaimuthu, Parthasarathy; Kasanga, Christopher; Kassuku, Ayub; Al-Mekhlafi, Hesham M.; Fong, Mun Yik; Khan, Mohammad Behram; Mahmud, Rohela; Lau, Yee Ling
In this study, the seroprevalence of sparganosis and its relationship with sociodemographic factors in northern Tanzania have been assessed. A total of 216 serum samples from two rural districts, Monduli and Babati, were tested for sparganosis using an enzyme-linked immunosorbent assay. The seroprevalence of anti-sparganum IgG antibodies was 62.5% (95% confidence interval [CI] = 56.1–68.9) in all age groups. There were significant associations between district (relative risk [RR] = 1.95, 95% CI = 1.42–2.69), education (RR = 1.40, 95% CI = 1.15–1.70), and pet ownership with seropositivity (RR = 1.48, 95% CI = 1.02–2.16) based on univariate analysis. However, only the district was significantly associated with seropositivity (odds ratio = 4.20, 95% CI = 1.89–9.32) in binary logistic regression analysis. Providing health education to people residing in sparganosis-endemic areas is likely to improve the efficacy of preventative measures and reduce human disease burden. PMID:27481059
demand pattern in Tanzania, Uganda and Nicaragua are discussed and a choice of strategy for an extensive survey of seed demand and supply in Tanzania is made. Different data collection methods and tools, e.g. quantitative and qualitative surveys and rapid rural appraisals, are described in detail...... and preferences among private farmers in Tanzania. A framework for investigating seed demand and supply is outlined. The role of a national tree seed project in a seed supply sector is discussed and data requirements for strategy on seed procurement and tree improvement are outlined. Earlier surveys on seed......Insufficient seed supplies is often a major constraint on tree planting activities in developing countries. A central problem is to assess the actual demands for tree seed. This report shall, as a part of a PhD-study, prepare an investigation of different methods for surveying tree seed demands...
Background notes on Tanzania present a profile of nationality, population count of 26 million, growth rate of 3.5%, ethnic groups (130), religions (33% Muslim, 33% animist, 33% Christian), languages, education (86% primary), literacy (79%), health (infant mortality of 106/1000), and work force (90% agriculture). Geographic data are given for the area, cities, terrain, and climate. The Tanzanian government is a republic with executive, legislative, and judicial branches of government. There is 1 political party and everyone 18 years is eligible to vote. 4% of the gross domestic product (GDP) ($5.9 billion) is devoted to defense. Economic growth is 4.3%/year and person income is $240/capita. Natural resources, agriculture, industry, and trade are identified. $400 million has been received between 1970-92 in US economic aid. The 1992 official exchange rate is 300 Tanzanian shillings to the US dollar. Descriptive text is given for the population, the history of Tanganyika and Zanzibar, the government, principal government officials (President, 1st Vice President [VP], 2nd VP and President of Zanzibar, Prime Minister, Foreign Affairs Minister, Ambassador to the US, Ambassador to the UN, and US embassy address and phone number), political conditions, the economy, the defense, foreign relations, and US-Tanzanian relations. Principal US officials are identified for the Ambassador, Deputy Chief of Mission, USAID Director, and Public Affairs Officer; the US embassy address is given also. The population is 80% rural with a density of 1/sq km in arid areas, 51/sq km on the mainland, and 134/sq km on Zanzibar. The new capital will be Dodoma in central Tanzania. Most residents are of Bantu stock; nomadic groups are the Masai and the Luo. 1% are non-Africans. Government has a strong central executive. The current President is Ali Hassan Mwinyi. The Revolutionary Party is in the primary policymaking body and provides all government leaders. The government seeks to foster the
Songstad Nils Gunnar
Full Text Available Abstract Background Severe shortages of qualified health workers and geographical imbalances in the workforce in many low-income countries require the national health sector management to closely monitor and address issues related to the distribution of health workers across various types of health facilities. This article discusses health workers' preferences for workplace and their perceptions and experiences of the differences in working conditions in the public health sector versus the church-run health facilities in Tanzania. The broader aim is to generate knowledge that can add to debates on health sector management in low-income contexts. Methods The study has a qualitative study design to elicit in-depth information on health workers' preferences for workplace. The data comprise ten focus group discussions (FGDs and 29 in-depth interviews (IDIs with auxiliary staff, nursing staff, clinicians and administrators in the public health sector and in a large church-run hospital in a rural district in Tanzania. The study has an ethnographic backdrop based on earlier long-term fieldwork in Tanzania. Results The study found a clear preference for public sector employment. This was associated with health worker rights and access to various benefits offered to health workers in government service, particularly the favourable pension schemes providing economic security in old age. Health workers acknowledged that church-run hospitals generally were better equipped and provided better quality patient care, but these concerns tended to be outweighed by the financial assets of public sector employment. In addition to the sector specific differences, family concerns emerged as important in decisions on workplace. Conclusions The preference for public sector employment among health workers shown in this study seems to be associated primarily with the favourable pension scheme. The overall shortage of health workers and the distribution between health
Chomi, Eunice Nahyuha; Mujinja, Phares Gamba; Enemark, Ulrika
cross-subsidisation across the funds. This paper analyses whether the risk distribution varies across the Community Health Fund (CHF) and National Health Insurance Fund (NHIF) in two districts in Tanzania. Specifically we aim to 1) identify risk factors associated with increased utilisation of health......INTRODUCTION: Multiple insurance funds serving different population groups may compromise equity due to differential revenue raising capacity and an unequal distribution of high risk members among the funds. This occurs when the funds exist without mechanisms in place to promote income and risk...... services and 2) compare the distribution of identified risk factors among the CHF, NHIF and non-member households. METHODS: Data was collected from a survey of 695 households. A multivariate logisitic regression model was used to identify risk factors for increased health care utilisation. Chi-square tests...
Full Text Available BACKGROUND: Brucellosis is a zoonosis of veterinary, public health and economic significance in most developing countries. Human brucellosis is a severely debilitating disease that requires prolonged treatment with a combination of antibiotics. The disease can result in permanent and disabling sequel, and results in considerable medical expenses in addition to loss of income due to loss of working hours. A study was conducted in Northern Tanzania to determine the risk factors for transmission of brucellosis to humans in Tanzania. METHODS: This was a matched case-control study. Any patient with a positive result by a competitive ELISA (c-ELISA test for brucellosis, and presenting to selected hospitals with at least two clinical features suggestive of brucellosis such as headache, recurrent or continuous fever, sweating, joint pain, joint swelling, general body malaise or backache, was defined as a case. For every case in a district, a corresponding control was traced and matched by sex using multistage cluster sampling. Other criteria for inclusion as a control included a negative c-ELISA test result and that the matched individual would present to hospital if falls sick. RESULTS: Multivariable analysis showed that brucellosis was associated with assisted parturition during abortion in cattle, sheep or goat. It was shown that individuals living in close proximity to other households had a higher risk of brucellosis. People who were of Christian religion were found to have a higher risk of brucellosis compared to other religions. The study concludes that assisting an aborting animal, proximity to neighborhoods, and Christianity were associated with brucellosis infection. There was no association between human brucellosis and Human Immunodeficiency Virus (HIV serostatus. Protecting humans against contact with fluids and tissues during assisted parturition of livestock may be an important means of reducing the risk of transferring brucellosis from
WETLAND VEGE TATION IN MINING SITES, LAKE VICTORIA BASIN,. TANZANIA. JF Machiwa. Department of Aquatic Environment and Conservation, ... basin where small-scale gold processing activities are carried out to assess levels of.
rapidly in areas with inadequate treatment of sewage and drinking ... the performance of pit latrines, septic tanks, disposal sites, drainage systems, solid waste management and ... endemic to Tanzania with small outbreaks being reported ...
Ngalawa, Athanas; Simmt, Elaine; Glanfield, Florence
This article describes a qualitative exploration of a primary school in a remote rural community of Tanzania, whose students showed promising performance in mathematics, as measured by the Primary School Leaving Examinations (PSLE). Case study methods were used to conduct research about the school and the community and included interviews, focus…
Dotchin Catherine L
Full Text Available Abstract Background Parkinson disease (PD causes physical disability that negatively affects the quality of life of the sufferer's and their families. There are no Parkinson's disease (PD social science studies published from Africa. This paper presents findings from a qualitative research study on how PD is perceived and treated in a population of approximately 161,000 within a demographic surveillance site in rural Tanzania. Methods We conducted in-depth interviews with 28 PD sufferers, 28 carers, 4 health workers and 2 traditional healers. In addition, 6 focus group discussions were conducted in 3 villages to investigate wider community views of PD. Results PD sufferers expressed frustration with the physical, psychological, social and economic consequences of the illness. Feelings of a diminished quality of life characterised by dependency, stigma and social isolation were common. Additionally, a handful of male sufferers related their sexual incompetence to the illness. Carers complained of lost income opportunities and social isolation resulting from caring for sufferers. Misconceptions about the cause, symptoms and appropriated PD treatment were widespread. Only 2 PD sufferers had commenced western type treatment through outsourcing drugs from other parts of the country and outside of Tanzania. Conclusions This study highlights the urgent need for PD awareness and treatment interventions in such settings. Such interventions need to address the concerns and needs of sufferers, their carers and the wider community, including the health care system.
The United Republic of Tanzania was formed in 26th, April 1964. It consists of the mainland, formerly known as Yanganyika and Zanzibar Island. The capital is Dares Salaam and the official administrative capital is Dodoma.
Since 1945 to date the governance of the rural water sector in Tanzania has passed through multiple phases, from the colonial era to the times characterized by liberalization, decentra
Since 1945 to date the governance of the rural water sector in Tanzania has passed through multiple phases, from the colonial era to the times characterized by liberalization,
Kooijman-van Dijk, Annemarije L.; Clancy, Joy
There is little empirical evidence to underpin strategies of poverty reduction through income generation in small scale rural enterprises through supplying energy. This paper reports on research findings from a three country study in Bolivia, Tanzania and Vietnam which aimed to provide insights into
This book is about the relationship between donors and aid recipients in bilateral development cooperation programmes. Using the example of the Dutch District Rural Development Programmes (DRDPs) in Bukoba, Tanzania, it examines the processes in which the aid beneficiaries are engaged, so that they
Gullberg, Monica; Katyega, Maneno; Kjellstroem, Bjoern
The rural electrification program in Tanzania has been on going since independence in 1961, with the national utility, Tanzania Electric Supply Company Ltd. (TANESCO) being responsible for its implementation. By 1992, 14 townships and 37 villages had been electrified as a result of this program. This covers only a small fraction of rural Tanzania. It is estimated that in 1998, less than 1% of the rural households in Tanzania had access to electricity. Electricity constitutes only 1% of Tanzania's final energy consumption. Except for the few latest years, electricity generation and distribution in Tanzania has been the full responsibility of TANESCO. The national electricity grid is mainly supplied by large-scale hydro power plants (391 MW), and thermal power plants (148 MW). Rural areas are supplied either by a transmission line from the national grid or by diesel generator sets. The isolated branches run by TANESCO have an installed capacity amounting to a total of 23 MW. Electric lighting is the dominating use of electricity in rural areas. Industrial use in these areas is marginal. Very few rural households use electricity for cooking. Cooking is made with fuelwood and to some extent charcoal and kerosene. Where electricity is not available, kerosene in simple wick lamps is used for lighting. As part of the research co-operation between TANESCO and the Stockholm Environment Institute, SEI, an extensive evaluation of the experiences from the rural electrification program in Tanzania was carried out in 1989 - 1991. The four main conclusions from this evaluation were in summary: The rural people appreciate electrification. Rural electrification is a large financial burden on TANESCO. The quality of the service, in particular the supply reliability, is low in rural areas. Many of the perceived benefits of rural electrification, like the creation of small scale industries or reduced use of fuel wood for cooking, have not materialised to a significant degree. As
The thesis examines cooperation and participation as modes of institutional action to address women’ social and economic problems and needs in the context of rural Tanzania. It does so against the background of the history of cooperatives in Tanzania and development cooperation. The thesis
The thesis examines cooperation and participation as modes of institutional action to address women’ social and economic problems and needs in the context of rural Tanzania. It does so against the background of the history of cooperatives in Tanzania and development cooperation. The thesis tak
The thesis examines cooperation and participation as modes of institutional action to address women’ social and economic problems and needs in the context of rural Tanzania. It does so against the background of the history of cooperatives in Tanzania and development cooperation. The thesis tak
Effectiveness of a nutrition education package in improving feeding practices, dietary adequacy and growth of infants and young children in rural Tanzania: rationale, design and methods of a cluster randomised trial.
Kulwa, Kissa B M; Verstraeten, Roosmarijn; Bouckaert, Kimberley P; Mamiro, Peter S; Kolsteren, Patrick W; Lachat, Carl
Strategies to improve infant and young child nutrition in low- and middle- income countries need to be implemented at scale. We contextualised and packaged successful strategies into a feasible intervention for implementation in rural Tanzania. Opportunities that can optimise delivery of the intervention and encourage behaviour change include mothers willingness to modifying practices; support of family members; seasonal availability and accessibility of foods; established set-up of village peers and functioning health system. The primary objective of the study is to evaluate the effectiveness of a nutrition education package in improving feeding practices, dietary adequacy and growth as compared to routine health education. A parallel cluster randomised controlled trial will be conducted in rural central Tanzania in 9 intervention and 9 control villages. The control group will receive routine health education offered monthly by health staff at health facilities. The intervention group will receive a nutrition education package in addition to the routine health education. The education package is comprised of four components: 1) education and counselling of mothers, 2) training community-based nutrition counsellors and monthly home visits, 3) sensitisation meetings with health staff and family members, and 4) supervision of community-based nutrition counsellors. The duration of the intervention is 9 months and infants will be recruited at 6 months of age. Primary outcome (linear growth as length-for-age Z-scores) and secondary outcomes (changes in weight-for-length Z-scores; mean intake of energy, fat, iron and zinc from complementary foods; proportion of children consuming 4 or more food groups and recommended number of semi-solid/soft meals and snacks per day; maternal level of knowledge and performance of recommended practices) will be assessed at baseline and ages 9, 12 and 15 months. Process evaluation will document reach, dose and fidelity of the
Full Text Available Abstract Background High levels of rural to urban migration are a feature of most African countries. Our aim was to investigate changes, and their determinants, in cardiovascular risk factors on rural to urban migration in Tanzania. Methods Men and women (15 to 59 years intending to migrate from Morogoro rural region to Dar es Salaam for at least 6 months were identified. Measurements were made at least one week but no more than one month prior to migration, and 1 to 3 monthly after migration. Outcome measures included body mass index, blood pressure, fasting lipids, and self reported physical activity and diet. Results One hundred and three men, 106 women, mean age 29 years, were recruited and 132 (63.2% followed to 12 months. All the figures presented here refer to the difference between baseline and 12 months in these 132 individuals. Vigorous physical activity declined (79.4% to 26.5% in men, 37.8% to 15.6% in women, p -1 respectively, p -1, p = 0.01, and triglycerides fell (0.31 mmoll-1, p = 0.034. Blood pressure appeared to fall in both men and women. For example, in men systolic blood pressure fell by 5.4 mmHg, p = 0.007, and in women by 8.6 mmHg, p = 0.001. Conclusion The lower level of physical activity and increasing weight will increase the risk of diabetes and cardiovascular disease. However, changes in diet were mixed, and may have contributed to mixed changes in lipid profiles and a lack of rise in blood pressure. A better understanding of the changes occurring on rural to urban migration is needed to guide preventive measures.
Goodman, Catherine; Kachur, S Patrick; Abdulla, Salim; Bloland, Peter; Mills, Anne
The impact of market concentration has been little studied in markets for ambulatory care in the developing world, where the retail sector often accounts for a high proportion of treatments. This study begins to address this gap through an analysis of the consumer market for malaria treatment in rural areas of three districts in Tanzania. We developed methods for investigating market definition, sales volumes and concentration, and used these to explore the relationship between antimalarial retail prices and competition.The market was strongly geographically segmented and highly concentrated in terms of antimalarial sales. Antimalarial prices were positively associated with market concentration. High antimalarial prices were likely to be an important factor in the low proportion of care-seekers obtaining appropriate treatment.Retail sector distribution of subsidised antimalarials has been proposed to increase the coverage of effective treatment, but this analysis indicates that local market power may prevent such subsidies from being passed on to rural customers. Policymakers should consider the potential to maintain lower retail prices by decreasing concentration among antimalarial providers and recommending retail price levels. Copyright (c) 2009 John Wiley & Sons, Ltd.
Ferry Grace A
Full Text Available Abstract Objective To explore the equity of utilization of inpatient health care at rural Tanzanian health centers through the use of a short wealth questionnaire. Methods Patients admitted to four rural health centers in the Kigoma Region of Tanzania from May 2008 to May 2009 were surveyed about their illness, asset ownership and demographics. Principal component analysis was used to compare the wealth of the inpatients to the wealth of the region's general population, using data from a previous population-based survey. Results Among inpatients, 15.3% were characterized as the most poor, 19.6% were characterized as very poor, 16.5% were characterized as poor, 18.9% were characterized as less poor, and 29.7% were characterized as the least poor. The wealth distribution of all inpatients (p Conclusion The findings indicated that while current Tanzanian health financing policies may have improved access to health care for children under five, additional policies are needed to further close the equity gap, especially for obstetric inpatients.
Gerrets Rene PM
Full Text Available Abstract Background Tanzania has a well-developed network of commercial ITN retailers. In 2004, the government introduced a voucher subsidy for pregnant women and, in mid 2005, helped distribute free nets to under-fives in small number of districts, including Rufiji on the southern coast, during a child health campaign. Contributions of these multiple insecticide-treated net delivery strategies existing at the same time and place to coverage in a poor rural community were assessed. Methods Cross-sectional household survey in 6,331 members of randomly selected 1,752 households of 31 rural villages of Demographic Surveillance System in Rufiji district, Southern Tanzania was conducted in 2006. A questionnaire was administered to every consenting respondent about net use, treatment status and delivery mechanism. Findings Net use was 62.7% overall, 87.2% amongst infants (0 to1 year, 81.8% amongst young children (>1 to 5 years, 54.5% amongst older children (6 to 15 years and 59.6% amongst adults (>15 years. 30.2% of all nets had been treated six months prior to interview. The biggest source of nets used by infants was purchase from the private sector with a voucher subsidy (41.8%. Half of nets used by young children (50.0% and over a third of those used by older children (37.2% were obtained free of charge through the vaccination campaign. The largest source of nets amongst the population overall was commercial purchase (45.1% use and was the primary means for protecting adults (60.2% use. All delivery mechanisms, especially sale of nets at full market price, under-served the poorest but no difference in equity was observed between voucher-subsidized and freely distributed nets. Conclusion All three delivery strategies enabled a poor rural community to achieve net coverage high enough to yield both personal and community level protection for the entire population. Each of them reached their relevant target group and free nets only temporarily
Nyamtema Angelo S
Full Text Available Abstract Background Antenatal care (ANC provides an important opportunity for pregnant women with a wide range of interventions and is considered as an important basic component of reproductive health care. Methods In 2008, severe maternal morbidity audit was established at Saint Francis Designated District Hospital (SFDDH, in Kilombero district in Tanzania, to ascertain substandard care and implement interventions. In addition, a cross-sectional descriptive study was carried out in 11 health facilities within the district to assess the quality of ANC and underlying factors in a broader view. Results Of 363 severe maternal morbidities audited, only 263 (72% ANC cards were identified. Additionally, 121 cards (with 299 ANC visits from 11 facilities were also reviewed. Hemoglobin and urine albumin were assessed in 22% – 37% and blood pressure in 69% - 87% of all visits. Fifty two (20% severe maternal morbidities were attributed to substandard ANC, of these 39 had severe anemia and eclampsia combined. Substandard ANC was mainly attributed to shortage of staff, equipment and consumables. There was no significant relationship between assessment of essential parameters at first ANC visit and total number of visits made (Spearman correlation coefficient, r = 0.09; p = 0.13. Several interventions were implemented and others were proposed to those in control of the health system. Conclusions This article reflects a worrisome state of substandard ANC in rural Tanzania resulting from inadequate human workforce and material resources for maternal health, and its adverse impacts on maternal wellbeing. These results suggest urgent response from those in control of the health system to invest more resources to avert the situation in order to enhance maternal health in this country.
Kunda John; Julie Fitzpatrick; Nigel French; Rudovick Kazwala; Dominic Kambarage; Mfinanga, Godfrey S; Alastair MacMillan; Sarah Cleaveland
BACKGROUND: Brucellosis is a zoonosis of veterinary, public health and economic significance in most developing countries. Human brucellosis is a severely debilitating disease that requires prolonged treatment with a combination of antibiotics. The disease can result in permanent and disabling sequel, and results in considerable medical expenses in addition to loss of income due to loss of working hours. A study was conducted in Northern Tanzania to determine the risk factors for transmission...
In this study, the production techniques of indigenous alcoholic beverages in a rural village in Tanzania were investigated. In the village, three different kinds of alcoholic beverages were produced: a maize turbid beer (komoni), a straw beer (kimpumu) and a hybrid straw beer (kiambule). In the course of the production of these three alcoholic beverages, two different kinds of porridge, a fermented porridge (nyambo) as a source of yeasts and a sweet porridge (kikonde) as a source of sacchari...
Summary Since 1945 to date the governance of the rural water sector in Tanzania has passed through multiple phases, from the colonial era to the times characterized by liberalization, decentralisation and privatization. Generally, changes in the policies and governance strategies reflect a correspondence with national and international reforms in the political and economic spheres. In turn, these changes made the sector to experience pendulum swings over time in terms of policies and a...
John W Stanifer
Full Text Available Traditional medicines are an important part of healthcare in sub-Saharan Africa, and building successful disease treatment programs that are sensitive to traditional medicine practices will require an understanding of their current use and roles, including from a biomedical perspective. Therefore, we conducted a mixed-method study in Northern Tanzania in order to characterize the extent of and reasons for the use of traditional medicines among the general population so that we can better inform public health efforts in the region.Between December 2013 and June 2014 in Kilimanjaro, Tanzania, we conducted 5 focus group discussions and 27 in-depth interviews of key informants. The data from these sessions were analyzed using an inductive framework method with cultural insider-outsider coding. From these results, we developed a structured survey designed to test different aspects of traditional medicine use and administered it to a random sample of 655 adults from the community. The results were triangulated to explore converging and diverging themes.Most structured survey participants (68% reported knowing someone who frequently used traditional medicines, and the majority (56% reported using them themselves in the previous year. The most common uses were for symptomatic ailments (42%, chronic diseases (15%, reproductive problems (11%, and malaria/febrile illnesses (11%. We identified five major determinants for traditional medicine use in Northern Tanzania: biomedical healthcare delivery, credibility of traditional practices, strong cultural identities, individual health status, and disease understanding.In order to better formulate effective local disease management programs that are sensitive to TM practices, we described the determinants of TM use. Additionally, we found TM use to be high in Northern Tanzania and that its use is not limited to lower-income areas or rural settings. After symptomatic ailments, chronic diseases were reported as
Full Text Available ABSTRACT The majority of people with dementia worldwide live in developing countries. Studies from the developed world have reported an association between lower educational attainment and dementia, but there are few data from the developing world where literacy and educational levels are frequently much lower. In this study we assessed the association between education and dementia prevalence in a rural Tanzanian setting. Methods: In phase I, 1198 individuals aged 70 and over were assessed using the Community Screening Instrument for Dementia (CSI-D. In phase Ii a stratified sample of those seen in phase I were fully assessed and a clinical diagnosis based on DSM-IV criteria was made where appropriate. Information regarding literacy, highest attained educational level and occupation were also collected. Results: The median subject cognitive score on the CSI-D was 25.7 (IQR 22.7 to 28.0 for females and 27.7 (IQR 25.7 to 29.4 for males. This difference was significant (U=117770.0, z= -9.880, p<0.001. In both males and females a lower CSI-D subject cognitive score was significantly associated with having had no formal education (U=34866.5, z= -6.688, p<0.001, for females; U=20757.0, z= -6.278, p<0.001, for males. After adjusting for the effect of age, having no formal education was significantly associated with greater odds of having 'probable dementia' by CSI-D, as was illiteracy. Amongst those interviewed in phase II, there was no significant difference in literacy or education between those with diagnosed DSM-IV dementia and those without. Conclusion: In this rural Tanzanian population, we found a significant association between low levels of education and dementia by CSI-D. This relationship was not significant in cases meeting DSM-IV criteria for dementia.
Mkumbo, Kitila Alexander
Teachers’ attitudes towards sexuality education are among the important predictors of their willingness to teach sexuality education programmes in schools. While there is a plethora of studies on teachers’ attitudes towards sexuality in developed countries, there is a paucity of such studies in sub-Saharan Africa in general and Tanzania in particular. This study examined teachers’ attitudes towards and comfort in teaching sexuality education in rural and urban Tanzania. The results show that ...
Salim, N; Schindler, T.; Abdul, U.; Rothen, J.; B. Genton; Lweno, O; Mohammed, A.S.; Masimba, J.; Kwaba, D.; Abdulla, S; TANNER, M; Daubenberger, C.; Knopp, S
Background There is a paucity of data pertaining to the epidemiology and public health impact of Enterobius vermicularis and Strongyloides stercoralis infections. We aimed to determine the extent of enterobiasis, strongyloidiasis, and other helminth infections and their association with asymptomatic Plasmodium parasitaemia, anaemia, nutritional status, and blood cell counts in infants, preschool-aged (PSAC), and school-aged children (SAC) from rural coastal Tanzania. Methods A total of 1,033 ...
Full Text Available Abstract Background Clinicians at Haydom Lutheran Hospital, a rural hospital in northern Tanzania noted an unusually high case-fatality rate of pediatric meningitis and suspected an outbreak of an unknown agent or an organism resistant to the empirical therapy. Methods We established a provisional microbiology laboratory to investigate the suspected outbreak. Blood and spinal fluid specimens were taken from children below the age of seven years with suspected meningitis. The blood and spinal fluid specimens were inoculated in commercial blood culture bottles and locally prepared Thayer-Martin medium in slanted tubes, respectively. The bacterial isolates were sent to Norway for further investigation, including susceptibility testing and pulsed-field gel-electrophoresis (PFGE. Results Among 24 children with suspected meningitis and/or septicemia, five neonates had meningitis caused by Salmonella enterica serotype Enteritidis, all of whom died. Two children had S. Enteritidis septicemia without meningitis and both survived. Genotyping with PFGE suggested a clonal outbreak. The salmonella strain was resistant to ampicillin and sensitive to gentamicin, the two drugs commonly used to treat neonatal meningitis at the hospital. Conclusion The investigation reminds us that nontyphoidal salmonellae can cause meningitis associated with very high case-fatality rates. Resistance to multiple antimicrobial agents increases the risk of treatment failure and may have contributed to the fatal outcome in all of the five patients with salmonella meningitis. The investigation indicated that the outbreak was nosocomial and the outbreak subsided after hygienic measures were instituted. Establishing a provisional microbiological laboratory is a valuable and affordable tool to investigate and control outbreaks even in remote rural areas.
Shikuku, Kelvin M.; Valdivia, Roberto O.; Paul, Birthe K.; Mwongera, Caroline; Winowiecki, Leigh; Läderach, Peter; Herrero, Mario; Silvestri, Silvia
Crop-livestock production systems play an important role in the livelihoods of many rural communities in sub-Saharan Africa (SSA) but are vulnerable to the adverse impacts of climate change. Understanding which farming options will give the highest return on investment in light of climate change
Wedner, S.; Ross, D.; Balira, R.; Kaji, L.; Foster, A.
AIMS—The study measured the prevalence of eye diseases in primary school children between 7 and 19 years of age in a rural area of Tanzania, and investigated whether teachers could successfully provide the first component of a school eye screening service. METHODS—Teachers from each of three primary schools in Mwanza Region tested visual acuity using a Snellen's E chart in 1438 pupils. 1386 of these pupils were then interviewed and underwent a full eye examination by an eye team. RESULTS—10 p...
This paper evaluates effects of community-level women's property and inheritance rights on women's economic outcomes using a 13 year longitudinal panel from rural Tanzania. In the preferred model specification, inverse probability weighting is applied to a woman-level fixed effects model to control for individual-level time invariant heterogeneity and attrition. Results indicate that changes in women's property and inheritance rights are significantly associated with women's employment outside the home, self-employment and earnings. Results are not limited to sub-groups of marginalised women. Findings indicate lack of gender equity in sub-Saharan Africa may inhibit economic development for women and society as a whole.
Rasch, Vibeke; Sørensen, Pernille H; Wang, Anna R
BackgroundThe circumstances under which women obtain unsafe abortion vary and depend on the traditional methods known and the type of providers present. In rural Tanzania women often resort to traditional providers who use plant species as abortion remedies. Little is known about how these plants...... the traditional methods used to induce abortion, in-depths interviews and focus group discussions were performed among traditional providers and nurses. Finally, the plant specimen¿s effectiveness as abortion remedies was assessed through pharmacological analyses.ResultsAmong women admitted with incomplete...... abortions, 67% had had an unsafe abortion. Almost half of the women who had experienced an unsafe abortion had resorted to traditional providers and plant species were in these cases often used as abortion remedies. In all 21 plant species were identified as potential abortion remedies and analysed, 16...
Chomi, Eunice Nahyuha; Mujinja, Phares Gamba; Enemark, Ulrika; Hansen, Kristian; Kiwara, Angwara Dennis
Multiple insurance funds serving different population groups may compromise equity due to differential revenue raising capacity and an unequal distribution of high risk members among the funds. This occurs when the funds exist without mechanisms in place to promote income and risk cross-subsidisation across the funds. This paper analyses whether the risk distribution varies across the Community Health Fund (CHF) and National Health Insurance Fund (NHIF) in two districts in Tanzania. Specifically we aim to 1) identify risk factors associated with increased utilisation of health services and 2) compare the distribution of identified risk factors among the CHF, NHIF and non-member households. Data was collected from a survey of 695 households. A multivariate logisitic regression model was used to identify risk factors for increased health care utilisation. Chi-square tests were performed to test whether the distribution of identified risk factors varied across the CHF, NHIF and non-member households. There was a higher concentration of identified risk factors among CHF households compared to those of the NHIF. Non-member households have a similar wealth status to CHF households, but a lower concentration of identified risk factors. Mechanisms for broader risk spreading and cross-subsidisation across the funds are necessary for the promotion of equity. These include risk equalisation to adjust for differential risk distribution and revenue raising capacity of the funds. Expansion of CHF coverage is equally important, by addressing non-financial barriers to CHF enrolment to encourage wealthy non-members to join, as well as subsidised membership for the poorest.
Rasch, Vibeke; Sørensen, Pernille H; Wang, Anna R; Tibazarwa, Flora; Jäger, Anna K
The circumstances under which women obtain unsafe abortion vary and depend on the traditional methods known and the type of providers present. In rural Tanzania women often resort to traditional providers who use plant species as abortion remedies. Little is known about how these plants are used and their potential effect. Data were obtained among women admitted with incomplete abortion at Kagera Regional Hospital during the period January - June, 2006. The women underwent an empathetic interview to determine if they had experienced an unsafe abortion prior to their admission. In all 125/187 women revealed having had an unsafe abortion. The women identified as having had an unsafe abortion underwent a questionnaire interview where information about abortion provider and abortion method used was obtained through open-ended questions. To get more detailed information about the traditional methods used to induce abortion, in-depths interviews and focus group discussions were performed among traditional providers and nurses. Finally, the plant specimen's effectiveness as abortion remedies was assessed through pharmacological analyses. Among women admitted with incomplete abortions, 67% had had an unsafe abortion. Almost half of the women who had experienced an unsafe abortion had resorted to traditional providers and plant species were in these cases often used as abortion remedies. In all 21 plant species were identified as potential abortion remedies and analysed, 16 of the species were found to have a uterine contractive effect; they significantly increased the force of contraction, increased the frequency of contractions or did both. Unsafe abortion is common in rural Tanzania where many women use plant species to terminate an unwanted pregnancy. The plants have a remarkable strong uterine contractive effect. To further understand the consequences of unsafe abortion there is a need for further analyses of the plants' potential toxicity and mutagenicity.
Mathew A. Mwanyangala
Full Text Available Background: Increasingly, human populations throughout the world are living longer and this trend is developing in sub-Saharan Africa. In developing African countries such as Tanzania, this demographic phenomenon is taking place against a background of poverty and poor health conditions. There has been limited research on how this process of ageing impacts upon the health of older people within such low-income settings. Objective: The objective of this study is to describe the impacts of ageing on the health status, quality of life and well-being of older people in a rural population of Tanzania. Design: A short version of the WHO Survey on Adult Health and Global Ageing questionnaire was used to collect information on the health status, quality of life and well-being of older adults living in Ifakara Health and Demographic Surveillance System, Tanzania, during early 2007. Questionnaires were administered through this framework to 8,206 people aged 50 and over. Results: Among people aged 50 and over, having good quality of life and health status was significantly associated with being male, married and not being among the oldest old. Functional ability assessment was associated with age, with people reporting more difficulty in performing routine activities as age increased, particularly among women. Reports of good quality of life and well-being decreased with increasing age. Women were significantly more likely to report poor quality of life (odds ratio 1.31; p<0.001, 95% CI 1.15–1.50. Conclusions: Older people within this rural Tanzanian setting reported that the ageing process had significant impacts on their health status, quality of life and physical ability. Poor quality of life and well-being, and poor health status in older people were significantly associated with marital status, sex, age and level of education. The process of ageing in this setting is challenging and raises public health concerns.
Makundi, E A; Manongi, R; Mushi, A K
. It is the provision of ownership of the derived health priorities to partners including the community that enhances research utilization of the end results. In addition to disease-based methods, the Nominal Group Technique is being proposed as an important research tool for involving the non-experts in priority....... The patients/caregivers, women's group representatives, youth leaders, religious leaders and community leaders/elders constituted the principal subjects. Emphasis was on providing qualitative data, which are of vital consideration in multi-disciplinary oriented studies, and not on quantitative information from...... larger samples. We found a high level of agreement across groups, that malaria remains the leading health problem in Moshi rural district in Tanzania both in the highland and lowland areas. Our findings also indicate that 'non-medical' issues including lack of water, hunger and poverty heralded priority...
Kaljee, Linda M; Pach, Alfred; Thriemer, Kamala; Ley, Benedikt; Jiddawi, Mohamed; Puri, Mahesh; Ochiai, Leon; Wierzba, Thomas; Clemens, John; Ali, Said M
Surveillance data indicate that Salmonella enterica serotype Typhi (S. Typhi) is a significant cause of morbidity and mortality in Africa. With limited anticipated short-term improvements in sanitation and water infrastructure, targeted vaccination campaigns may be an important prevention tool for typhoid fever. A cross-sectional survey was conducted with 435 randomly selected households in four rural villages on Pemba Island, Tanzania. A dichotomous 'readiness to pay' variable was created to assess vaccine desirability. Data analyses included univariate and bivariate descriptive statistics and binary logistic regression. Bivariate outcomes (ANOVA, t-tests, and chi-square) and odds ratios with 95% confidence intervals are reported. A total of 66% respondents stated that they would pay for a typhoid fever vaccine in the future. Readiness to pay was not significantly associated with household expenditures. Readiness to pay was associated with use of local Primary Health Care Units (PHCUs) compared to use of cottage or district hospitals (OR 1.8 [95% CI, 1.2-2.7]: p=.007) and with knowledge of someone being sick from typhoid fever (OR 2.2 [95% CI, 1.0-4.5]: p=.039). Respondents perceiving prevention measures as more effective (OR 1.0 [95% CI, 1.0-1.2]: p=.009) were also more likely ready to pay. Preferred methods of communication of information about a typhoid fever vaccine included broadcasting via microphone ('miking'), radio, and door-to-door visits. With rapid increase in numbers of licensed and promising vaccines, policy makers and health administrators are faced with decisions regarding allocation of scarce health resources for competing interventions. Community residents need to be informed about diseases which may not be readily recognized, diagnosed, and treated. Perceived vulnerability to the disease may increase likelihood of vaccine desirability. A better local understanding of typhoid fever is needed for general prevention measures, increasing treatment
Spangler, Sydney A; Bloom, Shelah S
Despite over 20 years of efforts to improve maternal health, complications of pregnancy and childbirth continue to threaten women's lives in many countries of sub-Saharan Africa. To reduce maternal mortality levels and achieve Millennium Development Goal Five, institutions working for safe motherhood are committed to making biomedical obstetric care more available to women during childbirth. However, implementation of this strategy is not reaching women at the lower end of the socioeconomic spectrum for reasons that are not well understood. Using data from fieldwork conducted between September 2007 and June 2008, this study examines women's use of biomedical obstetric care in two rural districts of south-central Tanzania where this care was being supplied. Specifically, it seeks to explain how social and material inequalities affect decisions and behaviors related to childbirth. In addressing this aim we employed a mixed-methods study design. Effects of sociodemographic characteristics on obstetric care use were examined with logistic regression analysis (n = 1150), while perspectives and experiences of childbearing women were explored with participant observation and in-depth interviews (n = 48). The results from quantitative and qualitative study components were interpreted in light of each other. Statistically significant social and material factors related to use of care included ethnicity, education, parity, and household assets. Qualitative themes involved physical, economic, and social access to health facilities as well as issues of risk perception and self-identity. The overall findings suggest that use of obstetric care is influenced by a complex interplay of factors closely tied to relative status in family and community. As individual agents differentially positioned by multiple markers of power, women pragmatically negotiate amidst a wide array of deterrents and motivators to secure the best care they can. In order to improve use of biomedical
Mogensen, Christian B; Soerensen, Jeff; Bjorkman, Anders
Anaemia among small children in tropical Africa is common and often caused by infection with Plasmodium falciparum. The diagnosis of anaemia is difficult without a laboratory estimation of haemoglobin. The aim of this study was to examine if clinical findings related to malaria and anaemia would...... help to detect moderate and/or severe anaemia in children in rural Tanzania....
Benziger Peter W
Full Text Available Abstract Background The objective of this project was to achieve high, sustainable levels of net coverage in a village in rural Tanzania by combining free distribution of long-lasting insecticide-impregnated nets (LLINs with community-tailored education. In Tanzania, malaria is the leading cause of morbidity and mortality. Although malaria bed nets have a well-established role in reducing disease burden, few rural households have access to nets, and effective use depends on personal practices and attitudes. Methods Five practices and attitudes inconsistent with effective LLIN use were identified from household interviews (n = 10. A randomized survey of villagers (n = 132 verified local prevalence of these practices and attitudes. Community leaders held an educational session for two members of every household addressing these practice and attitudes, demonstrating proper LLIN use, and emphasizing behaviour modification. Attendees received one or two LLINs per household. Surveys distributed three weeks (n = 104 and 15 months (n = 104 post-intervention assessed corrected practices and attitudes. Project efficacy was defined by correction of baseline practices and attitudes as well as high rates of reported daily net use, with statistical significance determined by chi-square test. Results Baseline interviews and surveys revealed incorrect practices and attitudes regarding 1 use of nets in dry season, 2 need to retreat LLINs, 3 children napping under nets, 4 need to repair nets, and 5 net procurement as a priority, with 53- 88.6% incorrect responses (11.4-47% correct responses. A three-week follow-up demonstrated 83-95% correct responses. Fifteen-month follow-up showed statistically significant (p Conclusions Results suggest that addressing community-specific practices and attitudes prior to LLIN distribution promotes consistent and correct use, and helps change attitudes towards bed nets as a preventative health measure. Future LLIN distributions
Full Text Available Abstract Background Tanzania has one of the highest maternal mortality ratios in sub-Saharan Africa. Due to the paucity of epidemiological information on maternal deaths, and the high maternal mortality estimates found earlier in the study area, our objective was to assess determinants of maternal deaths in a rural setting in the highlands of northern Tanzania by comparing the women dying of maternal causes with women from the same population who had attended antenatal clinics in the same time period. Methods A case-control study was done in two administrative divisions in Mbulu and Hanang districts in rural Tanzania. Forty-five cases of maternal death were found through a comprehensive community- and health-facility based study in 1995 and 1996, while 135 antenatal attendees from four antenatal clinics in the same population, geographical area, and time-span of 1995–96 served as controls. The cases and controls were compared using multivariate logistic regression analyses. Odds ratios, with 95% confidence intervals, were used as an approximation of relative risk, and were adjusted for place of residence (ward and age. Further adjustment was done for potentially confounding variables. Results An increased risk of maternal deaths was found for women from 35–49 years versus 15–24 years (OR 4.0; 95%CI 1.5–10.6. Women from ethnic groups other than the two indigenous groups of the area had an increased risk of maternal death (OR 13.6; 95%CI 2.5–75.0. There was an increased risk when women or husbands adhered to traditional beliefs, (OR 2.1; 95%CI 1.0–4.5 and (OR 2.6; 95%CI 1.2–5.7, respectively. Women whose husbands did not have any formal education appeared to have an increased risk (OR 2.2; 95%CI 1.0–5.0. Conclusion Increasing maternal age, ethnic and religious affiliation, and low formal education of the husbands were associated with increased risk of maternal death. Increased attention needs to be given to formal education of both
Patricia Mwesiga Lyatuu
Full Text Available Understanding the influence of specific livelihood variables on a household’s well-being provides a crucial basis for effective focus of poverty intervention, and consequently wiser resource allocation. This paper analyses the influence of land access, livelihood strategies (LS and selected demographic characteristics on household well-being status (HWBS in Mvomero District, Tanzania. The study adopted a cross-sectional research design whereby quantitative data were collected once from 267 randomly selected households in 8 villages. Data analysis was done using SPSS. Unlike the hypothesis, multinomial logistic regression results demonstrated that per capita land size and location have a positive significant influence (p < 0.05 on HWBS. Likewise, unlike the hypothesis, three more variables including exclusive farming, number of dependents and distance to farms were confirmed to have a negative significant influence (p < 0.05 on well-being. It is concluded that though per capita land size has a positive influence on HWBS, expanding farms through adding plots and distant farming hinders the attainment of well-being. Moreover, households with many dependents and those working in exclusive farming are disadvantaged in the attainment of well-being. There is therefore room to enhance progress in attainment of well-being through reducing the distance to farms and promoting diversification of livelihood strategies. The Tanzania government is advised to support distant farmers with settlements in their destinations. The government and other development agencies are also advised to enhance the capacity of the studied communities and dwellers of other rural land scarce areas in Tanzania for a meaningful diversification of livelihood strategies. This can be through supporting them to gain education and labor skills and also to engage in saving and credits projects. To be inclusive the strategies may pay special attention to households with a large number
Manongi, R; Mtei, F; Mtove, G; Nadjm, B; Muro, F; Alegana, V; Noor, AM; J. Todd; Reyburn, H.
ObjectiveTo investigate the association, if any, between child mortality and distance to the nearest hospital. MethodsThe study was based on data from a 1-year study of the cause of illness in febrile paediatric admissions to a district hospital in north-east Tanzania. All villages in the catchment population were geolocated, and travel times were estimated from availability of local transport. Using bands of travel time to hospital, we compared admission rates, inpatient case fatality rates ...
Full Text Available Maternal and perinatal mortality remain a challenge in resource-limited countries, particularly among the rural poor. To save lives at birth health facility delivery is recommended. However, increasing coverage of institutional deliveries may not translate into mortality reduction if shortage of qualified staff and lack of enabling working conditions affect quality of services. In Tanzania childbirth care is available in all facilities; yet maternal and newborn mortality are high. The study aimed to assess in a high facility density rural context whether a health system organization with fewer delivery sites is feasible in terms of population access.Data on health facilities' location, staffing and delivery caseload were examined in Ludewa and Iringa Districts, Southern Tanzania. Geospatial raster and network analysis were performed to estimate access to obstetric services in walking time. The present geographical accessibility was compared to a theoretical scenario with a 40% reduction of delivery sites.About half of first-line health facilities had insufficient staff to offer full-time obstetric services (45.7% in Iringa and 78.8% in Ludewa District. Yearly delivery caseload at first-line health facilities was low, with less than 100 deliveries in 48/70 and 43/52 facilities in Iringa and Ludewa District respectively. Wide geographical overlaps of facility catchment areas were observed. In Iringa 54% of the population was within 1-hour walking distance from the nearest facility and 87.8% within 2 hours, in Ludewa, the percentages were 39.9% and 82.3%. With a 40% reduction of delivery sites, approximately 80% of population will still be within 2 hours' walking time.Our findings from spatial modelling in a high facility density context indicate that reducing delivery sites by 40% will decrease population access within 2 hours by 7%. Focused efforts on fewer delivery sites might assist strengthening delivery services in resource-limited settings.
Pembe, Andrea B; Urassa, David P; Darj, Elisabeth; Carlsted, Anders; Olsson, Pia
The aim of this study was to describe perceptions of maternal referrals in a rural district in Tanzania. Focus group discussions (FGDs) with health workers and community members, stratified by age and gender, were conducted. The FGDs revealed that husbands and relatives are the decision makers in maternal referrals, whereas the women had limited influence, especially on emergency referrals. The process in deciding to seek referral care is envisaged within community perception of seriousness of the condition, difficulty to access and cost involved in transport, living expenses at the hospital, and perceived quality of care at facility level. The hospitals were seen as providing acceptable quality of care, whereas, the health centres had lower quality than expected. To improve maternal referral compliance and reduce perinatal and maternal morbidity and mortality, community views of existing referral guidelines, poverty reduction, women's empowerment and male involvement in maternal care are necessary.
Full Text Available Abstract Background The HIV/AIDS pandemic remains a leading challenge for global health. Although condoms are acknowledged for their key role on preventing HIV transmission, low and inappropriate use of condoms persists in Tanzania and elsewhere in Africa. This study assesses factors affecting acceptability of condom promotion and distribution among adolescents in Mpwapwa and Mbeya rural districts of Tanzania. Methods Data were collected in 2011 as part of a larger cross-sectional survey on condom use among 10–19 year-olds in Mpwapwa and Mbeya rural districts of Tanzania using a structured questionnaire. Associations between acceptability of condom promotion and distribution and each of the explanatory variables were tested using Chi Square. Multivariate logistic regression model was used to examine independent predictors of the acceptability of condom promotion and distribution using STATA (11 statistical software at 5% significance level. Results Mean age of the 1,327 adolescent participants (50.5% being males was 13.5 years (SD = 1.4. Acceptance of condom promotion and distribution was found among 37% (35% in Mpwapwa and 39% in Mbeya rural of the adolescents. Being sexually active and aged 15–19 was the strongest predictor of the acceptability of condom promotion and distribution (OR = 7.78, 95% CI 4.65-12.99. Others were; not agreeing that a condom is effective in preventing transmissions of STIs including HIV (OR = 0.34, 95% CI 0.20-0.56, being a resident of Mbeya rural district (OR = 1.67, 95% CI 1.28-2.19, feeling comfortable being seen by parents/guardians holding/buying condoms (OR = 2.20, 95% CI 1.40-3.46 and living with a guardian (OR = 1.48, 95% CI 1.08-2.04. Conclusion Acceptability of condom promotion and distribution among adolescents in Mpwapwa and Mbeya rural is low. Effect of sexual activity on the acceptability of condom promotion and distribution is age-dependent and was the strongest. Feeling
Full Text Available Abstract Background Monitoring dynamics in HIV-1 infection and risk behaviours is important in evaluating, adjusting and scaling up prevention programmes. The objective of this study was to estimate trends in the prevalence of HIV-1 infection and risk behaviours over 15 years in a rural village population in Kilimanjaro region of Tanzania using repeated population-based cross-sectional surveys. Methods Four rounds of HIV-1 sero-epidemiological and behavioural surveys were completed during 1991 to 2005 in the study village. House-to-house registrations of people aged 15–44 years with an address in the village were conducted before each survey. All consenting individuals were then interviewed for pertinent risk behaviours and tested for HIV-1 seropositivity. Results Participation proportions ranged from 73.0% to 79.1%. Overall, age and sex-adjusted HIV-1 prevalence increased from 3.2% in 1991 to 5.6 % in 2005 (relative increase 75.0%; ptrend trends trend trends trend Conclusion The HIV-1 prevalence seems to have increased among older participants but remained stable among younger participants. Encouraging trends toward safer sex practices were observed among young participants, while only modest behavioural changes were seen among the older participants. Prevention efforts in rural areas need to be intensified and to address people of all ages.
Fabian C Franzeck
Full Text Available BACKGROUND: Co-infection with hepatitis B virus (HBV is highly prevalent in people living with HIV in Sub-Saharan Africa. Screening for HBV surface antigen (HBsAg before initiation of combination antiretroviral therapy (cART is recommended. However, it is not part of diagnostic routines in HIV programs in many resource-limited countries although patients could benefit from optimized antiretroviral therapy covering both infections. Screening could be facilitated by rapid diagnostic tests for HBsAg. Operating experience with these point of care devices in HIV-positive patients in Sub-Saharan Africa is largely lacking. We determined the prevalence of HBV and Hepatitis C virus (HCV infection as well as the diagnostic accuracy of the rapid test device Determine HBsAg in an HIV cohort in rural Tanzania. METHODS: Prospectively collected blood samples from adult, HIV-1 positive and antiretroviral treatment-naïve patients in the Kilombero and Ulanga antiretroviral cohort (KIULARCO in rural Tanzania were analyzed at the point of care with Determine HBsAg, a reference HBsAg EIA and an anti-HCV EIA. RESULTS: Samples of 272 patients were included. Median age was 38 years (interquartile range [IQR] 32-47, 169/272 (63% subjects were females and median CD4+ count was 250 cells/µL (IQR 97-439. HBsAg was detected in 25/272 (9.2%, 95% confidence interval [CI] 6.2-13.0% subjects. Of these, 7/25 (28% were positive for HBeAg. Sensitivity of Determine HBsAg was rated at 96% (95% CI 82.8-99.6% and specificity at 100% (95% CI, 98.9-100%. Antibodies to HCV (anti-HCV were found in 10/272 (3.7%, 95% CI 2.0-6.4% of patients. CONCLUSION: This study reports a high prevalence of HBV in HIV-positive patients in a rural Tanzanian setting. The rapid diagnostic test Determine HBsAg is an accurate assay for screening for HBsAg in HIV-1 infected patients at the point of care and may further help to guide cART in Sub-Saharan Africa.
Sato, Miho; Maufi, Deogratias; Mwingira, Upendo John; Leshabari, Melkidezek T; Ohnishi, Mayumi; Honda, Sumihisa
The threshold of 2.3 skilled health workers per 1,000 population, published in the World Health Report in 2006, has galvanized resources and efforts to attain high coverage of skilled birth attendance. With the inception of the Sustainable Development Goals (SDGs), a new threshold of 4.45 doctors, nurses, and midwives per 1,000 population has been identified. This SDG index threshold indicates the minimum density to respond to the needs of health workers to deliver a much broader range of health services, such as management of non-communicable diseases to meet the targets under Goal 3: Ensure healthy lives and promote well-being for all people of all ages. In the United Republic of Tanzania, the density of skilled health workers in 2012 was 0.5 per 1,000 population, which more than doubled from 0.2 per 1,000 in 2002. However, this showed that Tanzania still faced a critical shortage of skilled health workers. While training, deployment, and retention are important, motivation is also necessary for all health workers, particularly those who serve in rural areas. This study measured the motivation of health workers who were posted at government-run rural primary health facilities. We sought to measure three aspects of motivation-Management, Performance, and Individual Aspects-among health workers deployed in rural primary level government health facilities. In addition, we also sought to identify the job-related attributes associated with each of these three aspects. Two regions in Tanzania were selected for our research. In each region, we further selected two districts in which we carried out our investigation. The two regions were Lindi, where we carried out our study in the Nachingwea District and the Ruangwa District, and Mbeya, within which the Mbarali and Rungwe Districts were selected for research. All four districts are considered rural. This cross-sectional study was conducted by administering a two-part questionnaire in the Kiswahili language. The first
Masanja, Honorati; Schellenberg, Joanna Armstrong; de Savigny, Don; Mshinda, Hassan; Victora, Cesar G
We examined the impact of the Integrated Management of Childhood Illness (IMCI) strategy on the equality of health outcomes and access across socioeconomic gradients in rural Tanzania, by comparing changes in inequities between 1999 and 2002 in two districts with IMCI (Morogoro Rural and Rufiji) and two without (Kilombero and Ulanga). Equity differentials for six child health indicators (underweight, stunting, measles immunization, access to treated and untreated nets, treatment of fever with antimalarial) improved significantly in IMCI districts compared with comparison districts (pstunting among children between 24-59 months of age. The concentration index improved from -0.102 in 1999 to -0.032 in 2002 for IMCI, while it remained almost unchanged -0.122 to -0.133 in comparison districts. IMCI was associated with improved equity for measles vaccine coverage, whereas the opposite was observed for DPT antigens. This study has shown how equity assessments can be incorporated in impact evaluation at relatively little additional cost, and how this may point to specific interventions that need to be reinforced. The introduction of IMCI led to improvements in child health that did not occur at the expense of equity.
Peletz, Rachel; Cock-Esteb, Alicea; Ysenburg, Dorothea; Haji, Salim; Khush, Ranjiv; Dupas, Pascaline
Improving access to sanitation is a global public health priority. Sufficient consumer demand is required for sanitation coverage to expand through private provision. To measure consumer demand for hygienic latrine platform products in rural Tanzania, we conducted a randomized, voucher-based real-money sales trial with 1638 households with unimproved latrines. We also evaluated multiple supply chain options to determine the costs of supplying latrine platform products to rural households. For concrete latrine SanPlats, 60% of households were willing to pay US$0.48 and 10% of households were willing to pay US$4.05, yet the average cost of supplying the SanPlat to households was US$7.51. Similarly, for plastic sanitary platforms, willingness-to-pay (WTP) dropped from almost 60% at a price of US$1.43 to 5% at a price of US$12.29, compared to an average supply cost of US$23.28. WTP was not significantly different between villages that had participated in the National Sanitation Campaign and those that had not. Randomized informational interventions, including hygiene data-sharing and peer-based exposure to latrine platform products, had minimal effects on WTP. In conclusion, current household demand for latrine platform products is too low to achieve national goals for improved sanitation coverage through fully commercial distribution.
Gladys Reuben Mahiti
Full Text Available Background: Maternal health care provision remains a major challenge in developing countries. There is agreement that the provision of quality clinical services is essential if high rates of maternal death are to be reduced. However, despite efforts to improve access to these services, a high number of women in Tanzania do not access them. The aim of this study is to explore women's views about the maternal health services (pregnancy, delivery, and postpartum period that they received at health facilities in order to identify gaps in service provision that may lead to low-quality maternal care and increased risks associated with maternal morbidity and mortality in rural Tanzania. Design: We gathered qualitative data from 15 focus group discussions with women attending a health facility after child birth and transcribed it verbatim. Qualitative content analysis was used for analysis. Results: ‘Three categories emerged that reflected women's perceptions of maternal health care services: “mothers perceive that maternal health services are beneficial,” “barriers to accessing maternal health services” such as availability and use of traditional birth attendants (TBAs and the long distances between some villages, and “ambivalence regarding the quality of maternal health services” reflecting that women had both positive and negative perceptions in relation to quality of health care services offered’. Conclusions: Mothers perceived that maternal health care services are beneficial during pregnancy and delivery, but their awareness of postpartum complications and the role of medical services during that stage were poor. The study revealed an ambivalence regarding the perceived quality of health care services offered, partly due to shortages of material resources. Barriers to accessing maternal health care services, such as the cost of transport and the use of TBAs, were also shown. These findings call for improvement on the services
Full Text Available Amon Exavery,1 Almamy Malick Kanté,1–3 Kassimu Tani,1 Ahmed Hingora,1 James F Phillips2 1Ifakara Health Institute, Dar es Salaam, Tanzania; 2Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA; 3Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland Background: This study examines prevalence and correlates of multiple sexual partnerships (MSP among women aged 15+ years in Rufiji, Kilombero, and Ulanga districts of Tanzania. Materials and methods: Data were collected in a cross-sectional household survey in Rufiji, Kilombero, and Ulanga districts in Tanzania in 2011. From the survey, a total of 2,643 sexually active women ages 15+ years were selected for this analysis. While the chi-square test was used for testing association between MSP and each of the independent variables, logistic regression was used for multivariate analysis. Results: Number of sexual partners reported ranged from 1 to 7, with 7.8% of the women reporting multiple sexual partners (2+ in the past year. MSP was more likely among both ever married women (adjusted odds ratio [AOR] =3.83, 95% confidence interval [CI] 1.40–10.49 and single women (AOR =6.13, 95% CI 2.45–15.34 than currently married women. There was an interaction between marital status and education, whereby MSP was 85% less likely among single women with secondary or higher education compared to married women with no education (AOR =0.15, 95% CI 0.03–0.61. Furthermore, women aged 40+ years were 56% less likely compared to the youngest women (<20 years to report MSP (AOR =0.44, 95% CI 0.24–0.80. The odds of MSP among Muslim women was 1.56 times as high as that for Christians women (AOR =1.56, 95% CI 1.11–2.21. Ndengereko women were 67% less likely to report MSP compared to Pogoro women (AOR =0.33, 95% CI 0.18–0.59. Conclusion: Eight percent of the women aged 15+ in Rufiji, Kilombero, and Ulanga
John W Stanifer; Uptal D Patel; Francis Karia; Nathan Thielman; Venance Maro; Dionis Shimbi; Humphrey Kilaweh; Matayo Lazaro; Oliver Matemu; Justin Omolo; David Boyd; Assessment for Risk factors
.... Therefore, we conducted a mixed-method study in Northern Tanzania in order to characterize the extent of and reasons for the use of traditional medicines among the general population so that we can...
Baraka, Jitihada; Rusibamayila, Asinath; Kalolella, Admirabilis; Baynes, Colin
Provider perspectives have been overlooked in efforts to address the challenges of unmet need for family planning (FP). This qualitative study was undertaken in Tanzania, using 22 key informant interviews and 4 focus group discussions. The research documents perceptions of healthcare managers and providers in a rural district on the barriers to meeting latent demand for contraception. Social-ecological theory is used to interpret the findings, illustrating how service capability is determined by the social, structural and organizational environment. Providers' efforts to address unmet need for FP services are constrained by unstable reproductive preferences, low educational attainment, and misconceptions about contraceptive side effects. Societal and organizational factors--such as gender dynamics, economic conditions, religious and cultural norms, and supply chain bottlenecks, respectively--also contribute to an adverse environment for meeting needs for care. Challenges that healthcare providers face interact and produce an effect which hinders efforts to address unmet need. Interventions to address this are not sufficient unless the supply of services is combined with systems strengthening and social engagement strategies in a way that reflects the multi-layered, social institutional problems.
Burt, Zachary; Njee, Robert M; Mbatia, Yolanda; Msimbe, Veritas; Brown, Joe; Clasen, Thomas F; Malebo, Hamisi M; Ray, Isha
Almost half of all deaths from drinking microbiologically unsafe water occur in Sub-Saharan Africa. Household water treatment and safe storage (HWTS) systems, when consistently used, can provide safer drinking water and improve health. Social marketing to increase adoption and use of HWTS depends both on the prices of and preferences for these systems. This study included 556 households from rural Tanzania across two low-income districts with low-quality water sources. Over 9 months in 2012 and 2013, we experimentally evaluated consumer preferences for six "low-cost" HWTS options, including boiling, through an ordinal ranking protocol. We estimated consumers' willingness to pay (WTP) for these options, using a modified auction. We allowed respondents to pay for the durable HWTS systems with cash, chickens or mobile money; a significant minority chose chickens as payment. Overall, our participants favored boiling, the ceramic pot filter and, where water was turbid, PuR™ (a combined flocculant-disinfectant). The revealed WTP for all products was far below retail prices, indicating that significant scale-up may need significant subsidies. Our work will inform programs and policies aimed at scaling up HWTS to improve the health of resource-constrained communities that must rely on poor-quality, and sometimes turbid, drinking water sources.
Maokola, W; Willey, B A; Shirima, K; Chemba, M; Armstrong Schellenberg, J R M; Mshinda, H; Alonso, P; Tanner, M; Schellenberg, D
To describe and evaluate the use of handheld computers for the management of Health Management Information System data. Electronic data capture took place in 11 sentinel health centres in rural southern Tanzania. Information from children attending the outpatient department (OPD) and the Expanded Program on Immunization vaccination clinic was captured by trained local school-leavers, supported by monthly supervision visits. Clinical data included malaria blood slides and haemoglobin colour scale results. Quality of captured data was assessed using double data entry. Malaria blood slide results from health centre laboratories were compared to those from the study's quality control laboratory. The system took 5 months to implement, and few staffings or logistical problems were encountered. Over the following 12 months (April 2006-March 2007), 7056 attendances were recorded in 9880 infants aged 2-11 months, 50% with clinical malaria. Monthly supervision visits highlighted incomplete recording of information between OPD and laboratory records, where on average 40% of laboratory visits were missing the record of their corresponding OPD visit. Quality of microscopy from health facility laboratories was lower overall than that from the quality assurance laboratory. Electronic capture of HMIS data was rapidly and successfully implemented in this resource-poor setting. Electronic capture alone did not resolve issues of data completeness, accuracy and reliability, which are essential for management, monitoring and evaluation; suggestions to monitor and improve data quality are made. © 2011 Blackwell Publishing Ltd.
Kweka, Eliningaya J; Mwang'onde, Beda J; Kimaro, Epiphania E; Msangi, Shandala; Tenu, Filemoni; Mahande, Aneth M
The recent spread of bedbugs, Cimex lectularius L. (Heteroptera: Cimicidae), has received attention of the public health sector for designing of effective plan of action for control. Several studies have focused on determining the distribution and abundance of bedbug populations in tropical areas. This study establishes baseline information on deltamethrin, permethrin, alphacypermethrin, lambdacypermethrin and K-O tab susceptibility status in a bedbug population collected from Magugu area in northern Tanzania. The evolution of insecticide resistance could be a primary factor in explaining this resurgence of bedbugs in many areas, both rural and urban. Evaluation of the bedbug population from houses in Magugu indicates that the population of bedbugs is susceptible to pyrethroid insecticides, which are commonly used. Without the development of new tactics for bedbug resistance management, further escalation of this public health problem should be expected when resistant gene spreads within the population. These results suggest that although all concentrations kill bedbugs, more evaluations should be done using WHO kits and mechanisms involved in pyrethroid resistance should be evaluated, such as metabolic and knockdown resistance gene, to have a broad picture for better design of control methodologies.
Eliningaya J Kweka
Full Text Available The recent spread of bedbugs, Cimex lectularius L. (Heteroptera: Cimicidae, has received attention of the public health sector for designing of effective plan of action for control. Several studies have focused on determining the distribution and abundance of bedbug populations in tropical areas. This study establishes baseline information on deltamethrin, permethrin, alphacypermethrin, lambdacypermethrin and K-O tab susceptibility status in a bedbug population collected from Magugu area in northern Tanzania. The evolution of insecticide resistance could be a primary factor in explaining this resurgence of bedbugs in many areas, both rural and urban. Evaluation of the bedbug population from houses in Magugu indicates that the population of bedbugs is susceptible to pyrethroid insecticides, which are commonly used. Without the development of new tactics for bedbug resistance management, further escalation of this public health problem should be expected when resistant gene spreads within the population. These results suggest that although all concentrations kill bedbugs, more evaluations should be done using WHO kits and mechanisms involved in pyrethroid resistance should be evaluated, such as metabolic and knockdown resistance gene, to have a broad picture for better design of control methodologies.
Wight, Daniel; Plummer, Mary L; Mshana, Gerry; Wamoyi, Joyce; Shigongo, Zachayo S; Ross, David A
There has been a long-running debate as to whether sexual cultures in sub-Saharan Africa are permissive or characterised by restrictive rules, rituals and self-restraint. This paper, based on participant observation data, outlines the main features of sexual culture in rural northern Tanzania and highlights both permissive and restrictive norms and expectations for young people. It also illustrates how sexual beliefs are socially constructed and subject to social change. Sexual activity is constrained by clear norms of school pupil abstinence, female sexual respectability and taboos around the discussion of sex. However, these norms are incompatible with several widely held expectations: that sexual activity is inevitable unless prevented, sex is a female resource to be exploited, restrictions on sexual activity are relaxed at festivals, and masculine esteem is boosted through sexual experience. Differential commitment to these norms and expectations reflects conflicts between generations and genders. Young people appear to manage the contradictions in these norms by concealing their sexual relationships. This almost certainly contributes to their short duration and the high levels of partner change, since relationships are not reinforced through social recognition and there is little scope to develop intimacy through non-sexual contacts.
Full Text Available The Helping Babies Breathe" (HBB program is an evidence-based curriculum in basic neonatal care and resuscitation, utilizing simulation-based training to educate large numbers of birth attendants in low-resource countries. We analyzed its cost-effectiveness at a faith-based Haydom Lutheran Hospital (HLH in rural Tanzania.Data about early neonatal mortality and fresh stillbirth rates were drawn from a linked observational study during one year before and one year after full implementation of the HBB program. Cost data were provided by the Tanzanian Ministry of Health and Social Welfare (MOHSW, the research department at HLH, and the manufacturer of the training material Lærdal Global Health.Costs per life saved were USD 233, while they were USD 4.21 per life year gained. Costs for maintaining the program were USD 80 per life saved and USD 1.44 per life year gained. Costs per disease adjusted life year (DALY averted ranged from International Dollars (ID; a virtual valuta corrected for purchasing power world-wide 12 to 23, according to how DALYs were calculated.The HBB program is a low-cost intervention. Implementation in a very rural faith-based hospital like HLH has been highly cost-effective. To facilitate further global implementation of HBB a cost-effectiveness analysis including government owned institutions, urban hospitals and district facilities is desirable for a more diverse analysis to explore cost-driving factors and predictors of enhanced cost-effectiveness.
INational Institute for Medical Research, P.O. Box 9653, Dar es Salaam, Tanzania;. 2University .... The mean annual temperature is 26°C', with ... range for youths and adults was l4-24 and 225 years, ..... Tanzania: Re-packaging Knowledge for.
Peck, Robert; Baisley, Kathy; Kavishe, Bazil; Were, Jackson; Mghamba, Janneth; Smeeth, Liam; Grosskurth, Heiner; Kapiga, Saidi
Data on renal dysfunction in sub-Saharan Africa, comparing urban and rural areas, have not yet been reported. Therefore, we aimed to determine the distribution of low estimated glomerular filtration rates (eGFRs) in urban and rural Tanzania, to describe factors associated with low eGFR and to quantify fractions attributable to common risk factors. We conducted a community-based survey of 1095 randomly selected Tanzanian adults (≥18 years). A structured questionnaire and examinations were used to document sociodemographic characteristics, diet, physical activity, anthropomorphic measurements and blood pressure. Blood tests were performed for HIV infection, diabetes mellitus and creatinine. eGFR was calculated using two equations recommended for African adults. Serum creatinine was available for 1043 participants: 170 in Mwanza city, 326 in district towns and 547 in rural areas. Mean age was 35.5 years and 54% were females. The prevalence of eGFR renal function is common in Tanzania, particularly in district towns, and unique risk factors for kidney disease may exist in this population. Population-specific strategies for prevention, early diagnosis and treatment of kidney disease are needed for Africa. © 2015 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.
Full Text Available Background: Birth preparedness and complication readiness (BP/CR strategies are aimed at reducing delays in seeking, reaching, and receiving care. Counselling on birth preparedness is provided during antenatal care visits. However, it is not clear why birth preparedness messages do not translate to utilisation of facility delivery. This study explores the perceptions, experiences, and challenges the community faces on BP/CR. Design: A qualitative study design using Focused Group Discussions was conducted. Twelve focus group discussions were held with four separate groups: young men and women and older men and women in a rural community in Tanzania. Qualitative content analysis was used to analyse the data. Results: The community members expressed a perceived need to prepare for childbirth. They were aware of the importance to attend the antenatal clinics, relied on family support for practical and financial preparations such as saving money for costs related to delivery, moving closer to the nearest hospital, and also to use traditional herbs, in favour of a positive outcome. Community recognised that pregnancy and childbirth complications are preferably treated at hospital. Facility delivery was preferred; however, certain factors including stigma on unmarried women and transportation were identified as hindering birth preparedness and hence utilisation of skilled care. Challenges were related to the consequences of poverty, though the maternal health care should be free, they perceived difficulties due to informal user fees. Conclusions: This study revealed community perceptions that were in favour of using skilled care in BP/CR. However, issues related to inability to prepare in advance hinder the realisation of the intention to use skilled care. It is important to innovate how the community reinforces BP/CR, such as using insurance schemes, using community health funds, and providing information on other birth preparedness messages via
Heemelaar, S; Nelissen, E; Mdoe, P; Kidanto, H; van Roosmalen, J; Stekelenburg, J
WHO uses the Caesarean section (CS) rate to monitor implementation of emergency obstetric care (EmOC). Although CS rates are rising in sub-Saharan Africa, maternal outcome has not improved. We audited indications for CS and related complications among women with severe maternal morbidity and mortality in a referral hospital in rural Tanzania. Cross-sectional study was from November 2009 to November 2011. Women with severe maternal morbidity and mortality were identified and those with CS were included in this audit. Audit criteria were developed based on the literature review and (inter)national guidelines. Tanzanian and Dutch doctors reviewed hospital notes. The main outcome measured was prevalence of substandard quality of care leading to unnecessary CS and delay in performing interventions to prevent CS. A total of 216 maternal near misses and 32 pregnancy-related deaths were identified, of which 82 (33.1%) had a CS. Indication for CS was in accordance with audit criteria for 36 of 82 (44.0%) cases without delay. In 20 of 82 (24.4%) cases, the indication was correct; however, there was significant delay in providing standard obstetric care. In 16 of 82 (19.5%) cases, the indication for CS was not in accordance with audit criteria. During office hours, CS was more often correctly indicated than outside office hours (60.0% vs. 36.0%, P EmOC as a high rate of unnecessary and potentially preventable CS was identified in this audit. © 2016 John Wiley & Sons Ltd.
Faraja S. Chiwanga
Full Text Available Background: The increase in prevalence of diabetes and pre-diabetes in sub-Saharan Africa underlines the importance of understanding its magnitude and causes in different population groups. We analyzed data from the Africa/Harvard Partnership for Cohort Research and Training (PaCT studies to determine the prevalence of diabetes and pre-diabetes and risk factors associated with diabetes. Methodology: Participants were randomly selected from peri-urban (n=297 and rural (n=200 communities in Uganda, and teachers were recruited from schools (n=229 in urban Tanzania. We used a standardized questionnaire to collect socio-demographic and self-reported disease status including diabetes status. Blood glucose was also measured after participants fasted for 8 h. We used standard protocols for anthropometric and blood pressure measurement. Results: The overall prevalence of diabetes was 10.1% and was highest in rural Ugandan residents (16.1% compared to teachers in Tanzania (8.3% and peri-urban Ugandan residents (7.6%. The prevalence of pre-diabetes was 13.8%. The prevalence of self-reported diabetes was low across all sites, where 68% of participants with diabetes were not captured by self-report. In multivariable logistic regression analysis, family history (OR 2.5, 95% CI: 1.1, 5.6 and hypertension (OR 2.3, 95% CI: 1.1, 5.2 were significantly associated with diabetes. Conclusions: The prevalence of diabetes and pre-diabetes in Uganda and Tanzania is high, differs markedly between population groups, and remains undiagnosed in an alarmingly high proportion of individuals. These findings highlight the need for large-scale, prospective studies to accurately quantify the burden and identify effective intervention and treatment strategies across diverse African populations.
Full Text Available This article describes a qualitative exploration of a primary school in a remote rural community of Tanzania, whose students showed promising performance in mathematics, as measured by the Primary School Leaving Examinations (PSLE. Case study methods were used to conduct research about the school and the community and included interviews, focus groups, and observations. This paper describes the role of community leadership in generating a learning community (Warren, 2005, that initiated community support of the school, which in turn prompted teachers’ innovations in professional development, that improved teaching and learning in mathematics and contributed to the observed promising performance on the PSLE. The article concludes that although school principals and teachers are regarded as keys in generating professional learning communities (DuFour, DuFour, & Eaker, 2008, under good community leadership communities may be essential catalysts in establishing and sustaining professional learning communities which may contribute to school improvement.
Nzalawahe, Jahashi; Kassuku, Ayub A; Stothard, J Russell; Coles, Gerald C; Eisler, Mark C
The epidemiology of trematode infections in cattle was investigated within highland and lowland areas of Iringa Rural District, in southern Tanzania. Fecal samples were collected from 450 cattle in 15 villages at altitudes ranging from 696 to 1800 m above the sea level. Freshwater snails were collected from selected water bodies and screened for emergence of cercariae. The infection rates in cattle were Fasciola gigantica 28·2%, paramphistomes 62·8% and Schistosoma bovis 4·8%. Notably, prevalence of trematode infections in cattle was much higher in highland (altitude > 1500 m) as compared with lowland (altitude snails collected included Lymnaea natalensis, Bulinus africanus, Bulinus tropicus, Bulinus forskali, Biomphalaria pfeifferi, Melanoides tuberculata and Bellamya constricta with a greater proportion of highland (75%) than lowland (36%) water bodies harbouring snails. Altitude is a major factor shaping the epidemiology of F. gigantica and paramphistomes infections in cattle in Iringa Rural District with greater emphasis upon control needed in highland areas.
Leonard E. G. Mboera
Full Text Available The use of microbial larvicides, a form of larval source management, is a less commonly used malaria control intervention that nonetheless has significant potential as a component of an integrated vector management strategy. We evaluated community acceptability of larviciding in a rural district in east-central Tanzania using data from 962 household surveys, 12 focus group discussions, and 24 in-depth interviews. Most survey respondents trusted in the safety (73.1% and efficacy of larviciding, both with regards to mosquito control (92.3% and to reduce malaria infection risk (91.9%. Probing these perceptions using a Likert scale provides a more detailed picture. Focus group participants and key informants were also receptive to larviciding, but stressed the importance of sensitization before its implementation. Overall, 73.4% of survey respondents expressed a willingness to make a nominal household contribution to a larviciding program, a proportion which decreased as the proposed contribution increased. The lower-bound mean willingness to pay is estimated at 2,934 Tanzanian Shillings (approximately US$1.76 per three month period. We present a multivariate probit regression analysis examining factors associated with willingness to pay. Overall, our findings point to a receptive environment in a rural setting in Tanzania for the use of microbial larvicides in malaria control.
Mkumbo, Kitila Alexander
Teachers’ attitudes towards sexuality education are among the important predictors of their willingness to teach sexuality education programmes in schools. While there is a plethora of studies on teachers’ attitudes towards sexuality in developed countries, there is a paucity of such studies in sub-Saharan Africa in general and Tanzania in particular. This study examined teachers’ attitudes towards and comfort in teaching sexuality education in rural and urban Tanzania. The results show that an overwhelming majority of teachers in both rural and urban districts supported the teaching of sexuality education in schools, and the inclusion of a wide range of sexuality education topics in the curriculum. Nevertheless, though teachers expressed commitment to teaching sexuality education in schools, they expressed difficult and discomfort in teaching most of the key sexuality education topics. This implies that declaration of positive attitudes towards teaching sexuality education alone is not enough; there is a need for facilitating teachers with knowledge, skills and confidence to teach various sexuality education topics. PMID:22980351
Mkumbo, Kitila Alexander
Teachers' attitudes towards sexuality education are among the important predictors of their willingness to teach sexuality education programmes in schools. While there is a plethora of studies on teachers' attitudes towards sexuality in developed countries, there is a paucity of such studies in sub-Saharan Africa in general and Tanzania in particular. This study examined teachers' attitudes towards and comfort in teaching sexuality education in rural and urban Tanzania. The results show that an overwhelming majority of teachers in both rural and urban districts supported the teaching of sexuality education in schools, and the inclusion of a wide range of sexuality education topics in the curriculum. Nevertheless, though teachers expressed commitment to teaching sexuality education in schools, they expressed difficult and discomfort in teaching most of the key sexuality education topics. This implies that declaration of positive attitudes towards teaching sexuality education alone is not enough; there is a need for facilitating teachers with knowledge, skills and confidence to teach various sexuality education topics.
Full Text Available Abstract Background Material exchange for sex (transactional sex may be important to sexual relationships and health in certain cultures, yet the motivations for transactional sex, its scale and consequences are still little understood. The aim of this paper is to examine young women's motivations to exchange sex for gifts or money, the way in which they negotiate transactional sex throughout their relationships, and the implications of these negotiations for the HIV epidemic. Method An ethnographic research design was used, with information collected primarily using participant observation and in-depth interviews in a rural community in North Western Tanzania. The qualitative approach was complemented by an innovative assisted self-completion questionnaire. Findings Transactional sex underlay most non-marital relationships and was not, per se, perceived as immoral. However, women's motivations varied, for instance: escaping intense poverty, seeking beauty products or accumulating business capital. There was also strong pressure from peers to engage in transactional sex, in particular to consume like others and avoid ridicule for inadequate remuneration. Macro-level factors shaping transactional sex (e.g. economic, kinship and normative factors overwhelmingly benefited men, but at a micro-level there were different dimensions of power, stemming from individual attributes and immediate circumstances, some of which benefited women. Young women actively used their sexuality as an economic resource, often entering into relationships primarily for economic gain. Conclusion Transactional sex is likely to increase the risk of HIV by providing a dynamic for partner change, making more affluent, higher risk men more desirable, and creating further barriers to condom use. Behavioural interventions should directly address how embedded transactional sex is in sexual culture.
William J Kisoka
Full Text Available BACKGROUND: In most countries of Sub-Saharan Africa, control of lymphatic filariasis (LF is based on annual mass drug administration (MDA with a combination of ivermectin and albendazole. Treatment coverages are however often suboptimal for programmes to reach the goal of transmission interruption within reasonable time. The present study aimed to identify predictors and barriers to individual drug uptake during MDA implementation by the National LF Elimination Programme in Tanzania. METHODS: A questionnaire based cross sectional household survey was carried out in two rural and two urban districts in Lindi and Morogoro regions shortly after the 2011 MDA. 3279 adults (≥15 years were interviewed about personal characteristics, socio-economic status, MDA drug uptake among themselves and their children, reasons for taking/not taking drugs, and participation in previous MDA activities for LF control. FINDINGS: The overall drug uptake rate was 55.1% (range of 44.5-75.6% between districts. There was no overall major difference between children (54.8% and adults (55.2% or between females (54.9% and males (55.8%, but the role of these and other predictors varied to some extent between study sites. Major overall predictors of drug uptake among the interviewed adults were increasing age and history of previous drug uptake. Being absent from home during drug distribution was the main reason for not taking the drugs (50.2% followed by clinical contraindications to treatment (10.8%, missing household visits of drug distributors (10.6%, and households not being informed about the distribution (9.0%. CONCLUSION: Drug uptake relied more on easily modifiable provider-related factors than on individual perceptions and practices in the target population. Limited investments in appropriate timing, dissemination of accurate timing information to recipients and motivation of drug distributors to visit all households (repeatedly when residents are absent are likely
Full Text Available Abstract Background Evidence suggests that a substantial proportion of new HIV infections in African countries are associated with herpes simplex virus type 2 (HSV-2. Thus, the magnitude of HSV-2 infection in an area may suggest the expected course of the HIV epidemic. We determined prevalence of genital herpes, syphilis and associated factors among pregnant women from a remote rural Tanzanian community that has a low but increasing HIV prevalence. Methods We analysed 1296 sera and responses to a standard structured questionnaire collected from pregnant women aged between 15–49 years, attending six different antenatal clinics within rural Manyara and Singida regions in Tanzania. Linked anonymous testing (with informed consent of the serum for specific antibodies against HSV-2 was done using a non-commercial peptide- 55 ELISA. Antibodies against syphilis were screened by using rapid plasma reagin (RPR and reactive samples confirmed by Treponema pallidum haemagglutination assay (TPHA. Results Previous analysis of the collected sera had shown the prevalence of HIV antibodies to be 2%. In the present study the prevalence of genital herpes and syphilis was 20.7% (95% CI: 18.53–23.00 and 1.6% (95% CI: 1.03–2.51, respectively. The presence of HSV-2 antibodies was associated with polygamy (OR 2.2, 95% CI: 1.62 – 3.01 and the use of contraceptives other than condoms (OR 1.7, 95% CI: 1.21 – 2.41. Syphilis was associated with reporting more than one lifetime sexual partner (OR 5.4, 95% CI: 1.88 – 15.76 and previous spontaneous abortion (OR 4.3, 95% CI: 1.52–12.02. Conclusion The low prevalence of HIV infection offers a unique opportunity for strengthening HIV prevention in a cost-effective manner. The identification and control of other prevalent curable STIs other than syphilis and specific intervention of HSV-2 in specific populations like pregnant women would be one among approaches towards preventing incident HIV infections.
Leyna Germana H
Full Text Available Abstract Background Variability in stages of the HIV-1 epidemic and hence HIV-1 prevalence exists in different areas in sub-Saharan Africa. The purpose of this study was to investigate the magnitude of HIV-1 infection and identify HIV-1 risk factors that may help to develop preventive strategies in rural Kilimanjaro, Tanzania. Methods A cross-sectional study was conducted between March and May of 2005 involving all individuals aged between 15–44 years having an address in Oria Village. All eligible individuals were registered and invited to participate. Participants were interviewed regarding their demographic characteristics, sexual behaviors, and medical history. Following a pre-test counseling, participants were offered an HIV test. Results Of the 2 093 eligible individuals, 1 528 (73.0% participated. The overall age and sex adjusted HIV-1 prevalence was 5.6%. Women had 2.5 times higher prevalence (8.0% vs. 3.2% as compared to men. The age group 25–44 years, marriage, separation and low education were associated with higher risk of HIV-1 infection for both sexes. HIV-1 infection was significantly associated with >2 sexual partners in the past 12 months (women: Adjusted odds ratio [AOR], 2.5 (95%CI: 1.3–4.7, and past 5 years, [(men: AOR, 2.2 (95%CI:1.2–5.6; women: AOR, 2.5 (95%CI: 1.4–4.0], unprotected casual sex (men: AOR,1.8 95%CI: 1.2–5.8, bottled alcohol (Men: AOR, 5.9 (95%CI:1.7–20.1 and local brew (men: AOR, 3.7 (95%CI: 1.5–9.2. Other factors included treatment for genital ulcers and genital discharge in the past 1 month. Health-related complaints were more common among HIV-1 seropositive as compared to seronegative participants and predicted the presence of HIV-1 infection. Conclusion HIV-1 infection was highly prevalent in this population. As compared to our previous findings, a shift of the epidemic from a younger to an older age group and from educated to uneducated individuals was observed. Women and married or
Mgode, Georgies F; Katakweba, Abdul S; Mhamphi, Ginethon G; Fwalo, Frank; Bahari, Mohamed; Mdangi, Mashaka; Kilonzo, Bukheti S; Mulungu, Loth S
Leptospirosis and toxoplasmosis are among understudied zoonotic diseases that are also not diagnosed routinely in Tanzania. Humans get leptospirosis and toxoplasmosis through contact with an environment contaminated with Leptospira bacteria and Toxoplasma protozoa from reservoir hosts, which are rodents and cats, respectively. The objective of this study was to determine the prevalence of Leptospira and Toxoplasma infections in rodents and shrews in Mikese area of Morogoro Rural District in eastern Tanzania. A total of 89 rodents and one shrew from cultivated and fallow land were tested for leptospirosis using six Leptospira serovars: Sokoine, Kenya, Canicola, Lora, Hebdomadis and Pomona. Toxoplasmosis was determined in 46 rodents brain smears. The prevalence of leptospirosis was 25.8%, and Leptospira serovar Sokoine was the most prevalent serovar (16.9%). Toxoplasma was detected in one rodent (2.17%) individual while three rodent individuals had Toxoplasma-like parasites hence were considered suspect positive. Findings suggest potential existence of human leptospirosis which needs to be further investigated. Public awareness of leptospirosis and toxoplasmosis should be promoted and their diagnosis considered in patients in health care facilities.
In recent decades, decentralization has been upheld by governments, donors and policy makers in many developing countries as a means of improving people’s participation and public services delivery. In 1996, the government of Tanzania embarked on major local government reforms reflecting the g
In recent decades, decentralization has been upheld by governments, donors and policy makers in many developing countries as a means of improving people’s participation and public services delivery. In 1996, the government of Tanzania embarked on major local government reforms reflecting the
In recent decades, decentralization has been upheld by governments, donors and policy makers in many developing countries as a means of improving people’s participation and public services delivery. In 1996, the government of Tanzania embarked on major local government reforms reflecting the g
Petry, KU; Scholz, U; Hollwitz, B; Wasielewski, R Von; Meijer, C.J.L.M.
Cervical cancer is the most common malignant tumor among women in Tanzania and other countries in tropical Africa. Genital schistosomiasis has been proposed as a possible cofactor in the genesis of this malignant disease that might contribute to its high incidence in regions where bilharzias is ende
Masanja, M Irene; McMorrow, Meredith; Kahigwa, Elizeus; Kachur, S Patrick; McElroy, Peter D
Rapid diagnostic tests (RDTs) were developed as an alternative to microscopy for malaria diagnosis. The RDTs detect malaria parasite antigen(s) in whole blood with high sensitivity and specificity. We assessed health worker malaria treatment practices after the introduction of RDTs in peripheral health facilities without microscopy. From December 2007 to October 2008, we introduced histidine-rich protein II (HRP-2)-based ParaHIT RDTs for routine use in 12 health facilities in Rufiji District, Tanzania. Health workers received training on how to perform RDTs for patients 5 years of age or older with fever or suspected malaria. Children rural health facilities resulted in high adherence to national treatment guidelines. Patients testing negative by RDT were rarely treated with antimalarials. Unapproved antimalarials were seldom used. Health workers continued to follow guidelines for the empiric treatment of febrile children.
Mselle, Lilian T; Kohi, Thecla W
Obstetric fistula is still a major problem in low income countries. While its main cause is untreated obstructed labour, misconceptions about it still persist. This study aimed at exploring and describing perceived health system causes of obstetric fistula from women affected by it in rural Tanzania. This exploratory qualitative study included twenty-eight women affected by obstetric fistula. Semi structured interviews and focus group discussions were held and thematic analysis used to analyse perceived health system causes of obstetric fistula from women's account. Perceived health system causes of obstetric fistula fundamentally reflected the poor quality of obstetric care women received at health care facilities relating to staff unaccountability, late referral, and torture by nurses. The women's perception emphasizes the importance of improving the quality of obstetric care provided by health care providers in health care facilities.
Justice Ajaari, MSc
Full Text Available Objectives:Studies on factors affecting neonatal mortality have rarely considered the impact of place of delivery on neonatal mortality. This study provides epidemiological information regarding the impact of place of delivery on neonatal deaths.Methods:We analyzed data from the Rufiji Health and Demographic Surveillance System (RHDSS in Tanzania. A total of 5,124 live births and 166 neonatal deaths were recorded from January 2005 to December 2006. The place of delivery was categorized as either in a health facility or outside, and the neonatal mortality rate (NMR was calculated as the number of neonatal deaths per 1,000 live births. Univariate and multivariate logistic regression models were used to assess the association between neonatal mortality and place of delivery and other maternal risk factors while adjusting for potential confounders.Results:Approximately 67% (111 of neonatal deaths occurred during the first week of life. There were more neonatal deaths among deliveries outside health facilities (NMR = 43.4 per 1,000 live births than among deliveries within health facilities (NMR = 27.0 per 1,000 live births. The overall NMR was 32.4 per 1,000 live births. Mothers who delivered outside a health facility experienced 1.85 times higher odds of experiencing neonatal deaths (adjusted odds ratio = 1.85; 95% confidence interval = 1.33–2.58 than those who delivered in a health facility.Conclusions and Public Health Implications:Place of delivery is a significant predictor of neonatal mortality. Pregnant women need to be encouraged to deliver at health facilities and this should be done by intensifying education on where to deliver. Infrastructure, such as emergency transport, to facilitate health facility deliveries also requires urgent attention.
Full Text Available Abstract Background The high rate of antenatal care attendance in sub-Saharan Africa, should facilitate provision of information on signs of potential pregnancy complications. The aim of this study was to assess quality of antenatal care with respect to providers' counselling of pregnancy danger signs in Rufiji district, Tanzania. Methods A cross-sectional study was conducted in 18 primary health facilities. Thirty two providers were observed providing antenatal care to 438 pregnant women. Information on counselling on pregnancy danger signs was collected by an observer. Exit interviews were conducted to 435 women. Results One hundred and eighty five (42% clients were not informed of any pregnancy danger signs. The most common pregnancy danger sign informed on was vaginal bleeding 50% followed by severe headache/blurred vision 45%. Nurse auxiliaries were three times more likely to inform a client of a danger sign than registered/enrolled nurses (OR = 3.7; 95% CI: 2.1-6.5 and Maternal Child Health Aides (OR = 2.3: 95% CI: 1.3-4.3 and public health nurses (OR = 2.5; CI: 1.4-4.2 were two times more likely to provide information on danger signs than registered/enrolled nurses. The clients recalled less than half of the pregnancy danger signs they had been informed during the interaction. Conclusion Two out of five clients were not counselled on pregnancy danger signs. The higher trained cadre, registered/enrolled nurses were not informing majority of clients pregnancy danger signs compared to the lower cadres. Supportive supervision should be made to enhance counselling of pregnancy danger signs. Nurse auxiliaries should be encouraged and given chance for further training and upgrading to improve their performance and increase human resource for health.
Shamba, Donat D; Schellenberg, Joanna; Penfold, Suzanne C; Mashasi, Irene; Mrisho, Mwifadhi; Manzi, Fatuma; Marchant, Tanya; Tanner, Marcel; Mshinda, Hassan; Schellenberg, David; Hill, Zelee
The study explored the childbirth-related hygiene and newborn care practices in home-deliveries in Southern Tanzania and barriers to and facilitators of behaviour change. Eleven home-birth narratives and six focus group discussions were conducted with recently-delivering women; two focus group discussions were conducted with birth attendants. The use of clean cloth for delivery was reported as common in the birth narratives; however, respondents did not link its use to newborn's health. Handwashing and wearing of gloves by birth attendants varied and were not discussed in terms of being important for newborn's health, with few women giving reasons for this behaviour. The lack of handwashing and wearing of gloves was most commonly linked to the lack of water, gloves, and awareness. A common practice was the insertion of any family member's hands into the vagina of delivering woman to check labour progress before calling the birth attendant. The use of a new razor blade to cut the cord was near-universal; however, the cord was usually tied with a used thread due to the lack of knowledge and the low availability of clean thread. Applying something to the cord was near-universal and was considered essential for newborn's health. Three hygiene practices were identified as needing improvement: family members inserting a hand into the vagina of delivering woman before calling the birth attendant, the use of unclean thread, and putting substances on the cord. Little is known about families conducting internal checks of women in labour, and more research is needed before this behaviour is targeted in interventions. The use of clean thread as cord-tie appears acceptable and can be addressed, using the same channels and methods that were used for successfully encouraging the use of new razor blade.
Full Text Available Abstract Background Acceptability is a poorly conceptualized dimension of access to health care. Using a study on childhood convulsion in rural Tanzania, we examined social acceptability from a user perspective. The study design is based on the premise that a match between health providers’ and clients’ understanding of disease is an important dimension of social acceptability, especially in trans-cultural communication, for example if childhood convulsions are not linked with malaria and local treatment practices are mostly preferred. The study was linked to health interventions with the objective of bridging the gap between local and biomedical understanding of convulsions. Methods The study combined classical ethnography with the cultural epidemiology approach using EMIC (Explanatory Model Interview Catalogue tool. EMIC interviews were conducted in a 2007/08 convulsion study (n = 88 and results were compared with those of an earlier 2004/06 convulsion study (n = 135. Earlier studies on convulsion in the area were also examined to explore longer-term changes in treatment practices. Results The match between local and biomedical understanding of convulsions was already high in the 2004/06 study. Specific improvements were noted in form of (1 46% point increase among those who reported use of mosquito nets to prevent convulsion (2 13% point decrease among caregivers who associated convulsion with ‘evil eye and sorcery’, 3 14% point increase in prompt use of health facility and 416% point decrease among those who did not use health facility at all. Such changes can be partly attributed to interventions which explicitly aimed at increasing the match between local and biomedical understanding of malaria. Caregivers, mostly mothers, did not seek advice on where to take an ill child. This indicates that treatment at health facility has become socially acceptable for severe febrile with convulsion. Conclusion As an important dimension
Muri, Lukas; Gamell, Anna; Ntamatungiro, Alex J.; Glass, Tracy R.; Luwanda, Lameck B.; Battegay, Manuel; Furrer, Hansjakob; Hatz, Christoph; Tanner, Marcel; Felger, Ingrid; Klimkait, Thomas; Letang, Emilio
Objective: To investigate the prevalence and determinants of virologic failure and acquired drug resistance-associated mutations (DRMs) in HIV-infected children and adolescents in rural Tanzania. Design: Prospective cohort study with cross-sectional analysis. Methods: All children 18 years or less attending the paediatric HIV Clinic of Ifakara and on antiretroviral therapy (ART) for at least 12 months were enrolled. Participants with virologic failure were tested for HIV-DRM. Pre-ART samples were used to discriminate acquired and transmitted resistances. Multivariate logistic regression analysis identified factors associated with virologic failure and the acquisition of HIV-DRM. Results: Among 213 children on ART for a median of 4.3 years, 25.4% failed virologically. ART-associated DRM were identified in 90%, with multiclass resistances in 79%. Pre-ART data suggested that more than 85% had acquired key mutations during treatment. Suboptimal adherence [odds ratio (OR) = 3.90; 95% confidence interval (CI) 1.11–13.68], female sex (aOR = 2.57; 95% CI 1.03–6.45), and current nonnucleoside reverse transcriptase inhibitor-based ART (aOR = 7.32; 95% CI 1.51–35.46 compared with protease inhibitor-based) independently increased the odds of virologic failure. CD4+ T-cell percentage (aOR = 0.20; 0.10–0.40 per additional 10%) and older age at ART initiation (aOR = 0.84 per additional year of age; 95% CI 0.73–0.97) were protective (also in predicting acquired HIV-DRM). At the time of virologic failure, less than 5% of the children fulfilled the WHO criteria for immunologic failure. Conclusion: Virologic failure rates in children and adolescents were high, with the majority of ART-failing children harbouring HIV-DRM. The WHO criteria for immunologic treatment failure yielded an unacceptably low sensitivity. Viral load monitoring is urgently needed to maintain future treatment options for the millions of African children living with HIV. PMID:27677163
Full Text Available Abstract Background Many programmes on young people and HIV/AIDS prevention have focused on the in-school and channeled sexual and reproductive health messages through schools with limited activities for the young people's families. The assumption has been that parents in African families do not talk about sexual and reproductive health (SRH with their children. These approach has had limited success because of failure to factor in the young person's family context, and the influence of parents. This paper explores parent-child communication about SRH in families, content, timing and reasons for their communication with their children aged 14-24 years in rural Tanzania. Methods This study employed an ethnographic research design. Data collection involved eight weeks of participant observation, 17 focus group discussions and 46 in-depth interviews conducted with young people aged 14-24 years and parents of young people in this age group. Thematic analysis was conducted with the aid of NVIVO 7 software. Results Parent-child communication about SRH happened in most families. The communication was mainly on same sex basis (mother-daughter and rarely father-son or father-daughter and took the form of warnings, threats and physical discipline. Communication was triggered by seeing or hearing something a parent perceived negative and would not like their child to experience (such as a death attributable to HIV and unmarried young person's pregnancy. Although most young people were relaxed with their mothers than fathers, there is lack of trust as to what they can tell their parents for fear of punishment. Parents were limited as to what they could communicate about SRH because of lack of appropriate knowledge and cultural norms that restricted interactions between opposite sex. Conclusions Due to the consequences of the HIV pandemic, parents are making attempts to communicate with their children about SRH. They are however, limited by cultural barriers
Consumption of arsenic contaminated water is one of the burning issues in the rural world. Poor public awareness program about health effects of drinking arsenic contaminated water and the rural methods to mitigate this problem poses a great threat of arsenic poisoning many people of the rural world. In this thesis, arsenic removal efficiency and the working mechanism of four rural and economical arsenic mitigation technologies i.e. solar oxidation and reduction of arsenic (SORAS), Bucket tr...
Epsley Elizabeth J
Full Text Available Abstract Background Village AIDS committees (VAC were formed by the Tanzanian government in 2003 to provide HIV education to their communities. However, their potential has not been realised due to their limited knowledge and misconceptions surrounding HIV, which could be addressed through training of VAC members. In an attempt to increase HIV knowledge levels and address common misconceptions amongst the VACs, an HIV curriculum was delivered to members in rural north western Tanzania. Methods An evaluation of HIV knowledge was conducted prior to and post-delivery of HIV training sessions, within members of three VACs in Kisesa ward. Quantitative surveys were used with several open-ended questions to identify local misconceptions and evaluate HIV knowledge levels. Short educational training sessions covering HIV transmission, prevention and treatment were conducted, with each VAC using quizzes, role-plays and participatory learning and action tools. Post-training surveys occurred up to seven days after the final training session. Results Before the training, "good" HIV knowledge was higher amongst men than women (p = 0.041, and among those with previous HIV education (p = 0.002. The trade-centre had a faster turn-over of VAC members, and proximity to the trade-centre was associated with a shorter time on the committee. Training improved HIV knowledge levels with more members achieving a "good" score in the post-training survey compared with the baseline survey (p = Conclusions In this setting, a series of HIV training sessions for VACs demonstrated encouraging results, with increased HIV knowledge levels following short educational sessions. Further work is required to assess the success of VAC members in disseminating this HIV education to their communities, as well as up-scaling this pilot study to other regions in Tanzania with different misconceptions.
Beegle, Kathleen; Rajeev H. Dehejia; Gatti, Roberta; Krutikova, Sofya
This paper exploits a unique longitudinal data set from Tanzania to examine the consequences of child labor on education, employment choices, and marital status over a 10-year horizon. Shocks to crop production and rainfall are used as instrumental variables for child labor. For boys, the findings show that a one-standard-deviation (5.7 hour) increase in child labor leads 10 years later to...
Full Text Available Abstract Background Home-management of malaria (HMM strategy improves early access of anti-malarial medicines to high-risk groups in remote areas of sub-Saharan Africa. However, limited data are available on the effectiveness of using artemisinin-based combination therapy (ACT within the HMM strategy. The aim of this study was to assess the effectiveness of artemether-lumefantrine (AL, presently the most favoured ACT in Africa, in under-five children with uncomplicated Plasmodium falciparum malaria in Tanzania, when provided by community health workers (CHWs and administered unsupervised by parents or guardians at home. Methods An open label, single arm prospective study was conducted in two rural villages with high malaria transmission in Kibaha District, Tanzania. Children presenting to CHWs with uncomplicated fever and a positive rapid malaria diagnostic test (RDT were provisionally enrolled and provided AL for unsupervised treatment at home. Patients with microscopy confirmed P. falciparum parasitaemia were definitely enrolled and reviewed weekly by the CHWs during 42 days. Primary outcome measure was PCR corrected parasitological cure rate by day 42, as estimated by Kaplan-Meier survival analysis. This trial is registered with ClinicalTrials.gov, number NCT00454961. Results A total of 244 febrile children were enrolled between March-August 2007. Two patients were lost to follow up on day 14, and one patient withdrew consent on day 21. Some 141/241 (58.5% patients had recurrent infection during follow-up, of whom 14 had recrudescence. The PCR corrected cure rate by day 42 was 93.0% (95% CI 88.3%-95.9%. The median lumefantrine concentration was statistically significantly lower in patients with recrudescence (97 ng/mL [IQR 0-234]; n = 10 compared with reinfections (205 ng/mL [114-390]; n = 92, or no parasite reappearance (217 [121-374] ng/mL; n = 70; p ≤ 0.046. Conclusions Provision of AL by CHWs for unsupervised malaria treatment at home
Tani, Kassimu; Exavery, Amon; Baynes, Colin D; Pemba, Senga; Hingora, Ahmed; Manzi, Fatuma; Phillips, James F; Kanté, Almamy Malick
Tanzania, like other African countries, faces significant health workforce shortages. With advisory and partnership from Columbia University, the Ifakara Health Institute and the Tanzanian Training Centre for International Health (TTCIH) developed and implemented the Connect Project as a randomized cluster experimental trial of the childhood survival impact of recruiting, training, and deploying of a new cadre of paid community health workers (CHW), named "Wawazesha wa afya ya Jamii" (WAJA). This paper presents an estimation of the cost of training and deploying WAJA in three rural districts of Tanzania. Costing data were collected by tracking project activity expenditure records and conducting in-depth interviews of TTCIH staff who have led the training and deployment of WAJA, as well as their counterparts at Public Clinical Training Centres who have responsibility for scaling up the WAJA training program. The trial is registered with the International Standard Randomized Controlled Trial Register number ( ISRCTN96819844 ). The Connect training cost was US$ 2,489.3 per WAJA, of which 40.1 % was for meals, 20.2 % for accommodation 10.2 % for tuition fees and the remaining 29.5 % for other costs including instruction and training facilities and field allowance. A comparable training program estimated unit cost for scaling-up this training via regional/district clinical training centres would be US$ 833.5 per WAJA. Of this unit cost, 50.3 % would involve the cost of meals, 27.4 % training fees, 13.7 % for field allowances, 9 % for accommodation and medical insurance. The annual running cost of WAJA in a village will cost US$ 1.16 per capita. Costs estimated by this study are likely to be sustainable on a large scale, particularly if existing regional/district institutions are utilized for this program.
Nnko, Soori; Whyte, Susan Reynolds; Geissler, Wenzel
in Mwanza region, North-Western Tanzania. The study explores reasons for scepticism and low uptake of insecticide treated mosquito nets (ITNs) that were promoted through social marketing strategy for malaria control prior to the introduction of long lasting nets (LLN). The paper breaks from traditional...... who could afford the prices of ITNs and who knew where to obtain the insecticides did not necessarily buy them. This suggests that, although people tend to report costrelated factors as a barrier against the use of ITNs, there are other critical concerns at work. Without underestimating the practical...
Duysburgh, Els; Temmerman, Marleen; Yé, Maurice; Williams, Afua; Massawe, Siriel; Williams, John; Mpembeni, Rose; Loukanova, Svetla; Haefeli, Walter E; Blank, Antje
To assess the impact of an intervention consisting of a computer-assisted clinical decision support system and performance-based incentives, aiming at improving quality of antenatal and childbirth care. Intervention study in rural primary healthcare (PHC) facilities in Burkina Faso, Ghana and Tanzania. In each country, six intervention and six non-intervention PHC facilities, located in one intervention and one non-intervention rural districts, were selected. Quality was assessed in each facility by health facility surveys, direct observation of antenatal and childbirth care, exit interviews, and reviews of patient records and maternal and child health registers. Findings of pre- and post-intervention and of intervention and non-intervention health facility quality assessments were analysed and assessed for significant (P < 0.05) quality of care differences. Post-intervention quality scores do not show a clear difference to pre-intervention scores and scores at non-intervention facilities. Only a few variables had a statistically significant better post-intervention quality score and when this is the case this is mostly observed in only one study-arm, being pre-/post-intervention or intervention/non-intervention. Post-intervention care shows similar deficiencies in quality of antenatal and childbirth care and in detection, prevention, and management of obstetric complications as at baseline and non-intervention study facilities. Our intervention study did not show a significant improvement in quality of care during the study period. However, the use of new technology seems acceptable and feasible in rural PHC facilities in resource-constrained settings, creating the opportunity to use this technology to improve quality of care. © 2015 John Wiley & Sons Ltd.
Lyimo Frida S
Full Text Available Abstract Background Cervical cancer is an important public health problem worldwide, which comprises approximately 12% of all cancers in women. In Tanzania, the estimated incidence rate is 30 to 40 per 100,000 women, indicating a high disease burden. Cervical cancer screening is acknowledged as currently the most effective approach for cervical cancer control, and it is associated with reduced incidence and mortality from the disease. The aim of the study was to identify the most important factors related to the uptake of cervical cancer screening among women in a rural district of Tanzania. Methods A cross sectional study was conducted with a sample of 354 women aged 18 to 69 years residing in Moshi Rural District. A multistage sampling technique was used to randomly select eligible women. A one-hour interview was conducted with each woman in her home. The 17 questions were modified from similar questions used in previous research. Results Less than one quarter (22.6% of the participants had obtained cervical cancer screening. The following characteristics, when examined separately in relation to the uptake of cervical cancer screening service, were significant: husband approval of cervical cancer screening, women's level of education, women's knowledge of cervical cancer and its prevention, women's concerns about embarrassment and pain of screening, women's preference for the sex of health provider, and women's awareness of and distance to cervical cancer screening services. When examined simultaneously in a logistic regression, we found that only knowledge of cervical cancer and its prevention (OR = 8.90, 95%CI = 2.14-16.03 and distance to the facility which provides cervical cancer screening (OR = 3.98, 95%CI = 0.18-5.10 were significantly associated with screening uptake. Conclusions Based on the study findings, three recommendations are made. First, information about cervical cancer must be presented to women. Second, public education of
Daudi O Simba
Full Text Available BACKGROUND: Effective and timely case management remains one of the fundamental pillars for control of malaria. Tanzania introduced artemisinin-combination therapy [ACT] for uncomplicated malaria; however, the policy change is challenged by limited availability of ACTs due to high cost. This study aimed to determine factors influencing prompt access to ACTs among febrile children in rural Kilosa, Tanzania. METHODS AND FINDINGS: In a community-based study, 1,235 randomly selected children under five were followed up weekly for six months, in 2008. Using a structured questionnaire, children's caretakers were asked about the child's febrile history in the last seven days, and treatment actions including timing, medicines used and source of care. Caretakers' knowledge about malaria and socioeconomic and demographic data were also obtained. About half of followed-up children had at least one episode of fever. Less than half (44.8% of febrile children were taken to government facilities. Almost one-third (37.6%; 95% CI 33.1-42.1 of febrile children had prompt access to ACT. Care-seeking from a government facility was the overriding factor, increasing the likelihood of prompt access to an ACT 18 times (OR 17.7; 95% CI 10.55-29.54; adjusted OR 16.9; 95% CI 10.06-28.28. Caretakers from the better-off household (3rd-5th quintiles were more likely to seek care from government facilities (OR 3.66; 95% CI 2.56-5.24; adjusted OR 1.80; 95% CI 1.18-2.76. The majority of antimalarials accessed by the poor were ineffective [86.0%; 295/343], however, they paid more for them (median Tsh 500 compared to the better-offs (median Tsh 0. CONCLUSIONS: Prompt access to ACT among febrile children was unacceptably low, due mainly to limited availability of subsidised ACT at the location where most caretakers sought care. There is urgent need to accelerate implementation of strategies that will ensure availability of ACT at an affordable price in remote rural areas, where
Daniel Wilfred Gunda
Full Text Available Introduction. HIV still causes high mortality despite use of ART. This study was designed to determine the prevalence and risk factors of mortality among HIV patients receiving ART in northwestern rural Tanzania. Methods. A retrospective study of HIV patients on ART was done at Sengerema in Mwanza, Tanzania. The data on demography, date of HIV diagnosis, WHO stage, opportunistic infections, CD4, hemoglobin, ART regimen, and time and outcome on treatment as dead or alive were collected and analyzed using STATA version 11. Results. In total, 740 patients were studied. The median age was 35 (27–42 years with female predominance of 465 (62.8%. Of the participants, 261 (35.3% had WHO stages 3 and 4 diseases. Most participants, 258 (34.9%, had baseline CD4 counts <200 cells/μl. Deaths occurred in 86 (11.6% patients which were independently associated with male gender (16.0% versus 9.0%, p=0.015, being divorced (OR = 2.7, p<0.001, WHO stages 3 and 4 (OR = 2.3, p=0.05, CD4 <200 cells/μl (OR = 3.4, p<0.001, and severe anemia (OR = 6.6, p<0.001. Conclusions. The mortality is high among HIV patients receiving ART in northwestern rural Tanzania. Universal testing could increase early diagnosis and treatment. A close follow-up of at-risk patients within the first year of ART could reduce the mortality of this subgroup of patients.
Daniel W. Gunda
Full Text Available Introduction. Smear positive TB carries high morbidity and mortality. The TB treatment aims at sputum conversion by two months of antituberculous. Patients who delay sputum conversion remain potentially infectious, with risk of treatment failure, drug resistance, and mortality. Little is known about the magnitude of this problem in our setting. This study was designed to determine the prevalence and risk factors of delayed sputum conversion in northwestern rural part of Tanzania. Methods. This was a retrospective cohort study involving smear positive TB patients at Sengerema DDH in 2015. Demographic data, HIV status, and sputum results at TB diagnosis and on TB treatment were collected and analyzed using STATA 11. Results. In total, 156 patients were studied. Males were 97 (62%; the median age was 39 [30–51] years. Fifty-five (35.3% patients were HIV coinfected and 13 (8.3% patients had delayed sputum conversion which was strongly associated with male gender (OR=8.2, p=0.046, age >50 years (OR=6.7, p=0.003, and AFB 3+ (OR=8.1, p=0.008. Conclusions. Delayed sputum conversion is prevalent in this study. These patients can potentially fail on treatment, develop drug resistance, and continue spreading TB. Strategies to reduce the rate of delayed sputum conversion could also reduce these potential unfavorable outcomes.
Full Text Available Abstract Background Controlled clinical trials have shown that a six-dose regimen of artemether-lumefantrine (AL therapy for uncomplicated Plasmodium falciparum malaria results in cure rates >95% with good tolerability. Materials and methods A prospective study was carried out to document the adherence to and acceptability of AL administration. This was undertaken in the context of the ALIVE study, a prospective, community-based, observational study in a rural, malaria-endemic area of Tanzania. Following microscopic confirmation of P. falciparum infection, the first AL dose was taken under supervision, with the subsequent five doses taken unsupervised at home. Patients were randomized to receive a home-based assessment close to the scheduled time for one of the unsupervised doses, but were blinded to which follow-up visit they had been allocated. A structured questionnaire was administered by trained staff and AL consumption was confirmed by inspection of blister packs. Results A total of 552 patients were recruited of whom 352 (63.8% were Discussion Factors contributing to adherence were likely to be helpful packaging, pictorial dosing instructions and patients' conviction that AL is effective. Conclusion Adherence to the dosing regimen and timing of AL administration was very good.
Nyambo, Brigitte; Ligate, Elly
Purpose: To identify and review production and marketing information sources and flows for smallholder cashew (Anacardium occidentale L.) growers in Tanzania and recommend systems improvements for better technology uptake. Design/methodology/approach: Two-stage purposive samples were drawn. First, two districts in the main cashew producing areas,…
Nyambo, Brigitte; Ligate, Elly
Purpose: To identify and review production and marketing information sources and flows for smallholder cashew (Anacardium occidentale L.) growers in Tanzania and recommend systems improvements for better technology uptake. Design/methodology/approach: Two-stage purposive samples were drawn. First, two districts in the main cashew producing areas,…
Illah, Evance; Mbaruku, Godfrey; Masanja, Honorati; Kahn, Kathleen
Complications of childbirth and pregnancy are leading causes of death among women of reproductive age. Developing countries account for 99% of maternal deaths. The aim of this study was to explore levels, causes and risk factors associated with maternal mortality in rural Tanzania. Longitudinal data (2002-2006) from Rufiji HDSS was used where a total of 26 427 women aged 15-49 years were included in the study; 64 died and there were 15 548 live births. Cox proportional hazards regression was used to assess the risk factors associated with maternal deaths. MMR was 412 per 100 000 live births. The main causes of death were haemorrhage (28%), eclampsia (19%) and puerperal sepsis (8%). An increased risk of 154% for maternal death was found for women aged 30-39 versus 15-19 years (HR=2.54, 95% CI=1.001-6.445). Married women had a protective effect of 62% over unmarried ones (HR=0.38, 95% CI=0.176-0.839).
Nordang, Sunniva; Shoo, Tiransia; Holmboe-Ottesen, Gerd; Kinabo, Joyce; Wandel, Margareta
Some progress has been achieved in reducing the prevalence of undernutrition among children under 5 years of age in Tanzania. In the Rukwa region (2010), the level of stunted and underweight children was 50·4 and 13·5 %, respectively. The aim of this study was to assess the nutritional status of children under 5 years of age, feeding practices and risk factors of undernutrition in a rural village in the Rukwa region, as well as to discuss the results in light of a similar study conducted in 1987/1988. This cross-sectional study was conducted in 152 households with children under 5 years of age. Data were obtained from the child's main caretaker and the household head, using a structured questionnaire and a 24 h dietary recall. Children's length/height and weight were measured. The prevalence of stunting and underweight was found to be 63·8 and 33·6 % (Z-scorechildren on the first day after birth. A thin gruel was introduced after a median of 2 months (25th-75th percentiles; 1-3). The time mothers spent farming was a significant risk factor for stunting (P=0·04). Illness, food shortage and dry-season cultivation were significant risk factors for underweight (Pfeeding practices were not in line with WHO recommendations. Women working in farms, food shortage, dry-season cultivation and diseases partly explain the children's poor nutritional status.
Kweka, Eliningaya J; Nkya, Watoky M M; Mahande, Aneth M
. Sporozoite infectivity rates, mosquito host blood meal source, bed net coverage and mosquito abundance were assessed in this study. METHODOLOGY: A longitudinal survey was conducted in four villages in two regions of Tanzania. Malaria vectors were sampled using the CDC light trap and pyrethrum spray catch...... methods. In each village, ten paired houses were selected for mosquitoes sampling. Sampling was done in fortnight case and study was undertaken for six months in both Kilimanjaro (Northern Tanzania) and Dodoma (Central Tanzania) regions. RESULTS: A total of 6,883 mosquitoes were collected including: 5......,628 (81.8%) Anopheles arabiensis, 1,100 (15.9%) Culex quinquefasciatus, 89 (1.4%) Anopheles funestus, and 66 (0.9%) Anopheles gambiae s.s. Of the total mosquitoes collected 3,861 were captured by CDC light trap and 3,022 by the pyrethrum spray catch method. The overall light trap: spray catch ratio was 1...
Full Text Available Background: The implementation of new technology can interrupt established workflows in health care settings. The Quality of Maternal Care (QUALMAT project has introduced an (eCDSS for antenatal care (ANC and delivery in rural primary health care facilities in Africa. Objective: This study was carried out to investigate the influence of the QUALMAT eCDSS on the workflow of health care workers in rural primary health care facilities in Ghana and Tanzania. Design: A direct observation, time-and-motion study on ANC processes was conducted using a structured data sheet with predefined major task categories. The duration and sequence of tasks performed during ANC visits were observed, and changes after the implementation of the eCDSS were analyzed. Results: In 24 QUALMAT study sites, 214 observations of ANC visits (144 in Ghana, 70 in Tanzania were carried out at baseline and 148 observations (104 in Ghana, 44 in Tanzania after the software was implemented in 12 of those sites. The median time spent combined for all centers in both countries to provide ANC at baseline was 6.5 min [interquartile range (IQR =4.0–10.6]. Although the time spent on ANC increased in Tanzania and Ghana after the eCDSS implementation as compared to baseline, overall there was no significant increase in time used for ANC activities (0.51 min, p=0.06 in Ghana; and 0.54 min, p=0.26 in Tanzania as compared to the control sites without the eCDSS. The percentage of medical history taking in women who had subsequent examinations increased after eCDSS implementation from 58.2% (39/67 to 95.3% (61/64 p<0.001 in Ghana but not in Tanzania [from 65.4% (17/26 to 71.4% (15/21 p=0.70]. Conclusions: The QUALMAT eCDSS does not increase the time needed for ANC but partly streamlined workflow at sites in Ghana, showing the potential of such a system to influence quality of care positively.
Mensah, Nathan; Sukums, Felix; Awine, Timothy; Meid, Andreas; Williams, John; Akweongo, Patricia; Kaltschmidt, Jens; Haefeli, Walter E; Blank, Antje
The implementation of new technology can interrupt established workflows in health care settings. The Quality of Maternal Care (QUALMAT) project has introduced an electronic clinical decision support system (eCDSS) for antenatal care (ANC) and delivery in rural primary health care facilities in Africa. This study was carried out to investigate the influence of the QUALMAT eCDSS on the workflow of health care workers in rural primary health care facilities in Ghana and Tanzania. A direct observation, time-and-motion study on ANC processes was conducted using a structured data sheet with predefined major task categories. The duration and sequence of tasks performed during ANC visits were observed, and changes after the implementation of the eCDSS were analyzed. In 24 QUALMAT study sites, 214 observations of ANC visits (144 in Ghana, 70 in Tanzania) were carried out at baseline and 148 observations (104 in Ghana, 44 in Tanzania) after the software was implemented in 12 of those sites. The median time spent combined for all centers in both countries to provide ANC at baseline was 6.5 min [interquartile range (IQR) =4.0-10.6]. Although the time spent on ANC increased in Tanzania and Ghana after the eCDSS implementation as compared to baseline, overall there was no significant increase in time used for ANC activities (0.51 min, p=0.06 in Ghana; and 0.54 min, p=0.26 in Tanzania) as compared to the control sites without the eCDSS. The percentage of medical history taking in women who had subsequent examinations increased after eCDSS implementation from 58.2% (39/67) to 95.3% (61/64) pGhana but not in Tanzania [from 65.4% (17/26) to 71.4% (15/21) p=0.70]. The QUALMAT eCDSS does not increase the time needed for ANC but partly streamlined workflow at sites in Ghana, showing the potential of such a system to influence quality of care positively.
Full Text Available Abstract Background Mild cases of malaria, pneumonia and diarrhea are readily treatable with complete recovery and with inexpensive and widely available first-line drugs. However, treatment is complicated and expensive, and mortality is higher when children present to the hospital with severe forms of these illnesses. We studied how care seeking behaviours and other factors contributed to severity of malaria, pneumonia and diarrhoea among children less than five years in rural Tanzania. Methods We interviewed consecutive care-takers of children diagnosed with malaria, pneumonia and/or diarrhea at Korogwe and Muheza district hospitals, in north-eastern Tanzania, between July 2009 and January 2010, and compared characteristics of children presenting with severe and those with non-severe disease. Results A total of 293 children with severe and 190 with non-severe disease were studied. We found persistent associations between severity of disease and caretaker’s lack of formal education (OR 6.6; 95% confidence interval (CI 2.7-15.8 compared to those with post-primary education, middle compared to high socio-economic status (OR 1.9; 95% CI 1.2-3.2, having 4 or more children compared to having one child (OR 2.5; 95% CI 1.4-4.5, having utilized a nearer primary health care (PHC facility for the same illness compared to having not (OR 5.2; 95% CI 3.0-9.1, and having purchased the first treatment other than paracetamol from local or drug shops compared to when the treatment was obtained from the public hospitals for the first time (OR 3.2; 95% CI 1.9-5.2. The old officially abandoned first line anti-malaria drug Sulfadoxin-pyrimethamine (SP was found to still be in use for the treatment of malaria and was significantly associated with childrens’ presentation to the hospital with severe malaria (OR 12.5; 95% CI 1.6-108.0. Conclusions Our results indicate that caretakers with no formal education, with lower SES and with many children can be target
Full Text Available INTRODUCTION: As part of maternal mortality reducing strategies, coverage of delivery care among sub-Saharan African rural poor will improve, with a range of facilities providing services. Whether high coverage will benefit all socio-economic groups is unknown. Iringa rural District, Southern Tanzania, with high facility delivery coverage, offers a paradigm to address this question. Delivery services are available in first-line facilities (dispensaries, health centres and one hospital. We assessed whether all socio-economic groups access the only comprehensive emergency obstetric care facility equally, and surveyed existing delivery services. METHODS: District population characteristics were obtained from a household community survey (n = 463. A Hospital survey collected data on women who delivered in this facility (n = 1072. Principal component analysis on household assets was used to assess socio-economic status. Hospital population socio-demographic characteristics were compared to District population using multivariable logistic regression. Deliveries' distribution in District facilities and staffing were analysed using routine data. RESULTS: Women from the hospital compared to the District population were more likely to be wealthier. Adjusted odds ratio of hospital delivery increased progressively across socio-economic groups, from 1.73 for the poorer (p = 0.0031 to 4.53 (p<0.0001 for the richest. Remarkable dispersion of deliveries and poor staffing were found. In 2012, 5505/7645 (72% institutional deliveries took place in 68 first-line facilities, the remaining in the hospital. 56/68 (67.6% first-line facilities reported ≤100 deliveries/year, attending 33% of deliveries. Insufficient numbers of skilled birth attendants were found in 42.9% of facilities. DISCUSSION: Poorer women remain disadvantaged in high coverage, as they access lower level facilities and are under-represented where life-saving transfusions and caesarean
Manongi, Rachel; Mtei, Frank; Mtove, George; Nadjm, Behzad; Muro, Florida; Alegana, Victor; Noor, Abdisalan M; Todd, Jim; Reyburn, Hugh
To investigate the association, if any, between child mortality and distance to the nearest hospital. The study was based on data from a 1-year study of the cause of illness in febrile paediatric admissions to a district hospital in north-east Tanzania. All villages in the catchment population were geolocated, and travel times were estimated from availability of local transport. Using bands of travel time to hospital, we compared admission rates, inpatient case fatality rates and child mortality rates in the catchment population using inpatient deaths as the numerator. Three thousand hundred and eleven children under the age of 5 years were included of whom 4.6% died; 2307 were admitted from time between admission and death. Assuming uniform mortality in the catchment population, the predicted number of deaths not benefiting from hospital admission prior to death increased by 21.4% per hour of travel time to hospital. If the same admission and death rates that were found at <3 h from the hospital applied to the whole catchment population and if hospital care conferred a 30% survival benefit compared to home care, then 10.3% of childhood deaths due to febrile illness in the catchment population would have been averted. The mortality impact of poor access to hospital care in areas of high paediatric mortality is likely to be substantial although uncertainty over the mortality benefit of inpatient care is the largest constraint in making an accurate estimate. © 2014 The Authors Tropical Medicine & International Health Published by John Wiley & Sons Ltd.
Lilleør, Helene Bie
Lack of primary schooling among rural children in developing countries is often attributed to credit constraints and household demand for child labour, implying that direct and indirect costs of schooling are high. Surprisingly few studies have considered the importance of parents' expected returns of investing in their childrens human capital, despite the fact that most parents rely on their children for old-age support and subsistence. In this paper, I propose an alternative model for human...
Full Text Available Abstract Background Once effective therapy for a previously untreatable condition is made available, a normalisation of the disease often occurs. As part of a broader initiative to monitor the implementation of the national antiretroviral therapy (ART programme, this qualitative study investigated the impact of ART availability on perceptions of HIV in a rural ward of North Tanzania and its implications for prevention. Methods A mix of qualitative methods was used including semi-structured interviews with 53 ART clinic clients and service providers. Four group activities were conducted with persons living with HIV. Data were analyzed using the qualitative software package NVIVO-7. Results People on ART often reported feeling increasingly comfortable with their status reflecting a certain "normalization" of the disease. This was attributed to seeing other people affected by HIV, regaining physical health, returning to productive activities and receiving emotional support from health service providers. Overcoming internalized feelings of shame facilitated disclosure of HIV status, helped to sustain treatment, and stimulated VCT uptake. However "blaming" stigma - where people living with HIV were considered responsible for acquiring a "moral disease" - persisted in the community and anticipating it was a key barrier to disclosure and VCT uptake. Attributing HIV symptoms to witchcraft seemed an effective mechanism to transfer "blame" from the family unit to an external force but could lead to treatment interruption. Conclusion As long as an HIV diagnosis continues to have moral connotations, a de-stigmatisation of HIV paralleling that occurring with diseases like cancer is unlikely to occur. Maximizing synergies between HIV treatment and prevention requires an enabling environment for HIV status disclosure, treatment continuation, and safer sexual behaviours. Local leaders should be informed and sensitised and communities mobilised to address the
Full Text Available Background: Prior to the scale-up of antiretroviral therapy (ART, demographic surveillance cohort studies showed higher mortality among migrants than residents in many rural areas. Objectives: This study quantifies the overall and AIDS-specific mortality between migrants and residents prior to ART, during ART scale-up, and after widespread availability of ART in Rufiji district in Tanzania. Design: In Health and Demographic Surveillance System (HDSS, the follow-up of individuals aged 15–59 years was categorized into three periods: before ART (1998–2003, during ART scale-up (2004–2007, and after widespread availability of ART (2008–2011. Residents were those who never migrated within and beyond HDSS, internal migrants were those who moved within the HDSS, and external migrants were those who moved into the HDSS from outside. Mortality rates were estimated from deaths and person-years of observations calculated in each time period. Hazard ratios were estimated to compare mortality between migrants and residents. AIDS deaths were identified from verbal autopsy, and the odds ratio of dying from AIDS between migrants and residents was estimated using the multivariate logistic regression model. Results: Internal and external migrants experienced higher overall mortality than residents before the introduction of ART. After widespread availability of ART overall mortality were similar for internal and external migrants. These overall mortality experiences observed were similar for males and females. In the multivariate logistic regression model, adjusting for age, sex, education, and social economic status, internal migrants had similar likelihood of dying from AIDS as residents (adjusted odds ratio [AOR]=1.14, 95% confidence interval [CI]: 0.70–1.87 while external migrants were 70% more likely to die from AIDS compared to residents prior to the introduction of ART (AOR=1.70, 95% CI: 1.06–2.73. After widespread availability of ART with the
Zinnen, Véronique; Paul, Elisabeth; Mwisongo, Aziza; Nyato, Daniel; Robert, Annie
An increasing number of studies explore the association between financial and non-financial incentives and the retention of health workers in developing countries. This study aims to contribute to empirical evidence on human resource for health motivation factors to assist policy makers in promoting effective and realistic interventions. A cross-sectional survey was conducted in four rural Tanzanian districts to explore staff stability and health workers' motivation. Data were collected using qualitative and quantitative techniques, covering all levels and types of health facilities. Stability of staff was found to be quite high. Public institutions remained very attractive with better job security, salary and retirement benefits. Satisfaction over working conditions was very low owing to inadequate working equipment, work overload, lack of services, difficult environment, favouritism and 'empty promotions'. Positive incentives mentioned were support for career development and supportive supervision. Attracting new staff in rural areas appeared to be more difficult than retaining staff in place. The study concluded that strategies to better motivate health personnel should focus on adequate remuneration, positive working and living environment and supportive management. However, by multiplying health facilities, the latest Tanzanian human resource for health plan could jeopardize current positive results.
Hosea Ken M
Full Text Available Abstract Background Ethnobotanical surveys were carried out to document herbal remedies used in the management of HIV/AIDS opportunistic infections in Bukoba Rural district, Tanzania. The district is currently an epicenter of HIV/AIDS and although over 90% of the population in the district relies on traditional medicines to manage the disease, this knowledge is impressionistic and not well documented. The HIV/AIDS opportunistic conditions considered during the study were Tuberculosis (TB, Herpes zoster (Shingles, Herpes simplex (Genital herpes, Oral candidiasis and Cryptococcal meningitis. Other symptomatic but undefined conditions considered were skin rashes and chronic diarrhea. Methods An open-ended semi-structured questionnaire was used in collecting field information. Descriptive statistics were used to analyze the ethnobotanical data collected. Factor of informant consensus (Fic was used to analyze the ethnobotanical importance of the plants. Results In the present study, 75 plant species belonging to 66 genera and 41 families were found to be used to treat one or more HIV/AIDS related infections in the district. The study revealed that TB and oral candidiasis were the most common manifestations of HIV/AIDS opportunistic infections affecting most of the population in the area. It unveils the first detailed account of ethnomedical documentation of plants focusing the management of HIV/AIDS related infections in the district. Conclusion It is concluded that the ethnopharmacological information reported forms a basis for further research to identify and isolate bioactive constituents that can be developed to drugs for the management of the HIV/AIDS opportunistic infections.
Sarah H Pedersen
Full Text Available Cryptosporidium epidemiology is poorly understood, but infection is suspected of contributing to childhood malnutrition and diarrhea-related mortality worldwide.A prospective cohort of 108 women and their infants in rural/semi-rural Tanzania were followed from delivery through six months. Cryptosporidium infection was determined in feces using modified Ziehl-Neelsen staining. Breastfeeding/infant feeding practices were queried and anthropometry measured. Maternal Cryptosporidium infection remained high throughout the study (monthly proportion = 44 to 63%. Infection did not differ during lactation or by HIV-serostatus, except that a greater proportion of HIV-positive mothers were infected at Month 1. Infant Cryptosporidium infection remained undetected until Month 2 and uncommon through Month 3 however, by Month 6, 33% of infants were infected. There were no differences in infant infection by HIV-exposure. Overall, exclusive breastfeeding (EBF was limited, but as the proportion of infants exclusively breastfed declined from 32% at Month 1 to 4% at Month 6, infant infection increased from 0% at Month 1 to 33% at Month 6. Maternal Cryptosporidium infection was associated with increased odds of infant infection (unadjusted OR = 3.18, 95% CI 1.01 to 9.99, while maternal hand washing prior to infant feeding was counterintuitively also associated with increased odds of infant infection (adjusted OR = 5.02, 95% CI = 1.11 to 22.78.Both mothers and infants living in this setting suffer a high burden of Cryptosporidium infection, and the timing of first infant infection coincides with changes in breastfeeding practices. It is unknown whether this is due to breastfeeding practices reducing pathogen exposure through avoidance of contaminated food/water consumption; and/or breast milk providing important protective immune factors. Without a Cryptosporidium vaccine, and facing considerable diagnostic challenges and ineffective treatment in
Permin, A; Magwisha, H; Kassuku, A A; Nansen, P; Bisgaard, M; Frandsen, F; Gibbons, L
A cross-sectional study on the prevalence of helminths in rural scavenging poultry on six hundred adult chickens selected randomly from six villages in the Morogoro Region, Tanzania during the wet and the dry seasons, was conducted. The trachea and gastrointestinal tract of each bird were examined for the presence of parasites. All chickens were infected with one or several species of helminths, the average being 4.8 +/- 1.7 helminths per chicken during the wet season and 5.1 +/- 1.8 during the dry season. A total of 29 different helminth species were shown in the trachea or the gastrointestinal tract. The following species were identified: Syngamus trachea (0.7% (wet season), 2% (dry season)); Gongylonema ingluvicola (6.3%, 17.7%); Tetrameres americana (54.3%, 60.3%); Dispharynx nasuta (0%, 2.7%); Acuaria hamulosa (8.3%, 19.3%); Ascaridia galli (28.3%, 32.3%); Heterakis gallinarum (74.0%, 78.7%); H. isolonche (18.7%, 5.0%); H. dispar (25.7%, 6.3%); Allodapa suctoria (40.0%, 52.0%); Subulura strongylina (3.3%, 1.0%); Strongyloides avium (0.3%, 3.0%); Capillaria annulata (2.0%, 0.0%); C. contorta (9.0%, 1.0%); C. caudinflata (2.0%, 4.3%); C. obsignata (8.7%, 25.0%); C. anatis (4.0%, 9.0%); C. bursata (1.0%, 2.7%); Raillietina echinobothrida (41.3%, 46.3%); R. tetragona (25.3%, 21. 3%); R. cesticillus (8.7%, 2.7%); Choanotaenia infundibulum (0.0%, 3. 7%); Hymenolepis carioca (9.0%, 18.0%); H. cantaniana (48.0%, 43. 0%); Amoebotaenia cuneata (39.3%, 36.0%); Metroliasthes lucida (1.0%, 0.3%); Davainea proglottina (5.7%, 0.3%) and Polymorphus boschadis (0.3%, 0.0%). No trematodes were found. No correlation was found between season and prevalence, or season and mean worm burdens. Twelve helminths of the species recovered represent new local records.
Dillip, Angel; Alba, Sandra; Mshana, Christopher; Hetzel, Manuel W; Lengeler, Christian; Mayumana, Iddy; Schulze, Alexander; Mshinda, Hassan; Weiss, Mitchell G; Obrist, Brigit
Acceptability is a poorly conceptualized dimension of access to health care. Using a study on childhood convulsion in rural Tanzania, we examined social acceptability from a user perspective. The study design is based on the premise that a match between health providers' and clients' understanding of disease is an important dimension of social acceptability, especially in trans-cultural communication, for example if childhood convulsions are not linked with malaria and local treatment practices are mostly preferred. The study was linked to health interventions with the objective of bridging the gap between local and biomedical understanding of convulsions. The study combined classical ethnography with the cultural epidemiology approach using EMIC (Explanatory Model Interview Catalogue) tool. EMIC interviews were conducted in a 2007/08 convulsion study (n = 88) and results were compared with those of an earlier 2004/06 convulsion study (n = 135). Earlier studies on convulsion in the area were also examined to explore longer-term changes in treatment practices. The match between local and biomedical understanding of convulsions was already high in the 2004/06 study. Specific improvements were noted in form of (1) 46% point increase among those who reported use of mosquito nets to prevent convulsion (2) 13% point decrease among caregivers who associated convulsion with 'evil eye and sorcery', 3) 14% point increase in prompt use of health facility and 4)16% point decrease among those who did not use health facility at all. Such changes can be partly attributed to interventions which explicitly aimed at increasing the match between local and biomedical understanding of malaria. Caregivers, mostly mothers, did not seek advice on where to take an ill child. This indicates that treatment at health facility has become socially acceptable for severe febrile with convulsion. As an important dimension of access to health care 'social acceptability' seems relevant in studying
Full Text Available Abstract Background African malaria vectors bite predominantly indoors at night so sleeping under an Insecticide-Treated Net (ITN can greatly reduce malaria risk. Behavioural adaptation by mosquitoes to increasing ITN coverage could allow vector mosquitoes to bite outside of peak sleeping hours and undermine efficacy of this key malaria prevention measure. Methods High coverage with largely untreated nets has been achieved in the Kilombero Valley, southern Tanzania through social marketing programmes. Direct surveys of nightly biting activity by An. gambiae Giles were conducted in the area before (1997 and after (2004 implementation of ITN promotion. A novel analytical model was applied to estimate the effective protection provided by an ITN, based on published experimental hut trials combined with questionnaire surveys of human sleeping behaviour and recorded mosquito biting patterns. Results An. gambiae was predominantly endophagic and nocturnal in both surveys: Approximately 90% and 80% of exposure occurred indoors and during peak sleeping hours, respectively. ITNs consistently conferred >70% protection against exposure to malaria transmission for users relative to non-users. Conclusion As ITN coverage increases, behavioural adaptation by mosquitoes remains a future possibility. The approach described allows comparison of mosquito biting patterns and ITN efficacy at multiple study sites and times. Initial results indicate ITNs remain highly effective and should remain a top-priority intervention. Combined with recently developed transmission models, this approach allows rapid, informative and cost-effective preliminary comparison of diverse control strategies in terms of protection against exposure before more costly and intensive clinical trials.
Madulu, Ndalahwa F.
Water scarcity is an important environmental constraint to development. Water availability is closely linked to human welfare and health by affecting nutrition status and quantity of drinking water especially for the poor. It has impacts on household labour because of the time and energy spent in obtaining it. These problems are more keenly felt among the poor households and in the agricultural subsistence economy. In many areas, the demand for water has been increasing due to rapid population growth, economic development, and climatic change. Water scarcity also stimulates social conflicts between various water users: individuals, communities, industries, livestock, wildlife, agriculture etc. Consequently, local communities have evolved strategies for coping with water stress and drought. These strategies include use of various sources of water, inaction to strict bye-laws regarding the use of water, crop diversification, wage labour, and possibly seasonal migration. The available strategies are likely to vary from one area to another. Some of these actions have measurable longterm demographic consequences, particularly if water stress is severe or repetitive. Although most governments and donor organizations often put much emphasis on the provision of water for drinking purposes, there is clear evidence that the supply of water for other uses has equal importance especially among rural communities. This observation suggests that putting too much emphasis on drinking water needs, addresses a rather insignificant part of the problem of water resources and biases the range of solutions which are likely to be proposed for perceived shortages. The presence of other water uses necessitates the provision of multi-purpose water sources that can serve a number of contrasting functions. This demand-responsive approach can enable the local communities and the poor households to choose the type of services they require on the basis of perceived needs and their ability to
Latham, Glenn; Burnham, Julia
Some innovative methods of serving the rural handicapped population are described: volunteers; telecommunications for home instruction; SPECIALNET electronic mail; and resources for parents. Three cases involving Utah's Cooperative Extension Project for the Handicapped summarize services for handicapped and Indian students. (GDC)
Mkoka, Dickson Ally; Kiwara, Angwara; Goicolea, Isabel; Hurtig, Anna-Karin
Many health policies developed internationally often become adopted at the national level and are implemented locally at the district level. A decentralized district health system led by a district health management team becomes responsible for implementing such policies. This study aimed at exploring the experiences of a district health management team in implementing Emergency Obstetric Care (EmOC) related policies and identifying emerging governance aspects. The study used a qualitative approach in which data was obtained from thirteen individual interviews and one focus group discussion (FGD). Interviews were conducted with members of the district health management team, district health service boards and NGO representatives. The FGD included key informants who were directly involved in the work of implementing EmOC services in the district. Documentary reviews and observation were done to supplement the data. All the materials were analysed using a qualitative content analysis approach. Implementation of EmOC was considered to be a process accompanied by achievements and challenges. Achievements included increased institutional delivery, increased number of ambulances, training service providers in emergency obstetric care and building a new rural health centre that provides comprehensive emergency obstetric care. These achievements were associated with good leadership skills of the team together with partnerships that existed between different actors such as the Non-Governmental Organization (NGO), development partners, local politicians and Traditional Birth Attendants (TBAs). Most challenges faced during the implementation of EmOC were related to governance issues at different levels and included delays in disbursement of funds from the central government, shortages of health workers, unclear mechanisms for accountability, lack of incentives to motivate overburdened staffs and lack of guidelines for partnership development. The study revealed that
Roosta, Neda; Black, David S; Rea, Thomas H
Leprosy is a chronic infection of the skin and peripheral nerves caused by the bacterium Mycobacterium leprae, which causes peripheral insensitivity and disfigurements of the skin, limbs, and digits. Social stigma is a common consequence of leprosy and may differ according to level of physical disfigurement and geographic location. The objective of this study was to assess social stigma encountered by patients with leprosy in clinical settings located in rural Tanzania and urban USA and to compare the social stigma reported in these regions. A total of 56 respondents were recruited from one leprosy inpatient facility in Shirati, Tanzania (n = 28), and one outpatient clinic in Los Angeles, USA (n = 28). Cross-sectional data were obtained from face-to-face interviews, which were conducted with respondents at each clinic location. Measures of perceived stigma were assessed in family relationship, vocational, social interaction, and interpersonal contexts. Patients in Tanzania, as compared with those in the USA, reported significantly higher levels of stigma in family relationship and vocational contexts. Tanzanian patients also reported higher levels of stigma in social interaction and self-esteem contexts, but these differences were marginally significant and may reflect the small sample size. Leprosy-related social stigma is a major problem in regions of both developed and developing countries; however, patients with leprosy in developing countries reported higher levels of stigma in four social contexts. A public health role in dermatology is discussed as an agent of early diagnosis, control, and education in order to reduce social stigma and promote social rehabilitation. © 2013 The International Society of Dermatology.
Rasch, Vibeke; Yambesi, Fortunata; Kipingili, Rose
BACKGROUND: This study describes the outcome of a postabortion care intervention aimed at introducing the female condom as a means of preventing women from having unwanted pregnancies and sexually transmitted infections (STIs)/HIV. METHODS: Postabortion contraceptive counseling and services were...... intended to use it again. CONCLUSION: Postabortion care programs provide an excellent entry point for introducing the female condom as a contraceptive method for the prevention of both repeat unwanted pregnancies and STI/HIV infection....... offered to 548 women admitted to the Kagera Regional Hospital for incomplete abortion. The counseling included information about STI/HIV and the use male or female condom. In total, 521 (95%) women accepted contraception. RESULTS: Contraceptive use was assessed 3 months after abortion among 475 (91...
Saronga, Happiness Pius; Dalaba, Maxwell Ayindenaba; Dong, Hengjin; Leshabari, Melkizedeck; Sauerborn, Rainer; Sukums, Felix; Blank, Antje; Kaltschmidt, Jens; Loukanova, Svetla
Poor quality of care is among the causes of high maternal and newborn disease burden in Tanzania. Potential reason for poor quality of care is the existence of a "know-do gap" where by health workers do not perform to the best of their knowledge. An electronic clinical decision support system (CDSS) for maternal health care was piloted in six rural primary health centers of Tanzania to improve performance of health workers by facilitating adherence to World Health Organization (WHO) guidelines and ultimately improve quality of maternal health care. This study aimed at assessing the cost of installing and operating the system in the health centers. This retrospective study was conducted in Lindi, Tanzania. Costs incurred by the project were analyzed using Ingredients approach. These costs broadly included vehicle, computers, furniture, facility, CDSS software, transport, personnel, training, supplies and communication. These were grouped into installation and operation cost; recurrent and capital cost; and fixed and variable cost. We assessed the CDSS in terms of its financial and economic cost implications. We also conducted a sensitivity analysis on the estimations. Total financial cost of CDSS intervention amounted to 185,927.78 USD. 77% of these costs were incurred in the installation phase and included all the activities in preparation for the actual operation of the system for client care. Generally, training made the largest share of costs (33% of total cost and more than half of the recurrent cost) followed by CDSS software- 32% of total cost. There was a difference of 31.4% between the economic and financial costs. 92.5% of economic costs were fixed costs consisting of inputs whose costs do not vary with the volume of activity within a given range. Economic cost per CDSS contact was 52.7 USD but sensitive to discount rate, asset useful life and input cost variations. Our study presents financial and economic cost estimates of installing and operating an
Hetherington, Erin; Eggers, Matthijs; Wamoyi, Joyce; Hatfield, Jennifer; Manyama, Mange; Kutz, Susan; Bastien, Sheri
Diarrheal disease is a major cause of mortality and morbidity in low and middle income countries with children being disproportionately affected. Project SHINE (Sanitation & Hygiene INnovation in Education) is a grassroots participatory science education and social entrepreneurship model to engage youth and the wider community in the development of sustainable strategies to improve sanitation and hygiene. Based in rural and remote Tanzania, this pilot study engaged pastoralist high-school students and communities in the development and evaluation of culturally and contextually relevant strategies to improve sanitation and hygiene. Using a train-the-trainer approach, key activities included teacher workshops, school-based lessons, extra-curricular activities, community events and a One Health sanitation science fair which showcased projects related to water, sanitation and hygiene in relation to human and animal health. The process and outcome of the study were evaluated through qualitative interviews and focus group discussions with diverse project participants, as well as pre- and post- questionnaires completed by students on knowledge, attitudes and practices concerning sanitation and hygiene. The questionnaire results at baseline and follow-up showed statistically significant improvements on key measures including a decrease in unhygienic behaviors, an increase in the perceived importance of handwashing and intention to use the toilet, and increased communication in the social network about the importance of clean water and improved sanitation and hygiene practices, however there were no significant changes in sanitation related knowledge. Qualitative data highlighted strong leadership emerging from youth and enthusiasm from teachers and students concerning the overall approach in the project, including the use of participatory methods. There was a high degree of community engagement with hundreds of community members participating in school-based events
Full Text Available Abstract Background Parenting through control and monitoring has been found to have an effect on young people's sexual behaviour. There is a dearth of literature from sub-Saharan Africa on this subject. This paper examines parental control and monitoring and the implications of this on young people's sexual decision making in a rural setting in North-Western Tanzania. Methods This study employed an ethnographic research design. Data collection involved 17 focus group discussions and 46 in-depth interviews conducted with young people aged 14-24 years and parents/carers of young people within this age-group. Thematic analysis was conducted with the aid of NVIVO 7 software. Results Parents were motivated to control and monitor their children's behaviour for reasons such as social respectability and protecting them from undesirable sexual and reproductive health (SRH outcomes. Parental control and monitoring varied by family structure, gender, schooling status, a young person's contribution to the economic running of the family and previous experience of a SRH outcome such as unplanned pregnancy. Children from single parent families reported that they received less control compared to those from both parent families. While a father's presence in the family seemed important in controlling the activities of young people, a mother's did not have a similar effect. Girls especially those still schooling received more supervision compared to boys. Young women who had already had unplanned pregnancy were not supervised as closely as those who hadn't. Parents employed various techniques to control and monitor their children's sexual activities. Conclusions Despite parents making efforts to control and monitor their young people's sexual behaviour, they are faced with several challenges (e.g. little time spent with their children which make it difficult for them to effectively monitor them. There is a need for interventions such as parenting skills building
Full Text Available Abstract Background Insecticide-treated nets (ITNs and indoor residual spraying (IRS represent the front-line tools for malaria vector control globally, but are optimally effective where the majority of baseline transmission occurs indoors. In the surveyed area of rural southern Tanzania, bed net use steadily increased over the last decade, reducing malaria transmission intensity by 94%. Methods Starting before bed nets were introduced (1997, and then after two milestones of net use had been reached-75% community-wide use of untreated nets (2004 and then 47% use of ITNs (2009-hourly biting rates of malaria vectors from the Anopheles gambiae complex and Anopheles funestus group were surveyed. Results In 1997, An. gambiae s.l. and An. funestus mosquitoes exhibited a tendency to bite humans inside houses late at night. For An. gambiae s.l., by 2009, nocturnal activity was less (p = 0.0018. At this time, the sibling species composition of the complex had shifted from predominantly An. gambiae s.s. to predominantly An. arabiensis. For An. funestus, by 2009, nocturnal activity was less (p = 0.0054 as well as the proportion biting indoors (p An. funestus s.s. remained the predominant species within this group. As a consequence of these altered feeding patterns, the proportion (mean ± standard error of human contact with mosquitoes (bites per person per night occurring indoors dropped from 0.99 ± 0.002 in 1997 to 0.82 ± 0.008 in 2009 for the An. gambiae complex (p = 0.0143 and from 1.00 ± An. funestus complex (p = 0.0004 over the same time period. Conclusions High usage of ITNs can dramatically alter African vector populations so that intense, predominantly indoor transmission is replaced by greatly lowered residual transmission, a greater proportion of which occurs outdoors. Regardless of the underlying mechanism, the residual, self-sustaining transmission will respond poorly to further insecticidal measures within houses. Additional vector control
Prytherch, Helen; Kagoné, Moubassira; Aninanya, Gifty A; Williams, John E; Kakoko, Deodatus C V; Leshabari, Melkidezek T; Yé, Maurice; Marx, Michael; Sauerborn, Rainer
In Burkina Faso, Ghana and Tanzania strong efforts are being made to improve the quality of maternal and neonatal health (MNH) care. However, progress is impeded by challenges, especially in the area of human resources. All three countries are striving not only to scale up the number of available health staff, but also to improve performance by raising skill levels and enhancing provider motivation. In-depth interviews were used to explore MNH provider views about motivation and incentives at primary care level in rural Burkina Faso, Ghana and Tanzania. Interviews were held with 25 MNH providers, 8 facility and district managers, and 2 policy-makers in each country. Across the three countries some differences were found in the reasons why people became health workers. Commitment to remaining a health worker was generally high. The readiness to remain at a rural facility was far less, although in all settings there were some providers that were willing to stay. In Burkina Faso it appeared to be particularly difficult to recruit female MNH providers to rural areas. There were indications that MNH providers in all the settings sometimes failed to treat their patients well. This was shown to be interlinked with differences in how the term 'motivation' was understood, and in the views held about remuneration and the status of rural health work. Job satisfaction was shown to be quite high, and was particularly linked to community appreciation. With some important exceptions, there was a strong level of agreement regarding the financial and non-financial incentives that were suggested by these providers, but there were clear country preferences as to whether incentives should be for individuals or teams. Understandings of the terms and concepts pertaining to motivation differed between the three countries. The findings from Burkina Faso underline the importance of gender-sensitive health workforce planning. The training that all levels of MNH providers receive in
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Background: Setting up Geographical Information Systems (GIS on the existing health infrastructure and ongoing and planned interventions in public health in Tanzania is still in its infancy. While there are several activities on gathering information and attempts of documentation there does not exist an overall systematic approach of generally capturing all health related facts and bringing them together into a unique information system yet. In order to strengthen the information system in the health sector in general, and to assist Ministry of Health and Social Welfare (MoHSW in better receiving an overview of health related infrastructure and intervention data for management purpose, a first-pilot GIS was built up in the Mbeya Region in cooperation with Tanzanian German Programme to Support Health (TGPSH/Gesellschaft für technische Zusammenarbeit (GTZ.
Methods: The Health-GIS contains information on all health facilities (HF in the region and their infrastructure. Therefore, personal interviews were conducted in selected HF based on a comprehensive questionnaire. The spatial coordinates of the HF were taken with a Global Positioning System (GPS. In a relational database, the newly coded HF are linked to the gathered information pertaining to them and in a second step are analysed and visualised with help of GIS. Results: First results show newly collected geometry and attribute data for a considerable number of HFs in Mbeya Region, which are then supplemented by information on the street network lately surveyed during the fieldtrip. With the help of a database management system (DBMS all information are stored and maintained within one health database. By their spatial relation, data may be analysed and mapped with a Health-GIS. Because of the targeted cooperation with people and institutions from the local health sector, the way for integrating the Health-GIS into the health
Høst, Jeppe Engset
I am going today to speak on rural development and how it is currently practiced in Europe, with a specific focus on the new rural paradigm and the LEADER method. I will try to explain the background and setup of rural development in the European Union, and try to describe the principles of the so...
Full Text Available To study private costs and other determinants of access to healthcare for childhood fevers in rural Tanzania.A case-control study was conducted in Tanzania to establish factors that determine access to a health facility in acute febrile illnesses in children less than 5 years of age. Carers of eligible children were interviewed in the community; cases were represented by patients who went to a facility and controls by those who did not. A Household Wealth Index was estimated using principal components analysis. A multivariable logistic regression analysis was performed to understand the factors which influenced attendance of healthcare facility including severity of the illness and household wealth/socio-demographic indicators. To complement the data on costs from community interviews, a hospital-based study obtained details of private expenditures for hospitalised children under the age of 5.Severe febrile illness is strongly associated with health facility attendance (OR: 35.76, 95%CI: 3.68-347.43, p = 0.002 compared with less severe febrile illness. Overall, the private costs of an illness for patients who went to a hospital were six times larger than private costs of controls ($5.68 vs. $0.90, p<0.0001. Household wealth was not significantly correlated with total costs incurred. The separate hospital based cost study indicated that private costs were three times greater for admissions at the mission versus public hospital: $13.68 mission vs. $4.47 public hospital (difference $ 9.21 (95% CI: 7.89 -10.52, p<0.0001. In both locations, approximately 50% of the cost was determined by the duration of admission, with each day in hospital increasing private costs by about 12% (95% CI: 5% - 21%.The more severely ill a child, the higher the probability of attending hospital. We did not find association between household wealth and attending a health facility; nor was there an association between household wealth and private cost.
Narh-Bana, S A; Chirwa, T F; Mwanyangala, M A; Nathan, R
To determine patterns and risk factors for cause-specific adult mortality in rural southern Tanzania. The study was a longitudinal open cohort and focused on adults aged 15-59 years between 2003 and 2007. Causes of deaths were ascertained by verbal autopsy (VA). Cox proportion hazards regression model was used to determine factors associated with cause-specific mortality over the 5-year period. Thousand three hundred and fifty-two of 65 548 adults died, representing a crude adult mortality rate (AMR) of 7.3 per 1000 person years of observation (PYO). VA was performed for 1132 (84%) deaths. HIV/AIDS [231 (20.4%)] was the leading cause of death followed by malaria [150 (13.2%)]. AMR for communicable disease (CD) causes was 2.49 per 1000 PYO, 1.21 per 1000 PYO for non-communicable diseases (NCD) and 0.53 per 1000 PYO for accidents/injury causes. NCD deaths increased from 16% in 2003 to 24% in 2007. High level of education was associated with a reduction in the risk of dying from NCDs. Those with primary education (HR = 0.67, 95% CI: 0.49, 0.92) and with education beyond primary school (HR = 0.11, 95% CI: 0.02, 0.40) had lower mortality than those who had no formal education. Compared with local residents, in-migrants were 1.7 (95% CI: 1.37, 2.11) times more likely to die from communicable disease causes. NCDs are increasing as a result of demographic and epidemiological transitions taking place in most African countries including Tanzania and require attention to prevent increased triple disease burden of CD, NCD and accident/injuries. © 2012 Blackwell Publishing Ltd.
Powell, Kathryn; Walker, Richard W; Rogathe, Jane; Gray, William K; Hunter, Ewan; Newton, Charles R; Burton, Kathryn
Eighty-five percent of the 33 million children with epilepsy (CWE) worldwide live in low- and middle-income countries (LMICs). There is limited research into epilepsy-related comorbidities in LMICs, and there are no studies of the long-term progression of behavioral and intellectual difficulties in childhood epilepsy in sub-Saharan Africa. We aimed to assess behavior and cognition at three-year follow-up in CWE in rural Tanzania. In 2010, a cross-sectional study identified 112 CWE 6 to 14years of age and 113 age- and sex-matched controls in the Hai district of northern Tanzania. From March to June 2013, cases and controls (now 10 to 18years of age) were followed up. At baseline, behavior was assessed using the Rutter A Questionnaire and cognition using the Goodenough-Harris Drawing Test. Details of current seizure frequency and antiepileptic drug (AED) use among CWE were collected. At follow-up, cases had significantly more behavioral difficulties compared with controls (48% of 108 cases versus 14% of 103 controls (p<0.001)). Additionally, 69% of the cases and 16% of the controls had cognitive impairment (p<0.001). In CWE with decreased seizure frequency from baseline to follow-up, behavior had improved significantly. At follow-up, there was no significant difference in behavior between CWE with decreased seizure frequency and those with good seizure control throughout. Behavioral difficulties and cognitive impairment are common among CWE in this population. Improved access to AED treatment and subsequent improved seizure control may reduce the frequency of behavioral difficulties seen in this population. Copyright © 2015 Elsevier Inc. All rights reserved.
Justice, C. J.
Eighty percent of Tanzania's population is involved in the agriculture sector. Despite this national dependence, agricultural reporting is minimal and monitoring efforts are in their infancy. The cropland mask developed through this study provides an underpinning for agricultural monitoring by informing analysis of crop conditions, dispersion, and intensity at a national scale. Tanzania is dominated by smallholder agricultural systems with an average field size of less than one hectare. At this field scale, previous classifications of agricultural land in Tanzania using MODIS coarse resolution data are insufficient to inform a working monitoring system. The nation-wide cropland mask in this study was developed using composited Landsat tiles from a 2010-2013 time-series. Decision tree classifier methods were used in the study with representative training areas collected for agriculture and no agriculture using appropriate indices to separate these classes. Validation was undertaken using a random sample and high resolution satellite images to compare agriculture and no agriculture samples from the study area. The cropland mask had high producer and user accuracy in the no agriculture class at 95.0% and 97.35% respectively. There was high producer accuracy in the agriculture class at 80.2% and moderate user accuracy at 67.9%. The principal metrics used for the classification support the theme that agriculture in Tanzania and Sub-Saharan Africa are less vegetated than surrounding areas and most similar to bare ground - emphasizing the need for improved access to inputs and irrigation to enhance productivity and smallholder livelihoods. The techniques used in this study were successful for developing a cropland mask and have the potential to be adapted for other countries, allowing targeted monitoring efforts to improve food security, market price, and inform agricultural policy.
Justice, C. J.
80% of Tanzania's population is involved in the agriculture sector. Despite this national dependence, agricultural reporting is minimal and monitoring efforts are in their infancy. The cropland mask developed through this study provides the framework for agricultural monitoring through informing analysis of crop conditions, dispersion, and intensity at a national scale. Tanzania is dominated by smallholder agricultural systems with an average field size of less than one hectare (Sarris et al, 2006). At this field scale, previous classifications of agricultural land in Tanzania using MODIS course resolution data are insufficient to inform a working monitoring system. The nation-wide cropland mask in this study was developed using composited Landsat tiles from a 2010-2013 time series. Decision tree classifiers methods were used in the study with representative training areas collected for agriculture and no agriculture using appropriate indices to separate these classes (Hansen et al, 2013). Validation was done using random sample and high resolution satellite images to compare Agriculture and No agriculture samples from the study area. The techniques used in this study were successful and have the potential to be adapted for other countries, allowing targeted monitoring efforts to improve food security, market price, and inform agricultural policy.
Anderson, C Leigh; Reynolds, Travis W; Gugerty, Mary Kay
We use OLS and logistic regression to investigate variation in husband and wife perspectives on the division of authority over agriculture-related decisions within households in rural Tanzania. Using original data from husbands and wives (interviewed separately) in 1,851 Tanzanian households, the analysis examines differences in the wife's authority over 13 household and farming decisions. The study finds that the level of decision-making authority allocated to wives by their husbands, and the authority allocated by wives to themselves, both vary significantly across households. In addition to commonly considered assets such as women's age and education, in rural agricultural households women's health and labor activities also appear to matter for perceptions of authority. We also find husbands and wives interviewed separately frequently disagree with each other over who holds authority over key farming, family, and livelihood decisions. Further, the results of OLS and logistic regression suggest that even after controlling for various individual, household, and regional characteristics, husband and wife claims to decision-making authority continue to vary systematically by decision-suggesting that decision characteristics themselves also matter. The absence of spousal agreement over the allocation of authority (i.e., a lack of "intra-household accord") over different farm and household decisions is problematic for interventions seeking to use survey data to develop and inform strategies for reducing gender inequalities or empowering women in rural agricultural households. Findings provide policy and program insights into when studies interviewing only a single spouse or considering only a single decision may inaccurately characterize intra-household decision-making dynamics.
Maliti Deodatus V
Full Text Available Abstract Background Verbal autopsy (VA is a widely used tool to assign probable cause of death in areas with inadequate vital registration systems. Its uses in priority setting and health planning are well documented in sub-Saharan Africa (SSA and Asia. However, there is a lack of data related to VA processing and completion rates in assigning causes of death in a community. There is also a lack of data on factors associated with undetermined causes of death documented in SSA. There is a need for such information for understanding the gaps in VA processing and better estimating disease burden. Objective The study's intent was to determine the completion rate of VA and factors associated with assigning undetermined causes of death in rural Tanzania. Methods A database of deaths reported from the Ifakara Health and Demographic Surveillance System from 2002 to 2007 was used. Completion rates were determined at the following stages of processing: 1 death identified; 2 VA interviews conducted; 3 VA forms submitted to physicians; 4 coding and assigning of cause of death. Logistic regression was used to determine factors associated with deaths coded as "undetermined." Results The completion rate of VA after identification of death and the VA interview ranged from 83% in 2002 and 89% in 2007. Ninety-four percent of deaths submitted to physicians were assigned a specific cause, with 31% of the causes coded as undetermined. Neonates and child deaths that occurred outside health facilities were associated with a high rate of undetermined classification (33%, odds ratio [OR] = 1.33, 95% confidence interval [CI] (1.05, 1.67, p = 0.016. Respondents reporting high education levels were less likely to be associated with deaths that were classified as undetermined (24%, OR = 0.76, 95% CI (0.60, -0.96, p = 0.023. Being a child of the deceased compared to a partner (husband or wife was more likely to be associated with undetermined cause of death classification
Mwanyangala, Mathew A; Urassa, Honorathy M; Rutashobya, Jensen C; Mahutanga, Chrisostom C; Lutambi, Angelina M; Maliti, Deodatus V; Masanja, Honorati M; Abdulla, Salim K; Lema, Rose N
Verbal autopsy (VA) is a widely used tool to assign probable cause of death in areas with inadequate vital registration systems. Its uses in priority setting and health planning are well documented in sub-Saharan Africa (SSA) and Asia. However, there is a lack of data related to VA processing and completion rates in assigning causes of death in a community. There is also a lack of data on factors associated with undetermined causes of death documented in SSA. There is a need for such information for understanding the gaps in VA processing and better estimating disease burden. The study's intent was to determine the completion rate of VA and factors associated with assigning undetermined causes of death in rural Tanzania. A database of deaths reported from the Ifakara Health and Demographic Surveillance System from 2002 to 2007 was used. Completion rates were determined at the following stages of processing: 1) death identified; 2) VA interviews conducted; 3) VA forms submitted to physicians; 4) coding and assigning of cause of death. Logistic regression was used to determine factors associated with deaths coded as "undetermined." The completion rate of VA after identification of death and the VA interview ranged from 83% in 2002 and 89% in 2007. Ninety-four percent of deaths submitted to physicians were assigned a specific cause, with 31% of the causes coded as undetermined. Neonates and child deaths that occurred outside health facilities were associated with a high rate of undetermined classification (33%, odds ratio [OR] = 1.33, 95% confidence interval [CI] (1.05, 1.67), p = 0.016). Respondents reporting high education levels were less likely to be associated with deaths that were classified as undetermined (24%, OR = 0.76, 95% CI (0.60, -0.96), p = 0.023). Being a child of the deceased compared to a partner (husband or wife) was more likely to be associated with undetermined cause of death classification (OR = 1.35, 95% CI (1.04, 1.75), p = 0.023). Every year
inertia, water balance, physiological strength, and susceptibility to predation between adults .... Judd PW and Rose FL 1977 Aspects of the thermal biology of the Texas tortoise ... pctrdolis lmheoeki) and their conservation in northern Tanzania.
Fraser-Hurt, N; Lyimo, E O
The Rotary Net Initiative, implemented in Kilombero District, southern United Republic of Tanzania, allowed us to explore different sales channels for the distribution of insecticide-treated nets (ITNs) and the insecticide treatment service in a rural area of very high malaria transmission. Several types of ITNs were promoted and sold through different channels in the public and private sector, i.e. hospital pharmacy, mother and child health (MCH) clinic, net committee, village health workers and retail shops. The ITNs were sold for US$ 5.0-9.2, with profit margins of 9-16%. Net treatment cost US$ 0.33, with commission fees of 75%. Net transport and treatment were partially subsidized. Some outlets established their own fund by ITN sales. Sales of nets and treatments were seasonal, and certain net types were preferred. Demand for insecticide treatment was generally low. Changes in net coverage were assessed in two villages. A range of outlet features were compared qualitatively. Our experience supports suggestions that ITN technology should be delivered through MCH care services and demonstrates that specific promotion and innovation are necessary to achieve substantial net treatment levels. A large-scale ITN project in the same area and other ITN studies should lead to better understanding of ITN implementation at the population level.
Plummer, Mary L; Wight, D; Wamoyi, J; Nyalali, K; Ingall, T; Mshana, G; Shigongo, Z S; Obasi, A I N; Ross, D A
African adolescents are at high risk of poor sexual health. School-based interventions could reach many adolescents in a sustainable and replicable way, if enrolment, funding and infrastructure are adequate. This study examined pupils', recent school leavers', parents' and teachers' views and experiences of rural Tanzanian primary schools, focusing on the implications for potential sexual health programmes. From 1999 to 2002, participant observation was conducted in nine villages for 158 person-weeks. Half of Year 7 pupils were 15-17 years old, and few went on to secondary school, suggesting that primary schools may be a good venue for such programmes. However, serious challenges include low enrolment and attendance rates, limited teacher training, little access to teaching resources and official and unofficial practices that may alienate pupils and their parents, e.g. corporal punishment, pupils being made to do unpaid work, forced pregnancy examinations, and some teachers' alcohol or sexual abuse. At a national level, improved teacher training and supervision are critical, as well as policies that better prevent, identify and correct undesired practices. At a programme level, intervention developers need to simplify the subject matter, introduce alternative teaching methods, help improve teacher-pupil and teacher-community relationships, and closely supervise and appropriately respond to undesired practices.
Prytherch, Helen; Leshabari, Melkidezek T.; Wiskow, Christiane; Aninanya, Gifty A.; Kakoko, Deodatus C.V.; Kagoné, Moubassira; Burghardt, Juliane; Kynast-Wolf, Gisela; Marx, Michael; Sauerborn, Rainer
Background The quality of health care depends on the competence and motivation of the health workers that provide it. In the West, several tools exist to measure worker motivation, and some have been applied to the health sector. However, none have been validated for use in sub-Saharan Africa. The complexity of such tools has also led to concerns about their application at primary care level. Objective To develop a common instrument to monitor any changes in maternal and neonatal health (MNH) care provider motivation resulting from the introduction of pilot interventions in rural, primary level facilities in Ghana, Burkina Faso, and Tanzania. Design Initially, a conceptual framework was developed. Based upon this, a literature review and preliminary qualitative research, an English-language instrument was developed and validated in an iterative process with experts from the three countries involved. The instrument was then piloted in Ghana. Reliability testing and exploratory factor analysis were used to produce a final, parsimonious version. Results and discussion This paper describes the actual process of developing the instrument. Consequently, the concepts and items that did not perform well psychometrically at pre-test are first presented and discussed. The final version of the instrument, which comprises 42 items for self-assessment and eight for peer-assessment, is then shown. This is followed by a presentation and discussion of the findings from first use of the instrument with MNH providers from 12 rural, primary level facilities in each of the three countries. Conclusions It is possible to undertake work of this nature at primary health care level, particularly if the instruments are kept as straightforward as possible and well introduced. However, their development requires very lengthy preparatory periods. The effort needed to adapt such instruments for use in different countries within the region of sub-Saharan Africa should not be underestimated. PMID
Vyagusa, Dismas B; Mubyazi, Godfrey M; Masatu, Melchiory
Access to quality maternal health services mainly depends on existing policies, regulations, skills, knowledge, perceptions, and economic power and motivation of service givers and target users. Critics question policy recommending involvement of traditional birth attendants (TBAs) in emergency obstetric care (EmoC) services in developing countries. This paper reports about knowledge and practices of TBAs on EmoC in Kigoma Rural District, Tanzania and discusses policy implications on involving TBAs in maternal health services. 157 TBAs were identified from several villages in 2005, interviewed and observed on their knowledge and practice in relation to EmoC. Quantitative and qualitative techniques were used for data collection and analysis depending on the nature of the information required. Among all 157 TBAs approached, 57.3% were aged 50+ years while 50% had no formal education. Assisting mothers to deliver without taking their full pregnancy history was confessed by 11% of all respondents. Having been attending pregnant women with complications was experienced by 71.2% of all respondents. Only 58% expressed adequate knowledge on symptoms and signs of pregnancy complications. Lack of knowledge on possible risk of HIV infections while assisting childbirth without taking protective gears was claimed by 5.7% of the respondents. Sharing the same pair of gloves between successful deliveries was reported to be a common practice by 21.1% of the respondents. Use of unsafe delivery materials including local herbs and pieces of cloth for protecting themselves against HIV infections was reported as being commonly practiced among 27.6% of the respondents. Vaginal examination before and during delivery was done by only a few respondents. TBAs in Tanzania are still consulted by people living in underserved areas. Unfortunately, TBAs' inadequate knowledge on EmOC issues seems to have contributed to the rising concerns about their competence to deliver the recommended maternal
Braae, Uffe Christian; Magnussen, Pascal; Harrison, Wendy; Ndawi, Benedict; Lekule, Faustin; Johansen, Maria Vang
Taenia solium is found throughout sub-Saharan Africa and co-endemic with schistosomiasis in many regions. Taenia solium leads to taeniosis and neurocysticercosis - the leading cause of preventable epilepsy globally. This study aimed to assess the effects of the National Schistosomiasis Control Programme on prevalence of taeniosis and porcine cysticercosis over a four year period in Tanzania. School-based mass drug administration (MDA) of praziquantel was carried out based on schistosomiasis endemicity. Four human and five porcine cross-sectional surveys were carried out from 2012 to 2015 in Mbozi and Mbeya district in Tanzania. Three rounds of school-based MDA of praziquantel were delivered in Mbozi and two in Mbeya. The prevalence of taeniosis and porcine cysticercosis was estimated annually. Stool samples were collected from humans and prevalence of taeniosis estimated by copro-Ag-ELISA. Blood samples from pigs were collected to estimate cysticercosis prevalence by Ag-ELISA. "Track-and-treat" of taeniosis cases was carried out after each survey. In total 12082 stool samples and 4579 porcine serum samples were collected. Significantly fewer children (≤ 15) from Mbozi were infected throughout the study than children from Mbeya who showed a significant decrease in copro-Ag prevalence after the first treatment only. During the final survey in Mbozi the prevalence of taeniosis in adults (1.8%) was significantly lower (p = 0.031, OR 0.40, CI: 0.17-0.89), compared to baseline (4.1%). The prevalence of porcine cysticercosis (8%) had also dropped significantly (p = 0.002, OR 0.49, CI: 0.32-0.76) in this district compared to baseline (13%), whereas no significant difference was seen in Mbeya compared to baseline. The study suggests that three rounds of MDA targeting schistosomiasis in school-aged children combined with 'track-and-treat' contributed to a reduction in prevalence of T. solium in this population, and also had a spillover effect on adults in treated
With constant deepening of the reform and opening-up,national economic system has changed from planned economy to market economy,and rural survey and statistics remain in a difficult transition period. In this period,China needs transforming original statistical mode according to market economic system. All levels of government should report and submit a lot and increasing statistical information. Besides,in this period,townships,villages and counties are faced with old and new conflicts. These conflicts perplex implementation of rural statistics and survey and development of rural statistical undertaking,and also cause researches and thinking of reform of rural statistical and survey methods.
Mubyazi, Godfrey M; Bloch, Paul; Byskov, Jens;
delivery between the HWs employed in private HFs and those in public HFs: those in private facilities were more comfortable with staff residential houses, HF buildings, equipment, availability of water, electricity and cups for clients to use while taking doses under direct observed therapy than...... other ANC services delivered in public and private health facilities (HFs) in Tanzania, using a case study of Mkuranga and Mufindi districts. METHODS: Interviews were conducted with 78 HWs participating in the delivery of ANC services in private and public HFs and were supplemented by personal...... their public facility counterparts. Employees in public HFs more acknowledged availability of clinical officers, nurses and midwives than their private facility counterparts. More results are presented and discussed. CONCLUSION: The study shows conditions related to staffing levels, health infrastructure...
Randall A. Kramer
Full Text Available The optimization of malaria control strategies is complicated by constraints posed by local health systems, infrastructure, limited resources, and the complex interactions between infection, disease, and treatment. The purpose of this paper is to describe the protocol of a randomized factorial study designed to address this research gap. This project will evaluate two malaria control interventions in Mvomero District, Tanzania: (1 a disease management strategy involving early detection and treatment by community health workers using rapid diagnostic technology; and (2 vector control through community-supported larviciding. Six study villages were assigned to each of four groups (control, early detection and treatment, larviciding, and early detection and treatment plus larviciding. The primary endpoint of interest was change in malaria infection prevalence across the intervention groups measured during annual longitudinal cross-sectional surveys. Recurring entomological surveying, household surveying, and focus group discussions will provide additional valuable insights. At baseline, 962 households across all 24 villages participated in a household survey; 2,884 members from 720 of these households participated in subsequent malariometric surveying. The study design will allow us to estimate the effect sizes of different intervention mixtures. Careful documentation of our study protocol may also serve other researchers designing field-based intervention trials.
Kramer, Randall A; Mboera, Leonard E G; Senkoro, Kesheni; Lesser, Adriane; Shayo, Elizabeth H; Paul, Christopher J; Miranda, Marie Lynn
The optimization of malaria control strategies is complicated by constraints posed by local health systems, infrastructure, limited resources, and the complex interactions between infection, disease, and treatment. The purpose of this paper is to describe the protocol of a randomized factorial study designed to address this research gap. This project will evaluate two malaria control interventions in Mvomero District, Tanzania: (1) a disease management strategy involving early detection and treatment by community health workers using rapid diagnostic technology; and (2) vector control through community-supported larviciding. Six study villages were assigned to each of four groups (control, early detection and treatment, larviciding, and early detection and treatment plus larviciding). The primary endpoint of interest was change in malaria infection prevalence across the intervention groups measured during annual longitudinal cross-sectional surveys. Recurring entomological surveying, household surveying, and focus group discussions will provide additional valuable insights. At baseline, 962 households across all 24 villages participated in a household survey; 2,884 members from 720 of these households participated in subsequent malariometric surveying. The study design will allow us to estimate the effect sizes of different intervention mixtures. Careful documentation of our study protocol may also serve other researchers designing field-based intervention trials.
Mselle Lilian T
Full Text Available Abstract Background Obstetric fistula is a physically and socially disabling obstetric complication that affects about 3,000 women in Tanzania every year. The fistula, an opening that forms between the vagina and the bladder and/or the rectum, is most frequently caused by unattended prolonged labour, often associated with delays in seeking and receiving appropriate and adequate birth care. Using the availability, accessibility, acceptability and quality of care (AAAQ concept and the three delays model, this article provides empirical knowledge on birth care experiences of women who developed fistula after prolonged labour. Methods We used a mixed methods approach to explore the birthing experiences of women affected by fistula and the barriers to access adequate care during labour and delivery. Sixteen women were interviewed for the qualitative study and 151 women were included in the quantitative survey. All women were interviewed at the Comprehensive Community Based Rehabilitation Tanzania in Dar es Salaam and Bugando Medical Centre in Mwanza. Results Women experienced delays both before and after arriving at a health facility. Decisions on where to seek care were most often taken by husbands and mothers-in-law (60%. Access to health facilities providing emergency obstetric care was inadequate and transport was a major obstacle. About 20% reported that they had walked or were carried to the health facility. More than 50% had reported to a health facility after two or more days of labour at home. After arrival at a health facility women experienced lack of supportive care, neglect, poor assessment of labour and lack of supervision. Their birth accounts suggest unskilled birth care and poor referral routines. Conclusions This study reveals major gaps in access to and provision of emergency obstetric care. It illustrates how poor quality of care at health facilities contributes to delays that lead to severe birth injuries, highlighting the need
Michelle C. Kondo; Kent D.W. Bream; Frances K. Barg; Charles C. Branas
Nonrandom sampling of populations in developing nations has limitations and can inaccurately estimate health phenomena, especially among hard-to-reach populations such as rural residents. However, random sampling of rural populations in developing nations can be challenged by incomplete enumeration of the base population. We describe a stratified random sampling method...
Full Text Available Abstract Background Malaria is still a leading child killer in sub-Saharan Africa. Yet, access to prompt and effective malaria treatment, a mainstay of any malaria control strategy, is sub-optimal in many settings. Little is known about obstacles to treatment and community-effectiveness of case-management strategies. This research quantified treatment seeking behaviour and access to treatment in a highly endemic rural Tanzanian community. The aim was to provide a better understanding of obstacles to treatment access in order to develop practical and cost-effective interventions. Methods We conducted community-based treatment-seeking surveys including 226 recent fever episodes in 2004 and 2005. The local Demographic Surveillance System provided additional household information. A census of drug retailers and health facilities provided data on availability and location of treatment sources. Results After intensive health education, the biomedical concept of malaria has largely been adopted by the community. 87.5% (78.2–93.8 of the fever cases in children and 80.7% (68.1–90.0 in adults were treated with one of the recommended antimalarials (at the time SP, amodiaquine or quinine. However, only 22.5% (13.9–33.2 of the children and 10.5% (4.0–21.5 of the adults received prompt and appropriate antimalarial treatment. Health facility attendance increased the odds of receiving an antimalarial (OR = 7.7 but did not have an influence on correct dosage. The exemption system for under-fives in public health facilities was not functioning and drug expenditures for children were as high in health facilities as with private retailers. Conclusion A clear preference for modern medicine was reflected in the frequent use of antimalarials. Yet, quality of case-management was far from satisfactory as was the functioning of the exemption mechanism for the main risk group. Private drug retailers played a central role by complementing existing formal health
Mselle, Lilian T; Kohi, Thecla W; Mvungi, Abu; Evjen-Olsen, Bjørg; Moland, Karen Marie
Obstetric fistula is a physically and socially disabling obstetric complication that affects about 3,000 women in Tanzania every year. The fistula, an opening that forms between the vagina and the bladder and/or the rectum, is most frequently caused by unattended prolonged labour, often associated with delays in seeking and receiving appropriate and adequate birth care. Using the availability, accessibility, acceptability and quality of care (AAAQ) concept and the three delays model, this article provides empirical knowledge on birth care experiences of women who developed fistula after prolonged labour. We used a mixed methods approach to explore the birthing experiences of women affected by fistula and the barriers to access adequate care during labour and delivery. Sixteen women were interviewed for the qualitative study and 151 women were included in the quantitative survey. All women were interviewed at the Comprehensive Community Based Rehabilitation Tanzania in Dar es Salaam and Bugando Medical Centre in Mwanza. Women experienced delays both before and after arriving at a health facility. Decisions on where to seek care were most often taken by husbands and mothers-in-law (60%). Access to health facilities providing emergency obstetric care was inadequate and transport was a major obstacle. About 20% reported that they had walked or were carried to the health facility. More than 50% had reported to a health facility after two or more days of labour at home. After arrival at a health facility women experienced lack of supportive care, neglect, poor assessment of labour and lack of supervision. Their birth accounts suggest unskilled birth care and poor referral routines. This study reveals major gaps in access to and provision of emergency obstetric care. It illustrates how poor quality of care at health facilities contributes to delays that lead to severe birth injuries, highlighting the need to ensure women's rights to accessible, acceptable and adequate
Mtowa, Angelina; Gerritsen, Annette A M; Mtenga, Sally; Mwangome, Mary; Geubbels, Eveline
Most HIV research in Sub-Saharan Africa (SSA) ignores persons aged 50 years and above, though a few studies have reported a high HIV prevalence among older people. This study aimed to estimate socio-demographic inequalities in HIV testing behaviour and HIV prevalence among adults aged 50+ years, living in Ifakara town, Tanzania. This cross-sectional study used data from the baseline measurement of the Ifakara MZIMA cohort study in 2012/13. Consenting participants were interviewed and tested for HIV. Associations between HIV testing behaviour and HIV prevalence with socio-demographic indicators were explored with multivariable logistic regression. Among the 1643 adults 50+ years included in the study, HIV prevalence and the HIV testing rate (ever tested) were 6% and 11.4% respectively. The HIV testing rate was lower for older people (aOR = 0.19 (95% CI 0.09-0.41 for 75+ versus 50-54 years); higher for those separated/divorced/widowed than those married (aOR = 1.46; 1.02-2.10); higher for "other Christians" than Muslims (aOR = 1.95; 1.06-3.58); and higher for primary (aOR = 1.54; 1.01-2.33) and secondary (aOR = 3.47; 2.11-5.70) school graduates than those without education. HIV prevalence was lower for older people (aOR = 0.27; 0.11-0.66 for 75+ versus 50-54); and for Catholics compared to Muslims (aOR = 0.54; 0.34-0.85). The high HIV prevalence among older adults and the low HIV testing behaviour call for more efforts on HIV prevention, treatment and care.
Mselle, Lilian T; Kohi, Thecla W
Increasing births with skilled attendants and increasing health facilities with Emergency Obstetric Care (EmOC) can reduce maternal mortality and are considered critical interventions for ensuring safe motherhood. Despite Tanzania's policy to support women to give birth with the assistance of skilled personnel, some women do not access this care. This article uses women's stories to illustrate the challenges that caused them to fail to access adequate obstetric care in a timely manner, hence causing the development of fistulas. This paper presents the narratives of 16 women who were conveniently selected based on their experiences of not being able to access adequate obstetric care in timely manner. The analysis was guided by recommendations for the identification and interpretation of narratives, and identified important components of women's experiences, paying attention to commonalities, differences and areas of emphasis. Semi-structured interviews were carried out at CCBRT hospital in Dar es Salaam. Four (4) general story lines were identified from women description of their inability to access quality obstetric care in a timely manner. These were; failing to decide on a health care facility for delivery, lacking money to get to a health care facility, lacking transportation to a health care facility and lacking quality birth care at the health care facility. Women were unable to reach to the health care facilities providing comprehensive emergency obstetric care (CEmOC) in time because of their lack of decision-making power, money and transportation, and those who did reach the facilities received low quality birth care. Empowering women socially and financially, upgrading primary health care facilities to provide CEmOC and increased numbers of skilled personnel would promote health care facility deliveries.
Full Text Available We report a cluster-randomised trial of a home-based counselling strategy, designed for large-scale implementation, in a population of 1.2 million people in rural southern Tanzania. We hypothesised that the strategy would improve neonatal survival by around 15%.In 2010 we trained 824 female volunteers to make three home visits to women and their families during pregnancy and two visits to them in the first few days of the infant's life in 65 wards, selected randomly from all 132 wards in six districts in Mtwara and Lindi regions, constituting typical rural areas in Southern Tanzania. The remaining wards were comparison areas. Participants were not blinded to the intervention. The primary analysis was an intention-to-treat analysis comparing the neonatal mortality (day 0-27 per 1,000 live births in intervention and comparison wards based on a representative survey in 185,000 households in 2013 with a response rate of 90%. We included 24,381 and 23,307 live births between July 2010 and June 2013 and 7,823 and 7,555 live births in the last year in intervention and comparison wards, respectively. We also compared changes in neonatal mortality and newborn care practices in intervention and comparison wards using baseline census data from 2007 including 225,000 households and 22,243 births in five of the six intervention districts. Amongst the 7,823 women with a live birth in the year prior to survey in intervention wards, 59% and 41% received at least one volunteer visit during pregnancy and postpartum, respectively. Neonatal mortality reduced from 35.0 to 30.5 deaths per 1,000 live births between 2007 and 2013 in the five districts, respectively. There was no evidence of an impact of the intervention on neonatal survival (odds ratio [OR] 1.1, 95% confidence interval [CI] 0.9-1.2, p = 0.339. Newborn care practices reported by mothers were better in intervention than in comparison wards, including immediate breastfeeding (42% of 7,287 versus 35% of 7
Tani, Kassimu; Stone, Allison; Exavery, Amon; Njozi, Mustafa; Baynes, Colin D; Phillips, James F; Kanté, Almamy Malick
Despite expanding international commitment to community health worker (CHW) deployment, little is known about how such workers actually use their time. This paper investigates this issue for paid CHWs named "Community Health Agents," which in Swahili is "Wawezeshaji wa Afya ya Jamii" ("WAJA"), trained for 9 months in primary health care service delivery and deployed to villages as subjects of a randomized trial of their impact on childhood survival in three rural districts of Tanzania. To capture information about time allocation, 30 WAJA were observed during conventional working hours by research assistants for 5 days each over a period of 4 weeks. Results were presented in term of percentage time allocation for direct client treatment, documentation activities, health education, health promotion non-work-related activities and personal activities. During routine 8-h workdays, 59.5 % of WAJA time was spent on the provision of health services and other work-related activities. Overall, WAJA spent 27.8 % of their work on traveling from home to home, 33.1 % on health education, 9.9 % of health promotion and only 12.3 % on direct patient care. Other activities related to documentation (7.8 %) and supervision (2.5 %). Results reflect the pressing obligations of WAJA to engage in activities other than direct work responsibilities during routine work hours. Time spent on work activities is primarily used for health education, promotion, moving between households, and direct patient care. However, greater effort should be directed to strengthening supervisory systems and follow-up of challenges WAJAs facing in order to increase proportion of working hours.
Mahiti, Gladys R; Kiwara, Angwara D; Mbekenga, Columba K; Hurtig, Anna-Karin; Goicolea, Isabel
In many low-income countries, formal post-partum care utilization is much lower than that of skilled delivery and antenatal care. While Traditional Birth Attendants (TBAs) might play a role in post-partum care, research exploring their attitudes and practices during this period is scarce. Therefore, the aim of this study was to explore TBAs' practices and perceptions in post-partum care in rural Tanzania. Qualitative in-depth interview data were collected from eight untrained and three trained TBAs. Additionally, five multiparous women who were clients of untrained TBAs were also interviewed. Interviews were conducted in February 2013. Data were digitally recorded and transcribed verbatim. Qualitative content analysis was used to analyze data. Our study found that TBAs take care of women during post-partum with rituals appreciated by women. They report lacking formal post-partum care training, which makes them ill-equipped to detect and handle post-partum complications. Despite their lack of preparation, they try to provide care for some post-partum complications which could put the health of the woman at risk. TBAs perceive that utilization of hospital-based post-partum services among women was only important for the baby and for managing complications which they cannot handle. They are poorly linked with the health system. This study found that the TBAs conducted close follow-ups and some of their practices were appreciated by women. However, the fact that they were trying to manage certain post-partum complications can put women at risk. These findings point out the need to enhance the communication between TBAs and the formal health system and to increase the quality of the TBA services, especially in terms of prompt referral, through provision of training, mentoring, monitoring and supervision of the TBA services.
Mselle, Lilian T; Kohi, Thecla W
Obstetric fistula is a worldwide problem that affects women and girls mostly in Sub Saharan Africa. It is a devastating medical condition consisting of an abnormal opening between the vagina and the bladder or rectum, resulting from unrelieved obstructed labour. Obstetric fistula has devastating social, economic and psychological effect on the health and wellbeing of the women living with it. This study aimed at exploring social-cultural experiences of women living with obstetric fistula in rural Tanzania. Women living with obstetric fistula were identified from the fistula ward at CCBRT hospital. Sixteen individual semi structured interviews and two (2) focus group discussions were conducted among consenting women. Interviews were transcribed verbatim and transcripts analysed independently by two researchers using a thematic analysis approach. Themes related to the experiences of living with obstetric fistula were identified. Four themes illustrating the socio-cultural experiences of women living with obstetric fistula emerged from the analysis of women experiences of living with incontinence and odour. These were keeping clean and neat, earning an income, maintaining marriage, and keeping association. Women experiences of living with fistula were largely influenced by perceptions of people around them basing on their cultural understanding of a woman. Living with fistula reveals women's day-to-day experiences of social discrimination and loss of control due to incontinence and odour. They cannot work and contribute to the family income, cannot satisfy their husband's sexual needs and or bear children, and cannot interact with members of the community in social activities. Women experience of living with fistula was influenced by perceptions of people around them. In the eyes of these people, women who leak urine were of less value since they were not capable of carrying out ascribed social roles.
Martínez Álvarez, Melisa; Borghi, Josephine; Acharya, Arnab; Vassall, Anna
The amount of Development Assistance for Health (DAH) available to low- and middle-income countries has increased exponentially over the past decade. However, there are concerns that DAH increases have not resulted in increased spending on health at the country level. This is because DAH may be fungible, resulting from the recipient government decreasing its contribution to the health sector as a result of external funding. The aim of this research is to assess whether DAH funds in Tanzania are fungible, by exploring government substitution of its own resources across sectors and within the health sector. A database containing 28140 projects of DAH expenditure between 2000 and 2010 was compiled from the Organisation for Economic Co-operation and Development's Creditor Reporting System (OECD-CRS) and AidData databases. Government health expenditure data for the same period were obtained from the Government of Tanzania, World Bank, public expenditure reviews and budget speeches and analysed to assess the degree of government substitution. 22 semi-structured interviews were conducted with Development Partners (DPs), government and non-government stakeholders between April and June 2012 to explore stakeholder perceptions of fungibility. We found some evidence of substitution of government funds at the health sector and sub-sector levels and two mechanisms through which it takes place: the resource allocation process and macro-economic factors. We found fungibility of external funds may not necessarily be detrimental to Tanzania's development (as evidence suggests the funds displaced may be reallocated to education) and the mechanisms used by DPs to prevent substitution were largely ineffective. We recommend DPs engage more effectively in the priority-setting process, not just with the Ministry of Health and Social Welfare (MoHSW), but also with the Ministry of Finance, to agree on priorities and mutual funding responsibilities at a macroeconomic level. We also call for
Full Text Available Rural development is a body of economical and social policies towards improving living conditions in rural areas through enabling rural population to utilize economical, social, cultural and technological blessing of city life in place, without migrating. As it is understood from this description, rural development is a very broad concept. Therefore, in development efforts problem should be stated clearly, analyzed and many criterias should be evaluated by experts. Analytic Hierarchy Process (AHP method can be utilized at there stages of development efforts. AHP methods is one of multi-criteria decision method. After degrading a problem in smaller pieces, relative importance and level of importance of two compared elements are determined. It allows evaluation of quality and quantity factors. At the same time, it permits utilization of ideas of many experts and use them in decision process. Because mentioned features of AHP method, it could be used in rural development works. In this article, cultural factors, one of the important components of rural development is often ignored in many studies, were evaluated as an example. As a result of these applications and evaluations, it is concluded that AHP method could be helpful in rural development efforts.
Full Text Available Abstract Background In the Kilimanjaro region the mother-in-law has traditionally had an important role in matters related to reproduction and childcare. The aim of this study was to explore the role of the mothers-in-law in prevention of mother-to-child transmission (PMTCT service utilization and adherence to infant feeding guidelines. Methods The study was conducted during 2007-2008 in rural and urban areas of Moshi district in the Kilimanjaro region of Tanzania. Mixed methods were used and included focus group discussions with mothers-in-law, mothers and fathers; in-depth interviews with mothers-in-law, mothers, fathers and HIV-infected mothers, and a survey of 446 mothers bringing their four-week-old infants for immunisation at five reproductive and child health clinics. Results The study demonstrated that the mother-in-law saw herself as responsible for family health issues in general and child care in particular. However she received limited trust, and couples, in particular couples living in urban areas, tended to exclude her from decisions related to childbearing and infant feeding. Mothers-in-law expected their daughters-in-law to breastfeed in a customary manner and were generally negative towards the infant feeding methods recommended for HIV-infected mothers; exclusive replacement feeding and exclusive breastfeeding. Conclusions Decreasing influence of the mother-in-law and increasing prominence of the conjugal couples in issues related to reproduction and child care, reinforce the importance of continued efforts to include male partners in the PMTCT programme. The potential for involving mothers-in-law in the infant feeding component, where she still has influence in some areas, should be further explored.
Pan, Yuchun; Chen, Baisong; Lu, Zhou; Li, Shuhua; Zhang, Jingbo; Zhou, YanBing
The transition of rural and agricultural management from divisional to integrated mode has highlighted the importance of data integration and sharing. Current data are mostly collected by specific department to satisfy their own needs and lake of considering on wider potential uses. This led to great difference in data format, semantic, and precision even in same area, which is a significant barrier for constructing an integrated rural spatial information system to support integrated management and decision-making. Considering the rural cadastral management system and postal zones, the paper designs a rural address geocoding method based on rural cadastral parcel. It puts forward a geocoding standard which consists of absolute position code, relative position code and extended code. It designs a rural geocoding database model, and addresses collection and update model. Then, based on the rural address geocoding model, it proposed a data model for rural agricultural resources management. The results show that the address coding based on postal code is stable and easy to memorize, two-dimensional coding based on the direction and distance is easy to be located and memorized, while extended code can enhance the extensibility and flexibility of address geocoding.
West Philippa A
Full Text Available Abstract Background Insecticide-treated nets (ITN are one of the most effective measures for preventing malaria. Mass distribution campaigns are being used to rapidly increase net coverage in at-risk populations. This study had two purposes: to evaluate the impact of a universal coverage campaign (UCC of long-lasting insecticidal nets (LLINs on LLIN ownership and usage, and to identify factors that may be associated with inadequate coverage. Methods In 2011 two cross-sectional household surveys were conducted in 50 clusters in Muleba district, north-west Tanzania. Prior to the UCC 3,246 households were surveyed and 2,499 afterwards. Data on bed net ownership and usage, demographics of household members and household characteristics including factors related to socio-economic status were gathered, using an adapted version of the standard Malaria Indicator Survey. Specific questions relating to the UCC process were asked. Results The proportion of households with at least one ITN increased from 62.6% (95% Confidence Interval (CI = 60.9-64.2 before the UCC to 90.8% (95% CI = 89.0-92.3 afterwards. ITN usage in all residents rose from 40.8% to 55.7%. After the UCC 58.4% (95% CI = 54.7-62.1 of households had sufficient ITNs to cover all their sleeping places. Households with children under five years (OR = 2.4, 95% CI = 1.9-2.9 and small households (OR = 1.9, 95% CI = 1.5-2.4 were most likely to reach universal coverage. Poverty was not associated with net coverage. Eighty percent of households surveyed received LLINs from the campaign. Conclusions The UCC in Muleba district of Tanzania was equitable, greatly improving LLIN ownership and, more moderately, usage. However, the goal of universal coverage in terms of the adequate provision of nets was not achieved. Multiple, continuous delivery systems and education activities are required to maintain and improve bed net ownership and usage.
Mubyazi Godfrey M
Full Text Available Abstract Background Since its introduction in the national antenatal care (ANC system in Tanzania in 2001, little evidence is documented regarding the motivation and performance of health workers (HWs in the provision of intermittent preventive treatment of malaria during pregnancy (IPTp services in the national ANC clinics and the implications such motivation and performance might have had on HWs and services' compliance with the recommended IPTp delivery guidelines. This paper describes the supply-related drivers of motivation and performance of HWs in administering IPTp doses among other ANC services delivered in public and private health facilities (HFs in Tanzania, using a case study of Mkuranga and Mufindi districts. Methods Interviews were conducted with 78 HWs participating in the delivery of ANC services in private and public HFs and were supplemented by personal communications with the members of the district council health management team. The research instrument used in the data collection process contained a mixture of closed and open-ended questions. Some of the open-ended questions had to be coded in the form that allowed their analysis quantitatively. Results In both districts, respondents acknowledged IPTp as an essential intervention, but expressed dissatisfaction with their working environments constraining their performance, including health facility (HF unit understaffing; unsystematic and unfriendly supervision by CHMT members; limited opportunities for HW career development; and poor (HF infrastructure and staff houses. Data also suggest that poor working conditions negatively affect health workers' motivation to perform for ANC (including IPTp services. Similarities and differences were noted in terms of motivational factors for ANC service delivery between the HWs employed in private HFs and those in public HFs: those in private facilities were more comfortable with staff residential houses, HF buildings, equipment
Full Text Available Abstract Background Prompt access to effective treatment is central in the fight against malaria. However, a variety of interlinked factors at household and health system level influence access to timely and appropriate treatment and care. Furthermore, access may be influenced by global and national health policies. As a consequence, many malaria episodes in highly endemic countries are not treated appropriately. Project The ACCESS Programme aims at understanding and improving access to prompt and effective malaria treatment and care in a rural Tanzanian setting. The programme's strategy is based on a set of integrated interventions, including social marketing for improved care seeking at community level as well as strengthening of quality of care at health facilities. This is complemented by a project that aims to improve the performance of drug stores. The interventions are accompanied by a comprehensive set of monitoring and evaluation activities measuring the programme's performance and (health impact. Baseline data demonstrated heterogeneity in the availability of malaria treatment, unavailability of medicines and treatment providers in certain areas as well as quality problems with regard to drugs and services. Conclusion The ACCESS Programme is a combination of multiple complementary interventions with a strong evaluation component. With this approach, ACCESS aims to contribute to the development of a more comprehensive access framework and to inform and support public health professionals and policy-makers in the delivery of improved health services.
But domestic tourism in many developing countries is nearly non-existent, with local ... Key words: Domestic tourism, local communities, northern circuit, Tanzania, wildlife ..... on wildlife and conservation issues than their rural .... and books (13.6 %), and TV and Radios (15%). .... Opportunities and Challenges in Agricultural.
Simonsen, Paul Erik; Derua, Yahya A.; Magesa, Stephen M.
BackgroundLymphatic filariasis (LF) control started in Tanga Region of Tanzania in 2004, with annual ivermectin/albendazole mass drug administration (MDA). Since then, the current project has monitored the effect in communities and schools in rural areas of Tanga District. In 2013, after 8 rounds...
Trærup, Sara Lærke Meltofte
This chapter explores a potential relationship between rainfall data and household self-reported harvest shocks and local (spatial) variability of harvest shocks and coping strategies based on a survey of 2700 rural households in the Kagera region of northern Tanzania. In addition, correlations...
Braae, Uffe Christian; Magnussen, Pascal; Ndawi, Benedict
This study evaluated the effect of mass drug administration (MDA) with praziquantel administered to school-aged children (SAC) combined with ‘track and treat’ of taeniosis cases on the prevalence of taeniosis. The study was conducted in 14 villages in Mbozi and Mbeya district, Tanzania. SAC recei...
Anne Nordrehaug Åstrøm
Full Text Available Objectives: The following questions were addressed; to what extent is sugar consumption, tooth brushing, and oral health related attitudes and knowledge subject to change following a combined atraumatic restorative treatment (ART /oral health education (OHE program? Are changes in intended sugar avoidance associated with changes in cognitions as specified by the Theory of Planned Behaviour (TPB? Are changes in oral health related knowledge associated with changes in attitudes and oral health behaviour?Method: A total of 1306 (follow-up prevalence 73.8% primary school students in Kilwa, Tanzania completed interviews before and after a combined ART/OHE program. Post intervention at 6 months follow-up assessed changes in oral health related knowledge, attitudes, and behaviours. Complete baseline and follow-up interviews were obtained from 221 and 1085 students who received ART/OHE and OHE only at schools, respectively.Results: Improvement was obtained with attitudes towards sugar avoidance, knowledge, and tooth brushing (effect sizes in the range 0.1-0.3. Within individual changes did not differ significantly between students receiving ART/ OHE and OHE only. Change scores of intended sugar avoidance associated in the expected direction with changes in sugar consumption. Attitudes and norms with respect to sugar avoidance deteriorated and improved among subjects who respectively decreased and increased intended sugar avoidance. Tooth brushing increased in students who improved oral knowledge.Conclusion: School based ART/OHE improved pupils’ tooth brushing, knowledge, and attitudes, but had no effect on sugar consumption. This study provided support for the validity of the TPB in predicting changes in intended sugar avoidance and reported sugar intake.
Full Text Available Background: The Tanzanian national HIV care and treatment programme has provided free antiretroviral therapy (ART to HIV-positive persons since 2004. ART has been available to participants of the Kisesa open cohort study since 2005, but data to 2007 showed a slow uptake of ART and a modest impact on mortality. Additional data from the 2010 HIV serological survey provide an opportunity to update the estimated impact of ART in this setting. Methods: The Kisesa Health and Demographic Surveillance Site (HDSS has collected HIV serological data and demographic data, including verbal autopsy (VA interviews since 1994. Serological data to the end of 2010 were used to make two estimates of HIV-attributable mortality, the first among HIV positives using the difference in mortality between HIV positives and HIV negatives, and the second in the population using the difference between the observed mortality rate in the whole population and the mortality rate among the HIV negatives. Four time periods (1994–1999, 2000–2004, 2005–2007, and 2008–2010 were used and HIV-attributable mortality estimates were analysed in detail for trends over time. A computer algorithm, InterVA-4, was applied to VA data to estimate the HIV-attributable mortality for the population, and this was compared to the estimates from the serological survey data. Results: Among HIV-positive adults aged 45–59 years, high mortality rates were observed across all time periods in both males and females. In HIV-positive men, the HIV-attributable mortality was 91.6% (95% confidence interval (CI: 84.6%–95.3% in 2000–2004 and 86.3% (95% CI: 71.1%–93.3% in 2008–2010, while among women, the HIV-attributable mortality was 87.8% (95% CI: 71.1%–94.3% in 2000–2004 and 85.8% (95% CI: 59.6%–94.4% in 2008–2010. In the whole population, using the serological data, the HIV-attributable mortality among men aged 30–44 years decreased from 57.2% (95% CI: 46.9%–65.3% in 2000–2004
Levira, Francis; Todd, Gemma
How are health inequalities articulated across urban and rural spaces in Tanzania? This research paper explores the variations, differences, and inequalities, in Tanzania's health outcomes-to question both the idea of an urban advantage in health and the extent of urban-rural inequalities in health. The three research objectives aim to understand: what are the health differences (morbidity and mortality) between Tanzania's urban and rural areas; how are health inequalities articulated within Tanzania's urban and rural areas; and how are health inequalities articulated across age groups for rural-urban Tanzania? By analyzing four national datasets of Tanzania (National Census, Household Budget Survey, Demographic Health Survey, and Health Demographic Surveillance System), this paper reflects on the outcomes of key health indicators across these spaces. The datasets include national surveys conducted from 2009 to 2012. The results presented showcase health outcomes in rural and urban areas vary, and are unequal. The risk of disease, life expectancy, and unhealthy behaviors are not the same for urban and rural areas, and across income groups. Urban areas show a disadvantage in life expectancy, HIV prevalence, maternal mortality, children's morbidity, and women's BMI. Although a greater level of access to health facilities and medicine is reported, we raise a general concern of quality and availability in health services; what data sources are being used to make decisions on urban-rural services, and the wider determinants of urban health outcomes. The results call for a better understanding of the sociopolitical and economic factors contributing to these inequalities. The urban, and rural, populations are diverse; therefore, we need to look at service quality, and use, in light of inequality: what services are being accessed; by whom; for what reasons?
Kondo, Michelle C; Bream, Kent D W; Barg, Frances K; Branas, Charles C
Nonrandom sampling of populations in developing nations has limitations and can inaccurately estimate health phenomena, especially among hard-to-reach populations such as rural residents. However, random sampling of rural populations in developing nations can be challenged by incomplete enumeration of the base population. We describe a stratified random sampling method using geographical information system (GIS) software and global positioning system (GPS) technology for application in a health survey in a rural region of Guatemala, as well as a qualitative study of the enumeration process. This method offers an alternative sampling technique that could reduce opportunities for bias in household selection compared to cluster methods. However, its use is subject to issues surrounding survey preparation, technological limitations and in-the-field household selection. Application of this method in remote areas will raise challenges surrounding the boundary delineation process, use and translation of satellite imagery between GIS and GPS, and household selection at each survey point in varying field conditions. This method favors household selection in denser urban areas and in new residential developments. Random spatial sampling methodology can be used to survey a random sample of population in a remote region of a developing nation. Although this method should be further validated and compared with more established methods to determine its utility in social survey applications, it shows promise for use in developing nations with resource-challenged environments where detailed geographic and human census data are less available.
Shoo, Tiransia Arthur
Background Food insecurity which is the one of the causes of child malnutrition is still prevalent in Tanzania. One of the causes of food insecurity as it has been reported by other scholars is gender inequality. Women, especially in developing countries have been reported to have very high workload in food production compared to men and in decision making power they are often subordinate to men. Other studies have showed that gender roles are dynamic and they change over time with economi...
Wamoyi, Joyce; Wight, Daniel
Research in high income countries shows parent–child connectedness to be protective against undesirable sexual and reproductive health (SRH) outcomes among young people. Little has been done to understand the nature of parent–child connectedness, the structural factors that impact on connectedness and parents’ understanding of how connectedness affects their children's sexual behaviour in sub-Saharan Africa and Tanzania in particular. Ethnographic research involved 30 days of observation in 1...
Mtenga, Sally; Masanja, Irene M; Mamdani, Masuma
Background Tanzania’s socio-economic development is challenged by sharp inequities between and within urban and rural areas, and among different socio-economic groups. This paper discusses the importance of strengthening SDH research, knowledge, relevant capacities and responsive systems towards addressing health inequities in Tanzania. Methods Based on a conceptual framework for building SDH research capacity, a mapping of existing research systems was undertaken between February and June 20...
Full Text Available The paper presents a methodology aimed at supporting the rural planning process. The analysis of the state of the art of local and regional policies focused on rural and suburban areas, and the study of the scientific literature in the field of spatial analysis methodologies, have allowed the definition of the basic concept of the research. The proposed method, developed in a GIS, is based on spatial metrics selected and defined to cover various agricultural, environmental, and socio-economic components. The specific goal of the proposed methodology is to identify homogeneous extra-urban areas through their objective characterization at different scales. Once areas with intermediate urban-rural characters have been identified, the analysis is then focused on the more detailed definition of periurban agricultural areas. The synthesis of the results of the analysis of the various landscape components is achieved through an original interpretative key which aims to quantify the potential impacts of rural areas on the urban system. This paper presents the general framework of the methodology and some of the main results of its first implementation through an Italian case study.
Nandonde, Felix Adamu
In the last decade, the economy of African continent and Tanzania in particular has witnessed a business boom of the tourism sector. While the sector has continued to grow and become a dependable source of direct and indirect employment to youths in urban and rural areas, the sector has been awash...... with challenges. These challenges include terrorism attacks, energy crises and poor infrastructure. However, the impact of these challenges on the image of Tanzania as a tourist destination has not received the deserved attention. This study explores the perception of visitors towards Tanzania as a tourist....... Front line employees, various tourist sites and access to services emerged to be strong tourist destination image factors. This implies that the efforts of marketing tourism destination should focus on promoting all the sites the country has....
ABSTRACT This thesis explores the extent to which the current Tanzanian Social Policy takes into consideration indigenous African cultural sensibilities for the social security of the elderly in a rural setting. This has been addressed in four scientific papers, which build on the first hand ethnographic data I gathered from Bukoba rural district over a period of six months 2010/2011. The first article discusses African Indigenous Knowledge and Social Security of the Elderly in Rural Tan...
Dempewolf, J.; Becker-Reshef, I.; Nakalembe, C. L.; Tumbo, S.; Maurice, S.; Mbilinyi, B.; Ntikha, O.; Hansen, M.; Justice, C. J.; Adusei, B.; Kongo, V.
In-season monitoring of crop conditions provides critical information for agricultural policy and decision making and most importantly for food security planning and management. Nationwide agricultural monitoring in countries dominated by smallholder farming systems, generally relies on extensive networks of field data collectors. In Tanzania, extension agents make up this network and report on conditions across the country, approaching a "near-census". Data is collected on paper which is resource and time intensive, as well as prone to errors. Data quality is ambiguous and there is a general lack of clear and functional feedback loops between farmers, extension agents, analysts and decision makers. Moreover, the data are not spatially explicit, limiting the usefulness for analysis and quality of policy outcomes. Despite significant advances in remote sensing and information communication technologies (ICT) for monitoring agriculture, the full potential of these new tools is yet to be realized in Tanzania. Their use is constrained by the lack of resources, skills and infrastructure to access and process these data. The use of ICT technologies for data collection, processing and analysis is equally limited. The AgriSense-STARS project is developing and testing a system for national-scale in-season monitoring of smallholder agriculture using a combination of three main tools, 1) GLAM-East Africa, an automated MODIS satellite image processing system, 2) field data collection using GeoODK and unmanned aerial vehicles (UAVs), and 3) the Tanzania Crop Monitor, a collaborative online portal for data management and reporting. These tools are developed and applied in Tanzania through the National Food Security Division of the Ministry of Agriculture, Food Security and Cooperatives (MAFC) within a statistically representative sampling framework (area frame) that ensures data quality, representability and resource efficiency.
Mayo, A. W.
Water, sanitation, housing and hygienic behavior plays dominant role in the transmission and intensification of diseases. To effectively utilize limited financial resources, it is important to prioritize disease intervention methods in order to minimize mortality and morbidity cases. Realization of the environmental health components that respond to the practical effects of their contribution to transmission of diseases has greater chances of effectively enhancing health. Data of frequency of diseases and mortality rate were collected from four municipal hospitals from districts of Ilala, Kinondoni, Temeke and Kibaha in Dar es Salaam and Coast Regions. The populations at risk were sub-categorized in relation to age; below five years and above five years. The age parameter assists on envisaging the major causes to be either in-house or in public domain. Data were analyzed to assess the role of water quality, water quantity, excreta disposal, waste disposal and hygiene education on spreading the diseases in order to come up with scientifically evaluated information. Scores were given to each intervention method depending on its importance in controlling a particular disease. The results indicate that incidences of malaria, skin and eye infections, pneumonia and diarrhea are frequent in these districts. Children under 5 years are particularly affected by pneumonia and diarrhea more than adults. Malaria, tuberculosis and pneumonia are the major causes of mortality rates in these districts. Fatality cases are caused largely by malaria, pneumonia and diarrhea for children less than 5 years, but malaria, tuberculosis and pneumonia are responsible for mortality rates in adults and children over 5 years. Statistical analysis revealed that in all districts, hygiene education is the major factor responsible for transmission of diseases accounting for 32-39%. Other factors, which are the major contributors to the incidences of diseases, are inadequacy of water (15.6-22.5%) and
Helen L Zhang
Full Text Available Zoonoses are common causes of human and livestock illness in Tanzania. Previous studies have shown that brucellosis, leptospirosis, and Q fever account for a large proportion of human febrile illness in northern Tanzania, yet they are infrequently diagnosed. We conducted this study to assess awareness and knowledge regarding selected zoonoses among healthcare providers in Moshi, Tanzania; to determine what diagnostic and treatment protocols are utilized; and obtain insights into contextual factors contributing to the apparent under-diagnosis of zoonoses.We conducted a questionnaire about zoonoses knowledge, case reporting, and testing with 52 human health practitioners and 10 livestock health providers. Immediately following questionnaire administration, we conducted semi-structured interviews with 60 of these respondents, using the findings of a previous fever etiology study to prompt conversation. Sixty respondents (97% had heard of brucellosis, 26 (42% leptospirosis, and 20 (32% Q fever. Animal sector respondents reported seeing cases of animal brucellosis (4, rabies (4, and anthrax (3 in the previous 12 months. Human sector respondents reported cases of human brucellosis (15, 29%, rabies (9, 18% and anthrax (6, 12%. None reported leptospirosis or Q fever cases. Nineteen respondents were aware of a local diagnostic test for human brucellosis. Reports of tests for human leptospirosis or Q fever, or for any of the study pathogens in animals, were rare. Many respondents expressed awareness of malaria over-diagnosis and zoonoses under-diagnosis, and many identified low knowledge and testing capacity as reasons for zoonoses under-diagnosis.This study revealed differences in knowledge of different zoonoses and low case report frequencies of brucellosis, leptospirosis, and Q fever. There was a lack of known diagnostic services for leptospirosis and Q fever. These findings emphasize a need for improved diagnostic capacity alongside healthcare
Swai, Johnson K; Finda, Marceline F; Madumla, Edith P; Lingamba, Godfrey F; Moshi, Irene R; Rafiq, Mohamed Y; Majambere, Silas; Okumu, Fredros O
Subsistence rice farmers in south-eastern Tanzania are often migratory, spending weeks or months tending to crops in distant fields along the river valleys and living in improvised structures known as Shamba huts, not fully protected from mosquitoes. These farmers also experience poor access to organized preventive and curative services due to long distances. Mosquito biting exposure in these rice fields, relative to main village residences was assessed, then a portable mosquito-proof hut was developed and tested for protecting these migratory farmers. Pair-wise mosquito surveys were conducted in four villages in Ulanga district, south-eastern Tanzania in 20 randomly-selected Shamba huts located in the distant rice fields and in 20 matched houses within the main villages, to assess biting densities and Plasmodium infection rates. A portable mosquito-proof hut was designed and tested in semi-field and field settings against Shamba hut replicas, and actual Shamba huts. Also, semi-structured interviews were conducted, timed-participant observations, and focus-group discussions to assess experiences and behaviours of the farmers regarding mosquito-bites and the mosquito-proof huts. There were equal numbers of mosquitoes in Shamba huts and main houses [RR (95% CI) 27 (25.1-31.2), and RR (95% CI) 30 (27.5-33.4)], respectively (P > 0.05). Huts having >1 occupant had more mosquitoes than those with just one occupant, regardless of site [RR (95% CI) 1.57 (1.30-1.9), P mosquitoes caught were negative for Plasmodium. Common night-time outdoor activities in the fields included cooking, eating, fetching water or firewood, washing dishes, bathing, and storytelling, mostly between 6 and 11 p.m., when mosquitoes were also biting most. The prototype hut provided 100% protection in semi-field and field settings, while blood-fed mosquitoes were recaptured in Shamba huts, even when occupants used permethrin-impregnated bed nets. Though equal numbers of mosquitoes were caught
Mamiro, Peter S; Kolsteren, Patrick; Roberfroid, Dominique; Tatala, Simon; Opsomer, Ann S; Van Camp, John H
Infants in Tanzania are particularly vulnerable to under-nutrition during transition from breastmilk (as the only source of nourishment) to solid foods. A cross-sectional study was undertaken in Kilosa district in Tanzania to determine the feeding practices and the extent of wasting, stunting, and iron-deficiency anaemia. The study was done in two stages: in the first stage, a 24-hour dietary assessment was conducted to identify the type of complementary foods given and the eating habits according to age for 378 children aged 3-23 months. In the second stage, a progressive recruitment of 309 infants aged six months was made to measure weight, length, haemoglobin (Hb) concentration, zinc protoporphyrin concentration, and malaria parasitaemia. Birth-weight, the potential contributing factor to under-nutrition and iron-deficiency anaemia, was obtained from the children's clinic cards. The 24-hour dietary assessment revealed that children consumed mainly a thin porridge prepared from maize flour as complementary food. Carbohydrates contributed most energy (on average 69%), followed by fats (18.6%) and protein (on average 12.1%). The complementary food co-vered only 15%, 20%, and 27% of the recommended iron intake for children aged 6-8, 9-11 and 12-23 months respectively. The mean Hb concentration was 9.3 +/- 1.9 g/dL, 68% of the infants were moderately anaemic (7 or =11 g/dL). Equally, the mean zinc protoporphyrin concentration was 10.0 +/- 6.2 microg/g Hb, and 76% of the infants were iron-deficient (>5 microg/g Hb). The prevalence of stunting was 35%, while wasting was only 1.3%. Low birth-weight and low body mass index of mothers were the strong predictors of stunting, whereas low birth-weight and iron-deficiency were the strong predictors of anaemia. The prevalence of malaria parasitaemia was high, affecting 50% of the infants. Having malaria was the only independent predictor associated with stunting, anaemia, and iron-deficiency. There is an urgent need to improve
Habib-Mintz, Nazia [Land Economy, St. Edmund' s College, University of Cambridge, Kings Lane CB3 0BN (United Kingdom)
Increasing demand for biofuels as a component of climate change mitigation, energy security, and a fossil fuel alternative attracts investors to developing countries like Tanzania. Ample unused land is critical for first generation biofuels production and an important feature to attract foreign direct investments that can contribute towards agricultural modernization and poverty reduction initiatives. Despite the economic justifications, the existing institutional and infrastructural capacities dictate the impacts of biofuels market penetrations. Furthermore, exogenous factors like global recessionary pressure depressed oil prices below the level at which biofuel production were profitable in 2007, making Tanzania's competitiveness and potential benefits questionable. This paper investigates the extent that first generation, jatropha-based biofuels industry development in Tanzania observed during fieldwork in Kisarawe and Bahi may fulfill policy objectives. This paper argues that without strong regulatory frameworks for land, investment management, and rural development, biofuel industrialization could further exacerbate poverty and food insecurity in Tanzania. The paper concludes with policy recommendations for first generation biofuel development while keeping in mind implications of second generation production. Since the topic is broad and multifaceted, a multidisciplinary approach is used that includes political, institutional, and agricultural economics to analyze and conceptualize biofuel industry development and food security. (author)
Habib-Mintz, Nazia, E-mail: email@example.com [Land Economy, St. Edmund' s College, University of Cambridge, Kings Lane CB3 0BN (United Kingdom)
Increasing demand for biofuels as a component of climate change mitigation, energy security, and a fossil fuel alternative attracts investors to developing countries like Tanzania. Ample unused land is critical for first generation biofuels production and an important feature to attract foreign direct investments that can contribute towards agricultural modernization and poverty reduction initiatives. Despite the economic justifications, the existing institutional and infrastructural capacities dictate the impacts of biofuels market penetrations. Furthermore, exogenous factors like global recessionary pressure depressed oil prices below the level at which biofuel production were profitable in 2007, making Tanzania's competitiveness and potential benefits questionable. This paper investigates the extent that first generation, jatropha-based biofuels industry development in Tanzania observed during fieldwork in Kisarawe and Bahi may fulfill policy objectives. This paper argues that without strong regulatory frameworks for land, investment management, and rural development, biofuel industrialization could further exacerbate poverty and food insecurity in Tanzania. The paper concludes with policy recommendations for first generation biofuel development while keeping in mind implications of second generation production. Since the topic is broad and multifaceted, a multidisciplinary approach is used that includes political, institutional, and agricultural economics to analyze and conceptualize biofuel industry development and food security.
Salerno, Jonathan D; Borgerhoff Mulder, Monique; Kefauver, Shawn C
A recent discussion debates the extent of human in-migration around protected areas (PAs) in the tropics. One proposed argument is that rural migrants move to bordering areas to access conservation outreach benefits. A counter proposal maintains that PAs have largely negative effects on local populations and that outreach initiatives even if successful present insufficient benefits to drive in-migration. Using data from Tanzania, we examined merits of statistical tests and spatial methods used previously to evaluate migration near PAs and applied hierarchical modeling with appropriate controls for demographic and geographic factors to advance the debate. Areas bordering national parks in Tanzania did not have elevated rates of in-migration. Low baseline population density and high vegetation productivity with low interannual variation rather than conservation outreach explained observed migration patterns. More generally we argue that to produce results of conservation policy significance, analyses must be conducted at appropriate scales, and we caution against use of demographic data without appropriate controls when drawing conclusions about migration dynamics. © 2014 Society for Conservation Biology.
Mwangungulu, Stephen Peter; Sumaye, Robert David; Limwagu, Alex Julius; Siria, Doreen Josen; Kaindoa, Emmanuel Wilson; Okumu, Fredros Oketch
Lack of reliable techniques for large-scale monitoring of disease-transmitting mosquitoes is a major public health challenge, especially where advanced geo-information systems are not regularly applicable. We tested an innovative crowd-sourcing approach, which relies simply on knowledge and experiences of residents to rapidly predict areas where disease-transmitting mosquitoes are most abundant. Guided by community-based resource persons, we mapped boundaries and major physical features in three rural Tanzanian villages. We then selected 60 community members, taught them basic map-reading skills, and offered them gridded maps of their own villages (grid size: 200m×200m) so they could identify locations where they believed mosquitoes were most abundant, by ranking the grids from one (highest density) to five (lowest density). The ranks were interpolated in ArcGIS-10 (ESRI-USA) using inverse distance weighting (IDW) method, and re-classified to depict areas people believed had high, medium and low mosquito densities. Finally, we used odor-baited mosquito traps to compare and verify actual outdoor mosquito densities in the same areas. We repeated this process for 12 months, each time with a different group of 60 residents. All entomological surveys depicted similar geographical stratification of mosquito densities in areas classified by community members as having high, medium and low vector abundance. These similarities were observed when all mosquito species were combined, and also when only malaria vectors were considered. Of the 12,412 mosquitoes caught, 60.9% (7,555) were from areas considered by community members as having high mosquito densities, 28% (3,470) from medium density areas, and 11.2% (1,387) from low density areas. This study provides evidence that we can rely on community knowledge and experiences to identify areas where mosquitoes are most abundant or least abundant, even without entomological surveys. This crowd-sourcing method could be further
Stephen Peter Mwangungulu
Full Text Available Lack of reliable techniques for large-scale monitoring of disease-transmitting mosquitoes is a major public health challenge, especially where advanced geo-information systems are not regularly applicable. We tested an innovative crowd-sourcing approach, which relies simply on knowledge and experiences of residents to rapidly predict areas where disease-transmitting mosquitoes are most abundant. Guided by community-based resource persons, we mapped boundaries and major physical features in three rural Tanzanian villages. We then selected 60 community members, taught them basic map-reading skills, and offered them gridded maps of their own villages (grid size: 200m×200m so they could identify locations where they believed mosquitoes were most abundant, by ranking the grids from one (highest density to five (lowest density. The ranks were interpolated in ArcGIS-10 (ESRI-USA using inverse distance weighting (IDW method, and re-classified to depict areas people believed had high, medium and low mosquito densities. Finally, we used odor-baited mosquito traps to compare and verify actual outdoor mosquito densities in the same areas. We repeated this process for 12 months, each time with a different group of 60 residents. All entomological surveys depicted similar geographical stratification of mosquito densities in areas classified by community members as having high, medium and low vector abundance. These similarities were observed when all mosquito species were combined, and also when only malaria vectors were considered. Of the 12,412 mosquitoes caught, 60.9% (7,555 were from areas considered by community members as having high mosquito densities, 28% (3,470 from medium density areas, and 11.2% (1,387 from low density areas. This study provides evidence that we can rely on community knowledge and experiences to identify areas where mosquitoes are most abundant or least abundant, even without entomological surveys. This crowd-sourcing method could
Yeates, Karen E; Sleeth, Jessica; Hopman, Wilma; Ginsburg, Ophira; Heus, Katharine; Andrews, Linda; Giattas, Mary Rose; Yuma, Safina; Macheku, Godwin; Msuya, Aziz; Oneko, Olola
Almost nine of 10 deaths resulting from cervical cancer occur in low-income countries. Visual inspection under acetic acid (VIA) is an evidence-based, cost-effective approach to cervical cancer screening (CCS), but challenges to effective implementation include health provider training costs, provider turnover, and skills retention. We hypothesized that a smartphone camera and use of cervical image transfer for real-time mentorship by experts located distantly across a closed user group through a commercially available smartphone application would be both feasible and effective in enhancing VIA skills among CCS providers in Tanzania. We trained five nonphysician providers in semirural Tanzania to perform VIA enhanced by smartphone cervicography with real-time trainee support from regional experts. Deidentified images were sent through a free smartphone application on the available mobile telephone networks. Our primary outcomes were feasibility of using a smartphone camera to perform smartphone-enhanced VIA and level of agreement in diagnosis between the trainee and expert reviewer over time. Trainees screened 1,072 eligible women using our methodology. Within 1 month of training, the agreement rate between trainees and expert reviewers was 96.8%. Providers received a response from expert reviewers within 1 to 5 minutes 48.4% of the time, and more than 60% of the time, feedback was provided by regional expert reviewers in less than 10 minutes. Our method was found to be feasible and effective in increasing health care workers' skills and accuracy. This method holds promise for improved quality of VIA-based CCS programs among health care providers in low-income countries.
Geneau, Robert; Massae, Patrick; Courtright, Paul; Lewallen, Susan
Cataract is the leading cause of avoidable blindness in Africa. There are various documented barriers to the uptake of cataract surgery, cost being one of them. There is, however, little evidence regarding patients' willingness to pay (WTP) for cataract surgery in Africa and the best way to measure it. We conducted a grounded theory study in order to understand better cataract patients' WTP for surgery in Tanzania. A total of 47 cataract patients from three regions of Tanzania were interviewed. The interviews were tape-recorded and transcribed verbatim. The coding process involved identifying emerging themes and categories and their interconnection. Our study reveals that the main factors behind patients' WTP for cataract surgery are (1) the level of perceived need for sight and cataract surgery; (2) the decision-making processes at the family level and (3) the characteristics of local eye care programs. Our study shows that WTP concerns not only the patients but also their relatives. For most patients and families, the amount of $20-$30 is deemed reasonable for a sight-restoring procedure. It does not appear realistic for eye care program managers to charge the real cost of cataract surgery at present (about US $70-in Kilimanjaro). However, eye care programs can influence WTP for cataract surgery by providing quality services and by offering adequate counseling about the procedure. The qualitative findings enriched the interpretation of a previously reported quantitative survey and yield implications for both researchers and decision-makers using or relying on WTP methodologies in developing countries.
A teacher developed multidisciplinary unit for teaching elementary and secondary students about Tanzania (Africa) is described. The unit can involve students and teachers from geography, economics, history, language arts, mathematics, literature, and art courses. (RM)
The journal publishes any contribution that advances medical science or ... these core objectives the journal publishes papers on original scientific research, short ... The Tanzania Medical Journal is an international Journal - ISSN: 0856-0719 ...
Millennium Challenge Corporation — Social Impact (SI) has been contracted by MCC to carry out an impact evaluation (IE) of the Tanzania Water Sector Project. This IE examines the effect of the WSP...
Items 1 - 19 of 19 ... The journal publishes original research, case report/case series, letter to ... The journal also engages in, and responds to, current scientific and .... The Tanzania Medical Journal is an international Journal - ISSN: 0856-0719.
disease surveillance system for 13 priority communicable diseases in Tanzania. Retrospective ... existing conditions, and preventing the emergency of new ones and ... dysentery, cerebro-spinal meningitis, cholera, measles, plague, rabies ...
seagrasses and also on the adjacent sediments. (Borowitzka ... characterised by a short, steep sandy slope, below which are ..... The differences in species composition could perhaps be attributed to .... shore waters of Tanzania. M .Sc. Thesis ...
The manuscripts should be prepared in the following order: Title, Abstract, Text, ... Average values must be accompanied by standard errors or standard deviations. .... Authorship: The Tanzania Medical Journal defines an 'author' according to ...
Xue LU; Zhongxiang YU
On the basis of analyzing cases of existing rural collectively owned profit-oriented construction land entering into trading market,this paper put forward several thoughts,introduced methods and paths for rural collectively owned profit-oriented construction land entering into trading market,including reforming rural collective land property right system,cultivating new rural collective economy organizations,helping them to become market entities; improving various legal systems,making clear range of construction land entering into trading market; formulating scientific benefit allocation mechanism; establishing fair and transparent decision making mechanism.
Full Text Available Background: Despite global recognition that sexual violence is a violation of human rights, evidence still shows it is a pervasive problem across all societies. Promising community intervention studies in the low- and middle-income countries are limited. Objective: This study assessed the impact of a community-based intervention, focusing on improving the community's knowledge and reducing social acceptability of violence against women norms with the goal to prevent and respond to sexual violence. Design: The strategies used to create awareness included radio programs, information, education communication materials, and advocacy meetings with local leaders. The intervention took place in Morogoro region in Tanzania. The evaluation used a quasi-experimental design including cross-sectional surveys at baseline (2012 and endline (2014 with men and women aged 18–49 years. Main outcome measures were number of reported rape cases at health facilities and the community's knowledge and attitudes toward sexual violence. Results: The number of reported rape events increased by more than 50% at health facilities during the intervention. Knowledge on sexual violence increased significantly in both areas over the study period (from 57.3 to 80.6% in the intervention area and from 55.5 to 71.9% in the comparison area; p<0.001, and the net effect of the intervention between the two areas was statistically significant (6.9, 95% CI 0.2–13.5, p=0.03. There was significant improvement in most of the attitude indicators in the intervention area, but not in the comparison area. However, the intervention had no significant effect on the overall scores of acceptance attitudes in the final assessment when comparing the two areas (−2.4, 95% CI: −8.4 to 3.6, p=0.42. Conclusions: The intervention had an effect on some indicators on knowledge and attitudes toward sexual violence even after a short period of intervention. This finding informs the public health
Wamoyi, Joyce; Wight, Daniel
Research in high income countries shows parent-child connectedness to be protective against undesirable sexual and reproductive health (SRH) outcomes among young people. Little has been done to understand the nature of parent-child connectedness, the structural factors that impact on connectedness and parents' understanding of how connectedness affects their children's sexual behaviour in sub-Saharan Africa and Tanzania in particular. Ethnographic research involved 30 days of observation in 10 households, 9 focus group discussions and 60 in-depth interviews. Thematic analysis was conducted using NVIVO qualitative data analysis software. The structural factors with greatest influence on connectedness were economic circumstances, gender, social status, state education, and globalisation. Economic circumstances impacted on parent-child connectedness through parents' ability to provide for their children's material needs, and the time their occupation allowed for them to spend with their children and monitor their activities. Appropriate parent-child interactions were shaped by gender norms and by social status in the form of respectability, adolescents' adherence to norms of respect/obedience shaping their parents' affection. State education affected parents' preferences between children but also undermined parental authority, as did broader globalisation. Connectedness was related to SRH in a bi-directional way: lack of connectedness was linked to young people's low self-esteem and risky sexual behaviour while unplanned pregnancies seriously undermined young women's connectedness with their parents. Since material provision was perceived to be a central element of parent-child connectedness, structural factors limiting provision made transactional sex more likely both through direct material pathways and emotional ones. Motives for transactional sex were said to be material needs and to feel loved and cared for. An important pathway by which structural factors shape
Labour Education, 1975
Several issues concerning rural workers' organizations and workers' education are discussed: motivation for self-organization, workers' education needs of rural workers, workers' education methods and techniques, training institutions and training personnel, financial resources, and the role of the International Labor Organization workers'…
Magilvy, Joan K.; And Others
Describes use of photography as method embedded within ethnographic investigation of rural home care for older adults. Illustrates how photography fostered data generation, elicited participants' stories, and showed patterns of rural aging. Notes that analysis of photographic data pooled with interview and observational data facilitated in-depth…
Labour Education, 1975
Several issues concerning rural workers' organizations and workers' education are discussed: motivation for self-organization, workers' education needs of rural workers, workers' education methods and techniques, training institutions and training personnel, financial resources, and the role of the International Labor Organization workers'…
Full Text Available This paper examines how early colonial, town-based wholesalers discerned rural African consumer tastes and measured demand for imported goods by focusing on the experience of the O’Swald Mwanza branch from 1906 through 1916. Like many metropolitan firms, O’Swald had extensive experience in the earlier caravan trade. Thus, several decades later, its representatives arrived in Mwanza expecting that import sales would still conform to the tastes of elite caravan era consumers. With the extension of steam transport into the interior and the onset of an early colonial “Cash Crop Revolution,” however, many more rural cultivators and herdspeople than ever before had the means to acquire imports, and these new consumers proved far more fickle with regard to brand, style and novelty than firms like O’Swald had anticipated. They no longer accepted some caravan era favorites, and desired others in increasing variety. Thus, in order to stay on top of what the firm only slowly came to understand as an emerging mass market, the O’Swald men spied on their competition, engaged in brand name advertising, interrogated shopkeepers and peddlers, and increasingly market-tested new products.
Full Text Available Abstract Background HIV/AIDS remains being a disease of great public health concern worldwide. In regions such as sub-Saharan Africa (SSA where women are disproportionately infected with HIV, women are reportedly less likely capable of negotiating condom use. However, while knowledge of condom use for HIV prevention is extensive among men and women in many countries including Tanzania, evidence is limited about the role of condom negotiation on condom use among women in rural Tanzania. Methods Data originate from a cross-sectional survey of random households conducted in 2011 in Rufiji, Kilombero and Ulanga districts in Tanzania. The survey assessed health-seeking behaviour among women and children using a structured interviewer-administered questionnaire. A total of 2,614 women who were sexually experienced and aged 15-49 years were extracted from the main database for the current analysis. Linkage between condom negotiation and condom use at the last sexual intercourse was assessed using multivariate logistic regression. Results Prevalence of condom use at the last sexual intercourse was 22.2% overall, ranging from12.2% among married women to 54.9% among unmarried (single women. Majority of the women (73.4% reported being confident to negotiate condom use, and these women were significantly more likely than those who were not confident to have used a condom at the last sexual intercourse (OR = 3.13, 95% CI 2.22-4.41. This effect was controlled for marital status, age, education, religion, number of sexual partners, household wealth and knowledge of HIV prevention by condom use. Conclusion Confidence to negotiate condom use is a significant predictor of actual condom use among women in rural Tanzania. Women, especially unmarried ones, those in multiple partnerships or anyone needing protection should be empowered with condom negotiation skills for increased use of condoms in order to enhance their sexual and reproductive health outcomes.
Braae, Uffe Christian; Magnussen, Pascal; Ndawi, Benedict; Harrison, Wendy; Lekule, Faustin; Johansen, Maria Vang
This study evaluated the effect of mass drug administration (MDA) with praziquantel administered to school-aged children (SAC) combined with 'track and treat' of taeniosis cases in the general population on the copro-antigen (Ag) prevalence of taeniosis. The study was conducted in 14 villages in Mbozi and Mbeya district, Tanzania. SAC made up 34% of the population and received MDA with praziquantel (40mg/kg) in 2012 (both districts) and in 2013 (Mbozi only). Three cross-sectional population-based surveys were performed in 2012 (R0), 2013 (R1), and 2014 (R2). In each survey approximately 3000 study subjects of all ages were tested for taeniosis using copro-Ag-ELISA. In total 9064 people were tested and copro-Ag-ELISA positive cases were offered treatment 6-8 months after sampling. The copro-Ag prevalence of taeniosis was significantly higher (Χ(2)-test, p=0.007) in Mbozi (3.0%) at R0 compared to Mbeya (1.5%). Twelve months after MDA in both districts (R1), the copro-Ag prevalence had dropped significantly in both Mbozi (2.0%, p=0.024) and in Mbeya (0.3%, p=0.004), but the significant difference between the districts persisted (Χ(2)-test, p<0.001). Ten months after the second round of MDA in Mbozi and 22 month after the first MDA (R2), the copro-Ag prevalence had dropped significantly again in Mbozi (0.8%, p<0.001), but had slightly increased in Mbeya (0.5%, p=0.051), with no difference between the two districts (Χ(2)-test, p=0.51). The taeniosis cases tracked and treated between round R0 and R2 represented 9% of the projected total number of taeniosis cases within the study area, based on the copro-Ag prevalence and village population data. Among SAC in Mbozi, infection significantly decreased at R1 (p=0.004, OR 0.12, CI: 0.02-0.41) and R2 (p=0.001, OR 0.24, CI: 0.09-0.53) when comparing to R0. In Mbeya infection significant decreased at R1 (p=0.013, OR 0.14, CI: 0.02-0.55), but no difference was found for R2 (p=0. 089), when comparing to R0 among SAC. This study
Githinji, V.; Crane, T.A.
Drawing on ethnographic research conducted in Nsisha, a rural village located close to the shores of Lake Victoria in northwestern Tanzania, this article analyzes how climate change and variability intersect with other stressors that affect rural livelihoods, particularly HIV/AIDS. The analysis inte
A. J. Uisso
Full Text Available To better plan for future involvement of women in the management of the environment, it is crucial to understand their perceptions on agroforestry practices for environmental conservation. The study assessed women’s perceptions on agroforestry for environmental conservation in Lubungo A and Maseyu villages which are adjacent to Kitulang’halo Forest Reserve in Morogoro Rural District. Secondary data reviews and Participatory Rural Appraisal (PRA involving Focus Group Discussions (FGDs, Key Informant Interviews (KIIs, field observations and household interviews were used for data collection. The results of this study indicated that in both villages studied there were dominance of male headed households, married head of households, working group, small and medium household size, number of respondents completed primary education and farming activities. From the Likert scale analysis it was realized that, the perception of women on the contribution of agroforestry to environmental conservation was generally positive. However, women were highly positive (1st Rank about the contribution of agroforestry to wind break. Furthermore, the chi-square (X2 test results showed that there was a significant relationship between household head (X2 = 8.63, p = 0.013, age (X2 = 11.227, p = 0.024 and the level of rating of the contribution of agroforestry to environmental conservation. Conversely, X2 test showed no association between marital status, education level and household size with respondent’s level of rating. For a better future management of the environment in the agricultural landscapes women should equally recognise all the environmental benefits of the agroforestry activities. Furthermore, provision of agroforestry and environmental education, accessible loan for agroforestry, seedlings and modern agricultural equipments for enhancing agroforestry practices for environmental conservation is necessary.
Full Text Available Tanzania is primarily an agro-based economy, characterized by subsistence agricultural production that employs more than 80% of the population and contributes up to 45% of the GDP (2005. This country is endowed with a cattle population of 21.3 M, composed mainly of indigenous Zebu breeds and about 680 000 improved dairy animals. About 70% of the milk produced comes from the traditional sector (indigenous cattle kept in rural areas, while the remaining 30% comes from improved cattle, mainly kept by smallholder producers. In Northern Tanzania and particularly in Hai district of Kilimanjaro Region, some dairy farmers organize themselves into small producer groups for the purpose of milk collecting, marketing and general promotion of the dairy sector in their community. Nronga Women Dairy Cooperative Society (NWDCS Limited is one of such organizations dedicated to improve the well-being of the Nronga village community through promoting small-scale dairy farming and its flow-on benefits. Milk flows out of the village, and services for investment and dairy production flow into the village, ensuring a sustainable financial circulation necessary for poverty reduction, rural development and better life for the rural community. In 2001 NWDCS introduced a school milk feeding program that has attracted Australian donors since 2005. Guided by Global Development Group, a multi-faceted project, integrating micro-enterprises, business, education and child health/nutrition, was proposed and initiated by building a dairy plant in Hai District headquarters, the Boma plant. In March 2013, the Australian High Commission to East Africa approved Direct Aid Program funding of AUD 30 000 towards the NWDCS - Biogas Pilot Project in Tanzania, which included the renovation of zero-grazing cow shade units, the construction of 6-m3 biodigester plants on each farm, and encouragement of the use of bioslurry for pasture production and home gardens.
Full Text Available Innovations are considered the engine of economic growth, because they serve a s basis for obtaining the competitive advantage. Tourism is one of the most profitable and dynamic sectors of economy, occupying the second position in the international trade after oil. Rural tourism also has major implications in the economic, social and cultural development of villages. This study presents an analysis of the fluctuation of the number of employees and of the number of accommodation units specific to rural tourism in Romania, between 2007-2014. To this end statistical data from the National Statistics Institute has been used. Volunteer tourism, the development of national portals for presentation of vacant jobs in the tourism sector and the development of human resources by absorption of European funds, are the three suggestions presented in this study, which have the purpose ofreinvigorating rural tourism in Romania.
Trærup, Sara Lærke Meltofte
This chapter explores a potential relationship between rainfall data and household self-reported harvest shocks and local (spatial) variability of harvest shocks and coping strategies based on a survey of 2700 rural households in the Kagera region of northern Tanzania. In addition, correlations...... of household reported harvest shocks differs significantly between districts and correspond to the observed variability in local climate patterns. Coping strategies are focused on spreading risks and include reduced consumption, casual employment, new crops, external support and the selling of assets...
Full Text Available Background: In 2007, the Tanzanian government called for improvements in its primary health care services. Part of this initiative was to accelerate the training rate for nurses qualified to work in rural areas. The aim of this study was to reflect on the issues experienced whilst establishing and implementing a faith-based organisation (FBO nursing school and make recommendations for other similar initiatives. Design: This paper describes an auto-ethnographic case study design to identify the key difficulties involved with establishing and implementing a new nursing school, and which factors helped the project achieve its goals. Results: Six themes emerged from the experiences that shaped the course of the project: 1 Motivation can be sustained if the rationale of the project is in line with its aims. Indeed, the project's primary health care focus was to strengthen the nursing workforce and build a public–private partnership with an FBO. All these were strengths, which helped in the midst of all the uncertainties. 2 Communication was an important and often underrated factor for all types of development projects. 3 Managing the unknown and 4 managing expectations characterised the project inception. Almost all themes had to do with 5 handling conflicts. With so many participants having their own agendas, tensions were unavoidable. A final theme was 6 the need to adjust to ever-changing targets. Conclusions: This retrospective auto-ethnographic manuscript serves as a small-scale case study, to illustrate how issues that can be generalised to other settings can be deconstructed to demonstrate how they influence health development projects in developing countries. From this narrative of experiences, key recommendations include the following: 1 Find the right ratio of stakeholders, participants, and agendas, and do not overload the project; 2 Be alert and communicate as much as possible with staff and do not ignore issues hoping they will solve
Mfinanga Godfrey S
Full Text Available Abstract Background Many factors have been mentioned as contributing to under-diagnosis and under-reporting of zoonotic diseases particularly in the sub-Sahara African region. These include poor disease surveillance coverage, poor diagnostic capacity, the geographical distribution of those most affected and lack of clear strategies to address the plight of zoonotic diseases. The current study investigates the knowledge of medical practitioners of zoonotic diseases as a potential contributing factor to their under-diagnosis and hence under-reporting. Methods The study was designed as a cross-sectional survey. Semi-structured open-ended questionnaire was administered to medical practitioners to establish the knowledge of anthrax, rabies, brucellosis, trypanosomiasis, echinococcosis and bovine tuberculosis in selected health facilities within urban and rural settings in Tanzania between April and May 2005. Frequency data were analyzed using likelihood ratio chi-square in Minitab version 14 to compare practitioners' knowledge of transmission, clinical features and diagnosis of the zoonoses in the two settings. For each analysis, likelihood ratio chi-square p-value of less than 0.05 was considered to be significant. Fisher's exact test was used where expected results were less than five. Results Medical practitioners in rural health facilities had poor knowledge of transmission of sleeping sickness and clinical features of anthrax and rabies in humans compared to their urban counterparts. In both areas the practitioners had poor knowledge of how echinococcosis is transmitted to humans, clinical features of echinococcosis in humans, and diagnosis of bovine tuberculosis in humans. Conclusion Knowledge of medical practitioners of zoonotic diseases could be a contributing factor to their under-diagnosis and under-reporting in Tanzania. Refresher courses on zoonotic diseases should be conducted particularly to practitioners in rural areas. More emphasis
Huria: Journal of the Open University of Tanzania. ... looking for originality, relevance, clarity, appropriateness of the methods, validity of data, reasonability of the conclusion and support from data. .... Dar es Salaam: Government Printing Office.
Our screening of indigenous medicinal plants from Tanzania has led to the ... Material and methods: The current study investigates the cytotoxic activity of methanol ... Result 16% of the tested plant extracts showed moderate to strong inhibitory ...
Enarson Donald A
Full Text Available Abstract Background Several FIDELIS projects (Fund for Innovative DOTS Expansion through Local Initiatives to Stop TB in Tanzania were conducted by the National Tuberculosis and Leprosy Programme (NTLP during the years 2004-2008 to strengthen diagnostic and treatment services. These projects collected information on treatment delay and some of it was available for research purposes. With this database our objective was to assess the duration and determinants of treatment delay among new smear positive pulmonary tuberculosis (TB patients in FIDELIS projects, and to compare delay according to provider visited prior to diagnosis. Methods Treatment delay among new smear positive TB patients was recorded for each patient at treatment initiation and this information was available and fairly complete in 6 out of 57 districts with FIDELIS projects enrolling patients between 2004 and 2007; other districts had discarded their forms at the time of analysis. It was analysed as a cross sectional study. Results We included 1161 cases, 10% of all patients recruited in the FIDELIS projects in Tanzania. Median delay was 12 weeks. The median duration of cough, weight loss and haemoptysis was 12, 8 and 3 weeks, respectively. Compared to Hai district Handeni had patients with longer delays and Mbozi had patients with shorter delays. Urban and rural patients reported similar delays. Patients aged 15-24 years and patients of 65 years or older had longer delays. Patients reporting contact with traditional healers before diagnosis had a median delay of 15 weeks compared to 12 weeks among those who did not. Patients with dyspnoea and with diarrhoea had longer delays. Conclusion In this patient sample in Tanzania half of the new smear positive pulmonary tuberculosis patients had a treatment delay longer than 12 weeks. Delay was similar in men and women and among urban and rural patients, but longer in the young and older age groups. Patients using traditional healers had
Vyas, Seema; Heise, Lori
Estimates of the effect of employment on women's risk of partner violence in cross-sectional studies are subject to potential "self-selection bias." Women's personal choice of whether to pursue employment or not may create fundamental differences between the group of women who are employed and those who are not employed that standard regression methods cannot account for even after adjusting for confounding. The aim of this study is to demonstrate the utility of propensity score matching (PSM), a technique used widely in econometrics, to address this bias in cross-sectional studies. We use PSM to estimate an unbiased effect-size of women's employment on their risk of experiencing partner violence in urban and rural Tanzania using data from the 2010 Tanzania Demographic and Health Survey (DHS). Three different measures of women's employment were analyzed: whether they had engaged in any productive work outside of the home in the past year, whether they received payment in cash for this productive work, and whether their employment was stable. Women who worked outside of the home were significantly different from those who did not. In both urban and rural Tanzania, women's risk of violence appears higher among women who worked in the past year than among those who did not, even after using PSM to account for underlying differences in these two groups of women. Being paid in cash reversed this effect in rural areas whereas stability of employment reduced this risk in urban centers. The estimated size of effect varied by type of matching estimator, but the direction of the association remained largely consistent. This study's findings suggest substantial self-selection into employment. PSM methods, by compensating for this bias, appear to be a useful tool for estimating the relationship between women's employment and partner violence in cross-sectional studies.
the unknown effects, cost, spouse's disapproval, religious belief and inadequate information. For a better ... hommes plus que les femmes parce qu'ils prennent les décisions principales sur l'utilisation des MMCN. (Rev Afr ... African Journal of Reproductive Health Vol. ... among the adult population, especially in the rural.
Ng'ang'a, Njoki; Byrne, Mary Woods; Kruk, Margaret E; Shemdoe, Aloisia; de Pinho, Helen
In sub-Saharan Africa, the capacity of human resources for health (HRH) managers to create positive practice environments that enable motivated, productive, and high-performing HRH is weak. We implemented a unique approach to examining HRH management practices by comparing perspectives offered by mid-level providers (MLPs) of emergency obstetric care (EmOC) in Tanzania to those presented by local health authorities, known as council health management teams (CHMTs). This study was guided by the basic strategic human resources management (SHRM) component model. A convergent mixed-method design was utilized to assess qualitative and quantitative data from the Health Systems Strengthening for Equity: The Power and Potential of Mid-Level Providers project. Survey data was obtained from 837 mid-level providers, 83 of whom participated in a critical incident interview whose aim was to elicit negative events in the practice environment that induced intention to leave their job. HRH management practices were assessed quantitatively in 48 districts with 37 members of CHMTs participating in semi-structured interviews. The eight human resources management practices enumerated in the basic SHRM component model were implemented unevenly. On the one hand, members of CHMTs and mid-level providers agreed that there were severe shortages of health workers, deficient salaries, and an overwhelming workload. On the other hand, members of CHMTs and mid-level providers differed in their perspectives on rewards and allocation of opportunities for in-service training. Although written standards of performance and supervision requirements were available in most districts, they did not reflect actual duties. Members of CHMTs reported high levels of autonomy in key HRH management practices, but mid-level providers disputed the degree to which the real situation on the ground was factored into job-related decision-making by CHMTs. The incongruence in perspectives offered by members of CHMTs
Chen, Christine; Gerace, Jay; Mehner, Nicole; Mohamed, Sharif; Reiss, Kelly
Condensed list of products and activities: 8 educational posters and 1 informational brochure (all original illustrations and text); a business plan with micro-agreements; corporation created called Tanzanian Power, LLC; business feasibility study developed with the University of Albany; Hampshire College collaborated in project development; research conducted seeking similar projects in underdeveloped countries; Citibank proposal submitted (but rejected); cleaned and sent PV panels to Tanzania; community center built in Tanzania; research and list provided to Robinson for educational TV videos and product catalogs; networked with Chase Manhattan Bank for new solar panels; maintained flow of information among many people (stateside and Tanzania); wrote and sent press releases and other outreach information. Several families purchased panels.
Mkoka, Dickson Ally; Goicolea, Isabel; Kiwara, Angwara; Mwangu, Mughwira; Hurtig, Anna-Karin
Provision of quality emergency obstetric care relies upon the presence of skilled health attendants working in an environment where drugs and medical supplies are available when needed and in adequate quantity and of assured quality. This study aimed to describe the experience of rural health facility managers in ensuring the timely availability of drugs and medical supplies for emergency obstetric care (EmOC). In-depth interviews were conducted with a total of 17 health facility managers: 14 from dispensaries and three from health centers. Two members of the Council Health Management Team and one member of the Council Health Service Board were also interviewed. A survey of health facilities was conducted to supplement the data. All the materials were analysed using a qualitative thematic analysis approach. Participants reported on the unreliability of obtaining drugs and medical supplies for EmOC; this was supported by the absence of essential items observed during the facility survey. The unreliability of obtaining drugs and medical supplies was reported to result in the provision of untimely and suboptimal EmOC services. An insufficient budget for drugs from central government, lack of accountability within the supply system and a bureaucratic process of accessing the locally mobilized drug fund were reported to contribute to the current situation. The unreliability of obtaining drugs and medical supplies compromises the timely provision of quality EmOC. Multiple approaches should be used to address challenges within the health system that prevent access to essential drugs and supplies for maternal health. There should be a special focus on improving the governance of the drug delivery system so that it promotes the accountability of key players, transparency in the handling of information and drug funds, and the participation of key stakeholders in decision making over the allocation of locally collected drug funds.
Beam, Margery Elizabeth
The combination of increasing enrollment and the importance of providing transfer students a solid foundation in science calls for science faculty to evaluate teaching methods in rural community colleges. The purpose of this study was to examine and compare the effectiveness of two teaching methods, inquiry teaching methods and didactic teaching methods, applied in a rural community college earth science course. Two groups of students were taught the same content via inquiry and didactic teaching methods. Analysis of quantitative data included a non-parametric ranking statistical testing method in which the difference between the rankings and the median of the post-test scores was analyzed for significance. Results indicated there was not a significant statistical difference between the teaching methods for the group of students participating in the research. The practical and educational significance of this study provides valuable perspectives on teaching methods and student learning styles in rural community colleges.
Full Text Available Abstract Background The Tanzania National Voucher Scheme (TNVS uses the public health system and the commercial sector to deliver subsidised insecticide-treated nets (ITNs to pregnant women. The system began operation in October 2004 and by May 2006 was operating in all districts in the country. Evaluating complex public health interventions which operate at national level requires a multidisciplinary approach, novel methods, and collaboration with implementers to support the timely translation of findings into programme changes. This paper describes this novel approach to delivering ITNs and the design of the monitoring and evaluation (M&E. Methods A comprehensive and multidisciplinary M&E design was developed collaboratively between researchers and the National Malaria Control Programme. Five main domains of investigation were identified: (1 ITN coverage among target groups, (2 provision and use of reproductive and child health services, (3 "leakage" of vouchers, (4 the commercial ITN market, and (5 cost and cost-effectiveness of the scheme. Results The evaluation plan combined quantitative (household and facility surveys, voucher tracking, retail census and cost analysis and qualitative (focus groups and in-depth interviews methods. This plan was defined in collaboration with implementing partners but undertaken independently. Findings were reported regularly to the national malaria control programme and partners, and used to modify the implementation strategy over time. Conclusion The M&E of the TNVS is a potential model for generating information to guide national and international programmers about options for delivering priority interventions. It is independent, comprehensive, provides timely results, includes information on intermediate processes to allow implementation to be modified, measures leakage as well as coverage, and measures progress over time.
Shija, Angela E; Msovela, Judith; Mboera, Leonard E G
High rate of maternal death is one of the major public health concerns in Tanzania. Most of maternal deaths are caused by factors attributed to pregnancy, childbirth and poor quality of health services. More than 80% of maternal deaths can be prevented if pregnant women access essential maternity care and assured of skilled attendance at childbirth as well as emergency obstetric care. The objective of this review was to analyse maternal mortality situation in Tanzania during the past 50 years and to identify efforts, challenges and opportunities of reducing it. This paper was written through desk review of key policy documents, technical reports, publications and available internet-based literature. From 1961 to 1990 maternal mortality ratio in Tanzania had been on a downward trend from 453 to 200 per 100,000 live births. However, from 1990's there been an increasing trend to 578 per 100,000 live births. Current statistics indicate that maternal mortality ratio has dropped slightly in 2010 to 454 per 100,000 live births. Despite a high coverage (96%) in pregnant women who attend at least one antenatal clinic, only half of the women (51%) have access to skilled delivery. Coverage of emergence obstetric services is 64.5% and utilization of modern family planning method is 27%. Only about 13% of home deliveries access post natal check-up. Despite a number of efforts maternal mortality is still unacceptably high. Some of the efforts done to reduce maternal mortality in Tanzania included the following initiatives: reproductive and child survival; increased skilled delivery; maternal death audit; coordination and integration of different programs including maternal and child health services, family planning, malaria interventions, expanded program on immunization and adolescent health and nutrition programmes. These initiatives are however challenged by inadequate access to maternal health care services. In order to considerably reduce maternal deaths some of recommended
Jiddawi, Narriman S; Ohman, Marcus C
Fishery resources are a vital source of food and make valuable economic contributions to the local communities involved in fishery activities along the 850 km stretch of the Tanzania coastline and numerous islands. Small-scale artisanal fishery accounts for the majority of fish catch produced by more than 43 000 fishermen in the country, mainly operating in shallow waters within the continental shelf, using traditional fishing vessels including small boats, dhows, canoes, outrigger canoes and dinghys. Various fishing techniques are applied using uncomplicated passive fishing gears such as basket traps, fence traps, nets as well as different hook and line techniques. Species composition and size of the fish varies with gear type and location. More than 500 species of fish are utilized for food with reef fishes being the most important category including emperors, snappers, sweetlips, parrotfish, surgeonfish, rabbitfish, groupers and goatfish. Most of the fish products are used for subsistence purposes. However, some are exported. Destructive fishing methods such as drag nets and dynamite fishing pose a serious problem as they destroy important habitats for fish and other organisms, and there is a long-term trend of overharvested fishery resources. However, fishing pressure varies within the country as fishery resources are utilized in a sustainable manner in some areas. For this report more than 340 references about Tanzanian fishery and fish ecology were covered. There are many gaps in terms of information needed for successful fishery management regarding both basic and applied research. Most research results have been presented as grey literature (57%) with limited distribution; only one-fifth were scientific publications in international journals.
Florence Kondylis; Marco Manacorda
Is improved school accessibility an effective policy tool for reducing child labor in developing countries? We address this question using micro data from rural Tanzania and a regression strategy that attempts to control for non-random location of households around schools as well as classical and non-classical measurement error in self-reported distance to school. Consistent with a simple model of child labor supply, but contrary to what appears to be a widespread perception, our analysis sh...
Manongi, Rachel N; Marchant, Tanya C; Bygbjerg, Ib Christian
In Tanzania access to urban and rural primary health care is relatively widespread, yet there is evidence of considerable bypassing of services; questions have been raised about how to improve functionality.The aim of this study was to explore the experiences of health workers working in the prim......In Tanzania access to urban and rural primary health care is relatively widespread, yet there is evidence of considerable bypassing of services; questions have been raised about how to improve functionality.The aim of this study was to explore the experiences of health workers working...
Full Text Available Abstract Background The diagnosis of typhoid fever is confirmed by culture of Salmonella enterica serotype Typhi (S. typhi. However, a more rapid, simpler, and cheaper diagnostic method would be very useful especially in developing countries. The Widal test is widely used in Africa but little information exists about its reliability. Methods We assessed the performance of the Widal tube agglutination test among febrile hospitalized Tanzanian children. We calculated the sensitivity, specificity, positive predictive value (PPV, and negative predictive value (NPV of various anti-TH and -TO titers using culture-confirmed typhoid fever cases as the "true positives" and all other febrile children with blood culture negative for S. typhi as the "true negatives." Results We found that 16 (1% of 1,680 children had culture-proven typhoid fever. A single anti-TH titer of 1:80 and higher was the optimal indicator of typhoid fever. This had a sensitivity of 75%, specificity of 98%, NPV of 100%, but PPV was only 26%. We compared our main findings with those from previous studies. Conclusion Among febrile hospitalized Tanzanian children with a low prevalence of typhoid fever, a Widal titer of ≥ 1:80 performed well in terms of sensitivity, specificity, and NPV. However a test with improved PPV that is similarly easy to apply and cost-efficient is desirable.
Factors Influencing the Consumption of Pulses in Rural and Urban Areas of Tanzania. ... Model results revealed that household sizes and education levels of the ... To increase the market share of pulses, traders should devise effective ...
Duan Juan; Lu Qi; Wen Yuyuan
Urban-rural interaction and conjunctional development is the effective way of harmonizing urban-rural relationship and promoting urban-rural development. However, there are differences in the level of urban-rural interaction and conjunctional development of China. How to measure and reflect the difference properly is a decision-making foundation for optimizing urban-rural development of different regions. The paper employs multiple methods to evaluate and order the urban-rural interaction and conjunctional development of 31provinces (municipalities) in China. Kendall's W consistency coefficient is employed to give a consistent test for the evaluation result series, and the results of multiple methods are aggregated as the final evaluation value. The results reflect the level of regional urban-rural interaction and conjunctional development in China.
Mul, M. L.; Savenije, H. H. G.; Uhlenbrook, S.
Understanding hydrological processes in poorly or ungauged catchments is of utmost importance for the management of water resources. This paper shows that a high resolution time series of hydrological data (rainfall, evaporation and runoff) collected over a limited period of time (i.e. 1.5 years), can give a good picture of the hydrological processes occurring in a 25 km2 catchment in Tanzania (Vudee catchment). In addition, several techniques, incl. tracer and mapping studies, have been applied to identify flow paths and contribution from different sources. All this information was used for the development of a conceptual hydrological model. The conceptual model is based on the Lumped Elementary Watershed (LEW) concept, restructured for hourly time steps. An additional flux, representing the drainage into the neighbouring catchment, identified using a multi-method approach, increased the model performance significantly, particularly related to a recession curve occurring at high flows. This corroborates the assumption that there is water draining towards the neighbouring catchment. The model runs show that surface runoff only occurs during heavy rains or directly thereafter, which is consistent with results from hydrograph separation. Overall, the major part of the runoff is generated by groundwater. Moreover, the model shows that the unsaturated zone has a relatively large storage capacity. At the meso-scale, hydrological processes are governed by a sub-daily timescale. As a result, only a high resolution conceptual model is able to mimic the hydrological processes accurately. By applying the LEW model, incorporating the hydrological processes as observed in the catchment, a better understanding has been obtained of the dominant hydrological processes at this scale. This is a prerequisite for sustainable management of the water resources in a water scarce region.
Full Text Available Background: Despite the implementation of various initiatives to address low enrollment in voluntary micro health insurance (MHI schemes in sub-Saharan Africa, the problem of low enrollment remains unresolved. The lack of process evaluations of such interventions makes it difficult to ascertain whether their poor results are because of design failures or implementation weaknesses. Objective: In this paper, we describe a process evaluation protocol aimed at opening the ‘black box’ to evaluate the implementation processes of the Redesigned Community Health Fund (CHF program in the Dodoma region of Tanzania. Design: The study employs a cross-sectional mixed methods design and is being carried out 3 years after the launch of the Redesigned CHF program. The study is grounded in a conceptual framework which rests on the Diffusion of Innovation Theory and the Implementation Fidelity Framework. The study utilizes a mixture of quantitative and qualitative data collection tools (questionnaires, focus group discussions, in-depth interviews, and document review, and aligns the evaluation to the Theory of Intervention developed by our team. Quantitative data will be used to measure program adoption, implementation fidelity, and their moderating factors. Qualitative data will be used to explore the responses of stakeholders to the intervention, contextual factors, and moderators of adoption, implementation fidelity, and sustainability. Discussion: This protocol describes a systematic process evaluation in relation to the implementation of a reformed MHI. We trust that the theoretical approaches and methodologies described in our protocol may be useful to inform the design of future process evaluations focused on the assessment of complex interventions, such as MHI schemes.
Xiuchuan; XU; Yuqing; WANG; Xiang; HE
Firstly,this paper reviews and analyzes historic background of urban-rural integration of Chongqing,and the evolution and trend of urban and rural dual economic structure.On the basis of previous researches,it selects factors and variables influencing urban and rural dual economic structure,and establishes an econometric model.By state space Kalman filtering method,it analyzes dynamic influence of factors upon urban-rural dual economic intensity.According to empirical conclusion,it puts forward corresponding policy recommendations for promoting integrated urban and rural economic development of Chongqing.
Meena, H.E. [Centre for Energy, Environment, Science and Technology, Dar es Salaam (Tanzania, United Republic of)
An objective of this study is to analyse the role of the land use sectors of Tanzania (especially forestry) on mitigation of greenhouse gases. Specific emphasis is placed on the relationship between forestry and energy supply from biomass. This is a follow up study on an earlier effort which worked on mitigation options in the country without an in-depth analysis of the forestry and land use sectors. (au)
Feinstein, Sheryl; Mwahombela, Lucas
The purpose of this survey was to acquire descriptive information regarding corporal punishment in Tanzania's O-level secondary schools. 448 individuals participated in the study: 254 teachers and 194 students, all from government or private secondary schools in the Iringa Region of Tanzania. In addition, 14 students and 14 teachers were…
Wulystan P. Mtega
Full Text Available Background: Access to agricultural knowledge is important in transforming livelihoods of those relying on agriculture for a living and in enhancing food security. This access to agricultural knowledge is influenced by infrastructure needed for information dissemination. However, information infrastructure is not uniformly distributed within and between countries. It is because of this that some of the farming communities are information rich while others are information poor. In Tanzania, the agricultural sector is characterised by poor research-extension-farmers linkage and inaccessibility of agricultural knowledge at farm levelObjective: The study investigated the factors influencing access to agricultural knowledge among smallholder rice farmers in the Kilombero district of Tanzania. Specifically, the study identified categories of agricultural knowledge needed by farmers, determined how farmers access agricultural knowledge, and assessed the factors limiting the accessibility of agricultural knowledge among rice farmers in the Kilombero district.Method: Quantitative data were collected via semi-structured questionnaires administered face-to-face with rice farmers, community leaders, and agricultural agents in four villages at the Kilombero district of the Morogoro region in Tanzania.Results: The key finding indicates that farmers accessed and used agricultural knowledge in undertaking agricultural activities. It was further revealed that the level of acquisition of agricultural knowledge increased with an increase in age. Farmers needed agricultural knowledge on land preparation, seed selection, and rice planting, while few acquired knowledge on agricultural markets. Among the agricultural knowledge sources used, demonstration plots and agricultural extension agents were found to be used by the majority of the farmers. It was also found that a limited number of demonstration plots, late delivery of information services, a limited number of
Geissbühler, Yvonne; Chaki, Prosper; Emidi, Basiliana; Govella, Nicodemus J; Shirima, Rudolf; Mayagaya, Valeliana; Mtasiwa, Deo; Mshinda, Hassan; Fillinger, Ulrike; Lindsay, Steven W; Kannady, Khadija; de Castro, Marcia Caldas; Tanner, Marcel; Killeen, Gerry F
Background Successful malaria vector control depends on understanding behavioural interactions between mosquitoes and humans, which are highly setting-specific and may have characteristic features in urban environments. Here mosquito biting patterns in Dar es Salaam, Tanzania are examined and the protection against exposure to malaria transmission that is afforded to residents by using an insecticide-treated net (ITN) is estimated. Methods Mosquito biting activity over the course of the night was estimated by human landing catch in 216 houses and 1,064 residents were interviewed to determine usage of protection measures and the proportion of each hour of the night spent sleeping indoors, awake indoors, and outdoors. Results Hourly variations in biting activity by members of the Anopheles gambiae complex were consistent with classical reports but the proportion of these vectors caught outdoors in Dar es Salaam was almost double that of rural Tanzania. Overall, ITNs confer less protection against exophagic vectors in Dar es Salaam than in rural southern Tanzania (59% versus 70%). More alarmingly, a biting activity maximum that precedes 10 pm and much lower levels of ITN protection against exposure (38%) were observed for Anopheles arabiensis, a vector of modest importance locally, but which predominates transmission in large parts of Africa. Conclusion In a situation of changing mosquito and human behaviour, ITNs may confer lower, but still useful, levels of personal protection which can be complemented by communal transmission suppression at high coverage. Mosquito-proofing houses appeared to be the intervention of choice amongst residents and further options for preventing outdoor transmission include larviciding and environmental management. PMID:17880679
Full Text Available Abstract Background Successful malaria vector control depends on understanding behavioural interactions between mosquitoes and humans, which are highly setting-specific and may have characteristic features in urban environments. Here mosquito biting patterns in Dar es Salaam, Tanzania are examined and the protection against exposure to malaria transmission that is afforded to residents by using an insecticide-treated net (ITN is estimated. Methods Mosquito biting activity over the course of the night was estimated by human landing catch in 216 houses and 1,064 residents were interviewed to determine usage of protection measures and the proportion of each hour of the night spent sleeping indoors, awake indoors, and outdoors. Results Hourly variations in biting activity by members of the Anopheles gambiae complex were consistent with classical reports but the proportion of these vectors caught outdoors in Dar es Salaam was almost double that of rural Tanzania. Overall, ITNs confer less protection against exophagic vectors in Dar es Salaam than in rural southern Tanzania (59% versus 70%. More alarmingly, a biting activity maximum that precedes 10 pm and much lower levels of ITN protection against exposure (38% were observed for Anopheles arabiensis, a vector of modest importance locally, but which predominates transmission in large parts of Africa. Conclusion In a situation of changing mosquito and human behaviour, ITNs may confer lower, but still useful, levels of personal protection which can be complemented by communal transmission suppression at high coverage. Mosquito-proofing houses appeared to be the intervention of choice amongst residents and further options for preventing outdoor transmission include larviciding and environmental management.
Stephen ED Nsimba; Phare G Mujinja
Objective:To observe and assess the compliance to sulfadoxine-pyrimethamine (SP) one and a half years after phasing out chloroquine (CQ) in Mkuranga District, Coast region, Tanzania. Methods:A randomly controlled baseline community study was conducted in rural areas of Mkuranga district, Tanzania. Semi-structured questionnaire consisted of open-and closed-ended questions including home stocking, home use, last fever episodes and treatment of underfives with malaria using CQ or SP. Results:The prevalence of fever or reported fever rate during the last 48 hours by their mothers or guardians was high (70%). Of all 117 blood samples, only 8 children after drug analysis were found to have CQ and 13 had SP concentrations within their blood respectively. None of these blood drug levels were above therapeutic ranges. Conclusions:Community interventions are urgently needed in rural communities and should specifically target households nucleus on early malaria fever recognition and provision of recommended antimalarials for the sick underfive children. However, sadly, there was an increase in underweight and undernourishment in the study areas, probably because of malaria in the area and poverty which are associated with poor nutrition in these youngsters.
Leticia K. Nkonya
Full Text Available Increasing human population, economic development and climatic changes in Sub-Saharan Africa (SSA have fuelled water scarcity, hence there is an urgent need for effective water management laws and institutions. Unfortunately, national and local governments rarely possess enough personnel or money to enforce their laws adequately. In SSA countries formal water management laws and institutions tend to ignore the customary laws and institutions. Additionally, local communities both filter and ignore formal laws and institutions and use their customary laws and institutions to manage their water resources. Despite their importance, there are only few empirical studies on customary laws and institutions for water management in SSA. This study attempts to fill this gap by analysing the impact of customary (informal laws on water management in Tanzania and show how they might be used to complement the statutory (formal laws for management of drinking water in rural Tanzania. The study will use both qualitative and quantitative methods to achieve this objective. This study found that customary laws and institutions are the most influential in water access, prevention of pollution and abuse of water. The awareness of the customary and water user group laws was also generally high, perhaps due to the participatory nature of those institutions. The study also found that statutory laws were important for water development issues but community awareness of these laws was low. These results suggest the need of using both customary and statutory laws since the two instruments complement each other.
Full Text Available Background: Maintaining and improving the quality of prosthetics and orthotics education at the Tanzania Training Centre for Orthopaedic Technologists is essential for the provision of appropriate prosthetics and orthotics services in African countries.Objectives: To describe how Tanzanian and Malawian graduates’ of the Diploma in Orthopaedic Technology perceive their education and how it could be improved or supplemented to facilitate clinical practice of graduates.Methods: Nineteen graduates from the diploma course in orthopaedic technology were interviewed and phenomenographic analysis was applied to the data.Results: Seven descriptive categories emerged, namely varied awareness of the profession before starting education, well-equipped teaching facilities, aspects lacking in the learning context, need for changes in the curriculum, enabling people to walk is motivating, obstacles in working conditions and the need for continuous professional development. All participants perceived possible improvements to the content and learning environment.Conclusions: Prosthetic and orthotic education can be better provided by modifying the content of the diploma programme by dedicating more time to the clinical management of different patient groups and applied biomechanics as well as reducing the programme content focusing on technical aspects of prosthetic and orthotic practice. Graduates were not prepared for the rural working conditions and the graduates desired continued training.Keywords: orthotic; prosthetic; education; Malawi; Tanzania; assistive device; assistive technology; developing countries; low-income country
Pima, John Marco; Odetayo, Michael; Iqbal, Rahat; Sedoyeka, Eliamani
This paper is about the use of a Mixed Methods approach in an investigation that sought to assess the available Information and Communication Technologies (ICT) infrastructure capable of supporting Collaborative Web Technologies (CWTs) in a Blended Learning (BL) environment in Tanzanian Higher Education Institutions (HEIs). We first used…
Lewis, Ashley L.; Baird, Timothy D.; Sorice, Michael G.
Throughout the developing world, mobile phones are spreading rapidly into rural areas where subsistence livelihoods, biodiversity conservation, and human-wildlife conflict (HWC) are each common. Despite this trend, little is known about the relationship between mobile phones and HWC in conservation landscapes. This paper examines this relationship within ethnically Maasai communities in northern Tanzania on the border of Tarangire National Park. Mixed qualitative and quantitative methods of data collection and analysis are used to (1) describe how Maasai agro-pastoralists use phones to manage human-wildlife interactions; and (2) assess the relationship between phone use and measures of HWC, controlling for other factors. The findings indicate that households use phones to reduce the number and severity of HWC events and that the relationship between phones and HWC varies according to the type of HWC.
Kuwawenaruwa, August; Mtei, Gemini; Baraka, Jitihada; Tani, Kassimu
Inequity in access and use of child and maternal health services is impeding progress towards reduction of maternal mortality in low-income countries. To address low usage of maternal and newborn health care services as well as financial protection of families, some countries have adopted demand-side financing. In 2010, Tanzania introduced free health insurance cards to pregnant women and their families to influence access, use, and provision of health services. However, little is known about whether the use of the maternal and child health cards improved equity in access and use of maternal and child health care services. A mixed methods approach was used in Rungwe district where maternal and child health insurance cards had been implemented. To assess equity, three categories of beneficiaries' education levels were used and were compared to that of women of reproductive age in the region from previous surveys. To explore factors influencing women's decisions on delivery site and use of the maternal and child health insurance card and attitudes towards the birth experience itself, a qualitative assessment was conducted at representative facilities at the district, ward, facility, and community level. A total of 31 in-depth interviews were conducted on women who delivered during the previous year and other key informants. Women with low educational attainment were under-represented amongst those who reported having received the maternal and child health insurance card and used it for facility delivery. Qualitative findings revealed that problems during the current pregnancy served as both a motivator and a barrier for choosing a facility-based delivery. Decision about delivery site was also influenced by having experienced or witnessed problems during previous birth delivery and by other individual, financial, and health system factors, including fines levied on women who delivered at home. To improve equity in access to facility-based delivery care using
Donge, van J.K.
The research for this thesis was carried out in Tanzania during the period 1985- 89 and focuses on the Mgeta division in the Uluguru mountains, Morogoro rural district. Research was also undertaken among migrants from the area living in Dar es Salaam where they traded in foodstuffs. I made
Lund, Henrik Hautop; Jensen, Line Steiness Dejnbjerg; Ssessanga, Yusuf
The pilot study in the Iringa region, Tanzania, indicates how the modular interactive tiles can be used for playful physical rehabilitation for many diverse patient groups (handicapped children, stroke, cardiac, diabetic patients, etc.) in both urban and rural areas, and how it motivates the user...
Donge, van J.K.
The research for this thesis was carried out in Tanzania during the period 1985- 89 and focuses on the Mgeta division in the Uluguru mountains, Morogoro rural district. Research was also undertaken among migrants from the area living in Dar es Salaam where they traded in foodstuffs. I made a return
Common bean (Phaseolus vulgaris L.) is the most important grain legume in human diets in East Africa. For example, it is estimated that over 75 % of rural households in Tanzania depend on it for daily dietary requirements. Despite its importance, bean yield in the East African region is among the lo...
Armstrong, Corinne E.; Martínez-Álvarez, Melisa; Singh, Neha S.; John, Theopista; Afnan-Holmes, Hoviyeh; Grundy, Chris; Ruktanochai, Corrine W.; Borghi, Josephine; Magoma, Moke; Msemo, Georgina; Matthews, Zoe; Mtei, Gemini; Lawn, Joy E.
Background Tanzania achieved the Millennium Development Goal for child survival, yet made insufficient progress for maternal and neonatal survival and stillbirths, due to low coverage and quality of services for care at birth, with rural women left behind. Our study aimed to evaluate Tanzania’s subnational (regional-level) variations for rural care at birth outcomes, i.e., rural women giving birth in a facility and by Caesarean section (C-section), and associations with health systems inputs ...
Full Text Available Abstract Background Estimation of maternal mortality is difficult in developing countries without complete vital registration. The indirect sisterhood method represents an alternative in places where there is high fertility and mortality rates. The objective of the current study was to estimate maternal mortality indices using the sisterhood method in a rural district in south-west Ethiopia. Method We interviewed 8,870 adults, 15–49 years age, in 15 randomly selected rural villages of Bonke in Gamo Gofa. By constructing a retrospective cohort of women of reproductive age, we obtained sister units of risk exposure to maternal mortality, and calculated the lifetime risk of maternal mortality. Based on the total fertility for the rural Ethiopian population, the maternal mortality ratio was approximated. Results We analyzed 8503 of 8870 (96% respondents (5262 [62%] men and 3241 ([38%] women. The 8503 respondents reported 22,473 sisters (average = 2.6 sisters for each respondent who survived to reproductive age. Of the 2552 (11.4% sisters who had died, 819 (32% occurred during pregnancy and childbirth. This provided a lifetime risk of 10.2% from pregnancy and childbirth with a corresponding maternal mortality ratio of 1667 (95% CI: 1564–1769 per 100,000 live births. The time period for this estimate was in 1998. Separate analysis for male and female respondents provided similar estimates. Conclusion The impoverished rural area of Gamo Gofa had very high maternal mortality in 1998. This highlights the need for strengthening emergency obstetric care for the Bonke population and similar rural populations in Ethiopia.
Full Text Available The main aim of the study was to determine knowledge and use of modem contractive methods among reproductive age group rural women in Zambia. The study is a descriptive cross-sectional study of 105 randomly selected rural women. Data was collected using semi-structured interview schedule and analyzed using EPI Info version 6 statistical packages. The findings revealed that 63% of the respondents were within the age group 21-35 years, 65% were married and 64% were peasant farmers. 90% of the respondents had heard about modem contraceptives and their main source of information was the Health worker (62%. 76% of the respondents stated that modem contraceptive methods could be obtained from public health facilities. 56% of the respondents were currently using modem contraceptive methods and 46% were not using modem contraceptive methods. Reasons for non use of contraceptive methods were religious beliefs (50%, partner disapproval (30% and side effects (20%. The results showed a relationship between educational level and use of contraceptives (Chi-square 7.83, df = 3, P < 0.05 and spouse approval or support of contractive methods and use of contraceptive (Chisquare 5.9, df = 2, P < 0.05. Therefore, efforts to promote modem contraceptive use among the rural women should be intensified to overcome barriers to contraceptive use and should involve men.
Percent sucrose in starch was 2.10 + 3.50% DM seed and 9.60+ 3.10% DM product. There were significant losses in fat, dietary fibre, moisture and carbohydrate ... Processing method resulted in slightly higher levels of essential nutrients in the ...
Nwachukwu, Ike; Obasi, O O
This paper studied the extent of utilization of Modern Birth Control Methods (MBCM) among rural dwellers in Imo State Nigeria. Three hundred and sixty households were randomly selected and data were obtained from them with the use of questionnaires and Focus Group Discussion. The results showed that only 30% of the respondents used MBCM while 57% of them used the traditional birth control methods. The most popular modern method was the condom (24.2%). This was followed by the IUD, used by only 2.5% of the respondents. Some of the identified factors that hindered the use of MBCM included perceived negative health reaction, fear of the unknown effects, cost, spouse's disapproval, religious belief and inadequate information. For a better understanding and utilization of MBCM, it is recommended that adequate educational campaign should be mounted in the rural areas on the advantages of MBCM. This campaign should target the men the more because they make the major decisions on MBCM use.
de Schutter, Anton
In participatory research, education and learner participation are directly connected. The document analyzes the role of a participatory research method in the basic education of rural adults. The different phases of the Participant Research method are presented, along with a profound analysis of both research and participation. The claim is that…
de Schutter, Anton
In participatory research, education and learner participation are directly connected. The document analyzes the role of a participatory research method in the basic education of rural adults. The different phases of the Participant Research method are presented, along with a profound analysis of both research and participation. The claim is that…
Full Text Available The scope of the reducing emissions from deforestation and forest degradation (REDD mechanism has broadened REDD+ to accommodate different country interests such as natural forests, protected areas, as well as forests under community-based management. In Tanzania the REDD+ mechanism is still under development and pilot projects are at an early stage. In this paper, we seek to understand how local priorities and needs could be met in REDD+ implementation and how these expectations match with global mitigation benefits. We examine the local priorities and needs in the use of land and forest resources in the Angai Villages Land Forest Reserve (AVLFR in the Liwale District of Lindi Region in Tanzania. Primary data was collected in two villages, Mihumo and Lilombe, using semistructured key informant interviews and participatory rural appraisal methods. In addition, the key informant interviews were conducted with other village, district, and national level actors, as well as international donors. Findings show that in the two communities REDD+ is seen as something new and is generating new expectations among communities. However, the Angai villagers highlight three key priorities that have yet to be integrated into the design of REDD+: water scarcity, rural development, and food security. At the local level improved forest governance and sustainable management of forest resources have been identified as one way to achieve livelihood diversification. Although the national goals of REDD+ include poverty reduction, these goals are not necessarily conducive to the goals of these communities. There exist both structural and cultural limits to the ability of the Angai villages to implement these goals and to improve forestry governance. Given the vulnerability to current and future climate variability and change it will be important to consider how the AVLFR will be managed and for whose benefit?
Objective To investigate the risk factors of HIV infection among women in the Dodoma region, Tanzania. Methods The protocol were assessed through a population-based cross sec-tional study. The participants were obtained by randomly selecting clusters of 10-households from Unga imited, Babati town and Matufa roadside village which are urban, semi-urban and rural communi-ties respectively. Informed verbal consent for participation in an interview and in HIV testing was sought from each respondent. Blood samples were collected from each consenting individual for HIV antibody testing using enzyme linked immunosorbent assay(ELISA) and all positive sera were con-firmed using repeated ELISA tests. Information on risk factors was obtained through the interview process using a structured questionnaire. Results Of 567 women who gave blood samples, 48 (8.5 % ) were HIV positive. The HIV seroprevalence rates among women in the urban area, the semi-ur-ban area and in the rural village were 14.4%, 6.9% and 2.3% respectively. Factors associated with significantly higher HIV seroprevalence were urban residence,history of having travelled out of Dodoma region within Tanzania, as well as having travelled abroad, having multiple sexual partners and having sexual intercourse under the influence of alcohol. Women who reported ever having used condoms had significantly higher probability of being infected with HIV than those who had never used condoms, suggesting that condom use may be a marker of high risk sexual behavior and that condom use was probably not adhered to in a way that consistently protects against HIV infection.Conclusions The results suggest the need for health education interventions aimed at increasing ap-propriate and consistent condom use and reduction of the number of sexual partners.
Engineering geological mapping of Dar es Salaam city in Tanzania has been carried out using .... faces and road cuts. The studied material ... for regional and city master planning, and these are geomorphological, geological, geo-hazard ...
Sources of information about malaria and its control were mainly from their teachers. (47.4%), print materials ... In Tanzania, mass media and public campaigns against malaria lias .... ownership of net and coverage at community level, for.
Gallagher Lisa G
Full Text Available Abstract Background Location is often an important component of exposure assessment, and positional errors in geocoding may result in exposure misclassification. In rural areas, successful geocoding to a street address is limited by rural route boxes. Communities have assigned physical street addresses to rural route boxes as part of E911 readdressing projects for improved emergency response. Our study compared automated and E911 methods for recovering and geocoding valid street addresses and assessed the impact of positional errors on exposure classification. Methods The current study is a secondary analysis of existing data that included 135 addresses self-reported by participants of a rural community study who were exposed via public drinking water to perfluorooctanoate (PFOA released from a DuPont facility in Parkersburg, West Virginia. We converted pre-E911 to post-E911 addresses using two methods: automated ZP4 address-correction software with the U.S. Postal Service LACS database and E911 data provided by Wood County, West Virginia. Addresses were geocoded using TeleAtlas, an online commercial service, and ArcView with StreetMap Premium North America NAVTEQ 2008 enhanced street dataset. We calculated positional errors using GPS measurements collected at each address and assessed exposure based on geocoded location in relation to public water pipes. Results The county E911 data converted 89% of the eligible addresses compared to 35% by ZP4 LACS. ArcView/NAVTEQ geocoded more addresses (n = 130 and with smaller median distance between geocodes and GPS coordinates (39 meters than TeleAtlas (n = 85, 188 meters. Without E911 address conversion, 25% of the geocodes would have been more than 1000 meters from the true location. Positional errors in TeleAtlas geocoding resulted in exposure misclassification of seven addresses whereas ArcView/NAVTEQ methods did not misclassify any addresses. Conclusions Although the study was limited by small
ZHOU De-min; XU Jian-chun; John RADKE; MU Lan
This study was undertaken to construct a preliminary spatial analysis method for building an urban-suburban-rural category in the specific sample area of central California and providing distribution characteristics in each category, based on which, some further studies such as regional manners of residential wood burning emission (PM2.5, the term used for a mixture of solid particles and liquid droplets found in the air, refers to particulate matter that is 2.5 μm or smaller in size) could be carried out for the project of residential wood combustion. Demographic and infrastructure data with spatial characteristics were processed by integrating both Geographic Information System (GIS) and statistics method (Cluster Analysis), and then output to a category map as the result. It approached the quantitative and multi-variables description on the major characteristics variations among the urban, suburban and rural;and perfected the TIGER's urban-rural classification scheme by adding suburban category. Based on the free public GIS data, the spatial analysis method provides an easy and ideal tool for geographic researchers, environmental planners, urban/regional planners and administrators to delineate different categories of regional function on the specific locations and dig out spatial distribution information they wanted. Furthermore, it allows for future adjustment on some parameters as the spatial analysis method is implemented in the different regions or various eco-social models.
Ziwa, Michael H; Matee, Mecky I; Hang'ombe, Bernard M; Lyamuya, Eligius F; Kilonzo, Bukheti S
Human plague remains a public health concern in Tanzania despite its quiescence in most foci for years, considering the recurrence nature of the disease. Despite the long-standing history of this problem, there have not been recent reviews of the current knowledge on plague in Tanzania. This work aimed at providing a current overview of plague in Tanzania in terms of its introduction, potential reservoirs, possible causes of plague persistence and repeated outbreaks in the country. Plague is believed to have been introduced to Tanzania from the Middle East through Uganda with the first authentication in 1886. Xenopsylla brasiliensis, X. cheopis, Dinopsyllus lypusus, and Pulex irritans are among potential vectors while Lophuromys spp, Praomys delectorum, Graphiurus murinus, Lemniscomys striatus, Mastomys natalensis, and Rattus rattus may be the potential reservoirs. Plague persistence and repeated outbreaks in Tanzania are likely to be attributable to a complexity of factors including cultural, socio-economical, environmental and biological. Minimizing or preventing people's proximity to rodents is probably the most effective means of preventing plague outbreaks in humans in the future. In conclusion, much has been done on plague diagnosis in Tanzania. However, in order to achieve new insights into the features of plague epidemiology in the country, and to reorganize an effective control strategy, we recommend broader studies that will include the ecology of the pathogen, vectors and potential hosts, identifying the reservoirs, dynamics of infection and landscape ecology.
Full Text Available Abstract Background Studies involving the built environment have typically relied on US Census data to measure residential density. However, census geographic units are often unsuited to health-related research, especially in rural areas where development is clustered and discontinuous. Objective We evaluated the accuracy of both standard census methods and alternative GIS-based methods to measure rural density. Methods We compared residential density (units/acre in 335 Vermont school neighborhoods using conventional census geographic units (tract, block group and block with two GIS buffer measures: a 1-kilometer (km circle around the school and a 1-km circle intersected with a 100-meter (m road-network buffer. The accuracy of each method was validated against the actual residential density for each neighborhood based on the Vermont e911 database, which provides an exact geo-location for all residential structures in the state. Results Standard census measures underestimate residential density in rural areas. In addition, the degree of error is inconsistent so even the relative rank of neighborhood densities varies across census measures. Census measures explain only 61% to 66% of the variation in actual residential density. In contrast, GIS buffer measures explain approximately 90% of the variation. Combining a 1-km circle with a road-network buffer provides the closest approximation of actual residential density. Conclusion Residential density based on census units can mask clusters of development in rural areas and distort associations between residential density and health-related behaviors and outcomes. GIS-defined buffers, including a 1-km circle and a road-network buffer, can be used in conjunction with census data to obtain a more accurate measure of residential density.
Full Text Available Abstract Background The focus on the determinants of the quality of health services in low-income countries is increasing. Health workers' motivation has emerged as a topic of substantial interest in this context. The main objective of this article is to explore health workers' experience of working conditions, linked to motivation to work. Working conditions have been pointed out as a key factor in ensuring a motivated and well performing staff. The empirical focus is on rural public health services in Tanzania. The study aims to situate the results in a broader historical context in order to enhance our understanding of the health worker discourse on working conditions. Methods The study has a qualitative study design to elicit detailed information on health workers' experience of their working conditions. The data comprise focus group discussions (FGDs and in-depth interviews (IDIs with administrators, clinicians and nursing staff in the public health services in a rural district in Tanzania. The study has an ethnographic backdrop based on earlier long-term fieldwork in the same part of Tanzania. Results The article provides insights into health workers' understanding and assessment of their working conditions. An experience of unsatisfactory working conditions as well as a perceived lack of fundamental fairness dominated the FGDs and IDIs. Informants reported unfairness with reference to factors such as salary, promotion, recognition of work experience, allocation of allowances and access to training as well as to human resource management. The study also revealed that many health workers lack information or knowledge about factors that influence their working conditions. Conclusions The article calls for attention to the importance of locating the discourse of unfairness related to working conditions in a broader historical/political context. Tanzanian history has been characterised by an ambiguous and shifting landscape of state regulation
Khalid, Md. Saifuddin; Nyvang, Tom
This chapter examines barriers and methods to identify barriers to educational technology in a rural technical vocational education and training institute in Bangladesh. It also examines how the application of participatory learning and action methods can provide information for barrier research...... and stakeholders in and around the school to pave the way for change by building awareness of both educational technology and the complexity of barriers. In this case study, school stakeholders are involved in the research and awareness-building process through three different data-production methods: cultural...
Foeken, D.W.J.; Sofer, M.; Mlozi, M.
This book, the result of a collaborative study carried out by researchers from Tanzania, Israel and the Netherlands, assesses the sustainability of urban agriculture in two medium-sized towns in Tanzania: Morogoro and Mbeya. It first gives an overview of urban agriculture in Tanzania and a descripti
Key words: Environmental degradation, intrahousehold labour allocation, intrahousehold welfare. Rural south Pare highlands in Tanzania experience a deteriorating environmental situation. Of particular importance is the disappearance of forests and woodlands. The consequence are declining amounts an
ADULTS IN A RURAL COASTAL COMMUNITY OF TANZANIA: KNOWLEDGE ... understanding of the knowledge of people in the community, their ... area in the Coast Region. Although .... malaria can be anticipated in communities living in.
Davisa, Peter; Baulch, Bob
This paper explores the implications of using two methodological approaches to study poverty dynamics in rural Bangladesh. Using data from a unique longitudinal study, we show how different methods lead to very different assessments of socio-economic mobility. We suggest five ways of reconciling these differences: considering assets in addition to expenditures, proximity to the poverty line, other aspects of well-being, household division, and qualitative recall errors. Considering assets and proximity to the poverty line along with expenditures resolves three-fifths of the qualitative and quantitative differences. Use of such integrated mixed-methods can therefore improve the reliability of poverty dynamics research.
Agergaard, Jytte; D'haen, Sarah Ann Lise; Birch-Thomsen, Torben
Since the late 1990s, Tanzania has experienced remarkable economic progress. Yet, overall societal benefits have been limited, in particular as to challenging persistent poverty. To counter this shortfall, support for urbanization has been identified as one of three major policy shifts needed...... in this period; the emergence of (smaller) urban centres. Often located in what is designated as rural areas and generally in clear distance of more established city regions and larger agglomerations, these urban centres are only attracting scant attention. This second part of the paper draws on ongoing research...... in Tanzania. In this paper we will take a critical look at trends in demographic shifts in Tanzania with a particular focus on how to identify processes of urban growth, urbanization and internal migration. In this respect we draw on existing analyses of urbanization produced in the context of the 2009 World...
perpetrators of child sex abuse in selected regions of Tanzania. Methods: Key ... embarrassment faced by the affected children and parents. The causes of ..... The sleeping of adults and children in the same room was cited as a risk factor that ...
Full Text Available Abstract Background There is no clear consensus on the most sustainable and effective distribution strategy for insecticide treated bed nets (ITNs. Tanzania has been a leader in social marketing but it is still not clear if this can result in high and equitable levels of coverage. Methods A cluster-randomized survey of ITN and bed net ownership and use was conducted in a rural area exposed to intense Plasmodium falciparum transmission in NE Tanzania where ITN distribution had been subject to routine delivery of national strategies and episodic free distribution through local clinics. Data were collected on household assets to assess equity of ITN coverage and a rapid diagnostic test for malaria (RDT was performed in all ages. Results Among 598 households in four villages the use of any or insecticidal bed nets in children less than five years of age was 71% and 54% respectively. However there was a 19.8% increase in the number of bed nets per person (p Conclusion Marked inequity persists with the poorest households still experiencing the highest risk of malaria and the lowest ITN coverage. Abolition of this inequity within the foreseeable future is likely to require mass or targeted free distribution, but risks damaging what is otherwise an effective commercial market.
Objectives of this study are to analyse the role of the land use sectors of Tanzania (especially forestry) on mitigation of greenhouse gases. Specific emphasis is placed on the relationship between forestry and energy supply from biomass, as well as other forestry products. This is a follow up study on an earlier effort which worked on mitigation options in the country without and in-depth analysis of the forestry and land use sectors. Analysis of the mitigation scenario has been based on Comprehensive Mitigation Analysis (COMAP). This study has analysed the forestry and land use sector behaviour on the basis of the current policies on land and environment. Furthermore three scenarios have been developed on the basis of what is expected to happen in the sectors, the worse scenario being a catastrophic one where if things takes the business as usual trend then the forest resources will easily be depleted. The TFAP scenario takes into account the implementation of the current plans as scheduled while the mitigation scenario takes into account the GHG mitigation in the implementation of the plans. A Comprehensive Mitigation Analysis Process (COMAP) has been used to analyse the GHG and cost implications of the various programmes under the mitigation scenario. (au) 30 refs.
Full Text Available Background: In Tanzania, a country of 42 million, access to oral morphine is rare.Aim: To demonstrate the effectiveness of palliative care teams in reducing patients’ pain and in increasing other positive life qualities in the absence of morphine; and to document the psychological burden experienced by their clinical providers, trained in morphine delivery, as they observed their patients suffering and in extreme pain.Setting: One hundred and forty-fie cancer patients were included from 13 rural hospitals spread across Tanzania.Method: A mixed method study beginning with a retrospective quantitative analysis of cancer patients who were administered the APCA African POS tool four times. Bivariate analyses of the scores at time one and four were compared across the domains. The qualitative arm included an analysis of interviews with six nurses, each with more than fie years’ palliative care experience and no access to strong opioids.Results: Patients and their family caregivers identifid statistically signifiant (p < 0.001 improvements in all of the domains. Thematic analysis of nurse interviews described the patient and family benefis from palliative care but also their great distress when ‘bad cases’ arose who would likely benefi only from oral morphine.Conclusion: People living with chronic cancer-related pain who receive palliative care experience profound physical, spiritual and emotional benefis even without oral morphine. These results demonstrate the need for continued advocacy to increase the availability of oral morphine in these settings in addition to palliative care services.
Ahluwalia, Indu B.; Robinson, Dorcas; Vallely, Lisa; Myeya, Juliana; Ngitoria, Lukumay; Kitambi, Victor; Kabakama, Alfreda
We examined the continuation of community-organized and financed emergency transport systems implemented by the Community-Based Reproductive Health Project (CBRHP) from 1998 to 2000 in two rural districts in Tanzania. The CBRHP was a multipronged program, one component of which focused on affordable transport to health facilities from the…
Brouwer, Roy; Job, Fumbi Crescent; van der Kroon, Bianca; Johnston, Richard
Access to safe drinking water has been on the global agenda for decades. The key to safe drinking water is found in household water treatment and safe storage systems. In this study, we assessed rural and urban household demand for a new gravity-driven membrane (GDM) drinking-water filter. A choice experiment (CE) was used to assess the value attached to the characteristics of a new GDM filter before marketing in urban and rural Kenya. The CE was followed by a contingent valuation (CV) question. Differences in willingness to pay (WTP) for the same filter design were tested between methods, as well as urban and rural samples. The CV follow-up approach produces more conservative and statistically more efficient WTP values than the CE, with only limited indications of anchoring. The effect of the new filter technology on children with diarrhea is among the most important drivers behind choice behavior and WTP in both areas. The urban sample is willing to pay more in absolute terms than the rural sample irrespective of the valuation method. Rural households are more price sensitive, and willing to pay more in relative terms compared with disposable household income. A differentiated marketing strategy across rural and urban areas is expected to increase uptake and diffusion of the new filter technology.
Khalid, Md. Saifuddin; Nyvang, Tom
and stakeholders in and around the school to pave the way for change by building awareness of both educational technology and the complexity of barriers. In this case study, school stakeholders are involved in the research and awareness-building process through three different data-production methods: cultural......This chapter examines barriers and methods to identify barriers to educational technology in a rural technical vocational education and training institute in Bangladesh. It also examines how the application of participatory learning and action methods can provide information for barrier research...... of teachers and computers are significant barriers) and macro (roughly the national level at which the lack of government planning and the lack of training of teachers are significant barriers). Finally, the paper also concludes that applied participatory learning and action-oriented techniques showed...
Full Text Available Abstract Background Improving maternal health by reducing maternal mortality constitutes the fifth Millennium Development Goal and represents a key public health challenge in the United Republic of Tanzania. In response to the need to evaluate and monitor safe motherhood interventions, this study aims at assessing the coverage of obstetric care according to the Unmet Obstetric Need (UON concept by obtaining information on indications for, and outcomes of, major obstetric interventions. Furthermore, we explore whether this concept can be operationalised at district level. Methods A two year study using the Unmet Obstetric Need concept was carried out in three districts in Tanga Region, Tanzania. Data was collected prospectively at all four hospitals in the region for every woman undergoing a major obstetric intervention, including indication and outcome. The concept was adapted to address differentials in access to emergency obstetric care between districts and between rural and urban areas. Based upon literature and expert consensus, a threshold of 2% of all deliveries was used to define the expected minimum requirement of major obstetric interventions performed for absolute maternal indications. Results Protocols covering 1,260 complicated deliveries were analysed. The percentage of major obstetric interventions carried out in response to an absolute maternal indication was only 71%; most major obstetric interventions (97% were caesarean sections. The most frequent indication was cephalo-pelvic-disproportion (51%. The proportion of major obstetric interventions for absolute maternal indications performed amongst women living in urban areas was 1.8% of all deliveries, while in rural areas it was only 0.7%. The high proportion (8.3% of negative maternal outcomes in terms of morbidity and mortality, as well as the high perinatal mortality of 9.1% (still birth 6.9%, dying within 24 hours 1.7%, dying after 24 hours 0.5% raise concern about the
Full Text Available In response to rural health workforce shortages, universities and training providers offer rural and remote clinical placements. This has led to development of educational methods to counter the barriers of distance. In this emerging field, recent improvements in technology have provided solutions including the use of sophisticated videoconferencing systems such as the Cisco TelePresence model CTS-500. This paper evaluates the use of TelePresence in diverse medical education activities using a mixed methods design—questionnaires n=60, individual interviews n=33, and observed practice of activities n=22. TelePresence was found to be beneficial to learning and teaching and superior to other systems participants had used. In particular, the audiovisual quality, resulting intimacy, convenience, and ease of use facilitated teaching and learning, while the fixed camera and poorly arranged physical environment were found to be limitations. The system is best suited for small group activities. Clinical skills-based activities are viable. It is recommended that technical support be available during setup and use and a picture-in-picture mode be included and improved integration of office suite software to provide a joint workspace for display of presentations, images, editing or annotation of documents, and file sharing.
Meijles, Erik; Van Hoven, Bettina
Drawing on experiences from a project conducted in the "Drentsche Aa" area in the Netherlands, this article discusses the concept of the "rural atelier" as a form of problem-based learning. The rural atelier principle was used originally in rural development planning and described as such by Foorthuis (2005) and Elerie and…
Meijles, Erik; Van Hoven, Bettina
Drawing on experiences from a project conducted in the 'Drentsche Aa' area in the Netherlands, this article discusses the concept of the 'rural atelier' as a form of problem-based learning. The rural atelier principle was used originally in rural development planning and described as such by
Meijles, Erik; Van Hoven, Bettina
Drawing on experiences from a project conducted in the 'Drentsche Aa' area in the Netherlands, this article discusses the concept of the 'rural atelier' as a form of problem-based learning. The rural atelier principle was used originally in rural development planning and described as such by Foorthu
The article reflects on a pilot teacher training programme in Tanzania, where videos are used for implementing new teaching methods, but also for initiating a discourse about corporal punishment. The culture of instruction in Tanzania is strictly based on a teacher-centred approach which leaves all activity to the teacher and turns students into passive listeners. In most cases, teachers deal with up to 80 students in one classroom. Therefore, discipline is an important matter of ...
Icarbord Tshabangu; Allen Msafiri
The study explored notions of quality in education and the challenges facing Tanzania. The inquiry adopted a humanist approach to determining levels of quality in schools, thus respondents recorded their perceptions on key issues on quality education, relevant to Tanzania. The study used mixed methods and non-probability sampling which selected 20 schools involving 200 participants. Data was collected using written accounts and qualitative questionnaires and a preliminary quantitative questio...
Full Text Available Abstract Background Population-based sample surveys and sentinel surveillance methods are commonly used as substitutes for more widespread health and demographic monitoring and intervention studies in resource-poor settings. Such methods have been criticised as only being worthwhile if the results can be extrapolated to the surrounding 100-fold population. With an emphasis on measuring mortality, this study explores the extent to which choice of sampling method affects the representativeness of 1% sample data in relation to various demographic and health parameters in a rural, developing-country setting. Methods Data from a large community based census and health survey conducted in rural Burkina Faso were used as a basis for modelling. Twenty 1% samples incorporating a range of health and demographic parameters were drawn at random from the overall dataset for each of seven different sampling procedures at two different levels of local administrative units. Each sample was compared with the overall 'gold standard' survey results, thus enabling comparisons between the different sampling procedures. Results All sampling methods and parameters tested performed reasonably well in representing the overall population. Nevertheless, a degree of variation could be observed both between sampling approaches and between different parameters, relating to their overall distribution in the total population. Conclusion Sample surveys are able to provide useful demographic and health profiles of local populations. However, various parameters being measured and their distribution within the sampling unit of interest may not all be best represented by a particular sampling method. It is likely therefore that compromises may have to be made in choosing a sampling strategy, with costs, logistics the intended use of the data being important considerations.
Jaime V Gabel; Robert M Chamberlain; Twalib Ngoma; Julius Mwaiselage; Kendra K Schmid; Crispin Kahesa; Amr S Soliman
AIM: To estimate the incidence of esophageal cancer(EC) in Kilimanjaro in comparison to other regions in Tanzania. METHODS: We also examined the clinical, epidemiologic, and geographic distribution of the 1332 EC patients diagnosed and/or treated at Ocean Road Cancer Institute(ORCI) during the period 2006-2013. Medical records were used to abstract patient information on age, sex, residence, smoking status, alcohol consumption, tumor site, histopathologic type of tumor, date and place of diagnosis, and type and date of treatment at ORCI. Regional variation of EC patients was investigated at the level of the 26 administrative regions of Tanzania. Total, age- and sex-specific incidence rates were calculated. RESULTS: Male patients 55 years and older had higher incidence of EC than female and younger patients. Of histopathologically-confirmed cases, squamous-cell carcinoma represented 90.9% of histopathologic types of tumors. The administrative regions in the central andeastern parts of Tanzania had higher incidence rates than western regions, specifically administrative regions of Kilimanjaro, Dar es Salaam, and Tanga had the highest rates. CONCLUSION: Further research should focus on investigating possible etiologic factors for EC in regions with high incidence in Tanzania.
The major wetland systems of Tanzania are described together with specific functions,products and attributes of lakes, rivers, swamps, estuaries, mangroves and coastal areas. Reasons and priorities for the conservation of wetlands are given together with the existingproblems of wetland conservation and their solutions.
Full Text Available Abstract Background Understanding the factors which determine a household's or individual's risk of malaria infection is important for targeting control interventions at all intensities of transmission. Malaria ecology in Tanzania appears to have reduced over recent years. This study investigated potential risk factors and clustering in face of changing infection dynamics. Methods Household survey data were collected in villages of rural Muheza district. Children aged between six months and thirteen years were tested for presence of malaria parasites using microscopy. A multivariable logistic regression model was constructed to identify significant risk factors for children. Geographical information systems combined with global positioning data and spatial scan statistic analysis were used to identify clusters of malaria. Results Using an insecticide-treated mosquito net of any type proved to be highly protective against malaria (OR 0.75, 95% CI 0.59-0.96. Children aged five to thirteen years were at higher risk of having malaria than those aged under five years (OR 1.71, 95% CI 1.01-2.91. The odds of malaria were less for females when compared to males (OR 0.62, 95% CI 0.39-0.98. Two spatial clusters of significantly increased malaria risk were identified in two out of five villages. Conclusions This study provides evidence that recent declines in malaria transmission and prevalence may shift the age groups at risk of malaria infection to older children. Risk factor analysis provides support for universal coverage and targeting of long-lasting insecticide-treated nets (LLINs to all age groups. Clustering of cases indicates heterogeneity of risk. Improved targeting of LLINs or additional supplementary control interventions to high risk clusters may improve outcomes and efficiency as malaria transmission continues to fall under intensified control.
Full Text Available OM Minzi,1 VS Manyilizu21Unit of Pharmacology and Therapeutics, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, 2Logistics System Strengthening Unit, John Snow Inc, Dar es Salaam, TanzaniaBackground: Provision of pharmaceutical services in accredited drug-dispensing outlets (ADDOs in Tanzania has not been reported. This study compared the antibiotics dispensing practice between ADDOs and part II shops, or duka la dawa baridi (DLDBs, in Tanzania.Methodology: This was a cross-sectional study that was conducted in ADDOs and DLDBs. A simulated client method for data collection was used, and a total of 85 ADDOs, located in Mvomero, Kilombero, and Morogoro rural districts, were compared with 60 DLDBs located in Kibaha district. The research assistants posed as simulated clients and requested to buy antibiotics from ADDOs and DLDBs after presenting a case scenario or disease condition. Among the diseases presented were those requiring antibiotics and those usually managed only by oral rehydration salt or analgesics. The simulated clients wanted to know the antibiotics that were available at the shop. The posed questions set a convincing ground to the dispenser either to dispense the antibiotic directly, request a prescription, or refer the patient to a health facility. Proportions were used to summarize categorical variables between ADDOs and DLDBs, and the chi-square test was used to test for statistical difference between the two drug-outlet types in terms of antibiotic-dispensing practice.Results: As many as 40% of trained ADDO dispensers no longer worked at the ADDO shops, so some of the shops employed untrained staff. A larger proportion of ADDOs than DLDBs dispensed antibiotics without prescriptions (P = 0.004. The overall results indicate that there was no difference between the two types of shops in terms of adhering to regulations for dispensing antibiotics. However, in some circumstances, eg
Stephen, Hobokela; Roberts, Bayard
Tanzania is host to one of the highest refugee populations in the world, with over half a million refugees in 2006. The purpose of this case study was to explore the application of the UNHCR ART policy for the provision of therapeutic, long-term antiretroviral therapy (ART) to refugees in Tanzania. A case study method was used and 18 semistructured key-informants interviews were conducted in July 2007 with a cross-section of stakeholders involved in provision of ART to refugees in Tanzania. The results suggest positive implementation of the key principles of the UNHCR policy. Some differing opinions existed between respondents over the key principles of considering ART provision at earliest possible stage of displacement, and the criteria for repatriation of refugees. The right of refugees to access ART is increasingly accepted and Tanzania provides a positive example of how ART services can be scaled up for refugees.
Kavishe, Reginald A; Kaaya, Robert D; Nag, Sidsel
and in private drug shops in sub-Saharan Africa. This study reports on the prevalence and distribution of Pfdhps mutations A540E and A581G in Tanzania. When found together, these mutations confer high-level SP resistance (sometimes referred to as 'super-resistance'), which is associated with loss in protective...... efficacy of SP-IPTp. METHODS: DNA samples were extracted from malaria-positive blood samples on filter paper, used malaria rapid diagnostic test strips and whole blood collected from eight sites in seven administrative regions of Tanzania. PCR-RFLP and SSOP-ELISA techniques were used to genotype the A540E...... = 85.3, p Tanzania and in Kagera (20.4 %) in northwestern Tanzania and the 540-581 EG haplotype was found at 54.5 and 19...
Msinde, John Victor; Urassa, Justin K.; Nathan, Iben
in the first quarter of 2014 in five villages of Kilombero Valley, Tanzania using a structured questionnaire. Income poverty was analysed using the Foster-Greer-Thorbecke (FGT) poverty index and two stage least square (2SLS) regression. Households with off-farm employment income were found to be less poor......Income poverty in Tanzania as elsewhere in developing countries is predominantly a rural phenomenon and affects largely households relying on subsistence farming. This is despite the fact that poverty reduction strategies have devoted increasing attention on the role farm employment in enhancing...... household income. This paper argues that, off-farm employment may have potential to contribute to reduction of rural households’ income poverty. Hence the main objective of the paper is set to examine effects of off-farm employment on income poverty. Data was collected from a random sample of 309 households...
Masatu Melkiory C
Full Text Available Abstract Background Sexual activities are increasingly changing from the cultural point of view what they used to be. Knowledge of these practices among adolescents may be a basis to create awareness among adolescents on practices that involve risks. This study aims to assess sexual practices among unmarried adolescents in Tanzania. Methods A cross-sectional survey was conducted among in-school and out-of-school but unmarried adolescents aged 10 to 19 in five locations in Tanzania. A questionnaire was used to collect information and to characterize sexual practices among these adolescents. Results About 32% of adolescents reported being sexually active; a higher proportion being males than females. The only inquired and reported sexual practices include vaginal sex, masturbation, oral and anal sex. About 15% of sexually active adolescents reported having multiple sexual partners. Significantly more males reported having multiple partners than females. Nearly 42% of sexually active adolescents reported having used a condom during most recent sexual act. Females reported older partners at first sexual act. Conclusion Adolescents experience several sexual practices that include penetrative and non-penetrative. More males reported being sexually active than females. Despite adolescents reporting having multiple sexual partners, reported condom use during the most recent sexual act was low. We advocate for a more enhanced approach of reproductive health education that includes safer sex to adolescents without forgetting those in-schools.
Kazaura, Method R; Masatu, Melkiory C
Background Sexual activities are increasingly changing from the cultural point of view what they used to be. Knowledge of these practices among adolescents may be a basis to create awareness among adolescents on practices that involve risks. This study aims to assess sexual practices among unmarried adolescents in Tanzania. Methods A cross-sectional survey was conducted among in-school and out-of-school but unmarried adolescents aged 10 to 19 in five locations in Tanzania. A questionnaire was used to collect information and to characterize sexual practices among these adolescents. Results About 32% of adolescents reported being sexually active; a higher proportion being males than females. The only inquired and reported sexual practices include vaginal sex, masturbation, oral and anal sex. About 15% of sexually active adolescents reported having multiple sexual partners. Significantly more males reported having multiple partners than females. Nearly 42% of sexually active adolescents reported having used a condom during most recent sexual act. Females reported older partners at first sexual act. Conclusion Adolescents experience several sexual practices that include penetrative and non-penetrative. More males reported being sexually active than females. Despite adolescents reporting having multiple sexual partners, reported condom use during the most recent sexual act was low. We advocate for a more enhanced approach of reproductive health education that includes safer sex to adolescents without forgetting those in-schools. PMID:19804651
Full Text Available Women entrepreneurs face a wide variety of barriers and challenges throughout the life and growth of their entrepreneurial venture. This study expands the knowledge base on women entrepreneurs’ needs, specifically their needs in terms of service areas and service delivery method preferences. Twenty three “needed” service areas were identified by 95 Manitoba based women entrepreneurs. The first five included: finding new customers, growth benefits and tools, market expansion, general marketing, and networking skills. This study also examined the differences between urban and rural based entrepreneurs. Two service need areas “how to find mentors and role models” and “legal issues” exhibited statistically significant priority differences. Service delivery methods did not produce any statistically significant differences. Overall, this study concludes that regardless of location, women entrepreneurs’ training and support needs are not significantly that different. The effects of entrepreneurial stage and years in business on entrepreneurial support needs are also examined.
Full Text Available Abstract Background To improve access to treatment in the private retail sector a new class of outlets known as accredited drug dispensing outlets (ADDO was created in Tanzania. Tanzania changed its first-line treatment for malaria from sulphadoxine-pyrimethamine (SP to artemether-lumefantrine (ALu in 2007. Subsidized ALu was made available in both health facilities and ADDOs. The effect of these interventions on access to malaria treatment was studied in rural Tanzania. Methods The study was carried out in the villages of Kilombero and Ulanga Demographic Surveillance System (DSS and in Ifakara town. Data collection consisted of: 1 yearly censuses of shops selling drugs; 2 collection of monthly data on availability of anti-malarials in public health facilities; and 3 retail audits to measure anti-malarial sales volumes in all public, mission and private outlets. The data were complemented with DSS population data. Results Between 2004 and 2008 access to malaria treatment greatly improved and the number of anti-malarial treatment doses dispensed increased by 78%. Particular improvements were observed in the availability (from 0.24 shops per 1,000 people in 2004 to 0.39 in 2008 and accessibility (from 71% of households within 5 km of a shop in 2004 to 87% in 2008 of drug shops. Despite no improvements in affordability this resulted in an increase of the market share from 49% of anti-malarial sales 2005 to 59% in 2008. The change of treatment policy from SP to ALu led to severe stock-outs of SP in health facilities in the months leading up to the introduction of ALu (only 40% months in stock, but these were compensated by the wide availability of SP in shops. After the introduction of ALu stock levels of the drug were relatively high in public health facilities (over 80% months in stock, but the drug could only be found in 30% of drug shops and in no general shops. This resulted in a low overall utilization of the drug (19% of all anti
Barbara van Koppen,
Full Text Available This paper focuses on the application of the concept of Integrated Water Resources Management (IWRM in Tanzania. It asks: how did IWRM affect the rural and fast-growing majority of smallholder farmersʼ access to water which contributes directly to poverty alleviation and employment creation in a country where poverty and joblessness are high? Around 1990, there were both a strong government-led infrastructure development agenda and IWRM ingredients in place, including cost-recovery of state services aligning with the Structural Adjustment Programmes, water management according to basin boundaries and the dormant colonial water rights (permits system. After the 1990s, the World Bank and other donors promoted IWRM with a strong focus on hydroelectric power development, River Basin Water Boards, transformation of the water right system into a taxation tool, and assessment of environmental flows. These practices became formalised in the National Water Policy (2002 and in the Water Resources Management Act (2009. Activities in the name of IWRM came to be closely associated with the post-2008 surge in large-scale land and water deals. Analysing 25 years of IWRM, the paper identifies the processes and identities of the losers (smallholders and – at least partially – the government and the winners (large-scale water users, including recent investors. We conclude that, overall, IWRM harmed smallholdersʼ access to water and rendered them more vulnerable to poverty and unemployment.
Porto, S. M. C.
Full Text Available The significant role that traditional rural buildings have with regard to environmental conservation and rural development is widely acknowledged by the scientific community. These buildings must be protected from inappropriate building interventions that may stem from their rather superficial knowledge. Therefore, this study was directed towards overcoming such a limitation by developing a method based on traditional rural buildings’ characterization. In particular, the study aimed at the characterization of building materials and techniques used for the construction of a number of building components that make up the external envelope of traditional rural buildings. The application of the method to a homogeneous area of the Etna Regional Park (Italy highlighted the need to improve the technical norms of the park’s Territorial Coordination Plan to respect the building characteristics of the traditional rural buildings located in the protected area.La comunidad científica le atribuye a las construcciones rurales tradicionales un papel fundamental en términos de conservación del medioambiente y de evolución rural. Dichos edificios deben ser protegidos contra obras inapropiadas debidas a un conocimiento más bien superficial. Por lo tanto, el objetivo de este estudio fue el de eliminar dichas limitaciones desarrollando un método basado en la caracterización de las construcciones rurales tradicionales, que puede ser aplicado para mejorar el conocimiento de estas últimas. En particular, el susodicho estudio tiene la finalidad de caracterizar los materiales y las técnicas constructivas a emplear para la construcción de algunos componentes del envoltorio externo de las construcciones rurales tradicionales. La aplicación del método propuesto a una zona homogénea del Parque Regional del Etna (Italia puso de relieve la necesidad de mejorar las normas técnicas del Plan de Coordinación Territorial del parque para respetar las caracter
Liu, J; Li, Y P; Huang, G H; Zeng, X T; Nie, S
In this study, an interval-stochastic-based risk analysis (RSRA) method is developed for supporting river water quality management in a rural system under uncertainty (i.e., uncertainties exist in a number of system components as well as their interrelationships). The RSRA method is effective in risk management and policy analysis, particularly when the inputs (such as allowable pollutant discharge and pollutant discharge rate) are expressed as probability distributions and interval values. Moreover, decision-makers' attitudes towards system risk can be reflected using a restricted resource measure by controlling the variability of the recourse cost. The RSRA method is then applied to a real case of water quality management in the Heshui River Basin (a rural area of China), where chemical oxygen demand (COD), total nitrogen (TN), total phosphorus (TP), and soil loss are selected as major indicators to identify the water pollution control strategies. Results reveal that uncertainties and risk attitudes have significant effects on both pollutant discharge and system benefit. A high risk measure level can lead to a reduced system benefit; however, this reduction also corresponds to raised system reliability. Results also disclose that (a) agriculture is the dominant contributor to soil loss, TN, and TP loads, and abatement actions should be mainly carried out for paddy and dry farms; (b) livestock husbandry is the main COD discharger, and abatement measures should be mainly conducted for poultry farm; (c) fishery accounts for a high percentage of TN, TP, and COD discharges but a has low percentage of overall net benefit, and it may be beneficial to cease fishery activities in the basin. The findings can facilitate the local authority in identifying desired pollution control strategies with the tradeoff between socioeconomic development and environmental sustainability.
Akarro, Rocky R.J.; Nathan Anthon Mtweve
The main aim of the study is to present the state of child labour and factors behind this citing one of the most prevalent areas for child labour in Tanzania known as Njombe. Njombe district which is predominantly a rural area is one of the most prevalent areas of child labour in Tanzania. A survey of 300 household heads that were randomly selected from accessible four villages in Igima ward in Njombe district confirmed this phenomenon. Chi-square statistic analysis on the relationship betwee...
Full Text Available Abstract Background The ACCESS programme aims at understanding and improving access to prompt and effective malaria treatment. Between 2004 and 2008 the programme implemented a social marketing campaign for improved treatment-seeking. To improve access to treatment in the private retail sector a new class of outlets known as accredited drug dispensing outlets (ADDO was created in Tanzania in 2006. Tanzania changed its first-line treatment for malaria from sulphadoxine-pyrimethamine (SP to artemether-lumefantrine (ALu in 2007 and subsidized ALu was made available in both health facilities and ADDOs. The effect of these interventions on understanding and treatment of malaria was studied in rural Tanzania. The data also enabled an investigation of the determinants of access to treatment. Methods Three treatment-seeking surveys were conducted in 2004, 2006 and 2008 in the rural areas of the Ifakara demographic surveillance system (DSS and in Ifakara town. Each survey included approximately 150 people who had suffered a fever case in the previous 14 days. Results Treatment-seeking and awareness of malaria was already high at baseline, but various improvements were seen between 2004 and 2008, namely: better understanding causes of malaria (from 62% to 84%; an increase in health facility attendance as first treatment option for patients older than five years (27% to 52%; higher treatment coverage with anti-malarials (86% to 96% and more timely use of anti-malarials (80% to 93-97% treatments taken within 24 hrs. Unfortunately, the change of treatment policy led to a low availability of ALu in the private sector and, therefore, to a drop in the proportion of patients taking a recommended malaria treatment (85% to 53%. The availability of outlets (health facilities or drug shops is the most important determinant of whether patients receive prompt and effective treatment, whereas affordability and accessibility contribute to a lesser extent. Conclusions An
M. V. S. N. Prasad
Full Text Available Mobile communication networks in rural zones were not given enough importance and emphasis unlike their urban counter parts due to the unattractive revenues and economic considerations for the cellular operators. In order to identify the suitable prediction methods for Indian rail road rural zones, train-based measurements were conducted in the northern and western rural zones along rail roads. These were carried out by recording the carriers emitted by the trackside base stations inside the moving train. The observed signal levels converted into path losses were compared initially with various conventional prediction methods. The observed results were also compared with the predicted results of radio planning tool utilizing digital terrain data. The constants of the model incorporated in the radio planning tool were tuned separately for north Indian and west Indian base stations based on the observed results. The suitability of the models has been evaluated in terms of standard statistical parameters.
van den Berg, Henk; Knols, Bart G J
Malaria has strong linkages with agriculture, and farmers in malarious regions have a central position in creating or controlling the conditions that favour disease transmission. An interdisciplinary and integrated approach is needed to involve farmers and more than one sector in control efforts. It is suggested that malaria control can benefit from a complementary intervention in rural development, the Farmer Field School (FFS) on Integrated Pest Management (IPM). This is a form of education that uses experiential learning methods to build farmers' expertise, and has proven farm-level and empowerment effects. The benefits of incorporating malaria control into the IPM curriculum are discussed. An example of a combined health-agriculture curriculum, labeled Integrated Pest and Vector Management (IPVM), developed in Sri Lanka is presented. Institutional ownership and support for IPVM could potentially be spread over several public sectors requiring a process for institutional learning and reform.
Knols Bart GJ
Full Text Available Abstract Malaria has strong linkages with agriculture, and farmers in malarious regions have a central position in creating or controlling the conditions that favour disease transmission. An interdisciplinary and integrated approach is needed to involve farmers and more than one sector in control efforts. It is suggested that malaria control can benefit from a complementary intervention in rural development, the Farmer Field School (FFS on Integrated Pest Management (IPM. This is a form of education that uses experiential learning methods to build farmers' expertise, and has proven farm-level and empowerment effects. The benefits of incorporating malaria control into the IPM curriculum are discussed. An example of a combined health-agriculture curriculum, labeled Integrated Pest and Vector Management (IPVM, developed in Sri Lanka is presented. Institutional ownership and support for IPVM could potentially be spread over several public sectors requiring a process for institutional learning and reform.
Full Text Available Context: Pap smear testing as a conventional cervical screening approach has limitations for implementation and aided visual cervical testing has varying results in different regions. Aims: The aim of this study is to demonstrate the performance of aided visual cervical screening tests as against conventional Pap smear testing in a rural community setting of North India. Settings and Design: This was a rural community based cross-sectional study. Materials and Methods: All 7603 ever married women of age 30-59 years surveyed in a pocket of Dadri Tehsil, Uttar Pradesh, India were targeted for screening by Pap, visual inspection of cervix using acetic acid (VIA and visual inspection of cervix using Lugol′s iodine (VILI methods. Screen positives were referred to colposcopy and confirmation by histology. Statistical Analysis Used: Detection of histological cervical intraepithelial neoplasia (CIN II + and CIN III + assessed separately by sensitivity, specificity and likelihood ratio′s and predictive values. Analysis of data was performed by using IBM SPSS statstics software version 16.0. Results: A total of 65.6%(4988/7604 eligible women of 30-59 years age group in the target population were screened. Out of 4988, further analysis was performed on 4148 after excluding those who did not complete all screenings, who lost to follow-up and had missing histology results. Screen positivity rates by Pap (ASCUS and above, VIA and VILI were 2.6%, 9.7% and 13.5% respectively. Sensitivity and specificity of detecting the CIN III+ lesions were 87.5 and 98.8% for Pap, 50.0% and 96.7% for VIA and 50.0% and 95.7% for VILI respectively. Conclusions: VIA screening demonstrated as a feasible primary screening test for detecting high grade CIN and as to perform better when the Pap test is not feasible.
Kasanga, C J; Wadsworth, J; Mpelumbe-Ngeleja, C A R; Sallu, R; Kivaria, F; Wambura, P N; Yongolo, M G S; Rweyemamu, M M; Knowles, N J; King, D P
This paper describes the molecular characterization of foot-and-mouth disease viruses (FMDV) recovered from outbreaks in Tanzania that occurred between 1967 and 2009. A total of 44 FMDV isolates, containing representatives of serotypes O, A, SAT 1 and SAT 2 from 13 regions of Tanzania, were selected from the FAO World Reference Laboratory for FMD (WRLFMD) virus collection. VP1 nucleotide sequences were determined for RT-PCR amplicons, and phylogenetic reconstructions were determined by maximum likelihood and neighbour-joining methods. These analyses showed that Tanzanian type O viruses fell into the EAST AFRICA 2 (EA-2) topotype, type A viruses fell into the AFRICA topotype (genotype I), type SAT 1 viruses into topotype I and type SAT 2 viruses into topotype IV. Taken together, these findings reveal that serotypes O, A, SAT 1 and SAT 2 that caused FMD outbreaks in Tanzania were genetically related to lineages and topotypes occurring in the East African region. The close genetic relationship of viruses in Tanzania to those from other countries suggests that animal movements can contribute to virus dispersal in sub-Saharan Africa. This is the first molecular description of viruses circulating in Tanzania and highlights the need for further sampling of representative viruses from the region so as to elucidate the complex epidemiology of FMD in Tanzania and sub-Saharan Africa.
Extension systems in Tanzania: identifying gaps in research. ... Tanzania Journal of Agricultural Sciences ... paper on extension system research in Tanzania for Innovative Agricultural Research Initiative (iAGRI) project. ... 1993 to 2012 in Tanzania on extension systems and lead international articles within the last 10 years.
movement of refugees. Societal violence against women and persons with albinism and women persisted. Female genital mutilation (FGM), especially of...Zanzibar /islands over 99% Muslim Literacy: Male, 77.5%; Female , 66.2% (2003) Under-5 Mortality: 165 deaths/1,000 live births HIV/AIDS adult...infection rate: 6.2% (2007) Life Expectancy, years at birth: Male, 50.5 Female , 53.5 (2009 est.) Sources: CIA World Factbook 2010. Tanzania
Willging, Cathleen E; Sommerfeld, David H; Aarons, Gregory A; Waitzkin, Howard
In July 2005, New Mexico initiated a major reform of publicly-funded behavioral healthcare to reduce cost and bureaucracy. We used a mixed-method approach to examine how this reform impacted the workplaces and employees of service agencies that care for low-income adults in rural and urban areas. Information technology problems and cumbersome processes to enroll patients, procure authorizations, and submit claims led to payment delays that affected the financial status of the agencies, their ability to deliver care, and employee morale. Rural employees experienced lower levels of job satisfaction and organizational commitment and higher levels of turnover intentions under the reform when compared to their urban counterparts.
Hutton, Mary Olivia; Leach, A.M.; Leip, Adrian; Galloway, J.N.; Bekunda, M.; Sullivan, C.; Lesschen, J.P.
We present the first nitrogen footprint model for a developing country: Tanzania. Nitrogen (N) is a crucial element for agriculture and human nutrition, but in excess it can cause serious environmental damage. The Sub-Saharan African nation of Tanzania faces a two-sided nitrogen problem: while there
By using the DEMATEL method,the 20 factors in four types that affect the rural cooperative economic system of Changjitu Area are analyzed.The comprehensive influencing matrix of each factor,and its influencing degree,central degree and reason degree are obtained,which indicates that macro economic system,law and regulations,thought pattern,government concept have great functions on rural cooperative organization.But the system environment is the major factor that affects the development of cooperatives.So the perfection of macro-economic system,laws and regulations,regional developmental strategy,logistics system,land system,households registration system,education system,administration system should be conducted to promote the rural economic development of Changjitu Area.
Yin, Kai; Wen, MeiPing; Zhang, FeiFei; Yuan, Chao; Chen, Qiang; Zhang, Xiupeng
With the acceleration of urbanization in China, most rural areas formed a widespread phenomenon, i.e., destitute village, labor population loss, land abandonment and rural hollowing. And it formed a unique hollow village problem in China finally. The governance of hollow village was the objective need of the development of economic and social development in rural area for Chinese government, and the research on the evaluation method of rural hollowing was the premise and basis of the hollow village governance. In this paper, several evaluation methods were used to evaluate the rural hollowing based on the survey data, land use data, social and economic development data. And these evaluation indexes were the transition of homesteads, the development intensity of rural residential areas, the per capita housing construction area, the residential population proportion in rural area, and the average annual electricity consumption, which can reflect the rural hollowing degree from the land, population, and economy point of view, respectively. After that, spatial analysis method of GIS was used to analyze the evaluation result for each index. Based on spatial raster data generated by Kriging interpolation, we carried out re-classification of all the results. Using the fuzzy clustering method, the rural hollowing degree in Ningxia area was reclassified based on the two spatial scales of county and village. The results showed that the rural hollowing pattern in the Ningxia Hui Autonomous Region had a spatial distribution characteristics that the rural hollowing degree was obvious high in the middle of the study area but was low around the study area. On a county scale, the specific performances of the serious rural hollowing were the higher degree of extensive land use, and the lower level of rural economic development and population transfer concentration. On a village scale, the main performances of the rural hollowing were the rural population loss and idle land. The
Mukhtar, Hanadi M E; Elnimeiri, Mustafa K
Although the mainstays of antipyretic treatments are drugs such as paracetamol and ibuprofen, physical methods are also used. These include tepid sponging, removing clothes, and cooling the environment with fans to improve ventilation. The objective of this study is to assess the physical methods used by Sudanese rural mothers to manage a child with fever. A cross-sectional descriptive study was designed and conducted within 6 months; it involved 332 mothers of children under five. The data were collected through using a standardized administered questionnaire and focus group discussion and analyzed by statistical package for social science version 15.0 (SPSS). Tepid sponging was used by 47% of the interviewed mothers. 15% of the mothers increased fluid intake, 7% bathed the child and 5% put the child in light clothes. 59% of mothers applied tepid sponging on head, 33.9% on all the body, 3.7% and 2.2% on groin area and axilla, respectively. The majority of mothers (86%) used water from refrigerator or zeir [water clay pot] for applying tepid sponging, 9% used tap water, and 3% used ice water. In conclusion, this study revealed that the common physical treatment method for fever used by mothers was tepid sponging with inappropriate application.
Calvert, Clara; Baisley, Kathy; Aoife M Doyle; Maganja, Kaballa; Changalucha, John; Watson-Jones, Deborah; Hayes, Richard J; Ross, David A
Background With effective contraceptives available, unplanned pregnancies are preventable and educational interventions have been cited as a promising platform to increase contraceptive use through improving knowledge. However, results from trials of educational interventions have been disappointing. In order to effectively target future interventions, this study aimed to identify risk factors for unplanned pregnancy among young women in Mwanza, Tanzania. Methods Data were analysed from the M...
Full Text Available Abstract Background In Tanzania, many people seek malaria treatment from retail drug sellers. The National Malaria Control Program identified the accredited drug dispensing outlet (ADDO program as a private sector mechanism to supplement the distribution of subsidized artemisinin-based combination therapies (ACTs from public facilities and increase access to the first-line antimalarial in rural and underserved areas. The ADDO program strengthens private sector pharmaceutical services by improving regulatory and supervisory support, dispenser training, and record keeping practices. Methods The government's pilot program made subsidized ACTs available through ADDOs in 10 districts in the Morogoro and Ruvuma regions, covering about 2.9 million people. The program established a supply of subsidized ACTs, created a price system with a cost recovery plan, developed a plan to distribute the subsidized products to the ADDOs, trained dispensers, and strengthened the adverse drug reactions reporting system. As part of the evaluation, 448 ADDO dispensers brought their records to central locations for analysis, representing nearly 70% of ADDOs operating in the two regions. ADDO drug register data were available from July 2007-June 2008 for Morogoro and from July 2007-September 2008 for Ruvuma. This intervention was implemented from 2007-2008. Results During the pilot, over 300,000 people received treatment for malaria at the 448 ADDOs. The percentage of ADDOs that dispensed at least one course of ACT rose from 26.2% during July-September 2007 to 72.6% during April-June 2008. The number of malaria patients treated with ACTs gradually increased after the start of the pilot, while the use of non-ACT antimalarials declined; ACTs went from 3% of all antimalarials sold in July 2007 to 26% in June 2008. District-specific data showed substantial variation among the districts in ACT uptake through ADDOs, ranging from ACTs representing 10% of all antimalarial sales
Full Text Available Abstract Background Efficient delivery strategies for health interventions are essential for high and sustainable coverage. We report impact of a change in programmatic delivery strategy from routine delivery through the Expanded Programme on Immunization (EPI+ approach to twice-yearly mass distribution campaigns on coverage of vitamin A supplementation in Tanzania Methods We investigated disparities in age, sex, socio-economic status, nutritional status and maternal education within vitamin A coverage in children between 1 and 2 years of age from two independent household level child health surveys conducted (1 during a continuous universal targeting scheme based on routine EPI contacts for children aged 9, 15 and 21 months (1999; and (2 three years later after the introduction of twice-yearly vitamin A supplementation campaigns for children aged 6 months to 5 years, a 6-monthly universal targeting scheme (2002. A representative cluster sample of approximately 2,400 rural households was obtained from Rufiji, Morogoro Rural, Kilombero and Ulanga districts. A modular questionnaire about the health of all children under the age of five was administered to consenting heads of households and caretakers of children. Information on the use of child health interventions including vitamin A was asked. Results Coverage of vitamin A supplementation among 1–2 year old children increased from 13% [95% CI 10–18%] in 1999 to 76% [95%CI 72–81%] in 2002. In 2002 knowledge of two or more child health danger signs was negatively associated with vitamin A supplementation coverage (80% versus 70% (p = 0.04. Nevertheless, we did not find any disparities in coverage of vitamin A by district, gender, socio-economic status and DPT vaccinations. Conclusion Change in programmatic delivery of vitamin A supplementation was associated with a major improvement in coverage in Tanzania that was been sustained by repeated campaigns for at least three years. There is a
Full Text Available Peste des petits ruminants virus (PPRV causes the acute, highly contagious disease peste des petits ruminants (PPR that affects small domestic and wild ruminants. PPR is of importance in the small livestock-keeping industry in Tanzania, especially in rural areas as it is an important source of livelihood. Morbidity and case fatality rate can be as high as 80–100% in naïve herds; however, in endemic areas, morbidity and case fatality range between 10 and 100% where previous immunity, age, and species of infected animal determine severity of outcome. PPR was officially confirmed in domestic animals in the Ngorongoro district of Tanzania in 2008. It is now considered to be endemic in the domestic sheep and goat populations throughout Tanzania, but restricted to one or more areas in the small ruminant wildlife population. In this article, we review the history and the current status of PPR in Tanzania and neighboring countries. To control and eradicate PPR in the region, a joint effort between these countries needs to be undertaken. The effort must also secure genuine engagement from the animal holders to succeed.
Torsson, Emeli; Kgotlele, Tebogo; Berg, Mikael; Mtui-Malamsha, Niwael; Swai, Emanuel S; Wensman, Jonas Johansson; Misinzo, Gerald
Peste des petits ruminants virus (PPRV) causes the acute, highly contagious disease peste des petits ruminants (PPR) that affects small domestic and wild ruminants. PPR is of importance in the small livestock-keeping industry in Tanzania, especially in rural areas as it is an important source of livelihood. Morbidity and case fatality rate can be as high as 80-100% in naïve herds; however, in endemic areas, morbidity and case fatality range between 10 and 100% where previous immunity, age, and species of infected animal determine severity of outcome. PPR was officially confirmed in domestic animals in the Ngorongoro district of Tanzania in 2008. It is now considered to be endemic in the domestic sheep and goat populations throughout Tanzania, but restricted to one or more areas in the small ruminant wildlife population. In this article, we review the history and the current status of PPR in Tanzania and neighboring countries. To control and eradicate PPR in the region, a joint effort between these countries needs to be undertaken. The effort must also secure genuine engagement from the animal holders to succeed.
Packer, C; Brink, H; Kissui, B M; Maliti, H; Kushnir, H; Caro, T
Tanzania holds most of the remaining large populations of African lions (Panthera leo) and has extensive areas of leopard habitat (Panthera pardus), and both species are subjected to sizable harvests by sport hunters. As a first step toward establishing sustainable management strategies, we analyzed harvest trends for lions and leopards across Tanzania's 300,000 km(2) of hunting blocks. We summarize lion population trends in protected areas where lion abundance has been directly measured and data on the frequency of lion attacks on humans in high-conflict agricultural areas. We place these findings in context of the rapidly growing human population in rural Tanzania and the concomitant effects of habitat loss, human-wildlife conflict, and cultural practices. Lion harvests declined by 50% across Tanzania between 1996 and 2008, and hunting areas with the highest initial harvests suffered the steepest declines. Although each part of the country is subject to some form of anthropogenic impact from local people, the intensity of trophy hunting was the only significant factor in a statistical analysis of lion harvest trends. Although leopard harvests were more stable, regions outside the Selous Game Reserve with the highest initial leopard harvests again showed the steepest declines. Our quantitative analyses suggest that annual hunting quotas be limited to 0.5 lions and 1.0 leopard/1000 km(2) of hunting area, except hunting blocks in the Selous Game Reserve, where harvests should be limited to 1.0 lion and 3.0 leopards/1000 km(2) .
Witteveen, Loes; Lie, Rico
Rural Development Professionals (RDPs) are key actors in processes of social change for people living with HIV/AIDS in rural areas. This article reports on the filming of a series of workshops and courses for RDPs in Ghana, India, Tanzania and Zambia. In this article the filming and the films are analyzed as tools for learning and social change…
Yogendra V, Shuaib Ahmed, Sana Jaweriya, Sagorika Mullick
Full Text Available Background: Contraception is as old as mankind.In view of increasing population there’s need for awareness regarding the use of various contraceptive methods. Aims and Objectives: To assess the Knowledge, Attitude & Practice regarding the various contraceptive methods in a rural setup of Hoskote. Materials & Methods: A cross sectional study was carried out at MVJ, UHC & PHC of Hoskote Taluk on OPD basis. Data was collected by a pre-designed questionnaire at the OPD. Statistical analysis was done using SPSS software. People were simultaneously educated regarding the various contraceptive methods. Results: Total sample size was 150 of which 75 were males and 75 females. Knowledge about contraceptives was seen more in males (93.3% when compared to females (72%. 95.2% of gradates had knowledge regarding the methods of contraception. This suggests that the knowledge about contraception is better perceived and understood among the literate group. Most common method of contraceptive practiced was barrier methods (40%, followed by sterilization procedure (20%, IUCD (18.67%, OCP (12%, coitus interruptus (8.67% and emergency contraception (0.67%. Conclusion: There has been a considerable improvement among the people even in rural setup regarding the contraceptive use, but there still exists lack of awareness and knowledge regarding the use of contraceptive methods in some small groups of people. IEC activities have to be increased especially for females of this rural setup.
Kayombo, Edmund J; Uiso, Febronia C; Mahunnah, Rogasian L A
Health care utilization in many developing countries, Tanzania included, is mainly through the use of traditional medicine (TRM) and its practitioners despite the presence of the conventional medicine. This article presents findings on the study that aimed to get an experience of health care utilization from both urban and rural areas of seven administrative regions in Tanzania. A total of 33 health facility managers were interviewed on health care provision and availability of supplies including drugs, in their respective areas. The findings revealed that the health facilities were overburden with higher population to serve than it was planned. Consequently essential drugs and other health supplies were available only in the first two weeks of the month. Conventional health practitioners considered traditional health practitioners to be more competent in mental health management, and overall, they were considered to handle more HIV/AIDS cases knowingly or unknowingly due to shear need of healthcare by this group. In general conventional health practitioners were positive towards traditional medicine utilization; and some of them admitted using traditional medicines. Traditional medicines like other medical health systems worldwide have side effects and some contentious ethical issues that need serious consideration and policy direction. Since many people will continue using traditional/alternative medicine, there is an urgent need to collaborate with traditional/alternative health practitioners through the institutionalization of basic training including hygiene in order to improved healthcare in the community and attain the Millennium Development Goals by 2015.
Kayombo Edmund J
Full Text Available Abstract Health care utilization in many developing countries, Tanzania included, is mainly through the use of traditional medicine (TRM and its practitioners despite the presence of the conventional medicine. This article presents findings on the study that aimed to get an experience of health care utilization from both urban and rural areas of seven administrative regions in Tanzania. A total of 33 health facility managers were interviewed on health care provision and availability of supplies including drugs, in their respective areas. The findings revealed that the health facilities were overburden with higher population to serve than it was planned. Consequently essential drugs and other health supplies were available only in the first two weeks of the month. Conventional health practitioners considered traditional health practitioners to be more competent in mental health management, and overall, they were considered to handle more HIV/AIDS cases knowingly or unknowingly due to shear need of healthcare by this group. In general conventional health practitioners were positive towards traditional medicine utilization; and some of them admitted using traditional medicines. Traditional medicines like other medical health systems worldwide have side effects and some contentious ethical issues that need serious consideration and policy direction. Since many people will continue using traditional/alternative medicine, there is an urgent need to collaborate with traditional/alternative health practitioners through the institutionalization of basic training including hygiene in order to improved healthcare in the community and attain the Millennium Development Goals by 2015.
Stacciarini, Jeanne-Marie R; Smith, Rebekah; Garvan, Cynthia Wilson; Wiens, Brenda; Cottler, Linda B
Upon immigration to the rural areas in the US, Latino families may experience cultural, geographic, linguistic and social isolation, which can detrimentally affect their wellbeing by acting as chronic stressors. Using a community engagement approach, this is a pilot mixed-method study with an embedded design using concurrent qualitative and quantitative data. The purpose of this study is to evaluate family and social environments in terms of protective factors and modifiable risks associated with mental well-being in Latino immigrants living in rural areas of Florida. Latino immigrant mother and adolescent dyads were interviewed by using in-depth ethnographic semistructured interviews and subsequent quantitative assessments, including a demographic questionnaire and three structured instruments: the Family Environment Scale Real Form, the SF-12v2™ Health Survey and the short version (eight items) of PROMIS Health Organization Social Isolation. This mixed-method pilot study highlighted how family, rural, and social environments can protect or impair wellbeing in rural Latino immigrant mother and adolescent dyads.
Challe, J.F.X.; Struik, P.C.
This paper examines the gathering of wild orchids and its effect on orchid species diversity and abundance in rural communities with high prevalence of HIV/AIDS and high numbers of orphans. The study was conducted in three villages in the Makete District of Tanzania. The study used a triangulation o
This paper focuses on ethno-cognitive connections between HIV/AIDS and banana plants in the Bahaya agricultural society that emerged from an anthropological study carried out in 2005-2006 in Nsisha, a rural village in Bukoba District, north-western Tanzania. The paper briefly describes the historica
Sun, Shi-Hua; Jia, Cun-Xian
Background This study aims to describe the specific characteristics of completed suicides by violent methods and non-violent methods in rural Chinese population, and to explore the related factors for corresponding methods. Methods Data of this study came from investigation of 199 completed suicide cases and their paired controls of rural areas in three different counties in Shandong, China, by interviewing one informant of each subject using the method of Psychological Autopsy (PA). Results There were 78 (39.2%) suicides with violent methods and 121 (60.8%) suicides with non-violent methods. Ingesting pesticides, as a non-violent method, appeared to be the most common suicide method (103, 51.8%). Hanging (73 cases, 36.7%) and drowning (5 cases, 2.5%) were the only violent methods observed. Storage of pesticides at home and higher suicide intent score were significantly associated with choice of violent methods while committing suicide. Risk factors related to suicide death included negative life events and hopelessness. Conclusions Suicide with violent methods has different factors from suicide with non-violent methods. Suicide methods should be considered in suicide prevention and intervention strategies. PMID:25111835
Full Text Available The work presents a brief report of the main results of a study carried out by the Spatial Engineering Division of the Department of Agricultural Economics and Engineering of the University of Bologna, within a broader PRIN 2005 research project concerning landscape and economic analysis, planning and programming. In particular, the study focuses on the design of spatial analysis methods aimed at building knowledge frameworks of the various natural and anthropic resources of rural areas. The goal is to increase the level of spatial and information detail of common databases, thus allowing higher accuracy and effectiveness of the analyses needed to achieve the goals of new generation spatial and agriculture planning. Specific in-depth analyses allowed to define techniques useful in order to reduce the increase in survey costs. Moreover, the work reports the main results regarding a multicriteria model for the analysis of the countryside defined by the research. Such model is aimed to assess the various agricultural, environmental and landscape features, vocations, expressions and attitudes, and support the definition and implementation of specific and targeted planning and programming policies.
Benson, J S
In the late 1980s, many developing countries were forced to adopt structural adjustment policies as a condition for securing loans from the International Monetary Fund (IMF) and the World Bank. One of the World Bank's recommended policies was to change the mix of private and public health facilities. This study, based on fieldwork done in Tanzania in 1993, examines the impact of this policy on health-care accessibility in two northern Tanzanian districts, one rural and one urban. Accessibility was measured in terms of equality and equity of coverage. The placement of the very few government clinics opened during the years 1985-1993 did much more to improve coverage than the haphazard location of many new private clinics. Equity was not improved as very few clinics were placed in demographically needy areas.
Full Text Available Abstract Background Religion shapes everyday beliefs and activities, but few studies have examined its associations with attitudes about HIV. This exploratory study in Tanzania probed associations between religious beliefs and HIV stigma, disclosure, and attitudes toward antiretroviral (ARV treatment. Methods A self-administered survey was distributed to a convenience sample of parishioners (n = 438 attending Catholic, Lutheran, and Pentecostal churches in both urban and rural areas. The survey included questions about religious beliefs, opinions about HIV, and knowledge and attitudes about ARVs. Multivariate logistic regression analysis was performed to assess how religion was associated with perceptions about HIV, HIV treatment, and people living with HIV/AIDS. Results Results indicate that shame-related HIV stigma is strongly associated with religious beliefs such as the belief that HIV is a punishment from God (p Conclusion The decision to start ARVs hinged primarily on education-level and knowledge about ARVs rather than on religious factors. Research results highlight the influence of religious beliefs on HIV-related stigma and willingness to disclose, and should help to inform HIV-education outreach for religious groups.
Krause, Ariane [Engineers Without Boarders (Germany), Berlin (DE). Project ' ' Carbonization as Sanitation' ' (CaSa)
The need for sustainable systems is apparent as climate change and other adverse anthropogenic activities continue to negatively affect the soil fertility in Africa. One of the indicators of the loss of soil fertility is the continuous decrease in soil organic matter, which is the major building block of a fertile soil. This is mainly attributed to the inappropriate practice of human-beings of taking more substances from the ecosystem than the amount replaced. As the soil fertility is increasingly lost, food insecurity, due to dropped productivity of the soil, is becoming a critical issue in many areas of Africa, Tanzania is not any different in this respect. On the other hand, most people in rural areas of Africa still lack possibilities to cover their daily energy needs in a more sustainable way and many people mainly rely on firewood. This, in turn, has an adverse impact on the climate and the soil, causing a local viscous circle of poor soil and productivity conditions. Moreover, the sanitation coverage of those areas is very low and there is a need for appropriate sanitation systems. Therefore, the aim of this project is, to conduct research on the possibility of establishing a self-sustaining system for the rural areas of Kagera, Tanzania, to address the three basic issues: sanitation, energy supply and soil fertility. The system consists of a small-scale biogas digester, a urine diverting dehydrating toilet (UDDT) and an adaptive hydrothermal carbonization (HTC) unit. Biogas is produced from crop residues and other domestic organic waste. The fermentation residues and the dehydrated fecal matter from the UDDT is then treated with HTC. The carbonised and sanitized residue is then applied as soil amendment to improve the soil fertility as manifested by the Terra Preta in the Amazon. This holistic approach is a new development in ecological sanitation. Therefore, a comprehensive sustainability assessment including environmental, economic and socio
Wilunda, Calistus; Massawe, Siriel; Jackson, Caroline
To identify determinants of moderate-to-severe anaemia among women of reproductive age in Tanzania. We included participants from the 2010 Tanzania Demographic and Health Survey, which collected data on socio-demographic and maternal health and determined haemoglobin levels from blood samples. We performed logistic regression to calculate adjusted odds ratios for associations between socio-demographic, contextual, reproductive and lifestyle factors, and moderate-to-severe anaemia and investigated interactions between certain risk factors. Of 9477 women, 20.1% were anaemic. Pregnancy was significantly associated with anaemia (adjusted OR 1.75, 95% CI 1.43-2.15), but the effect varied significantly by urban/rural residence, wealth and education. The effect of pregnancy was stronger in women without education and those who were in lower wealth groups, with significant interactions observed for each of these factors. Education was associated with a lower anaemia risk, particularly in the poorest group (OR 0.58, 95% CI 0.43-0.80), and in pregnant women. The risk of anaemia fell with rising iron supplementation coverage. Lack of toilet facilities increased anaemia risk (OR 1.26, 95% CI 1.00-1.60), whereas using hormonal contraception reduced it. There was no association with age, urban/rural residence, wealth or type of cooking fuel in adjusted analysis. Pregnant women in Tanzania are particularly at risk of moderate-to-severe anaemia, with the effect modified by urban/rural residence, education and wealth. Prevention interventions should target women with lower education or without proper sanitation facilities, and women who are pregnant, particularly if they are uneducated or in lower wealth groups. © 2013 John Wiley & Sons Ltd.
Following decades of neoliberal policies promoting commodity driven export production, the small scale farming sector in many developing countries has suffered from declining market share, lessening productivity and deepening poverty. In recent years, biofuels have been promoted within developing countries to foster rural development and provide new markets for the smallholders. Using Tanzania as a case study, this thesis evaluates the extent to which the emerging biofuel sector provides opportunities for smallholders to gain beneficial access to markets -- or whether the sector is following the trajectory of other export-oriented commodity projects of the past and resulting in the marginalisation of smallholders. This thesis asserts that the biofuel sector in Tanzania presents more threats than benefits for smallholders; a pattern can be witnessed that favours foreign investors and dispossesses farmers of existing land, while providing few opportunities at a local level for income generation and employment.
Full Text Available This paper summarises key findings from a comprehensive analysis commissioned by the Japan International Cooperation Agency (JICA of the nature of decentralisation in the three East African countries: Kenya, Uganda and Tanzania. The specific objectives of the study were: • Provide a basic comparative analysis of the forms and processes of decentralisation reforms in the three countries • Analyse the specific modalities in the three countries for local service delivery planning and provision within the three sectors of basic education, primary health care and agricultural extension, with a particular emphasis on rural areas. TIDEMAND: Local level service delivery, decentralisation and governance: A comparative study of Uganda, Kenya and Tanzania CJLG May 2009 145 • Explore the impact of the specific forms of decentralisation and local level service delivery arrangements in terms of efficiency, accountability (transparency and democratic process (participation.
Mwakalukwa, Ezekiel Edward; Meilby, Henrik; Treue, Thorsten
Tools to accurately estimate tree volume and biomass are scarce for most forest types in East Africa, including Tanzania. Based on a sample of 142 trees and 57 shrubs from a 6,065 ha area of dry miombo woodland in Iringa rural district in Tanzania, regression models were developed for volume...... and biomass of three important species, Brachystegia spiciformis Benth. (n=40), Combretum molle G. Don (n=41), and Dalbergia arbutifolia Baker (n=37) separately, and for broader samples of trees (28 species, n=72), shrubs (16 species, n=31), and trees and shrubs combined (44 species, n=104). Applied...... of the predictions tended to increase from general to species-specific models. Except for a few volume and biomass models developed for shrubs, all models had R2 values of 96–99%. Thus, the models appear robust and should be applicable to forests with similar site conditions, species, and diameter ranges....
Full Text Available Abstract Background After a national voucher scheme in 2004 provided pregnant women and infants with highly subsidized insecticide-treated nets (ITNs, use among children under five years (U5s in mainland Tanzania increased from 16% in 2004 to 26.2% in 2007. In 2008, the Ministry of Health and Social Welfare planned a catch-up campaign to rapidly and equitably deliver a free long-lasting insecticidal net (LLIN to every child under five years in Tanzania. Methods The ITN Cell, a unit within the National Malaria Control Programme (NMCP, coordinated the campaign on behalf of the Ministry of Health and Social Welfare. Government contractors trained and facilitated local government officials to supervise village-level volunteers on a registration of all U5s and the distribution and issuing of LLINs. The registration results formed the basis for the LLIN order and delivery to village level. Caregivers brought their registration coupons to village issuing posts during a three-day period where they received LLINs for their U5s. Household surveys in five districts assessed ITN ownership and use immediately after the campaign. Results Nine donors contributed to the national campaign that purchased and distributed 9.0 million LLINs at an average cost of $7.07 per LLIN, including all campaign-associated activities. The campaign covered all eight zones of mainland Tanzania, the first region being covered separately during an integrated measles immunization/malaria LLIN distribution in August 2008, and was implemented one zone at a time from March 2009 until May 2010. ITN ownership at household level increased from Tanzania's 2008 national average of 45.7% to 63.4%, with significant regional variations. ITN use among U5s increased from 28.8% to 64.1%, a 2.2-fold increase, with increases ranging from 22.1-38.3% percentage points in different regions. Conclusion A national-level LLIN distribution strategy that fully engaged local government authorities helped
Full Text Available Abstract Background Insecticide-treated nets represent currently a key malaria control strategy, but low insecticide re-treatment rates remain problematic. Olyset™ nets are currently one of two long-lasting insecticidal nets recommended by WHO. An assessment was carried out of the effect of Olyset™ nets after seven years of use in rural Tanzania. Methods A survey of Olyset™ nets was conducted in two Tanzanian villages to examine their insecticide dosage, bioassay efficacy and desirability compared with ordinary polyester nets. Results Of 103 randomly selected nets distributed in 1994 to 1995, 100 could be traced. Most nets were in a condition likely to offer protection against mosquito biting. Villagers appreciated mainly the durability of Olyset™ nets and insecticide persistence. People disliked the small size of these nets and the light blue colour and preferred a smaller mesh size, features that can easily be modified. At equal price, 51% said they would prefer to buy an Olyset™ net and 49% opted for an ordinary polyester net. The average permethrin content was 33%-41% of the initial insecticide dose of 20,000 mg/Kg. Bioassay results indicated high knock-down rates at 60 minutes, but the mosquito mortality after 24 hours was rather low (mean: 34%. No significant correlation was found between bioassay results and insecticide concentration in and on the net. Conclusions Olyset™ nets are popular, durable and with a much longer insecticide persistence than ordinary polyester nets. Hence, Olyset™ nets are one of the best choices for ITN programmes in rural malaria-endemic areas.
Mbunde, Mourice Victor Nyangabo; Innocent, Ester; Mabiki, Faith; Andersson, Pher G.
Background/Aim: Some of the antifungal drugs used in the current treatments regime are responding to antimicrobial resistance. In rural areas of Southern Tanzania, indigenous people use antifungal drugs alone or together with medicinal plants to curb the effects of antibiotic resistance. This study documented ethnobotanical information of medicinal plants used for managing fungal infections in the Southern Highlands of Tanzania and further assess their safety. Materials and Methods: Ethnobotanical survey was conducted in Makete and Mufindi districts between July 2014 and December 2015 using semi-structured questionnaires followed by two focus group discussions to verify respondents’ information. Cytotoxicity study was conducted on extracts of collected plants using brine shrimp lethality test and analyzed by MS Excel 2013 program. Results: During this survey about 46 plant species belonging to 28 families of angiosperms were reported to be traditionally useful in managing fungal and other health conditions. Among these, Terminalia sericea, Aloe nutii, Aloe lateritia, Zanthoxylum chalybeum, Zanthoxylum deremense, and Kigelia africana were frequently mentioned to be used for managing fungal infections. The preparation of these herbals was mostly by boiling plant parts especially the leaves and roots. Cytotoxicity study revealed that most of the plants tested were nontoxic with LC50 > 100 which implies that most compounds from these plants are safe for therapeutic use. The dichloromethane extract of Croton macrostachyus recorded the highest with LC50 value 12.94 µg/ml. The ethnobotanical survey correlated well with documented literature from elsewhere about the bioactivity of most plants. Conclusions: The ethnobotanical survey has revealed that traditional healers are rich of knowledge to build on for therapeutic studies. Most of the plants are safe for use; and thus can be considered for further studies on drug discovery. PMID:28163965
Kate Orkin; St. Antony's College, University of Oxford; Department for International Development:, (DFID)
Participation in work and school are often assumed to be mutually exclusive. Thus, economists commonly present children’s work and study patterns as a competition over time. In this paper, it is not the time involved, but the characteristics of the activity that appear to influence complementary or competitive relationship between work and school. This mixed methods study combines qualitative data from Leki, a field site in a rural area near lake Ziway in the Oromia region, Ethiopia, and ...
dence in December 1961 under the leadership of Mwalimu Julius Nyerere. The transition ..... declared the CCM presidential candidate, Salmin Armour, as duly elected ..... The issue of the electoral politics and conflict management in Tanzania,.
INTRODUCTION Tanzania with a total production of 6.2 million tonnes in 1998 ... The International Institute of Tropical ..... representative for the stage when plants were collected (ca. 5 MAP) ..... bean landraces from Chile based on RAPD.
May 1, 2013 ... Surgeon, Canadian Network for International Surgery, Vancouver, Canada, ... Institute, Morogoro, Mtwara, Kigoma, Musoma regional hospitals and Korogwe ... Conclusion: Injuries in Tanzania are an important public health ...
We reviewed published literature on water resources ... to have sustainable agricultural production for the reduction of poverty ... health, tourism, coastal development, and biodiversity ...... Tanzania: Centre for Energy, Environment,. Science ...
US Agency for International Development — MEMS II is a two-year project to enable USAID/Tanzania and a number of its partners to meet their multifold performance reporting responsibilities; upgrade,...
Teaching 'natural product chemistry' in Tanzania. ... PROMOTING ACCESS TO AFRICAN RESEARCH. AFRICAN JOURNALS ONLINE (AJOL) · Journals ... Natural products 'historically' and 'today' have vast importance. This article describes ...
Mboya, Beati; Temu, Florence; Awadhi, Bayoum; Ngware, Zubeda; Ndyetabura, Elly; Kiondo, Gloria; Maridadi, Janneth
Introduction Currently, Tanzania's HIV prevalence is 5.7%. Gender inequality and Gender Based Violence (GBV) are among factors fuelling the spread of HIV in Tanzania. This study was conducted to assess universal access to HIV prevention services among GBV survivors in Iringa and Dar-es-Salaam where HIV prevalence is as high as 14.7% and 9% respectively compared to a national average of 5.7%. Methods In 2010, a mixed methods study using triangulation model was conducted in Iringa and Dar-es-Sa...
Swai, Emanuel S; Schoonman, Luuk; Daborn, Chris J
Zoonoses are infections naturally transmitted between vertebrate animals and humans. An exploratory questionnaire-based survey of animal health workers(n=36) and livestock keepers(n=43) was carried out from April 2001 to March 2002 in Tanga and Arusha regions, northern Tanzania, to assess local knowledge, attitudes and public awareness for animal zoonoses. A combination of closed and open-ended questions, focus group discussions and ranking techniques were employed to gather information on perceptions concerning the type of zoonotic diseases prevalent in the study area, level of risk, mode of transmission and methods of preventing disease transmission from animals to humans. The results demonstrated that rabies, tuberculosis and anthrax were considered the three most common zoonotic diseases. Sharing living accommodation with animals, consumption of un-treated livestock products (i.e. milk, meat or eggs) and attending to parturition were perceived as routes of transmission. Knowledge about zoonosis was higher in smallholder dairy (92%; 33/36) than traditional livestock keepers (Pzoonosis was significantly higher in traditional livestock (86%; 6/7) than smallholder dairy keepers (Pzoonosis by farm location revealed that rural farms (85%; 7/8) were considered significantly at a higher risk when compared to peri or urban located farms (P<0.05). Most of the respondents stated cooking of meat or boiling of milk as a way to prevent transmission. However, there was a significant difference in the perception of the risk posed by contact with potentially infected animals /or animal products with animal health workers having a much higher level of perception compared to livestock keepers. These results suggest that in the Tanga and Arusha, Tanzania, patchy awareness and knowledge of zoonoses, combined with food consumption habits and poor animal husbandry are likely to expose respondents to an increased risk of contracting zoonoses. Public health promotion on education and
Nakalembe, C. L.; Dempewolf, J.; Justice, C. J.; Becker-Reshef, I.; Tumbo, S.; Maurice, S.; Mbilinyi, B.; Ibrahim, K.; Materu, S.
In Tanzania agricultural extension agents traditionally collect field data on agriculture and food security on paper, covering most villages throughout the country. The process is expensive, slow and cumbersome and prone to data transcription errors when the data get entered at the district offices into electronic spreadsheets. Field data on the status and condition of agricultural crops, the population's nutritional status, food storage levels and other parameters are needed in near realtime for early warning to make critical but most importantly timely and appropriate decisions that are informed with verified data from the ground. With the ubiquitous distribution of cell phones, which are now used by the vast majority of the population in Tanzania including most farmers, new, efficient and cost-effective methods for field data collection have become available. Using smartphones and tablets data on crop conditions, pest and diseases, natural disasters and livelihoods can be collected and made available and easily accessible in near realtime. In this project we implemented a process for obtaining high quality electronic field data using the GeoODK application with a large network of field extension agents in Tanzania and Uganda. These efforts contribute to work being done on developing an advanced agriculture monitoring system for Tanzania, incorporating traditional data collection with satellite information and field data. The outcomes feed directly into the National Food Security Bulletin for Tanzania produced by the Ministry of Agriculture as well as a form a firm evidence base and field scale monitoring of the disaster risk financing in Uganda.
Full Text Available Europe is characterised by a rich net of itineraries that during the Middle Ages were taken by pilgrims head toward the holy places of Christianity. In Italy the main pilgrimage route is the Via Francigena (the road that comes from France, which starts from Canterbury and arrives in Rome, running through Europe for about 1800 km. Municipalities and local associations are focused on purposes and actions aimed at the promotion of those routes, rich in history and spirituality. Also for the European Union the enhancement of those itineraries, nowadays used both by pilgrims and tourists, is crucial, as shown by the various projects aimed at the identification of tools for the development of sustainable cultural tourism. It is important to understand how landscape, that according to the European Landscape Convention reflects the sense of places and represents the image of their history, has evolved along those roads, and to analyse the relationships between the built and natural environments, since they maintain a remarkable symbolic connection between places and peoples over time and history. This study focuses on the Italian section of the Via Francigena that crosses the Emilia-Romagna region, in the province of Piacenza. A land classification method is proposed, with the aim to take into account different indicators: land zoning provided by regional laws, elements of relevant historical and natural value, urban elements, type of agriculture. The analyses are carried out on suitable buffers around the path, thus allowing to create landscape profiles. As nature is a key element for the spirituality character of these pilgrimage routes, the classification process takes into account both protected and other valuable natural elements, besides agricultural activities. The outcomes can be useful to define tools aimed to help pilgrims and tourists to understand the surrounding places along their walk, as well as to lend support to rural and urban planning
Hutton, Mary Olivia; Leach, Allison M.; Leip, Adrian; Galloway, James N.; Bekunda, Mateete; Sullivan, Clare; Lesschen, Jan Peter
We present the first nitrogen footprint model for a developing country: Tanzania. Nitrogen (N) is a crucial element for agriculture and human nutrition, but in excess it can cause serious environmental damage. The Sub-Saharan African nation of Tanzania faces a two-sided nitrogen problem: while there is not enough soil nitrogen to produce adequate food, excess nitrogen that escapes into the environment causes a cascade of ecological and human health problems. To identify, quantify, and contribute to solving these problems, this paper presents a nitrogen footprint tool for Tanzania. This nitrogen footprint tool is a concept originally designed for the United States of America (USA) and other developed countries. It uses personal resource consumption data to calculate a per-capita nitrogen footprint. The Tanzania N footprint tool is a version adapted to reflect the low-input, integrated agricultural system of Tanzania. This is reflected by calculating two sets of virtual N factors to describe N losses during food production: one for fertilized farms and one for unfertilized farms. Soil mining factors are also calculated for the first time to address the amount of N removed from the soil to produce food. The average per-capita nitrogen footprint of Tanzania is 10 kg N yr-1. 88% of this footprint is due to food consumption and production, while only 12% of the footprint is due to energy use. Although 91% of farms in Tanzania are unfertilized, the large contribution of fertilized farms to N losses causes unfertilized farms to make up just 83% of the food production N footprint. In a developing country like Tanzania, the main audiences for the N footprint tool are community leaders, planners, and developers who can impact decision-making and use the calculator to plan positive changes for nitrogen sustainability in the developing world.
... economic and social effects. Keywords: climate change, food security, agriculture, adaptation, Tanzania ... According to the IPCC (2008) report, global warming is already .... health in the southern highlands of Tanzania. He concluded that ...
Knopp, Stefanie; Salim, Nahya; Schindler, Tobias; Karagiannis Voules, Dimitrios A; Rothen, Julian; Lweno, Omar; Mohammed, Alisa S; Singo, Raymond; Benninghoff, Myrna; Nsojo, Anthony A; Genton, Blaise; Daubenberger, Claudia
Sensitive diagnostic tools are crucial for an accurate assessment of helminth infections in low-endemicity areas. We examined stool samples from Tanzanian individuals and compared the diagnostic accuracy of a real-time polymerase chain reaction (PCR) with the FLOTAC technique and the Kato-Katz method for hookworm and the Baermann method for Strongyloides stercoralis detection. Only FLOTAC had a higher sensitivity than the Kato-Katz method for hookworm diagnosis; the sensitivities of PCR and the Kato-Katz method were equal. PCR had a very low sensitivity for S. stercoralis detection. The cycle threshold values of the PCR were negatively correlated with the logarithm of hookworm egg and S. stercoralis larvae counts. The median larvae count was significantly lower in PCR false negatives than true positives. All methods failed to detect very low-intensity infections. New diagnostic approaches are needed for monitoring of progressing helminth control programs, confirmation of elimination, or surveillance of disease recrudescence.
Mwakyusa, Wilson Pholld; Mwalyagile, Neema Venance
It is experienced that most of the Higher Learning Institutions (HLIs) in developing countries including Tanzania fails to fully implement e-learning system as a an alternative method of delivering education to a large population in the universities. However, some of HLIs are practicing the blended method by which both elearning and traditional…
Trærup, Sara Lærke Meltofte; Mertz, Ole
Climate variability is an important stress factor for rural livelihoods in most developing countries where households have been adapting to environmental shocks for decades. Climate change results in increased variability and poses new challenges for rural livelihoods, as well as for policymakers...... in adjusting policies to changing conditions. This paper examines the potential relationships between rainfall data and household self-reported harvest shocks and local (spatial) variability of harvest shocks and coping strategies based on a survey of 2,700 rural households in the Kagera region of northern...... Tanzania. The results show that rainfall patterns in the region are very location-specific and that the distribution of household reported harvest shocks differs significantly between districts and correspond to the observed variability in local climate patterns. Coping strategies are focused on spreading...
In this article, I argue for the need to improve teacher preparation (TP) courses for elementary education student teachers to teach English-language arts (ELA). In particular, these TP programs need to support student teachers in delivering culturally responsive pedagogy within rural classrooms. Twenty-three student teachers participated in this…
Anderson, Teresa, Comp.; And Others
Compiled in July, 1971, this bibliography lists approximately 1,950 books, journal articles, and unpublished manuscripts dealing with rural development in Africa generally and in central and east Africa specifically. General entries appear under the following headings: agriculture; economic affairs; bibliography; law; economic and technical…
Kajeguka, Debora C; Kaaya, Robert D; Mwakalinga, Steven;
and chikungunya virus among participants presenting with malaria-like symptoms (fever, headache, rash, vomit, and joint pain) in three communities with distinct ecologies of north-eastern Tanzania. METHODS: Cross sectional studies were conducted among 1100 participants (aged 2-70 years) presenting with malaria....... Further analyses revealed that headache and joint pain were significantly associated with chikungunya IgM seropositivity. CONCLUSION: In north-eastern Tanzania, mainly chikungunya virus appears to be actively circulating in the population. Continuous surveillance is needed to determine the contribution...
PROMOTING ACCESS TO AFRICAN RESEARCH ... Huria: Journal of the Open University of Tanzania ... Open Access DOWNLOAD FULL TEXT ... depends on availability and effective utilization of human resources, which in turn are predicated on the level, ... in Tanzania and its contribution to the development of Tanzania.
Training Teachers in Special Needs Education in Tanzania: A Long and Challenging Ordeal to Inclusion. ... Huria: Journal of the Open University of Tanzania. Journal Home · ABOUT · Advanced Search · Current Issue · Archives ... Specifically it aimed at providing in brief, the history and the challenges that Tanzania is ...
Keller, Amélie; de Courten, Max; Dræbel, Tania
and vegetable consumption and prevalence of diet-related NCDs in Zanzibar. Methods We used mixed methods research. The quantitative part of the study is a secondary analysis of data for obesity, hypertension, diabetes, and fruit and vegetable consumption previously collected in the Zanzibar NCD STEPS survey (n...... includes ten household assessments of fruit and vegetable preparation and consumption and 20 market assessments of fruit and vegetable purchases. We did a systematic analysis of transcribed, coded data to classify themes and sub-themes. Findings Mean daily fruit intake was 72 g (SD 64, range 0...
Full Text Available Abstract Background There is a need for studies evaluating oral health related quality of life (OHRQoL of children in developing countries. Aim to assess the psychometric properties, prevalence and perceived causes of the child version of oral impact on daily performance inventory (Child-OIDP among school children in two socio-demographically different districts of Tanzania. Socio-behavioral and clinical correlates of children's OHRQoL were also investigated. Method One thousand six hundred and one children (mean age 13 yr, 60.5% girls attending 16 (urban and rural primary schools in Kinondoni and Temeke districts completed a survey instrument in face to face interviews and participated in a full mouth clinical examination. The survey instrument was designed to measure a Kiswahili translated and culturally adapted Child-OIDP frequency score, global oral health indicators and socio-demographic factors. Results The Kiswahili version of the Child-OIDP inventory preserved the overall concept of the original English version and revealed good reliability in terms of Cronbach's alpha coefficient of 0.77 (Kinondoni: 0.62, Temeke: 0.76. Weighted Kappa scores from a test-retest were 1.0 and 0.8 in Kinondoni and Temeke, respectively. Validity was supported in that the OIDP scores varied systematically and in the expected direction with self-reported oral health measures and socio-behavioral indicators. Confirmatory factor analyses, CFA, confirmed three dimensions identified initially by Principle Component Analysis within the OIDP item pool. A total of 28.6% of the participants had at least one oral impact. The area specific rates for Kinondoni and Temeke were 18.5% and 45.5%. The most frequently reported impacts were problems eating and cleaning teeth, and the most frequently reported cause of impacts were toothache, ulcer in mouth and position of teeth. Conclusion This study showed that the Kiswahili version of the Child-OIDP was applicable for use among
Renouf, Tia; Alani, Sabrina; Whalen, Desmond; Harty, Chris; Pollard, Megan; Morrison, Megan; Coombs-Thorne, Heidi; Dubrowski, Adam
To examine perceived communication barriers between urban consultants and rural family physicians practising routine and emergency care in remote subarctic Newfoundland and Labrador (NL). This study used a mixed-methods design. Quantitative and qualitative data were collected through exploratory surveys, comprised of closed and open-ended questions. The quantitative data was analysed using comparative statistical analyses, and a thematic analysis was applied to the qualitative data. 52 self-identified rural family physicians and 23 urban consultants were recruited via email. Rural participants were also recruited at the Family Medicine Rural Preceptor meetings in St John's, NL. Rural family physicians and urban consultants in NL completed a survey assessing perceived barriers to effective communication. Data confirmed that both groups perceived communication difficulties with one another; with 23.1% rural and 27.8% urban, rating the difficulties as frequent (p=0.935); 71.2% rural and 72.2% urban as sometimes (p=0.825); 5.8% rural and 0% urban acknowledged never perceiving difficulties (p=0.714). Overall, 87.1% of participants indicated that perceived communication difficulties impacted patient care. Primary trends that emerged as perceived barriers for rural physicians were time constraints and misunderstanding of site limitations. Urban consultants' perceived barriers were inadequate patient information and lack of native language skills. Barriers to effective communication are perceived between rural family physicians and urban consultants in NL. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Mmbando, Bruno Paul; Cole-Lewis, H; Sembuche, S;
at determining whether there was a difference in rates of LBW in areas of varying malaria transmission intensity in Korogwe, Tanzania. Retrospective data for one year (June 2004-May 2005) in three maternal and child health (MCH) clinics in the district were analysed. Villages were stratified into three strata......: lowlands-semi urban (average altitude of 320m), lowlands-rural (below 600m) and highlands (> or =600m). There was a significant decreasing trend of rate of LBW from rural lowlands to highlands (chi2trend = 7.335, P=0.007). Adjusting for covariates, women in parity-two were at reduced risk of delivering LBW...
Full Text Available Abstract Background Telemedicine technology can improve care to patients in rural and medically underserved communities yet adoption has been slow. The objective of this study was to study organizational readiness to participate in an academic-community hospital partnership including clinician education and telemedicine outreach focused on sepsis and trauma care in underserved, rural hospitals. Methods This is a multi-method, observational case study. Participants included staff from 4 participating rural South Carolina hospitals. Using a readiness-for-change model, we evaluated 5 general domains and the related factors or topics of organizational context via key informant interviews (n=23 with hospital leadership and staff, compared these to data from hospital staff surveys (n=86 and triangulated data with investigators’ observational reports. Survey items were grouped into 4 categories (based on content and fit with conceptual model and scored, allowing regression analyses for inferential comparisons to assess factors related to receptivity toward the telemedicine innovation. Results General agreement existed on the need for the intervention and feasibility of implementation. Previous experience with a telemedicine program appeared pivotal to enthusiasm. Perception of need, task demands and resource need explained nearly 50% of variation in receptivity. Little correlation emerged with hospital or ED leadership culture and support. However qualitative data and investigator observations about communication and differing support among disciplines and between staff and leadership could be important to actual implementation. Conclusions A mixed methods approach proved useful in assessing organizational readiness for change in small organizations. Further research on variable operational definitions, potential influential factors, appropriate and feasible methods and valid instruments for such research are needed.
The need to promote behaviour change at the cultural level: one factor explaining the limited impact of the MEMA kwa Vijana adolescent sexual health intervention in rural Tanzania. A process evaluation
Full Text Available Abstract Background Few of the many behavioral sexual health interventions in Africa have been rigorously evaluated. Where biological outcomes have been measured, improvements have rarely been found. One of the most rigorous trials was of the multi-component MEMA kwa Vijana adolescent sexual health programme, which showed improvements in knowledge and reported attitudes and behaviour, but none in biological outcomes. This paper attempts to explain these outcomes by reviewing the process evaluation findings, particularly in terms of contextual factors. Methods A large-scale, primarily qualitative process evaluation based mainly on participant observation identified the principal contextual barriers and facilitators of behavioural change. Results The contextual barriers involved four interrelated socio-structural factors: culture (i.e. shared practices and systems of belief, economic circumstances, social status, and gender. At an individual level they appeared to operate through the constructs of the theories underlying MEMA kwa Vijana - Social Cognitive Theory and the Theory of Reasoned Action – but the intervention was unable to substantially modify these individual-level constructs, apart from knowledge. Conclusion The process evaluation suggests that one important reason for this failure is that the intervention did not operate sufficiently at a structural level, particularly in regard to culture. Recently most structural interventions have focused on gender or/and economics. Complementing these with a cultural approach could address the belief systems that justify and perpetuate gender and economic inequalities, as well as other barriers to behaviour change.
Donge, van, J.K.
The research for this thesis was carried out in Tanzania during the period 1985- 89 and focuses on the Mgeta division in the Uluguru mountains, Morogoro rural district. Research was also undertaken among migrants from the area living in Dar es Salaam where they traded in foodstuffs. I made a return visit to the area in November 1991 to look again at questions which arose during writing up. The research also reflects seven years' employment at the University of Dar es Salaam (1982-89). The Tan...
Campbell Norman RC
Full Text Available Abstract Background Patients with hypertension continue to have less than optimal blood pressure control, with nearly one in five Canadian adults having hypertension. Pharmacist prescribing is gaining favor as a potential clinically efficacious and cost-effective means to improve both access and quality of care. With Alberta being the first province in Canada to have independent prescribing by pharmacists, it offers a unique opportunity to evaluate outcomes in patients who are prescribed antihypertensive therapy by pharmacists. Methods The study is a randomized controlled trial of enhanced pharmacist care, with the unit of randomization being the patient. Participants will be randomized to enhanced pharmacist care (patient identification, assessment, education, close follow-up, and prescribing/titration of antihypertensive medications or usual care. Participants are patients in rural Alberta with undiagnosed/uncontrolled blood pressure, as defined by the Canadian Hypertension Education Program. The primary outcome is the change in systolic blood pressure between baseline and 24 weeks in the enhanced-care versus usual-care arms. There are also three substudies running in conjunction with the project examining different remuneration models, investigating patient knowledge, and assessing health-resource utilization amongst patients in each group. Discussion To date, one-third of the required sample size has been recruited. There are 15 communities and 17 pharmacists actively screening, recruiting, and following patients. This study will provide high-level evidence regarding pharmacist prescribing. Trial Registration Clinicaltrials.gov NCT00878566.
Hokororo, Adolfine; Kihunrwa, Albert F; Kalluvya, Samuel; Changalucha, John; Fitzgerald, Daniel W; Downs, Jennifer A
In Tanzania, approximately 25% of adolescents give birth and 50% more become sexually active during adolescence. We hypothesised that reproductive health education and services for adolescent girls are inaccessible and conducted this study to gain insights into their perceptions of sexually transmitted infections (STIs) and barriers to reproductive health service utilisation in rural Mwanza, Tanzania. We conducted nine focus groups among pregnant adolescents aged 15-20 years. Data were transcribed, translated and coded for relevant themes using NVivo10 software for qualitative data analysis. Most participants were aware of the dangers of STIs to themselves and their unborn babies, but did not perceive themselves as at risk of acquiring STIs. They viewed condoms as ineffective for preventing STIs and pregnancies and unnecessary for those in committed relationships. Stigma, long waiting times, and lack of privacy in the clinics discouraged adolescent girls from seeking reproductive health care. Reproductive health care for adolescent girls who are not pregnant is practically nonexistent in Tanzania. Healthcare access for pregnant young women is also limited. Targeted changes to increase clinic accessibility and to provide reproductive health education to all rather than only pregnant women have the potential to address these gaps. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.
Felichesmi Selestine Lyakurwa
Full Text Available Energy access has a significant contribution to the social, economic and environmental dimensions of the human development. The access to clean and safe energy can improve the human health and quality of ecosystems by reducing the extent of pollution caused by use of inefficient cooking equipments and processes, and by slowing environmental degradation. In this paper Monte Carlo simulation was applied to evaluate the amount of crop residues available which provided the basis for the quantity of energy that can be generated from the crop residues and animal wastes in Tanzania. The amount of crop residues and animal wastes was estimated from the agricultural statistical data obtained from the Food and Agriculture Organization of the United Nations (FAO from 1961 – 2012. The analysis revealed the bioenergy potential of crop residues in Tanzania to be 5,714 TJ in 2012, which is extremely larger than the installed electric energy generation capacity of 1564 MW in 2013. Besides, the estimation of renewable energy potential of live animals indicated the ability to generate 1,397 TJ/year if exploited. Thus, effective utilization of crop residues and animal wastes without compromising the amount required for the soil fertility and animal feeds can contribute greatly to the access of safe and clean anergy for sustainable development of the rural and urban areas of Tanzania.
Mwanri, A.W.; Kinabo, J.L.; Ramaiya, K.; Feskens, E.J.M.
Aim: Hypertension during pregnancy (HDP) is one of the leading causes of maternal and perinatal mortality worldwide. This study examined prevalence and potential risk factors for HDP among pregnant women in Tanzania. Methods: We examined 910 pregnant women, aged at least 20 years, mean gestational a
Mosha, I.H.; Ruben, R.; Kakoko, D.
Background: Contraceptive use is low in developing countries which are still largely driven by male dominated culture and patriarchal values. This study explored family planning (FP) decisions, perceptions and gender dynamics among couples in Mwanza region of Tanzania. Methods: Twelve focus group di
Kumburu, Happiness Houka; Sonda, Tolbert; Mmbaga, Blandina Theophil
Objective To determine the causative agents of infections and their antimicrobial susceptibility at a tertiary care hospital in Moshi, Tanzania, to guide optimal treatment. Methods A total of 590 specimens (stool (56), sputum (122), blood (126) and wound swabs (286)) were collected from 575 patie...
Mkumbo, Kitila A. K.
Objective: The objective of this paper was to assess students' attitudes towards school-based sex and relationships education (SRE). Design: This study featured a cross-sectional survey design. Method: A sample of 715 students from two districts in Tanzania completed a survey questionnaire assessing various aspects related to their attitudes…
THIS REPORT ON THE SALIENT FEATURES AND CONCERNS OF CORRESPONDENCE INSTRUCTION IN ETHIOPIA, KENYA, TANZANIA, MALAWI, ZAMBIA, AND UGANDA--(1) DISCUSSES ADVANTAGES, DISADVANTAGES, AND REQUIREMENTS OF THE CORRESPONDENCE METHOD IN AN AFRICAN CONTEXT, (2) SURVEYS CONDITIONS AND FACILITIES (POSTAL SERVICES, ROADS, INSTRUCTIONAL RADIO AND TELEVISION,…
Eijck, van J.
This study analyses the recent emergence of a biofuels sector in Tanzania. The focus is on 'Jatropha curcas', an oil-bearing plant that is widely seen as having great potential as an energy crop throughout the developing world. Using the Strategic Niche Management research method, designed to
Kifaro, Emmanuel G; Nkangaga, Japhet; Joshua, Gradson; Sallu, Raphael; Yongolo, Mmeta; Dautu, George; Kasanga, Christopher J
Rift Valley fever virus (RVFV) is an acute, zoonotic viral disease caused by a Phlebovirus, which belongs to the Bunyaviridae family. Among livestock, outbreaks of the disease are economically devastating. They are often characterised by large, sweeping abortion storms and have significant mortality in adult livestock. The aim of the current study was to investigate RVFV infection in the Kigoma region, which is nestled under the hills of the western arm of the Great Rift Valley on the edge of Lake Tanganyika, Tanzania. A region-wide serosurvey was conducted on non-vaccinated small ruminants (sheep and goats, n = 411). Sera samples were tested for the presence of anti-RVFV antibodies and viral antigen, using commercial enzyme-linked immunosorbent assay and reverse transcriptase polymerase chain reaction, respectively. The overall past infections were detected in 22 of the 411 animals, 5.4% (Confidence Interval (CI) 95% = 3.5% - 8.1%). The Kigoma rural area recorded the higher seroprevalence of 12.0% (CI 95% = 7.3% - 18.3%; p 0.05) and the Kasulu district at 0.8% (CI 95% = 0.0% - 4.2%; p > 0.05). The prevalence was 12.5% and 4.7% for sheep and goats, respectively. Reverse transcriptase polymerase chain reaction results indicated that only eight samples were found to be positive (n = 63). This study has confirmed, for the first time, the presence of the RVFV in the Kigoma region four years after the 2007 epizootic in Tanzania. The study further suggests that the virus activity exists during the inter-epizootic period, even in regions with no history of RVFV.
Conditional cash transfer programs are often used to encourage poor families to take young children for regular health check-ups and enroll them in school decision making. Can cash transfers successfully cut transmission of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) by reducing risky sexual behaviors? How can these programs be structured for maximum im...
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HEAVY METALS IN GREEN VEGETABLES AND SOILS. FROM VEGETABLE .... 2/TM supplied by the International Atomic Energy Agency (IAEA), Monaco. 39 ..... 12: 213-216. Furr AK, Kelly WC, Backe CA, Gutenmann WH and Lish DJ 1976.
Full Text Available The paper stresses on understanding factors affecting development of citrus industry in Tanzania particularly in Muheza District, in Tanga region. Citrus fruit is one of the most important crops in Muheza District of Tanga region in Tanzania particularly in improving rural farmers’ income. The study employed institutional framework methodology. The study disclosed that the government of Tanzania has been implementing various agricultural development programmes in improving citrus fruit production as well as to enhance farmers’ income. However, yet the results reveal that the citrus farming practices in the surveyed area are not well developed. And these are because citruses are still grown under rain fed regime without any form of irrigation, citrus seedlings are produced by individual farmers locally in their backyard nurseries. There is no professional company responsible for seedling production. Also, citrus farmers’ skills in citrus husbandry practices are limited. Lastly, all citrus varieties used contain many seeds in the citrus fruits whereas the market demands seedless citrus fruits. It is therefore, recommended that the policy maker should focus on development of citrus industry in Tanzania using proper institutional framework support, which could increase growth and development of citrus production through the provision of subsides for inputs to reduce cost of production and enlightenment campaigns to improve farmer’s knowledge and technical skills on how to reach lucrative markets.
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AJRH Managing Editor
Africa and Asia accounting for 50% and 45% of the cases ... was supported by a study conducted in the USA which showed a ... whereas increased parity conferred increasing .... The literacy rate in this area has been ... interest. The causes of deaths in the HDSS had already been determined by the physicians using.
Kandi Catherine Muze
Full Text Available Tanzania is located in east Africa with a population of 45 million. The country′s population is growing at 2.5% annually. The International Diabetes Federation Child Sponsorship Program was launched in Tanzania in 2005. The number of type 1 diabetes mellitus children enrolled in the changing diabetes in children program in Tanzania has augmented from almost below 50 in 2005 to over 1200 in 2014. The country had an overall trend of HbA1c value of 14% in 2005 while the same has reduced over the years to 10% in 2012-13. The program has been able to reduce the proportion of patients with HbA1c values of 11-14%; from 71.9% in 2008 to 49.8% in 2012-13. The challenges, which CDiC faces are misdiagnosis, low public awareness, and stigma especially in the reproductive age/adolescent groups.
Nandlal B, Karthikeya Patil, Ravi S
Full Text Available Introduction: Teeth and dental restorations are resistant to destruction by fire and the elements are therefore useful in identification. This permits accurate identification of a missing child or remains. The Rural Residential free school at Suttur houses a large number of inmates and hence dental records are kept for their identification. Objective: Estimation of Age of children. Methods: Orthopantomographs were used to study for estimation of age of children, using a Nolla’s method of dental age estimation. Results: In this study Nolla’s method underestimated the chronological age of the individuals and underestimation of age increased as the chronological age of the individuals increased. Conclusion: Studies involving larger sample size and population specific data needs to be developed.
Christenson, Elizabeth; Elliott, Mark; Banerjee, Ovik; Hamrick, Laura; Bartram, Jamie
Global climate change (GCC) has led to increased focus on the occurrence of, and preparation for, climate-related extremes and hazards. Population exposure, the relative likelihood that a person in a given location was exposed to a given hazard event(s) in a given period of time, was the outcome for this analysis. Our objectives were to develop a method for estimating the population exposure at the country level to the climate-related hazards cyclone, drought, and flood; develop a method that readily allows the addition of better datasets to an automated model; differentiate population exposure of urban and rural populations; and calculate and present the results of exposure scores and ranking of countries based on the country-wide, urban, and rural population exposures to cyclone, drought, and flood. Gridded global datasets on cyclone, drought and flood occurrence as well as population density were combined and analysis was carried out using ArcGIS. Results presented include global maps of ranked country-level population exposure to cyclone, drought, flood and multiple hazards. Analyses by geography and human development index (HDI) are also included. The results and analyses of this exposure assessment have implications for country-level adaptation. It can also be used to help prioritize aid decisions and allocation of adaptation resources between countries and within a country. This model is designed to allow flexibility in applying cyclone, drought and flood exposure to a range of outcomes and adaptation measures.
Wilkinson, Andra; Pettifor, Audrey; Rosenberg, Molly; Halpern, Carolyn; Thirumurthy, Harsha; Collinson, Mark A.; Kahn, Kathleen
South Africa has high youth unemployment. This paper examines the predictors of youth employment in rural Agincourt, Mpumalanga Province. A survey of 187 out-of-school 18–24 year olds found only 12% of women and 38% of men were currently employed. Men with skills/training were significantly more likely to report employment, mostly physical labour (aOR: 4.5; CI: 1.3, 15.3). In-depth interviews with 14 of the youth revealed women are perceived more suitable for formal employment, which is scarce informing why women were more likely to pursue further education and yet less likely to be employed. Ten key informants from local organisations highlighted numerous local youth employment resources while, in contrast, all youth in the sample said no resources were available, highlighting a need for the organisations to extend their services into rural areas. As these services are focused on entrepreneurship, programs to increase financial literacy and formal employment opportunities are also needed. PMID:28190915
Wilkinson, Andra; Pettifor, Audrey; Rosenberg, Molly; Halpern, Carolyn; Thirumurthy, Harsha; Collinson, Mark A; Kahn, Kathleen
South Africa has high youth unemployment. This paper examines the predictors of youth employment in rural Agincourt, Mpumalanga Province. A survey of 187 out-of-school 18-24 year olds found only 12% of women and 38% of men were currently employed. Men with skills/training were significantly more likely to report employment, mostly physical labour (aOR: 4.5; CI: 1.3, 15.3). In-depth interviews with 14 of the youth revealed women are perceived more suitable for formal employment, which is scarce informing why women were more likely to pursue further education and yet less likely to be employed. Ten key informants from local organisations highlighted numerous local youth employment resources while, in contrast, all youth in the sample said no resources were available, highlighting a need for the organisations to extend their services into rural areas. As these services are focused on entrepreneurship, programs to increase financial literacy and formal employment opportunities are also needed.
Simmons, L A; Huddleston-Casas, C A; Morgan, K A; Feldman, D
The purpose of this mixed methods study was to examine the health issues and health management strategies utilized by rural low-income women and their families to inform the design, implementation, and evaluation of health reform in rural areas of the USA. METHODS; Quantitative data was analyzed from 271 rural, low-income women and their families and qualitative data from a sub-sample of 44. Specifically explored were the: (1) types and perceived severity of health conditions rural, low-income individuals report; (2) perceived value and utilization of a usual source of care; and (3) strategies these individuals employ to manage their health. Rural American families manage multiple healthcare needs with limited resources; 42.1% reported 1-4 chronic conditions in the family, 31.4% reported 5-8 conditions, and 17.7% reported 9 or more conditions. The majority of participants (79.0%) reported having a doctor or other healthcare professional that they usually see; 61.3% reported their partners had a usual provider, and 91.7% reported their children had a usual provider. Analysis of the qualitative data revealed two main themes regarding management of health conditions: (1) lack of engagement in managing overall health; and (2) ineffective utilization of health care. Rural low-income individuals in the US may benefit from new policies that promote patient-centered, personalized care. However, any policy change must be carefully designed to consider the ways in which rural American families manage their health in order to improve individual health status and reduce rural health disparities.
Full Text Available Agriculture is the main economic activity in Tanzania and the country´s largest employer, providing livelihood for at least 80 % of the economically active population. Many studies have identified key challenges facing the sector for Africa in general – among these lack of access to knowledge. For agricultural producers, access to knowledge is important for an improved productivity and competitiveness. The fast diffusion of information and communication technologies (ICT such as mobile phones across Africa in the last years has resulted in an improved access and transfer of agricultural knowledge. Studies have shown that rural actors like farmers in remote areas even use mobile phones for their farming business. Based on qualitative interviews in the Mwanza Region in northwestern Tanzania, this study aims to identify and categorise the different types of knowledge which are transferred via mobile phones. Our results show that mobile phones enlarge the ability of farmers to access business-relevant knowledge at an increasing spatial scale. However, the effects of the use depend on the type of knowledge and other factors. The results add to existing studies by deepening the understanding of the benefits of ICT on knowledge access and transfer for the context of rural small-scale framers in Tanzania.
Trevisan, Chiara; Devleesschauwer, Brecht; Schmidt, Veronika; Winkler, Andrea Sylvia; Harrison, Wendy; Johansen, Maria Vang
Taenia solium is a zoonotic parasite prevalent in many low income countries throughout Latin America, Asia and sub-Saharan Africa, including Tanzania. The parasite is recognized as a public health threat; however the burden it poses on populations of Tanzania is unknown. The aim of this study was to estimate the societal cost of T. solium cysticercosis in Tanzania, by assessing both the health and economic burden. The societal cost of T. solium cysticercosis was assessed in humans and pigs based on data obtained by a systematic review. Experts' opinion was sought in cases where data were not retrievable. The health burden was assessed in terms of annual number of neurocysticercosis (NCC) associated epilepsy incident cases, deaths and disability-adjusted life years (DALYs), while the economic burden was assessed in terms of direct and indirect costs imposed by NCC-associated epilepsy and potential losses due to porcine cysticercosis. Based on data retrieved from the systematic review and burden assessments, T. solium cysticercosis contributed to a significant societal cost for the population. The annual number of NCC-associated epilepsy incident cases and deaths were 17,853 (95% Uncertainty Interval (UI), 5666-36,227) and 212 (95% UI, 37-612), respectively. More than 11% (95% UI, 6.3-17) of the pig population was infected with the parasite when using tongue examination as diagnostic method. For the year 2012 the number of DALYs per thousand person-years for NCC-associated epilepsy was 0.7 (95% UI, 0.2-1.6). Around 5 million USD (95% UI, 797,535-16,933,477) were spent due to NCC-associated epilepsy and nearly 3 million USD (95% UI, 1,095,960-5,366,038) were potentially lost due to porcine cysticercosis. Our results show that T. solium imposes a serious public health, agricultural and economic threat for Tanzania. We urge that a One Health approach, which involves the joint collaboration and effort of veterinarians, medical doctors, agricultural extension officers
Bynum, Ann B; Cranford, Charles O; Irwin, Cathy A; Denny, George S
Socioeconomic and demographic factors can affect the impact of telehealth education programs that use interactive compressed video technology. This study assessed program satisfaction among participants in the University of Arkansas for Medical Sciences' School Telehealth Education Program delivered by interactive compressed video. Variables in the one-group posttest study were age, gender, ethnicity, education, community size, and program topics for years 1997-1999. The convenience sample included 3,319 participants in junior high and high schools. The School Telehealth Education Program provided information about health risks, disease prevention, health promotion, personal growth, and health sciences. Adolescents reported medium to high levels of satisfaction regarding program interest and quality. Significantly higher satisfaction was expressed for programs on muscular dystrophy, anatomy of the heart, and tobacco addiction (p Education Program, delivered by interactive compressed video, promoted program satisfaction among rural and minority populations and among junior high and high school students. Effective program methods included an emphasis on participants' learning needs, increasing access in rural areas among ethnic groups, speaker communication, and clarity of the program presentation.
Ramli, Rohaini; Kasim, Maznah Mat; Ramli, Razamin; Kayat, Kalsom; Razak, Rafidah Abd
Ministry of Tourism and Culture Malaysia has long introduced homestay programs across the country to enhance the quality of life of people, especially those living in rural areas. This type of program is classified as a community-based tourism (CBT) as it is expected to economically improve livelihood through cultural and community associated activities. It is the aspiration of the ministry to see that the income imbalance between people in the rural and urban areas is reduced, thus would contribute towards creating more developed states of Malaysia. Since 1970s, there are 154 homestay programs registered with the ministry. However, the performance and sustainability of the programs are still not satisfying. There are only a number of homestay programs that perform well and able to sustain. Thus, the aim of this paper is to identify relevant criteria contributing to the sustainability of a homestay program. The criteria are evaluated for their levels of importance via the use of a modified pairwise method and analyzed for other potentials. The findings will help the homestay operators to focus on the necessary criteria and thus, effectively perform as the CBT business initiative.
Daud, Shahidah Md; Ramli, Razamin; Kasim, Maznah Mat; Kayat, Kalsom; Razak, Rafidah Abd
Tourism industry has become the highlighted sector which has amazingly increased the national income level. Despite the tourism industry being one of the highest income generating sectors, Homestay Programme as a Community-Based Tourism (CBT) product in Malaysia does not absorbed much of the incoming wealth. Homestay Programme refers to a programme in a community where a tourist stays together with a host family and experiences the everyday way of life of the family in both direct and indirect manner. There are over 100 Homestay Programme currently being registered with the Ministry of Culture and Tourism Malaysia which mostly are located in rural areas, but only a few excel and enjoying the fruit of the booming industry. Hence, this article seeks to identify the critical success factors for a Community-Based Rural Homestay Programme in Malaysia. A modified pairwise method is utilized to further evaluate the identified success factors in a more meaningful way. The findings will help Homestay Programme function as a community development tool that manages tourism resources. Thus, help the community in improving local economy and creating job opportunities.
Misinzo, G; Magambo, J; Masambu, J; Yongolo, M G; Van Doorsselaere, J; Nauwynck, H J
Outbreaks of African swine fever (ASF) have been reported in the past from several countries in sub-Saharan Africa. The aim of this study was to genotype ASF viruses (ASFVs) from the 2008 outbreak in Morogoro and Dar es Salaam regions of Tanzania. Tissue samples from domestic pigs that died as a result of severe haemorrhagic disease were collected and analysed with PCR and genome sequencing methods using ASFV-specific primer sets. Nucleotide sequence data were obtained for the B646L (p72), E183L (p54) and the variable region of the B602L gene sequences. Phylogenetic analyses based on DNA sequences showed that the 2008 Tanzanian isolates belonged to p72 genotype XV and clustered together with those derived from the 2001 outbreak in Tanzania. Analysis of the tetrameric amino acid repeat regions within the variable region of the B602L gene showed that the repeat signature of the 2008 Tanzanian ASFV was unique and contained three novel tetramers (U = NIDT/NTDT and X = NTDI). Epidemiological investigation suggested that transportation of live pigs continues to play an active role in the epidemiology of ASF in Tanzania. It is recommended that future control of ASF spread in Tanzania should focus on the early detection and confirmation of the disease, prompt institution of quarantine measures, culling and proper disposal of infected and in-contact animals and decontamination of affected premises.
Sang-kon Kim; Maeng-eon Park; Seung-gyun Baek; Kyu-youl Sung; Sun-ok Kim; Hee-yul Park
Chemical composition, Raman microspectrometry, and Fourier transform infrared (FT-IR) and SEM-CL (Cathodluminescence) analyses are carried out for Tanzania and Madagascar garnets for locality identification. Inclusion study was sustained after electron probe microanalysis (EPMA). Needle-like illmenites, apatites and zircons were the most common solid inclusions in Tanzania garnets. Madagascar garnets revealed rutile needles and apatites were also observed, but differences in size, shape and distribution patterns were noticed compared to Tanzania garnets. Tanzania garnets exhibited all types of observable fluid inclusions such as "fingerprint" pattern, called Type Ⅰ-A, liquid-only (L) single phase fluid inclusion, called Type Ⅰ-B and Type Ⅱ-A (L + S), Type Ⅱ-B (L + V) and Type Ⅲ-A (L + Sylvite +S), Type Ⅲ-B (L+S+V), while no more than two phase fluid inclusions found in both Madagascar and Korea garnets even if all examined garnets from three localities retained "fingerprint" features, so called, partially healed fractures, in common. Chemical composition, Raman microspectrometry and Fourier transform infrared (FT-IR) analysis taken turned out to be useful methods for the purpose of this study. Using consequences of SEM-CL and inclusion study, accordingly,the locality identification of gem-quality garnets is capable of being available in further application for other kinds of gemstones.
Goüy de Bellocq, Joëlle; Borremans, Benny; Katakweba, Abdul; Makundi, Rhodes; Baird, Stuart J. E.; Becker-Ziaja, Beate; Günther, Stephan; Leirs, Herwig
To determine the specificity of Morogoro virus for its reservoir host, we studied its host range and genetic diversity in Tanzania. We found that 2 rodent species other than Mastomys natalensis mice carry arenaviruses. Analysis of 340 nt of the viral RNA polymerase gene showed sympatric occurrence of 3 distinct arenaviruses.
The Laetolil Beds in Tanzania, 20-30 miles south of Olduvai Gorge, have been extensively sampled by parties under the leadership of Mrs. Dr. Mary D. Leakey, who very kindly sent me Hipparion material collected in 1974, 1975, and 1976. In a restudy of proboscidean material from these beds described
The main aim of this thesis was to describe and assess the efficacy of the Patient-Centred Treatment (PCT) strategy for the delivery and supervision of tuberculosis (TB) treatment as implemented by the National Tuberculosis and Leprosy programme of Tanzania. The studies presented in this thesis show
31 No. 7. Regional Dermatology Training Centre in Moshi, Tanzania – pursuing a dream ... little training in the management of skin disease. ... through lack of trained personnel or resources ... With time, other facilities such as a library, a pharmaceutical compounding ... of information on dermatology and STIs in a tropical ...
The Laetolil Beds in Tanzania, 20-30 miles south of Olduvai Gorge, have been extensively sampled by parties under the leadership of Mrs. Dr. Mary D. Leakey, who very kindly sent me Hipparion material collected in 1974, 1975, and 1976. In a restudy of proboscidean material from these beds described b
Schistosomiasis is a helminthic worm infection that affects 260 million people worldwide, 90% of whom live in sub-Saharan Africa. In Tanzania, where the research in this thesis was conducted, two species of schistosomes are highly endemic (Schistosoma haematobium and S. mansoni), with more than 50%
Laudisoit, Anne; Leirs, Herwig; Makundi, Rhodes H
Domestic fleas were collected in 12 villages in the western Usambara Mountains in Tanzania. Of these, 7 are considered villages with high plague frequency, where human plague was recorded during at least 6 of the 17 plague seasons between 1986 and 2004. In the remaining 5 villages with low plague...
de Bellocq, Joëlle Goüy; Borremans, Benny; Katakweba, Abdul
To determine the specificity of Morogoro virus for its reservoir host, we studied its host range and genetic diversity in Tanzania. We found that 2 rodent species other than Mastomys natalensis mice carry arenaviruses. Analysis of 340 nt of the viral RNA polymerase gene showed sympatric occurrence...
Full Text Available Abstract Background Early and frequent antenatal care attendance during pregnancy is important to identify and mitigate risk factors in pregnancy and to encourage women to have a skilled attendant at childbirth. However, many pregnant women in sub-Saharan Africa start antenatal care attendance late, particularly adolescent pregnant women. Therefore they do not fully benefit from its preventive and curative services. This study assesses the timing of adult and adolescent pregnant women's first antenatal care visit and identifies factors influencing early and late attendance. Methods The study was conducted in the Ulanga and Kilombero rural Demographic Surveillance area in south-eastern Tanzania in 2008. Qualitative exploratory studies informed the design of a structured questionnaire. A total of 440 women who attended antenatal care participated in exit interviews. Socio-demographic, social, perception- and service related factors were analysed for associations with timing of antenatal care initiation using regression analysis. Results The majority of pregnant women initiated antenatal care attendance with an average of 5 gestational months. Belonging to the Sukuma ethnic group compared to other ethnic groups such as the Pogoro, Mhehe, Mgindo and others, perceived poor quality of care, late recognition of pregnancy and not being supported by the husband or partner were identified as factors associated with a later antenatal care enrolment (p Conclusions Factors including poor quality of care, lack of awareness about the health benefit of antenatal care, late recognition of pregnancy, and social and economic factors may influence timing of antenatal care. Community-based interventions are needed that involve men, and need to be combined with interventions that target improving the quality, content and outreach of antenatal care services to enhance early antenatal care enrolment among pregnant women.
Njau, B; Watt, M H; Ostermann, J; Manongi, R; Sikkema, K J
It is estimated that 5.6% of the Tanzanian population ages 15-49 are infected with HIV, but only 30% of adults have ever had an HIV test. Couples' testing has proven to increase testing coverage and introduce HIV prevention, but barriers include access to testing services and unequal gender dynamics in relationships. Innovative approaches are needed to address barriers to couple's testing and increase uptake of HIV testing. Using qualitative data collection methods, a formative study was conducted to assess the acceptability of a home-based couples counseling and testing (HBCCT) approach. Eligible study participants included married men and women, HIV-infected individuals, health care and home-based care providers, voluntary counseling and testing counselors, and community leaders. A total of 91 individuals participated in focus group discussions (FGDs) and in-depth interviews conducted between September 2009 and January 2010 in rural settings in Northern Tanzania. An HBCCT intervention appears to be broadly acceptable among participants. Benefits of HBCCT were identified in terms of access, confidentiality, and strengthening the relationship. Fears of negative consequences from knowing one's HIV status, including stigma, blame, physical abuse, or divorce, remain a concern and a potential barrier to the successful provision of the intervention. Lessons for implementation highlighted the importance of appointments for home visits, building relationships of confidence and trust between counselors and clients, and assessing and responding to a couple's readiness to undergo HIV testing. HBCCT should addresses HIV stigma, emphasize confidentiality, and improve communication skills for disclosure and decision-making among couples.
Mahmud Khan, M; Hotchkiss, David R; Berruti, Andrés A; Hutchinson, Paul L
Previous studies have consistently found an inverse relationship between household-level poverty and health status. However, what is not well understood is whether and how the average economic status at the community level plays a role in the poverty-health relationship. The purpose of this study is to investigate the concentration of poverty at the community level in Tanzania and its association with the availability and quality of primary health care services, the utilization of services, and health outcomes among household categories defined by wealth scores. A principal component method has been applied to rank households separately by urban/rural location using reported levels of asset ownership and living conditions. The household wealth scores were also used to classify communities into three cluster-types based on the proportion of households belonging to the poorest wealth tercile. On average, all the wealth terciles living in low poverty concentration areas were found to have better health outcomes and service utilization rates than their counterparts living in high poverty concentration clusters. Consistent with the finding is that high poverty concentration areas were further away from facilities offering primary health care than low poverty concentration areas. Moreover, the facilities closest to the high poverty concentration areas had fewer doctors, medical equipment and drugs. Among the high poverty concentration clusters, the 10 communities with the best women's body mass index (BMI) measures were found to have access to facilities with a greater availability of equipment and drugs than the 10 communities with the worst BMI measures. Although this study does not directly measure quality, the characteristics that differentiate high poverty concentration clusters from low poverty concentration clusters point to quality as more important than physical access among the study population.
Assessing performance enhancing tools: experiences with the open performance review and appraisal system (OPRAS and expectations towards payment for performance (P4P in the public health sector in Tanzania
Full Text Available Abstract Background Health workers’ motivation is a key determinant of the quality of health services, and poor motivation has been found to be an obstacle to service delivery in many low-income countries. In order to increase the quality of service delivery in the public sector in Tanzania, the Open Performance Review and Appraisal System (OPRAS has been implemented, and a new results-based payment system, Payment for performance (P4P is introduced in the health sector. This article addresses health workers’ experiences with OPRAS, expectations towards P4P and how lessons learned from OPRAS can assist in the implementation of P4P. The broader aim is to generate knowledge on health workers’ motivation in low-income contexts. Methods A qualitative study design has been employed to elicit data on health worker motivation at a general level and in relation to OPRAS and P4P in particular. Focus group discussions (FGDs and in-depth interviews (IDIs have been conducted with nursing staff, clinicians and administrators in the public health sector in a rural district in Tanzania. The study has an ethnographic backdrop based on earlier long-term fieldwork in Tanzania. Results Health workers evaluated OPRAS and P4P in terms of the benefits experienced or expected from complying with the tools. The study found a general reluctance towards OPRAS as health workers did not see OPRAS as leading to financial gains nor did it provide feedback on performance. Great expectations were expressed towards P4P due to its prospects of topping up salaries, but the links between the two performance enhancing tools were unclear. Conclusions Health workers respond to performance enhancing tools based on whether the tools are found appropriate or yield any tangible benefits. The importance placed on salary and allowances forms the setting in which OPRAS operates. The expected addition to the salary through P4P has created a vigorous discourse among health workers
Full Text Available Abstract Background Early childhood caries (ECC is a serious problem that has remained unexplored in sub-Saharan Africa. This study aimed to identify possible socio-behavioral correlates of ECC focusing 6–36 months old children and their caretakers. Methods Cross sectional studies were conducted in a high fluoride rural area, Manyara, Tanzania and a low fluoride urban area, Kampala, Uganda. Totals of 1221 and 816 child - caretaker pairs attending health care facilities for growth monitoring were recruited in Manyara and Kampala, respectively. All caretakers completed face to face interviews at the health care facility. Children underwent oral clinical examination whereby ECC and Enamel hypoplasia were recorded using the dmft (WHO 1997 and the DDE index (FDI 1992. Results The prevalence of ECC was 3.7% in Manyara and 17.6% in Kampala. According to multiple logistic regression analyses, received oral health information from health worker was the strongest determinant of ECC in Manyara, adjusted OR 0.3, 95% CI 0.09 – 0.93. In Kampala, visible plaque, high sugar intake and presence of enamel hypoplasia associated with ECC, adjusted ORs 2.8 (95% CI 1.61- 4.95, 3.0 (95% CI 1.39 – 6.34 and 2.3 (95% CI 1.36 - 3.95. Conclusion Oral health education aimed at caretakers of 6–36 months, including health care workers’ information regarding the detrimental consequences for oral health of frequent sugar consumption and poor oral hygiene is important for prevention of ECC in Tanzania and Uganda.
Sweat, Michael; Morin, Stephen; Celentano, David; Mulawa, Marta; Singh, Basant; Mbwambo, Jessie; Kawichai, Surinda; Chingono, Alfred; Khumalo-Sakutukwa, Gertrude; Gray, Glenda; Richter, Linda; Kulich, Michal; Sadowski, Andrew; Coates, Thomas
SUMMARY BACKGROUND HIV counseling and testing is the gateway to treatment and care and provides important preventative and personal benefits to recipients. However, in developing countries the majority of HIV infected persons have not been tested for HIV. Combining community mobilization, mobile community-based HIV testing and counseling, and post-test support may increase HIV testing rates. METHODS We randomly assigned half of 10 rural communities in Tanzania, 8 in Zimbabwe, and 14 in Thailand to receive a multiple component community-based voluntary counseling and testing (CBVCT) intervention together with access to standard clinic-based voluntary counseling and testing (SVCT). The control communities received only SVCT. The intervention was provided for approximately 3 years. The primary study endpoint is HIV incidence and is pending completion of the post-intervention assessment. This is a descriptive interim analysis examining the percentage of the total population aged 16–32 years tested for HIV across study arms, and differences in client characteristics by study arm. FINDINGS A higher percentage of 16–32 year-olds were tested in intervention communities than in control communities (37% vs. 9% in Tanzania; 51% vs. 5% in Zimbabwe; and 69% vs. 23% in Thailand). The mean difference between the percentage of the population tested in CBVCT versus SVCT communities was 40.4% across the 3 country study arm pairs, (95% CI 15.8% – 64.7%, p-value 0.019, df=2). Despite higher prevalence of HIV among those testing at SVCT venues the intervention detected 3.6 times more HIV infected clients in the CBVCT communities than in SVCT communities (952 vs. 264, pHIV by the end of the intervention period. INTERPRETATION This multiple component, community-level intervention is effective at both increasing HIV testing rates and detecting HIV cases in rural settings in developing countries. PMID:21546309
Full Text Available Abstract Background Clefts of the lip (CL, the palate (CP, or both (CLP are the most common orofacial congenital malformations found among live births, accounting for 65% of all head and neck anomalies. The frequency and pattern of orofacial clefts in different parts of the world and among different human groups varies widely. Generally, populations of Asian or Native American origin have the highest prevalence, while Caucasian populations show intermediate prevalence and African populations the lowest. To date, little is known regarding the epidemiology and pattern of orofacial clefts in Tanzania. Methods A retrospective descriptive study was conducted at Bugando Medical Centre to identify all children with orofacial clefts that attended or were treated during a period of five years. Cleft lip and/or palate records were obtained from patient files in the Hospital's Departments of Surgery, Paediatrics and medical records. Age at presentation, sex, region of origin, type and laterality of the cleft were recorded. In addition, presence of associated congenital anomalies or syndromes was recorded. Results A total of 240 orofacial cleft cases were seen during this period. Isolated cleft lip was the most common cleft type followed closely by cleft lip and palate (CLP. This is a departure from the pattern of clefting reported for Caucasian and Asian populations, where CLP or isolated cleft palate is the most common type. The distribution of clefts by side showed a statistically significant preponderance of the left side (43.7% (χ2 = 92.4, p Conclusions Unilateral orofacial clefts were significantly more common than bilateral clefts; with the left side being the most common affected side. Most of the other findings did not show marked differences with orofacial cleft distributions in other African populations.
Key words: Environmental degradation, intrahousehold labour allocation, intrahousehold welfare. Rural south Pare highlands in Tanzania experience a deteriorating environmental situation. Of particular importance is the disappearance of forests and woodlands. The consequence are declining amounts and reliability of rainfall, declining amounts of water levels and loss of biodiversity. Deterioration of environmental resources increases costs of collecting environmental products, which in many re...
Ji, Xiang; Liu, Li-Ming; Li, Hong-Qing
Taking Jinjing Town in Dongting Lake area as a case, this paper analyzed the evolution of rural landscape patterns by means of life cycle theory, simulated the evolution cycle curve, and calculated its evolution period, then combining CA-Markov model, a complete prediction model was built based on the rule of rural landscape change. The results showed that rural settlement and paddy landscapes of Jinjing Town would change most in 2020, with the rural settlement landscape increased to 1194.01 hm2 and paddy landscape greatly reduced to 3090.24 hm2. The quantitative and spatial prediction accuracies of the model were up to 99.3% and 96.4%, respectively, being more explicit than single CA-Markov model. The prediction model of rural landscape patterns change proposed in this paper would be helpful for rural landscape planning in future.
Based on summarizing the research on the division of urban and rural areas, this paper defines the attributes of "cities" and "villages", and establishes a set of methods for the division of urban and rural areas based on multi-layer conditions and related indicator system. By using the method based on multi-layer condition, in combination with cumulative percentage and other mathematical methods, adopting the spatial comparison method by using Google Earth satellite images, the optimal threshold is decided through multi-condition screening and then the definitional standards are confirmed. This paper divides the urban and rural areas by selecting Xi'an city as the research area. The divided results compare to the results concluded by the National Bureau of Statistics of the People's Republic of China. It is found that the urbanization rate is reduced by 3.24%. Through overlapping comparison of satellite remote sensing images, it is proven that the feasibility and sophistication of the methods for the division of urban and rural areas through screening multiple conditions. Table Comparing the statistical methods and the research results. Discrepancy indicators Division results (cities and towns) by the Plan Division rresults by the National Bureau of Statistics (cities and towns) Number of census blocks 1257 1370 Total area of cities and towns 957.34km2 1579.21km2 Population 5429354 5698970 Urbanization Rate 65.36% 68.6%
Van Dyk, FE
Full Text Available .csir.co.za Implementing farm-to-fork traceability in Tanzania Esbeth van Dyk CSIR Centre for Logistics ORSSA/SAIIE August 2005 Copyright @ CSIR 2005 www.csir.co.za Structure • Why traceability? • Legislation • Tanzania project • Recordkeeping in coffee...” Copyright @ CSIR 2005 www.csir.co.za Tanzania project Copyright @ CSIR 2005 www.csir.co.za Tanzania project • DANIDA funded (Danish government) • Business Sector Programme Support II • 4 components: Improved access to markets • 3 sub-components...
Full Text Available Abstract Background Due to escalating treatment costs, pharmacoeconomic analysis has been assigned a key role in the quest for increased efficiency in resource allocation for drug therapies in high-income countries. The extent to which pharmacoeconomic analysis is employed in the same role in low-income countries is less well established. This systematic review identifies and briefly describes pharmacoeconomic studies which have been conducted in Tanzania and further assesses their influence in the selection of essential medicines. Methods Pubmed, Embase, Cinahl and Cochrane databases were searched using “economic evaluation”, “cost-effectiveness analysis”, “cost-benefit analysis” AND “Tanzania” as search terms. We also scanned reference lists and searched in Google to identify other relevant articles. Only articles reporting full economic evaluations about drug therapies and vaccines conducted in Tanzania were included. The national essential medicine list and other relevant policy documents related to the identified articles were screened for information regarding the use of economic evaluation as a criterion for medicine selection. Results Twelve pharmacoeconomic studies which met our inclusion criteria were identified. Seven studies were on HIV/AIDS, malaria and diarrhoea, the three highest ranked diseases on the disease burden in Tanzania. Six studies were on preventive and treatment interventions targeting pregnant women and children under the age of five years. The national essential medicine list and the other identified policy documents do not state the use of economic evaluation as one of the criteria which has influenced the listing of the drugs. Conclusion Country specific pharmacoeconomic analyses are too scarce and inconsistently used to have had a significant influence on the selection of essential medicines in Tanzania. More studies are required to fill the existing gap and to explore whether decision-makers have
Sommer, Marni; Likindikoki, Samuel; Kaaya, Sylvia
The challenge of violence for youth in low-income countries includes a range of experiences from witnessing, to experiencing, to participating in violence. Although boys and young men are often the perpetrators of such violence, they may also be its victims. Yet little evidence exists from the voiced experiences of boys themselves on perceptions and interpretations of the violence around them. Given the numerous negative health implications of violence for boys, for the girls and other boys with whom they interact, and for the health of their future partners and families, we conducted an in-depth study in rural and urban Tanzania with adolescent boys on the masculinity norms shaping their transitions through puberty that might be contributing to high-risk behaviours, including engagement in violence. The findings identified underlying societal gendered norms influencing the enactment of violence, and recommendations from the boys on how to diminish the violence around them. Additional research is needed with boys on the social norms and structural factors influencing their engagement in violence.
Makuka, Gerald Jamberi; Egger, Joseph R.; Maro, Venance; Maro, Honest; Karia, Francis; Patel, Uptal D.; Burton, Matthew J.
Background In sub-Saharan Africa, diabetes is a growing burden, yet little is known about its prevalence, risk factors, and complications. To address these gaps and help inform public health efforts aimed at prevention and treatment, we conducted a community-based study assessing diabetes epidemiology. Methods and Findings We conducted a stratified, cluster-designed, serial cross-sectional household study from 2014–2015 in the Kilimanjaro Region, Tanzania. We used a three-stage cluster probability sampling method to randomly select individuals. To estimate prevalence, we screened individuals for glucose impairment, including diabetes, using hemoglobin A1C. We also screened for hypertension and obesity, and to assess for potential complications, individuals with diabetes were assessed for retinopathy, neuropathy, and nephropathy. We enrolled 481 adults from 346 urban and rural households. The prevalence of glucose impairment was 21.7% (95% CI 15.2–29.8), which included diabetes (5.7%; 95% CI 3.37–9.47) and glucose impairment with increased risk for diabetes (16.0%; 95% CI 10.2–24.0). Overweight or obesity status had an independent prevalence risk ratio for glucose impairment (2.16; 95% CI 1.39–3.36). Diabetes awareness was low (35.6%), and few individuals with diabetes were receiving biomedical treatment (33.3%). Diabetes-associated complications were common (50.2%; 95% CI 33.7–66.7), including renal (12.0%; 95% CI 4.7–27.3), ophthalmic (49.6%; 95% CI 28.6–70.7), and neurological (28.8%; 95% CI 8.0–65.1) abnormalities. Conclusions In a northern region of Tanzania, diabetes is an under-recognized health condition, despite the fact that many people either have diabetes or are at increased risk for developing diabetes. Most individuals were undiagnosed or untreated, and the prevalence of diabetes-associated complications was high. Public health efforts in this region will need to focus on reducing modifiable risk factors, which appear to include
Zhu, Chang; Justice Mugenyi, Kintu
This research examines the strengths, weaknesses, opportunities and threats (SWOT) to integrating e-learning perceived by academic staff at a university in Uganda and a university in Tanzania. Mixed-methods research was used in which a main qualitative study was complemented by a quantitative method. The sample participants were academic staff…
Zhu, Chang; Justice Mugenyi, Kintu
This research examines the strengths, weaknesses, opportunities and threats (SWOT) to integrating e-learning perceived by academic staff at a university in Uganda and a university in Tanzania. Mixed-methods research was used in which a main qualitative study was complemented by a quantitative method. The sample participants were academic staff…
Maliyamkono, T. L.
In newly independent countries where traditional theories of educational policy have continued to be followed, education has persisted as little more than a sophisticated mechanism for the recruitment of elites, and there has been an increased dependence on the advanced industrial nations for aid, experts and educational models. Tanzania, however, has attempted to break away from traditional strategies, and the author here describes and analyses the impact of two of the most far-reaching reforms — Education for Self-Reliance, and Decentralization — on national goals and policies. President Nyerere enunciated the objectives for Education for Self-Reliance in 1967 as relating education to rural life, correcting the elitist bias of education, and changing negative attitudes among students towards agriculture and rural life. Five major programmes of reform covering primary and secondary education, teacher and higher education, and examinations were to be pursued, ensuring a closer integration of schools with local communities, e.g., through school farms and co-operative shops, and making curricula directly relevant to local needs. A policy of Decentralization is being implemented, allowing, theoretically at least, a much greater participation at community level in decision-making. In primary and adult education this has already been effected to some extent, though there is evidence to suggest that decentralization in some regions and districts has resulted in the creation of local bureaucratic machinery for control, defeating the intention of the reform. Decentralization of secondary and teacher education is likely to follow, leaving only higher education centrally controlled for manpower training and allocation purposes. Finally the author discusses the question of the transferability of the Tanzanian reforms.
Full Text Available BACKGROUND: Since 2008, Tanzanian guidelines for prevention of mother-to-child-transmission of HIV (PMTCT recommend combination regimen for mother and infant starting in gestational week 28. Combination prophylaxis is assumed to be more effective and less prone to resistance formation compared to single-drug interventions, but the required continuous collection and intake of drugs might pose a challenge on adherence especially in peripheral resource-limited settings. This study aimed at analyzing adherence to combination prophylaxis under field conditions in a rural health facility in Kyela, Tanzania. METHODS AND FINDINGS: A cohort of 122 pregnant women willing to start combination prophylaxis in Kyela District Hospital was enrolled in an observational study. Risk factors for decline of prophylaxis were determined, and adherence levels before, during and after delivery were calculated. In multivariate analysis, identified risk factors for declining pre-delivery prophylaxis included maternal age below 24 years, no income-generating activity, and enrolment before 24.5 gestational weeks, with odds ratios of 5.8 (P = 0.002, 4.4 (P = 0.015 and 7.8 (P = 0.001, respectively. Women who stated to have disclosed their HIV status were significantly more adherent in the pre-delivery period than women who did not (P = 0.004. In the intra- and postpartum period, rather low drug adherence rates during hospitalization indicated unsatisfactory staff performance. Only ten mother-child pairs were at least 80% adherent during all intervention phases; one single mother-child pair met a 95% adherence threshold. CONCLUSIONS: Achieving adherence to combination prophylaxis has shown to be challenging in this rural study setting. Our findings underline the need for additional supervision for PMTCT staff as well as for clients, especially by encouraging them to seek social support through status disclosure. Prophylaxis uptake might be improved by preponing drug intake to
Full Text Available Abstract Background Resting mosquitoes can easily be collected using an aspirating device. The most commonly used mechanical aspirator is the CDC Backpack aspirator. Recently, a simple, and low-cost aspirator called the Prokopack has been devised and proved to have comparable performance. The following study evaluates the Prokopack aspirator compared to the CDC backpack aspirator when sampling resting mosquitoes in rural Tanzania. Methods Mosquitoes were sampled in- and outdoors of 48 typical rural African households using both aspirators. The aspirators were rotated between collectors and households in a randomized, Latin Square design. Outdoor collections were performed using artificial resting places (large barrel and car tyre, underneath the outdoor kitchen (kibanda roof and from a drop-net. Data were analysed with generalized linear models. Results The number of mosquitoes collected using the CDC Backpack and the Prokopack aspirator were not significantly different both in- and outdoors (indoors p = 0.735; large barrel p = 0.867; car tyre p = 0.418; kibanda p = 0.519. The Prokopack was superior for sampling of drop-nets due to its smaller size. The number mosquitoes collected per technician was more consistent when using the Prokopack aspirator. The Prokopack was more user-friendly: technicians preferred using the it over the CDC backpack aspirator as it weighs considerably less, retains its charge for longer and is easier to manoeuvre. Conclusions The Prokopack proved in the field to be more advantageous than the CDC Backpack aspirator. It can be self assembled using simple, low-cost and easily attainable materials. This device is a useful tool for researchers or vector-control surveillance programs operating in rural Africa, as it is far simpler and quicker than traditional means of sampling resting mosquitoes. Further longitudinal evaluations of the Prokopack aspirator versus the gold standard pyrethrum spray catch for indoor resting
LeDoux, Larry S.
This mixed method survey study examined the inter-relationships between teaching styles and the depth of classroom-based technology applications used by teachers participating in 1:1 digitally enhanced classrooms in thirteen of Alaska's rural school districts. The promise of technology to catalyze the transformation of schools into learner centric…
Farina, Andrea J.
This explanatory mixed-method study explored the dropout phenomenon from an ecological perspective identifying the school organizational (academics, activities, structure) and social relationship (teachers, peers) factors that most significantly influence students' decisions to leave school prior to graduation at a rural high school in south…
Davis, Melinda M.; Spurlock, Margaret; Ramsey, Katrina; Smith, Jamie; Beamer, Beth Ann; Aromaa, Susan; McGinnis, Paul B.
Providing flavored milk in school lunches is controversial, with conflicting evidence on its impact on nutritional intake versus added sugar consumption and excess weight gain. Nonindustry-sponsored studies using individual-level analyses are needed. Therefore, we conducted this mixed-methods study of flavored milk removal at a rural primary…
Barton, Maria; Kearney, John; Stewart-Knox, Barbara J.
Objective: Understand food choice, from the perspective of people residing in socioeconomically deprived rural neighborhoods. Methods: Focus groups (n = 7) were undertaken within a community setting involving 42 adults (2 males and 40 females) recruited through voluntary action groups. Data were recorded, transcribed verbatim, and content…
Barton, Maria; Kearney, John; Stewart-Knox, Barbara J.
Objective: Understand food choice, from the perspective of people residing in socioeconomically deprived rural neighborhoods. Methods: Focus groups (n = 7) were undertaken within a community setting involving 42 adults (2 males and 40 females) recruited through voluntary action groups. Data were recorded, transcribed verbatim, and content…
Deasy, Gia; And Others
West Virginia University provides on-the-job practicum experience to rural special education teachers who are pursuing certification while working on "out-of-field" permits. An important aspect of the competency-based practicum experience is evaluative feedback. Two methods of evaluative feedback were used with 22 practicum students who…
Francis Mulekya Bwambale
Full Text Available This paper illustrates how locally appropriate methods can be used to collect quantitative data from illiterate respondents. This method uses local beads to represent quantities, which is a novel yet potentially valuable methodological improvement over standard Western survey methods.
Caro, Tim; Davenport, Tim R B
Tanzania, arguably mainland Africa's most important nation for conservation, is losing habitat and natural resources rapidly. Moving away from a charcoal energy base and developing sustainable finance mechanisms for natural forests are critical to slowing persistent deforestation. Addressing governance and capacity deficits, including law enforcement, technical skills, and funding, across parts of the wildlife sector are key to effective wildlife protection. These changes could occur in tandem with bringing new models of natural resource management into play that include capacity building, corporate payment for ecosystem services, empowering nongovernmental organizations in law enforcement, greater private-sector involvement, and novel community conservation strategies. The future of Tanzania's wildlife looks uncertain-as epitomized by the current elephant crisis-unless the country confronts issues of governance, embraces innovation, and fosters greater collaboration with the international community.
Emmanuel G. Kifaro
Full Text Available Rift Valley fever virus (RVFV is an acute, zoonotic viral disease caused by a Phlebovirus, which belongs to the Bunyaviridae family. Among livestock, outbreaks of the disease are economically devastating. They are often characterised by large, sweeping abortion storms and have significant mortality in adult livestock. The aim of the current study was to investigate RVFV infection in the Kigoma region, which is nestled under the hills of the western arm of the Great Rift Valley on the edge of Lake Tanganyika, Tanzania. A region-wide serosurvey was conducted on non-vaccinated small ruminants (sheep and goats, n = 411. Sera samples were tested for the presence of anti-RVFV antibodies and viral antigen, using commercial enzyme-linked immunosorbent assay and reverse transcriptase polymerase chain reaction, respectively. The overall past infections were detected in 22 of the 411 animals, 5.4% (Confidence Interval (CI 95% = 3.5% – 8.1%. The Kigoma rural area recorded the higher seroprevalence of 12.0% (CI 95% = 7.3% – 18.3%; p < 0.0001, followed by Kibondo at 2.3% (CI 95% = 0.5% – 6.5%; p > 0.05 and the Kasulu district at 0.8% (CI 95% = 0.0% – 4.2%; p > 0.05. The prevalence was 12.5% and 4.7% for sheep and goats, respectively. Reverse transcriptase polymerase chain reaction results indicated that only eight samples were found to be positive (n = 63. This study has confirmed, for the first time, the presence of the RVFV in the Kigoma region four years after the 2007 epizootic in Tanzania. The study further suggests that the virus activity exists during the inter-epizootic period, even in regions with no history of RVFV.
Łyniewska, Agnieszka Anna; Selezneva, Olga
This master thesis, as a part of a project on business trainings in Tanzania, investigates the effects of these trainings on change in mindset and soft skills of microentrepreneurs in Dar es Salaam. It focuses on following dimensions: Creativity, Individualism, Locus of Control, Need for Achievement, Dispositional Optimism and Trust/Relationship. The significant differences are found on the number of dimensions. Entrepreneurs who took part in the training have more internal loc...
Olsen, Ø E; Ndeki, S; Norheim, O F
Our objective was to determine the availability and quality of obstetric care to improve resource allocation in northern Tanzania. We surveyed all facilities providing delivery services (n=129) in six districts in northern Tanzania using the UN Guidelines for monitoring emergency obstetric care (EmOC). The three last questions in this audit outline are examined: Are the right women (those with obstetric complications) using emergency obstetric care facilities (Met Need)? Are sufficient quantities of critical services being provided (cesarean section rate (CSR))? Is the quality of the services adequate (case fatality rate (CFR))? Complications are calculated using Plan 3 of the UN Guidelines to assess the value of routine data for EmOC indicator monitoring. Nearly 60% of the expected complicated deliveries in the study population were conducted at EmOC qualified health facilities. 81.2% of the expected complicated deliveries are conducted in any facility (including facilities not qualifying as EmOC facilities). There is an inadequate level of critical services provided (CSR 4.6). Voluntary agencies provide most of these services in rural settings. All indicators show large variations with the setting (urban/rural location, level and ownership of facilities). Finally, there is large variation in the CFR with only one facility meeting the minimum accepted level. Utilization and quality of critical obstetric services at lower levels and in rural districts must be improved. The potential for improving the resource allocation within lower levels of the health care system is discussed. Given the small number of qualified facilities yet relatively high Met Need, we argue that it is neither the mothers' ignorance nor their lack of ability to get to a facility that is the main barrier to receiving quality care when needed, but rather the lack of quality care at the facility. Little can be concluded using the CFR to describe the quality of services provided.
In Tanzania, the international microfinance network FINCA set up shop and began training its first Village Banking Groups in June 1998, disbursing its first loans in July with a grant from the US Agency for International Development. Within 2 months, the program reached 757 low-income women and distributed loans worth US$57,183 using the group support system in which 30-50 neighbors come together to guarantee one another's loans. With the loans from FINCA, entrepreneurs quickly became involved in a range of business activities, from selling tomatoes to starting a hair salon. Located in Mwanza, in the Lake Zone, FINCA Tanzania's clients include many members of the Sukuma tribe. It is noted that in this region there are a few job opportunities in the formal economy. In 1999, FINCA Tanzania reached 3632 clients, exceeding its targets despite a difficult economic environment. In that same year, FINCA partnered with Freedom from Hunger in launching a program that offers some of its members health education and basic business training at Village Banking Group meetings.
The majority of undocumented Congolese refugee children living in Dar es Salaam, Tanzania, experience extreme poverty and social exclusion, harassment and discrimination. Their fear of deportation, forcible removal to refugee camps and imprisonment is coupled with a strong feeling that they are unwelcome in Tanzania. These realities require that…
Reed, Elizabeth; Donta, Balaiah; Dasgupta, Anindita; Ghule, Mohan; Battala, Madhusudana; Nair, Saritha; Silverman, Jay; Jadhav, Arun; Palaye, Prajakta; Saggurti, Niranjan; Raj, Anita
Objectives The social positioning (i.e. social status and autonomy) of women in the household facilitates women's access to and decision-making power related to family planning (FP). Women's access to spending money, which may be an indicator of greater social positioning in the household, may also be greater among women who engage in income generating activities for their families, regardless of women's status in the household. However, in both scenarios, access to money may independently afford greater opportunity to obtain family planning services among women. This study seeks to assess whether access to money is associated with FP outcomes independently of women's social positioning in their households. Methods Using survey data from married couples in rural Maharashtra, India (n = 855), crude and adjusted regression was used to assess women's access to their own spending money in relation to past 3 month use of condoms and other forms of contraceptives (pills, injectables, intrauterine device). Results Access to money (59 %) was associated with condom and other contraceptive use (AORs ranged 1.5-1.8). These findings remained significant after adjusting for women's FP decision-making power in the household and mobility to seek FP services. Conclusion While preliminary, findings suggest that access to money may increase women's ability to obtain FP methods, even in contexts where social norms to support women's power in FP decision-making may not be readily adopted.
Njelekela, Marina A.; Alfa Muhihi; Mpembeni, Rose N. M.; Amani Anaeli; Omary Chillo; Sulende Kubhoja; Benjamin Lujani; Davis Ngarashi; Mwanamkuu Maghembe
Background: Childhood obesity has increased over the past two decades. Child obesity is likely to persist through adulthood and increases the risk of non-communicable diseases (NCDs) later in life. This study assessed knowledge and attitudes towards obesity among primary school children in Dar es Salaam, Tanzania. Materials and Methods: A cross-sectional study was conducted in randomly selected primary schools in Dar es Salaam. A structured questionnaire was used to assess the knowledge and a...
Cagua, Edgar F.; Cochran, Jesse; Rohner, Chris; Igulu, Mathias M.; Rubens, Jason; Pierce, Simon J.; Berumen, Michael L.
Background. The Western Indian Ocean is a globally important region for the whale shark Rhincodon typus, with well-studied coastal aggregation sites in southern Mozambique, Seychelles and Djibouti. Here we present an overview of a new study at Mafia Island, Tanzania. Methods. We monitored whale shark abundances on 103 boat trips from October 2012–March 2013. We also used passive acoustic telemetry (VEMCO® V16 tags) and photographic identification to monitor the residency times and local movem...
... Rural Health Topics & States Topics View more Rural Aging The nation's population is aging, and with that change comes increased healthcare needs. ... Disease Control and Prevention report, The State of Aging and Health in America 2013 , the population 65 ...
Topa, Maria Elena; Herslund, Lise; Cavan, Gina; Printz, Andreas; Simonis, Ingo; Bucchignani, Edoardo; Jean-Baptiste, Nathalie; Hellevik, Siri; Johns, Regina; Kibassa, Deusdedit; Kweka, Clara; Magina, Fredrick; Mangula, Alpha; Mbuya, Elinorata; Uhinga, Guido; Kassenga, Gabriel; Kyessi, Alphonce; Shemdoe, Riziki; Kombe, Wilbard
CLUVA (CLimate change and Urban Vulnerability in Africa; http://www.cluva.eu/) is a 3 years project, funded by the European Commission in 2010. The main objective of CLUVA is to develop context-centered methods and knowledge to be applied to African cities to assess vulnerabilities and increase knowledge on managing climate related risks. The project estimates the impacts of climate changes in the next 40 years at urban scale and downscales IPCC climate projections to evaluate specific threats to selected African test cities. These are mainly from floods, sea-level rise, droughts, heat waves, and desertification. The project evaluates and links: social vulnerability; urban green structures and ecosystem services; urban-rural interfaces; vulnerability of urban built environment and lifelines; and related institutional and governance dimensions of adaptation. The multi-scale and multi-disciplinary qualitative, quantitative and probabilistic approach of CLUVA is currently being applied to selected African test cities (Addis Ababa - Ethiopia; Dar es Salaam - Tanzania; Douala - Cameroun; Ouagadougou - Burkina Faso; St. Louis - Senegal). In particular, the poster will present preliminary findings for the Dar es Salaam case study. Dar es Salaam, which is Tanzania's largest coastal city, is exposed to floods, coastal erosion, droughts and heat waves, and highly vulnerable to impacts as a result of ineffective urban planning (about 70% unplanned settlements), poverty and lack of basic infrastructure (e.g. lack of or poor quality storm water drainage systems). Climate change could exacerbate the current situation increasing hazard-exposure alongside the impacts of development pressures which act to increase urban vulnerability for example because of informal (unregulated) urbanization. The CLUVA research team - composed of climate and environmental scientists, risk management experts, urban planners and social scientists from both European and African institutions - has
Belland, Brian R.; Gu, Jiangyue; Armbrust, Sara; Cook, Brant
A common way for students to develop scientific argumentation abilities is through argumentation about socioscientific issues, defined as scientific problems with social, ethical, and moral aspects. Computer-based scaffolding can support students in this process. In this mixed method study, we examined the use and impact of computer based…
Feaster, Toby D.; Gotvald, Anthony J.; Weaver, J. Curtis
Reliable estimates of the magnitude and frequency of floods are essential for the design of transportation and water-conveyance structures, flood-insurance studies, and flood-plain management. Such estimates are particularly important in densely populated urban areas. In order to increase the number of streamflow-gaging stations (streamgages) available for analysis, expand the geographical coverage that would allow for application of regional regression equations across State boundaries, and build on a previous flood-frequency investigation of rural U.S Geological Survey streamgages in the Southeast United States, a multistate approach was used to update methods for determining the magnitude and frequency of floods in urban and small, rural streams that are not substantially affected by regulation or tidal fluctuations in Georgia, South Carolina, and North Carolina. The at-site flood-frequency analysis of annual peak-flow data for urban and small, rural streams (through September 30, 2011) included 116 urban streamgages and 32 small, rural streamgages, defined in this report as basins draining less than 1 square mile. The regional regression analysis included annual peak-flow data from an additional 338 rural streamgages previously included in U.S. Geological Survey flood-frequency reports and 2 additional rural streamgages in North Carolina that were not included in the previous Southeast rural flood-frequency investigation for a total of 488 streamgages included in the urban and small, rural regression analysis. The at-site flood-frequency analyses for the urban and small, rural streamgages included the expected moments algorithm, which is a modification of the Bulletin 17B log-Pearson type III method for fitting the statistical distribution to the logarithms of the annual peak flows. Where applicable, the flood-frequency analysis also included low-outlier and historic information. Additionally, the application of a generalized Grubbs-Becks test allowed for the
Full Text Available Maize storage and pest control method as practiced in traditional clay granaries in the Kédougou region in eastern Senegal were evaluated under rural conditions during two successive years. Three storage modes, i.e. maize cobs, winnowed and non-winnowed maize grains, were tested in seven granaries where the insecticidal plants Hyptis spicigera or H. suaveolens were either incorporated in the store structure or deposited as layers intermittently with maize. At the beginning of the storage period, all granaries were artificially infested with 7 pairs Tribolium castaneum and Sitophilus zeamais. No damage, losses or live insects were observed during 7 months of storage when maize cobs were placed between layers of H. spicigera. Compared with the control, incorporation of insecticidal plants within the granary bottom had no significant effect on the damage and loss level irrespective of the storage mode. Non-winnowed maize always suffered less damage and losses than the winnowed variant. In all granaries depredation, insect abundance and moisture content were highest toward the end of storage period between June and July.
Full Text Available For several decades, community interventions have promoted community development with strategies involving capacity building, advocacy, social change, and empowerment. Although community interventions intend to ameliorate social and economic inequalities, there is still a need to evaluate the outcomes of Participatory Action Research (PAR. PAR approaches have demonstrated to be a helpful tool for addressing and identifying community issues and strengths, while leading community members into action. The PAR approach described in this case study of Ciudad Renace (Townv Reborn—the Concerns Report Method (CRM—provided a process for the community to come together and identify main issues, organize, and take actions. The findings suggest multiple activities and outcomes in areas like environmental contamination, social services, and education. Participatory methodologies like the Concerns report Method provided opportunities for community members to become engaged in pursing issues and addressing their own needs. The implications for community psychology research and practice are discussed.
Kamalanathan, J P
Contraceptive prevalence was determined in the Kelantan region of Malaysia, an area with relatively poor health indices. 350 women attending health clinics on rubber and palm-oil estates and living in surrounding suburbs were surveyed by clinic workers or during home visits. The sample included 273 Malays, 64 Indians and 13 Chinese. This area of Peninsular Malaysia is noted for the highest infant mortality rate (17.7), second highest crude birth rate (35.2) and highest dependency ratio (88%) in the country. 44.9% practiced contraception, highest in Chinese and lowest in Indians. Methods used were pills by (55%), traditional methods (19%), tubal ligation (18%), safe period (14%), injections (5.5%), IUD (4.7%), and condom (2.3%). The Malaysian traditional methods are herbal preparations from tree bark or roots, herb pills, and exercises after coitus. 34% of the non contraceptors had used contraception before but stopped because of side effects, religious or spousal objections, or desire to conceive. 74% had married in their teens. 46% of the non-contraceptors were spacing their children by prolonged breastfeeding.
Full Text Available The emergence of an accessible market for buying and selling agricultural products by networks of rural and farming cooperatives in Iran has given rise to the need to devote considerable attention to marketing and the use of new marketing methods. In view of this fact, this research will attempt to provide insight and help understand why managers of these institutions use these methods rarely. To this end, we designed a questionnaire and distributed it to the statistical sample, comprised of managers of rural cooperative institutions in the Kohgilooyeh and Boyerahmad Province. The results of analysing their responses indicate that there is a considerable level of correlation between the application of new marketing managers of rural cooperatives and the level of education, knowledge, social and cultural factors of the geographical location of their environment. However, no significant correlation was found between the use of new marketing methods and the work experience of surveyed managers. Furthermore, the lack of facilities and infrastructure required for using new marketing methods cannot be the rationale for dismissing these methods by the managers of these institutions.
Seha, A M; Klepp, K I; Ndeki, S S
Based on the World Health Organization's standardized survey inventories assessing AIDS-related knowledge, attitudes, beliefs, and practices (KABP) for adolescents, a written questionnaire was developed and pilot tested among primary school children in Northern Tanzania. Subjects included 472 fifth and sixth graders at four schools in Arusha and Kilimanjaro regions. Results indicated that the large majority of the students understood the questions and were able and willing to complete the survey. Non-response patterns did not seem to be related to the sensitivity of included questions. AIDS-related knowledge and attitudes toward engaging in sexual behavior had acceptable reliability and construct validity when compared with similar surveys in Western countries, while perceived social norms and self-efficacy need further development. KABP questionnaires may serve as a useful method in AIDS-related surveys and evaluation studies among school children in Tanzania if survey instruments are adapted to reflect the local social and cultural context.
Roser Manzanera Ruíz
Full Text Available Los procesos de liberalización de los mercados, que han acompañado a las dinámicas económicas globales más recientes, han provocado importantes cambios en la producción de cultivos comerciales. Estos cambios han ampliado la desigualdad en el acceso y el reparto de los ingresos provenientes de la agricultura comercial entre hombres y mujeres. Algunas mujeres se han organizado y agrupado para dar respuesta a esta situación y mejorar diferentes aspectos de sus vidas. El objetivo de este artículo es analizar los procesos de empoderamiento económico de las mujeres rurales en Soni (Tanzania ante el desigual acceso a la producción y distribución de los ingresos en este sector económico. Se pone de manifiesto que estos procesos parten de la toma de conciencia de intereses estratégicos compartidos. Los datos se han obtenido del trabajo documental y de campo, y la posterior aplicación de metodología cualitativa, para analizar el caso particular de un pueblo del municipio de Soni, en el Distrito de Lushoto, al norte de Tanzania (2006-2009.
Pope, Rachel; Bangser, Maggie; Requejo, Jennifer Harris
This study explores barriers and facilitating factors women experience re-integrating into society after treatment of an obstetric fistula in rural Tanzania. A total of 71 women were interviewed in the Mwanza region of Tanzania, including a community control group. The majority of the women who received successful surgical repairs reported that, over time, they were able to resume many of the social and economic activities they engaged in prior to the development of a fistula. Familial support facilitated both accessing repair and recovery. For 60% of the women recovering from an obstetric fistula, work was the most important factor in helping them feel 'normal again'. However, physical limitations and other residual problems often hampered their ability to continue working. All of the treated women expressed interest in follow-up discussions with health care providers regarding their health and concerns about future pregnancies. Special attention is needed for women who are not completely healed and/or for those who experience other related medical or emotional problems after repair, especially if they lack a social network.
Bygbjerg Ib Christian
Full Text Available Abstract In Tanzania access to urban and rural primary health care is relatively widespread, yet there is evidence of considerable bypassing of services; questions have been raised about how to improve functionality. The aim of this study was to explore the experiences of health workers working in the primary health care facilities in Kilimanjaro Region, Tanzania, in terms of their motivation to work, satisfaction and frustration, and to identify areas for sustainable improvement to the services they provide. The primary issues arising pertain to complexities of multitasking in an environment of staff shortages, a desire for more structured and supportive supervision from managers, and improved transparency in career development opportunities. Further, suggestions were made for inter-facility exchanges, particularly on commonly referred cases. The discussion highlights the context of some of the problems identified in the results and suggests that some of the preferences presented by the health workers be discussed at policy level with a view to adding value to most services with minimum additional resources.
Ezekiel Edward Mwakalukwa
Full Text Available Tools to accurately estimate tree volume and biomass are scarce for most forest types in East Africa, including Tanzania. Based on a sample of 142 trees and 57 shrubs from a 6,065 ha area of dry miombo woodland in Iringa rural district in Tanzania, regression models were developed for volume and biomass of three important species, Brachystegia spiciformis Benth. (n = 40, Combretum molle G. Don (n = 41, and Dalbergia arbutifolia Baker (n = 37 separately, and for broader samples of trees (28 species, n = 72, shrubs (16 species, n = 32, and trees and shrubs combined (44 species, n = 104. Applied independent variables were log-transformed diameter, height, and wood basic density, and in each case a range of different models were tested. The general tendency among the final models is that the fit improved when height and wood basic density were included. Also the precision and accuracy of the predictions tended to increase from general to species-specific models. Except for a few volume and biomass models developed for shrubs, all models had R2 values of 96–99%. Thus, the models appear robust and should be applicable to forests with similar site conditions, species, and diameter ranges.
Van Eijck, J. [Diligent Tanzania, Moshi (Tanzania); Romijn, H.A. [Faculty of Technology Management, Eindhoven University of Technology TUE, Eindhoven (Netherlands)
The paper reports on recent research in Tanzania about the scope for developing biofuels from an oil-seed bearing plant called Jatropha Curcas Linnaeus. The plant is widely seen to have potential to help combat the greenhouse effect, help to stop local soil erosion, create additional income for the rural poor, and provide a major source of energy both locally and internationally. The oil can be used in diesel engines, oil lamps and cooking stoves, and as a basic component in soapmaking. The seedcake can be used for biogas production and as fertiliser. Our principal analytic tool is Strategic Niche Management (SNM), a recently developed approach rooted in evolutionary innovation theory. We analyse how the scope for an energy transition is influenced by factors at three societal levels distinguished in SNM, namely: the overarching 'landscape'; the sectoral setting or 'regime'; and the 'niche' level where the innovation develops and diffuses. Valuable niche processes were found in a few areas, especially in cultivation, but there are still many obstacles in Tanzania's prevailing energy regime. The development of Jatropha biofuels is still in an early phase. The SNM analysis yields several policy recommendations. Methodological issues arising from the use of SNM are discussed as well.
Trépanier, Amélie; Gagnon, Marie-Pierre; Mbemba, Gisèle Irène Claudine; Côté, José; Paré, Guy; Fortin, Jean-Paul; Duplàa, Emmanuel; Courcy, François
To identify factors that influence the initial plan and final decision to choose a rural area as first employment location in final-year nursing students or newly graduated nurses. We conducted a mixed-methods review of the literature, including both published and gray literature, using established criteria. Two reviewers performed data extraction of relevant information independently. We retrieved empirical studies from the following databases: PubMED, Embase, CINAHL (EBSCO), Web of Science (SCI and SSCI), The Cochrane Library, Business Source Premier (EBSCO), ERIC, Proquest and PsychInfo. We also searched for empirical studies in the technical and gray literature and reviewed journals related to rural health. Additionally, we conducted searches in websites such as the Center for Health Workforce Planning and Analysis, as well as Google and Google Scholar search engines. Of the 523 studies thus screened, 15 were included for data extraction. We identified more than 40 factors associated with initial plans and final decision to settle in a rural area among nursing graduates. Only limited literature is currently available on the factors associated with the intention of nursing students or newly graduated nurses of practicing in rural areas and on the relationship between intention and effective behavior. This review highlights the needs for further research in this field. Copyright © 2012 Elsevier Ltd. All rights reserved.
Dunstan Debra A
Full Text Available Abstract Background Children living in socioeconomic disadvantage are at risk of poor mental health outcomes. In order to focus and evaluate population health programs to facilitate children’s resilience, it is important to accurately assess baseline levels of functioning. With this end in mind, the aim of this study was to test the utility of 1 a voluntary random sampling method and 2 quantitative measures of adaptation (with national normative data for assessing the resilience of children in an identified community. Method This cross-sectional study utilized a sample of participants (N = 309, including parents (n = 169, teachers (n = 20 and children (n = 170; age range = 5-16 years, recruited from the schools in Tenterfield; a socioeconomically disadvantaged community in New South Wales, Australia. The Strengths and Difficulties Questionnaire (SDQ; including parent, teacher and youth versions was used to measure psychological well-being and pro-social functioning, and NAPLAN results (individual children’s and whole school’s performance in literacy and numeracy were used to measure level of academic achievement. Results The community’s disadvantage was evident in the whole school NAPLAN performance but not in the sample’s NAPLAN or SDQ results. The teacher SDQ ratings appeared to be more reliable than parent’s ratings. The voluntary random sampling method (requiring parental consent led to sampling bias. Conclusions The key indicators of resilience - psychological well-being, pro-social functioning and academic achievement – can be measured in whole communities using the teacher version of the SDQ and whole school results on a national test of literacy and numeracy (e.g., Australia’s NAPLAN. A voluntary random sample (dependent upon parental consent appears to have limited value due to the likelihood of sampling bias.
Full Text Available Abstract Background Antimicrobial resistance is particularly harmful to infectious disease management in low-income countries since expensive second-line drugs are not readily available. The objective of this study was to implement and evaluate a computerized system for surveillance of antimicrobial resistance at a tertiary hospital in Tanzania. Methods A computerized surveillance system for antimicrobial susceptibility (WHONET was implemented at the national referral hospital in Tanzania in 1998. The antimicrobial susceptibilities of all clinical bacterial isolates received during an 18 months' period were recorded and analyzed. Results The surveillance system was successfully implemented at the hospital. This activity increased the focus on antimicrobial resistance issues and on laboratory quality assurance issues. The study identified specific nosocomial problems in the hospital and led to the initiation of other prospective studies on prevalence and antimicrobial susceptibility of bacterial infections. Furthermore, the study provided useful data on antimicrobial patterns in bacterial isolates from the hospital. Gram-negative bacteria displayed high rates of resistance to common inexpensive antibiotics such as ampicillin, tetracycline and trimethoprim-sulfamethoxazole, leaving fluoroquinolones as the only reliable oral drugs against common Gram-negative bacilli. Gentamicin and third generation cephalosporins remain useful for parenteral therapy. Conclusion The surveillance system is a low-cost tool to generate valuable information on antimicrobial resistance, which can be used to prepare locally applicable recommendations on antimicrobial use. The system pinpoints relevant nosocomial problems and can be used to efficiently plan further research. The surveillance system also functions as a quality assurance tool, bringing attention to methodological issues in identification and susceptibility testing.
Mfinanga, G S; Mutayoba, B; Mbogo, G; Kahwa, A; Kimaro, G; Mhame, P P; Mwangi, C; Malecela, M N; Kitua, A Y
Tanzania is scaling up prevention, treatment, care and support of individuals affected with HIV. There is therefore a need for high quality and reliable HIV infection testing and AIDS staging. The objective of this study was to assess laboratories capacities of services in terms of HIV testing and quality control. A baseline survey was conducted from December 2004 to February 2005 in 12 laboratories which were conveniently selected to represent all the zones of Tanzania. The questionnaires comprised of questions on laboratory particulars, internal and external quality control for HIV testing and quality control of reagents. Source and level of customer satisfaction of HIV test kits supply was established. Of 12 laboratories, nine used rapid tests for screening and two used rapid tests for diagnosis. In the 12 laboratories, four used double ELISA and five used single ELISA and three did not use ELISA. Confirmatory tests observed were Western Blot in three laboratories, DNA PCR in two laboratories, CD4 counting in seven laboratories, and viral load in two laboratories. Although all laboratories conducted quality control (QC) of the HIV kits, only two laboratories had Standard Operating Procedures (SOPs). Internal and external quality control (EQC) was done at varied proportions with the highest frequency of 55.6% (5/9) for internal quality control (IQC) for rapid tests and EQC for ELISA, and the lowest frequency of 14.3% (1/ 7) for IQC for CD4 counting. None of the nine laboratories which conducted QC for reagents used for rapid tests and none of the five which performed IQC and EQC had SOPs. HIV kits were mainly procured by the Medical Store Department and most of laboratories were not satisfied with the delay in procurement procedures. Most of the laboratories used rapid tests only, while some used both rapid tests and ELISA method for HIV testing. In conclusion, the survey revealed inadequacy in Good Laboratory Practice and poor laboratory quality control process
Full Text Available A great deal of uncertain information which is difficult to quantify is taken into account by farmers and experts in the enterprise when making decisions. We are interested in the problems of the implementation of a rabbit-breeding farm. One of the first decisions to be taken refers to the design or type of structure for housing the animals, which is determined by the level of environmental control sought to be maintained in its interior. A farmer was consulted, and his answers were incorporated into the analysis, by means of the fuzzy TOPSIS methodology. The main purpose of this paper is to study the problem by means of the fuzzy TOPSIS method as multicriteria decision making, when the information was given in linguistic terms.
Xu, Saiping; Zhao, Qianjun; Yin, Kai; Cui, Bei; Zhang, Xiupeng
Hollow village is a special phenomenon in the process of urbanization in China, which causes the waste of land resources. Therefore, it's imminent to carry out the hollow village recognition and renovation. However, there are few researches on the remote sensing identification of hollow village. In this context, in order to recognize the abandoned homesteads by remote sensing technique, the experiment was carried out as follows. Firstly, Gram-Schmidt transform method was utilized to complete the image fusion between multi-spectral images and panchromatic image of WorldView-2. Then the fusion images were made edge enhanced by high pass filtering. The multi-resolution segmentation and spectral difference segmentation were carried out to obtain the image objects. Secondly, spectral characteristic parameters were calculated, such as the normalized difference vegetation index (NDVI), the normalized difference water index (NDWI), the normalized difference Soil index (NDSI) etc. The shape feature parameters were extracted, such as Area, Length/Width Ratio and Rectangular Fit etc.. Thirdly, the SEaTH algorithm was used to determine the thresholds and optimize the feature space. Furthermore, the threshold classification method and the random forest classifier were combined, and the appropriate amount of samples were selected to train the classifier in order to determine the important feature parameters and the best classifier parameters involved in classification. Finally, the classification results was verified by computing the confusion matrix. The classification results were continuous and the phenomenon of salt and pepper using pixel classification was avoided effectively. In addition, the results showed that the extracted Abandoned Homesteads were in complete shapes, which could be distinguished from those confusing classes such as Homestead in Use and Roads.
Hunt, Justin B; Curran, Geoffrey; Kramer, Teresa; Mouden, Sip; Ward-Jones, Susan; Owen, Richard; Fortney, John
Mental health and substance abuse are among the most commonly reported reasons for visits to Federally Qualified Health Centers (CHCs), yet only 6.5% of encounters are with on-site behavioral health specialists. Rural CHCs are significantly less likely to have on-site behavioral specialists than urban CHCs. Because of this lack of mental health specialists in rural areas, the most promising approach to improving mental health outcomes is to help rural primary care (PC) providers deliver evidence-based practices (EBPs). Despite the scope of these problems, no research has developed an effective implementation strategy for facilitating the adoption of mental health EBPs for rural CHCs. We sought to describe the conceptual components of an implementation partnership that focuses on the adaption and adoption of mental health EBPs by rural CHCs in Arkansas. We present a conceptual model that integrates seven separate frameworks: (1) Jones and Wells' Evidence-Based Community Partnership Model, (2) Kitson's Promoting Action on Research Implementation in Health Services (PARiHS) implementation framework, (3) Sackett's definition of evidence-based medicine, (4) Glisson's organizational social context model, (5) Rubenstein's Evidence-Based Quality Improvement (EBQI) facilitation process, (6) Glasgow's RE-AIM evaluation approach, and (7) Naylor's concept of shared decision making. By integrating these frameworks into a meaningful conceptual model, we hope to develop a successful implementation partnership between an academic health center and small rural CHCs to improve mental health outcomes. Findings from this implementation partnership should have relevance to hundreds of clinics and millions of patients, and could help promote the sustained adoption of EBPs across rural America.
Henry N. Young, PhD
Full Text Available Purpose: Methods used to deliver and test a pharmacy-based asthma care telephonic service for an underserved, rural patient population are described. Summary: In a randomized controlled trial (RCT, the Patient And phaRmacist Telephonic Encounters (PARTE project is assessing the feasibility, acceptability, and preliminary impact of providing pharmacy-based asthma care service telephonically. The target audience is a low income patient population across a large geographic area served by a federally qualified community health center. Ninety-eight participants have been randomized to either standard care or the intervention group who received consultation and direct feedback from pharmacists via telephone regarding their asthma self-management and medication use. Pharmacists used a counseling framework that incorporates the Indian Health Services 3 Prime Questions and the RIM Technique (Recognition, Identification, and Management for managing medication use problems. Pharmacists encouraged patients to be active partners in the decision-making process to identify and address the underlying cause of medication use problems. Uniquely, this trial collected process and summative data using qualitative and quantitative approaches. Pharmacists’ training, the fidelity and quality of pharmacists’ service delivery, and short term patient outcomes are being evaluated. This evaluation will improve our ability to address research challenges and intervention barriers, refine staff training, explore patient perspectives, and evaluate measures’ power to provide preliminary patient outcome findings. Conclusion: A mixed method evaluation of a structured pharmacist intervention has the potential to offer insights regarding staff training, service fidelity and short term outcomes using quantitative and qualitative data in an RCT. Results will provide evidence regarding the feasibility and quality of carrying out the study and service delivery from the multiple
Emery, Jon D; Walter, Fiona M; Gray, Vicky; Sinclair, Craig; Howting, Denise; Bulsara, Max; Bulsara, Caroline; Webster, Andrew; Auret, Kirsten; Saunders, Christobel; Nowak, Anna; Holman, C D'Arcy
Previous studies have focused on the treatment received by rural cancer patients and have not examined their diagnostic pathways as reasons for poorer outcomes in rural Australia. To compare and explore symptom appraisal and help-seeking behaviour in patients with breast, lung, prostate or colorectal cancer from rural Western Australia (WA). A mixed-methods study of people recently diagnosed with breast, lung, prostate or colorectal cancer from rural WA. The time from first symptom to diagnosis (i.e. total diagnostic interval, TDI) was calculated from interviews and medical records. Sixty-six participants were recruited (24 breast, 20 colorectal, 14 prostate and 8 lung cancer patients). There was a highly significant difference in time from symptom onset to seeking help between cancers (P = 0.006). Geometric mean symptom appraisal for colorectal cancer was significantly longer than that for breast and lung cancers [geometric mean differences: 2.58 (95% confidence interval, CI: 0.64-4.53), P = 0.01; 3.97 (1.63-6.30), P = 0.001, respectively]. There was a significant overall difference in arithmetic mean TDI (P = 0.046); breast cancer TDI was significantly shorter than colorectal or prostate cancer TDI [mean difference : 266.3 days (95% CI: 45.9-486.8), P = 0.019; 277.0 days, (32.1-521.9), P = 0.027, respectively]. These differences were explained by the nature and personal interpretation of symptoms, perceived as well as real problems of access to health care, optimism, stoicism, machismo, fear, embarrassment and competing demands. Longer symptom appraisal was observed for colorectal cancer. Participants defined core characteristics of rural Australians as optimism, stoicism and machismo. These features, as well as access to health care, contribute to later presentation of cancer.
Nwanna-Nzewunwa, Obieze C; Ajiko, Mary-Margaret; Kirya, Fred; Epodoi, Joseph; Kabagenyi, Fiona; Batibwe, Emmanuel; Feldhaus, Isabelle; Juillard, Catherine; Dicker, Rochelle
Surgical care delivery is poorly understood in resource-limited settings. To effectively move toward universal health coverage, there is a critical need to understand surgical care delivery in developing countries. This study aims to identify the barriers and facilitators of surgical care delivery at Soroti Regional Referral Hospital in Uganda. In this mixed methods study, we (1) applied the Surgeons OverSeas' Personnel, Infrastructure, Procedures, Equipment, and Supplies tool to assess surgical capacity; (2) retrospectively reviewed inpatient records; (3) conducted four semistructured focus group discussions with 18 purposively sampled providers involved in perioperative care; and (4) observed the perioperative process of care using a time and motion approach. Descriptive statistics were generated from quantitative data. Qualitative data were thematically analyzed. The Personnel, Infrastructure, Procedures, Equipment, and Supplies survey revealed severe deficiencies in workforce (P-score = 14) and infrastructure (I-score = 5). Equipment, supplies, and procedures were generally available. Male and female wards were overbooked 83% and 60% of the time, respectively. Providers identified lack of space, patient overload, and superfluous patients' attendants as barriers to surgical care. Workforce challenges were tackled using teamwork and task sharing. Inadequate equipment and processes were addressed using improvisations. All observed subjects (n = 31) received interventions. The median decision-to-intervention time was 2.5 h (Interquartile Range [IQR], 0.4, 21.4). However, 48% of subjects experienced delays. Median decision-to-intervention delay was 14.8 h (IQR, 0.9, 26.6). Despite severe workforce and physical infrastructural deficiencies at Soroti Regional Referral Hospital, providers are adjusting and innovating to deliver surgical care. Copyright © 2016 Elsevier Inc. All rights reserved.
Bridges, Daniel J; Molyneux, Malcolm; Nkhoma, Standwell
We conducted a prevalence study of mutations in Plasmodium falciparum that are associated with antimalarial drug resistance at a rural site in Karonga near Malawi's northern border with Tanzania. We found a higher prevalence of the key chloroquine resistance-conferring mutation in the pfcrt gene (K76T) at this site in comparison with the prevalence in Blantyre, a city in the south of Malawi, far from an international border (9%vs. 0%; P Malawi was recently reported to be over 50%. Our findings suggest a considerable 'leakage' of parasite antimalarial drug resistance across the border between two countries with different national malaria control policies and with different levels of resistance. Neighbouring countries should consider implementing common regional rather than national malaria treatment policies to prevent the spread of antimalarial drug resistance alleles across their borders.
Bhat, Amritha; Reed, Susan; Mao, Johnny; Vredevoogd, Mindy; Russo, Joan; Unger, Jennifer; Rowles, Roger; Unützer, Jürgen
Universal screening for depression during pregnancy and postpartum is recommended, yet mental health treatment and follow-up rates among screen-positive women in rural settings are low. We studied the feasibility, acceptability and effectiveness of perinatal depression treatment integrated into a rural obstetric setting. We conducted an open treatment study of a screening and intervention program modified from the Depression Attention for Women Now (DAWN) Collaborative Care model in a rural obstetric clinic. Depression screen-positive pregnant and postpartum women received problem-solving therapy (PST) with or without antidepressants. A care manager coordinated communication between patient, obstetrician and psychiatric consultant. We measured change in the Patient Health Questionnaire 9 (PHQ-9) score. We used surveys and focus groups to measure patient and provider satisfaction and analyzed focus groups using qualitative analysis. The intervention was well accepted by providers and patients, based on survey and focus group data. Feasibility was also evidenced by recruitment (87.1%) and retention (92.6%) rates and depression outcomes (64% with >50% improvement in PHQ 9) which were comparable to clinical trials in similar urban populations. Conclusions for practice: DAWN Collaborative Care modified for treatment of perinatal depression in a rural obstetric setting is feasible and acceptable. Behavioral health services integrated into rural obstetric settings could improve care for perinatal depression.
Marchant, T; Armstrong Schellenberg, J R M; Edgar, T; Ronsmans, C; Nathan, R; Abdulla, S; Mukasa, O; Urassa, H; Lengeler, C
Anaemia in pregnancy is associated with maternal morbidity and mortality and is a risk factor for low birth-weight. Of 507 pregnant women recruited in a community, cross-sectional study in southern Tanzania, 11% were severely anaemic (food taboos in the study area principally restrict the consumption of fish and meat. Effective anti-malaria and iron-supplementation interventions are available but are not currently in place; improvements in the mechanisms for the delivery of such interventions are urgently required. Additionally, opportunities for contacting the target groups beyond the clinic environment need to be developed.
Full Text Available Mobile technology offers an unprecedented growth op portunity for banking industry in Tanzania. As the economy continues to prosper, increasingly affluent consumers and underbanked segments create demand for new financial products and services. Many consu mers in Tanzania have mobile phones, but not bank accounts. Therefore, the mobile channel presents an effective way to connect them to the national fina ncial grid. For the local banks, going mobile may increas e banks opportunities to unlock the inherent potent ial of underbanked segments. This paper addresses the c urrent state, future prospects, and security challe nges to the usage of mobile banking in Tanzania.
Mangesho, Peter Ernest; Neselle, Moses Ole; Karimuribo, Esron D; Mlangwa, James E; Queenan, Kevin; Mboera, Leonard E G; Rushton, Jonathan; Kock, Richard; Häsler, Barbara; Kiwara, Angwara; Rweyemamu, Mark
Zoonoses account for the most commonly reported emerging and re-emerging infectious diseases in Sub-Saharan Africa. However, there is limited knowledge on how pastoral communities perceive zoonoses in relation to their livelihoods, culture and their wider ecology. This study was carried out to explore local knowledge and perceptions on zoonoses among pastoralists in Tanzania. This study involved pastoralists in Ngorongoro district in northern Tanzania and Kibaha and Bagamoyo districts in eastern Tanzania. Qualitative methods of focus group discussions, participatory epidemiology and interviews were used. A total of 223 people were involved in the study. Among the pastoralists, there was no specific term in their local language that describes zoonosis. Pastoralists from northern Tanzania possessed a higher understanding on the existence of a number of zoonoses than their eastern districts' counterparts. Understanding of zoonoses could be categorized into two broad groups: a local syndromic framework, whereby specific symptoms of a particular illness in humans concurred with symptoms in animals, and the biomedical framework, where a case definition is supported by diagnostic tests. Some pastoralists understand the possibility of some infections that could cross over to humans from animals but harm from these are generally tolerated and are not considered as threats. A number of social and cultural practices aimed at maintaining specific cultural functions including social cohesion and rites of passage involve animal products, which present zoonotic risk. These findings show how zoonoses are locally understood, and how epidemiology and biomedicine are shaping pastoralists perceptions to zoonoses. Evidence is needed to understand better the true burden and impact of zoonoses in these communities. More studies are needed that seek to clarify the common understanding of zoonoses that could be used to guide effective and locally relevant interventions. Such studies should
Mapingure Munyaradzi P
Full Text Available Abstract Background Substantial heterogeneity in HIV prevalence has been observed within sub-Saharan Africa. It is not clear which factors can explain these differences. Our aim was to identify risk factors that could explain the large differences in HIV-1 prevalence among pregnant women in Harare, Zimbabwe, and Moshi, Tanzania. Methods Cross-sectional data from a two-centre study that enrolled pregnant women in Harare (N = 691 and Moshi (N = 2654 was used. Consenting women were interviewed about their socio-demographic background and sexual behaviour, and tested for presence of sexually transmitted infections and reproductive tract infections. Prevalence distribution of risk factors for HIV acquisition and spread were compared between the two areas. Results The prevalence of HIV-1 among pregnant women was 26% in Zimbabwe and 7% in Tanzania. The HIV prevalence in both countries rises constantly with age up to the 25-30 year age group. After that, it continues to rise among Zimbabwean women, while it drops for Tanzanian women. Risky sexual behaviour was more prominent among Tanzanians than Zimbabweans. Mobility and such infections as HSV-2, trichomoniasis and bacterial vaginosis were more prevalent among Zimbabweans than Tanzanians. Reported male partner circumcision rates between the two countries were widely different, but the effect of male circumcision on HIV prevalence was not apparent within the populations. Conclusions The higher HIV-1 prevalence among pregnant women in Zimbabwe compared with Tanzania cannot be explained by differences in risky sexual behaviour: all risk factors tested for in our study were higher for Tanzania than Zimbabwe. Non-sexual transmission of HIV might have played an important role in variation of HIV prevalence. Male circumcision rates and mobility could contribute to the rate and extent of spread of HIV in the two countries.
Borrego, D.; Kachingwe, M.; Nyblade, A.; Shillington, D. J.; Gaherty, J. B.; Ebinger, C. J.; Accardo, N. J.; O'Donnell, J. P.; Mbogoni, G. J.; Mulibo, G. D.; Chindandali, P. R. N.; Mphepo, F.; Ferdinand-Wambura, R.; Tepp, G.
Crustal Structure in Northern Malawi and Southern Tanzania surrounding Lake Malawi and the Rungwe Volcanic Province David Borrego, Marsella Kachingwe, Andrew Nyblade, Donna Shillington, James Gaherty, Cynthia Ebinger, Natalie Accardo, J.P. O'Donnell, Gabriel Mbogoni, Gabriel Mulibo, Richard Ferdinand, Patrick Chindandali, Felix Mphepo, Gabrielle Tepp, Godson Kamihanda We investigate crustal structure around the northern end of Lake Malawi and in the Rungwe Volcanic Province using teleseismic receiver functions from the SEGMeNT broadband seismic network. The SEGMeNT network includes 55 broadband stations deployed in northern Malawi and southern Tanzania, with station spacing of 20-50 km. Fourteen stations were deployed in August 2013, and an additional of 41 stations were added to the study region beginning June/July 2014. Fifteen stations are located in Malawi and 40 stations in Tanzania. Data from teleseismic earthquakes with magnitude 5.5 or greater in the 30 to 90 degrees distance range have been used to calculate P-wave receiver functions. Estimates of Moho depth and Vp/Vs ratios have been obtained by using the H-k stacking method and by jointly inverting the receiver functions with Rayleigh wave phase velocities. Preliminary results show an average Moho depth of 40 km and an average Vp/Vs ratio of 1.72. Little evidence is found for magmatic underplating beneath the Rungwe Volcanic Province.
Kenton, O [University of Pennsylvania, School of Arts and Sciences, College of Liberal and Professional Studies, Philadelphia, PA (United States); Dachi, J [Ocean Road Cancer Institute, Dar Es Salaam (Tanzania, United Republic of); Metz, J [University of Pennsylvania, Perelman School of Medicine, Department of Radiation Oncology, Philadelphia, PA (United States); Avery, S [University of Pennsylvania, School of Arts and Sciences, College of Liberal and Professional Studies, Philadelphia, PA (United States); University of Pennsylvania, Perelman School of Medicine, Department of Radiation Oncology, Philadelphia, PA (United States)
Purpose: Develop solutions to critical medical physics challenges in Tanzania. Methods: In September of 2013 we began working with Jumaa Bin Dachi, a Therapy Physicist at the Ocean Road Cancer Institute in Dar es Salaam, Tanzania. We developed a bi-lateral learning partnership over the course of eight qualitative Skype meetings with Jumaa. From these meetings we have ascertained that there is a gap between the installation of new equipment and treating patients. This gap has often been overlooked by international partners attempting to improve radiation therapy access. Relationships with academic institutions abroad can fill these gaps, and lead to sustained care of patients needing radiation. Results: Our efforts are best given in a supporting role to help develop solutions and new technology that can reduce the burden on the Medical Physicist. Solutions may include: training material, support for radiation therapy classes, development of appropriate local protocols, and peer-review on documents being produced. New technology needs to focus around simple and easy field shaping, improved patient imaging systems, and systems for patient set-up. We believe our work can help alleviate some of the burdens faced by this institute. Conclusion: While we are just in the beginning stage of this partnership, we believe there is great potential for success between both parties. We hope that the Ocean Road Cancer Institute will benefit from potential funding and resources by partnering with a High Income Country to develop affordable solutions to clinical problems in Tanzania.
Manuela De Allegri
Full Text Available This study aimed to explore factors shaping the decision to undergo Human Immunodeficiency Virus (HIV testing among men in rural Burkina Faso.The study took place in 2009 in the Nouna Health District and adopted a triangulation mixed methods design. The quantitative component relied on data collected through a structured survey on a representative sample of 1130 households. The qualitative component relied on 38 in-depth interviews, with men purposely selected to represent variation in testing decision, age, and place of residence. A two-part model was conducted, with two distinct outcome variables, i.e. "being offered an HIV test" and "having done an HIV test". The qualitative data analysis relied on inductive coding conducted by three independent analysts.Of the 937 men, 357 had been offered an HIV test and 97 had taken the test. Younger age, household wealth, living in a village under demographic surveillance, and knowing that HIV testing is available at primary health facilities were all positively associated with the probability of being offered an HIV test. Household wealth and literacy were found to be positively associated, and distance was found to be negatively associated with the probability of having taken an HIV test. Qualitative findings indicated that the limited uptake of HIV testing was linked to poor knowledge on service availability and to low risk perceptions.With only 10% of the total sample ever having tested for HIV, our study confirmed that male HIV testing remains unacceptably low in Sub-Saharan Africa. This results from a combination of health system factors, indicating general barriers to access, and motivational factors, such as one's own knowledge of service availability and risk perceptions. Our findings suggested that using antenatal care and curative services as the exclusive entry points into HIV testing may not be sufficient to reach large portions of the male population. Thus, additional strategies are urgently
Full Text Available A review was conducted to provide comprehensive update on Rift Valley fever (RVF in Tanzania, with particular attention devoted to trend of occurrence, epidemiological factors, socio-economic impact and measures which were applied to its control. Information presented in this paper was obtained through extensive literature review. Rift Valley fever was documented for the first time in Tanzania in 1977. This was followed by epidemics in 1997 and 2007. Contrary to the latest epidemic in 2007 sporadic cases of RVF during the previous epidemics were confined to mainly livestock and mostly affecting northern parts of Tanzania. The latest disease epidemic expanded to cover wider areas (mostly northern and central zones of the country involving both human and domestic ruminants. During the latest disease outbreak 52.4% (n = 21 of regions in Tanzania mainland were affected and majority (72.7, n = 11 of the regions had concurrent infections in human and animals. Phylogenetic comparison of nucleotide and amimo acid sequences revealed different virus strains between Kenya and Tanzania.Epidemiological factors that were considered responsible for the previous RVF epidemics in Tanzania included farming systems, climatic factors, vector activities and presence of large population of ruminant species, animal movements and food consumption habits. Majority of the RVF positive cases in the latest epidemic were livestock under pastoral and agro-pastoral farming systems.The disease caused serious effects on rural people’s food security and household nutrition and on direct and indirect losses to livestock producers in the country. Psycho-social distress that communities went through was enormous, which involved the thinking about the loss of their family members and/or relatives, their livestock and crop production. Socially, the status of most livestock producers was eroded in their communities.Cessation of lucrative trade in ruminants resulted in serious
Christopher J. Kasanga
Full Text Available This study was conducted to investigate the presence of foot-and-mouth disease virus (FMDV in different geographic locations of Tanzania. Epithelial tissues and fluids (n = 364 were collected from cattle exhibiting oral and foot vesicular lesions suggestive of FMD and submitted for routine FMD diagnosis. The analysis of these samples collected during the period of 2002 and 2010 was performed by serotype-specific antigen capture ELISA to determine the presence of FMDV. The results of this study indicated that 167 out of 364 (46.1% of the samples contained FMDV antigen. Of the 167 positive samples, 37 (28.4% were type O, 7 (4.1% type A, 45 (21.9% SAT 1 and 79 (45.6% SAT 2. Two FMDV serotypes (O and SAT 2 were widely distributed throughout Tanzania whilst SAT 1 and A types were only found in the Eastern zone. Our findings suggest that serotypes A, O, SAT 1 and SAT 2 prevail in Tanzania and are associated with the recent FMD outbreaks. The lack of comprehensive animal movement records and inconsistent vaccination programmes make it difficult to determine the exact source of FMD outbreaks or to trace the transmission of the disease over time. Therefore, further collection and analysis of samples from domestic and wild animals are being undertaken to investigate the genetic and antigenic characteristics of the circulating strains, so that a rational method to control FMD in Tanzania and the neighbouring countries can be recommended.
Rebecca F Baggaley
Full Text Available BACKGROUND: Unsafe abortion is estimated to account for 13% of maternal mortality globally. Medical abortion is a safe alternative. METHODS: By estimating mortality risks for unsafe and medical abortion and childbirth for Tanzania and Ethiopia, we modelled changes in maternal mortality that are achievable if unsafe abortion were replaced by medical abortion. We selected Ethiopia and Tanzania because of their high maternal mortality ratios (MMRatios and contrasting situations regarding health care provision and abortion legislation. We focused on misoprostol-only regimens due to the drug's low cost and accessibility. We included the impact of medical abortion on women who would otherwise choose unsafe abortion and on women with unwanted/mistimed pregnancies who would otherwise carry to term. RESULTS: Thousands of lives could be saved each year in each country by implementing medical abortion using misoprostol (2122 in Tanzania and 2551 in Ethiopia assuming coverage equals family planning services levels: 56% for Tanzania, 31% for Ethiopia. Changes in MMRatios would be less pronounced because the intervention would also affect national birth rates. CONCLUSIONS: This is the first analysis of impact of medical abortion provision which takes into account additional potential users other than those currently using unsafe abortion. Thousands of women's lives could be saved, but this may not be reflected in as substantial changes in MMRatios because of medical abortion's demographic impact. Therefore policy makers must be aware of the inability of some traditional measures of maternal mortality to detect the real benefits offered by such an intervention.