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4. Arranged Marriages
(1994) Katapa, R. S.
Access to Artemisinin-Based Anti-Malarial Treatment and Its Related Factors in Rural Tanzania
(2013-05) Khatib, Rashid A.; Selemani, Majige; Mrisho, Gumi A.; Masanja, Irene M.; Amuri, Mbaraka; Njozi, Mustafa; Dan, Kajungu; Kuepfer, Irene; Abdulla, Salim; De Savigny, Don
Background Artemisinin-based combination treatment (ACT) has been widely adopted as one of the main malaria control strategies. However, its promise to save thousands of lives in sub-Saharan Africa depends on how effective the use of ACT is within the routine health system. The INESS platform evaluated effective coverage of ACT in several African countries. Timely access within 24 hours to an authorized ACT outlet is one of the determinants of effective coverage and was assessed for artemether-lumefantrine (Alu), in two district health systems in rural Tanzania. Methods From October 2009 to June 2011we conducted continuous rolling household surveys in the Kilombero-Ulanga and the Rufiji Health and Demographic Surveillance Sites (HDSS). Surveys were linked to the routine HDSS update rounds. Members of randomly pre-selected households that had experienced a fever episode in the previous two weeks were eligible for a structured interview. Data on individual treatment seeking, access to treatment, timing, source of treatment and household costs per episode were collected. Data are presented on timely access from a total of 2,112 interviews in relation to demographics, seasonality, and socio economic status. Results In Kilombero-Ulanga, 41.8% (CI: 36.6–45.1) and in Rufiji 36.8% (33.7–40.1) of fever cases had access to an authorized ACT provider within 24 hours of fever onset. In neither of the HDSS site was age, sex, socio-economic status or seasonality of malaria found to be significantly correlated with timely access. Conclusion Timely access to authorized ACT providers is below 50% despite interventions intended to improve access such as social marketing and accreditation of private dispensing outlets. To improve prompt diagnosis and treatment, access remains a major bottle neck and new more innovative interventions are needed to raise effective coverage of malaria treatment in Tanzania.
Assessing The Effects of Mosquito Nets on Malaria Mortality Using a Space Time Model: A Case Study of Rufiji And Ifakara Health And Demographic Surveillance System Sites In Rural Tanzania
(2016-11) Selemani, Majige; Msengwa, Amina; Mrema, Sigilbert; Shamte, Amri; Mahande, Michael J.; Yeates, Karen; Mbago, Maurice; Lutambi, Angelina M.
Background: Although malaria decline has been observed in most sub-Saharan African countries, the disease still represents a significant public health burden in Tanzania. There are contradictions on the effect of ownership of at least one mosquito net at household on malaria mortality. This study presents a Bayesian modelling framework for the analysis of the effect of ownership of at least one mosquito net at household on malaria mortality with environmental factors as confounder variables. Methods: The analysis used longitudinal data collected in Rufiji and Ifakara Health Demographic Surveillance System (HDSS) sites for the period of 1999-2011 and 2002-2012, respectively. Bayesian framework modelling approach using integrated nested laplace approximation (INLA) package in R software was used. The space time models were established to assess the effect of ownership of mosquito net on malaria mortality in 58 villages in the study area. Results: The results show that an increase of 10 % in ownership of mosquito nets at village level had an average of 5.2 % decrease inall age malaria deaths (IRR = 0.948, 95 % CI = 0.917, 0.977) in Rufiji HDSS and 12.1 % decrease in all age malaria deaths (IRR = 0.879, 95 % CI = 0.806, 0.959) in Ifakara HDSS. In children under 5 years, results show an average of 5.4 % decrease of malaria deaths (IRR = 0.946, 95 % CI = 0.909, 0.982) in Rufiji HDSS and 10 % decrease of malaria deaths (IRR = 0.899, 95 % CI = 0.816, 0.995) in Ifakara HDSS. Model comparison show that model with spatial and temporal random effects was the best fitting model compared to other models without spatial and temporal, and with spatial-temporal interaction effects. Conclusion: This modelling framework is appropriate and provides useful approaches to understanding the effect of mosquito nets for targeting malaria control intervention. Furthermore, ownership of mosquito nets at household showed a significant impact on malaria mortality.
Assessing the Effects of Mosquito Nets on Malaria Mortality Using a Space Time Model: A Case Study of Rufiji and Ifakara Health and Demographic Surveillance System Sites in Rural Tanzania
(BioMed Central, 2016) Selemani, Majige; Msengwa, Amina S.; Mrema, Sigilbert; Shamte, Amri; Mahande, Michael J.; Yeates, Karen; Mbago, Maurice C. Y.; Lutambi, Angelina M.
Background: Although malaria decline has been observed in most sub-Saharan African countries, the disease still represents a significant public health burden in Tanzania. There are contradictions on the effect of ownership of at least one mosquito net at household on malaria mortality. This study presents a Bayesian modelling framework for the analysis of the effect of ownership of at least one mosquito net at household on malaria mortality with environmental factors as confounder variables. Methods: The analysis used longitudinal data collected in Rufiji and Ifakara Health Demographic Surveillance System (HDSS) sites for the period of 1999–2011 and 2002–2012, respectively. Bayesian framework modelling approach using integrated nested laplace approximation (INLA) package in R software was used. The space time models were established to assess the effect of ownership of mosquito net on malaria mortality in 58 villages in the study area. Results: The results show that an increase of 10 % in ownership of mosquito nets at village level had an average of 5.2 % decrease inall age malaria deaths (IRR = 0.948, 95 % CI = 0.917, 0.977) in Rufiji HDSS and 12.1 % decrease in all age malaria deaths (IRR = 0.879, 95 % CI = 0.806, 0.959) in Ifakara HDSS. In children under 5 years, results show an average of 5.4 % decrease of malaria deaths (IRR = 0.946, 95 % CI = 0.909, 0.982) in Rufiji HDSS and 10 % decrease of malaria deaths (IRR = 0.899, 95 % CI = 0.816, 0.995) in Ifakara HDSS. Model comparison show that model with spatial and temporal random effects was the best fitting model compared to other models without spatial and temporal, and with spatial–temporal interaction effects. Conclusion: This modelling framework is appropriate and provides useful approaches to understanding the effect of mosquito nets for targeting malaria control intervention. Furthermore, ownership of mosquito nets at household showed a significant impact on malaria mortality.
Caretakers of AIDS Patients in Rural Tanzania
(2004) Katapa, R. S.
Socio-economic characteristics of caretakers of bed-ridden AIDS patients in two rural communities of Rungwe district, Tanzania were sought. The study also explored what caretaking entailed. Data were collected from 60 caretakers between September and November 2002. The proportion of female caretakers was significantly higher than that of male caretakers; the majority of the caretakers were old. The majority of the AIDS patients were family members of the caretakers. The caretakers' households lacked basic needs for the patients. Some of the caretakers sold family assets in order to buy medicines for the patients. Most of the caretakers worked under stress and there was no one to counsel them. Community members offered very little or no support to caretakers and the households were stigmatized. People in the communities knew about HIV/AIDS transmission, but their behaviour did not match their knowledge.
Challenges in Establishing A Cohort-Event Monitoring Drug Safety Study in Ifakara And Rufiji HDSS
(2011-08) Amuri, Mbaraka; Kigahe, Brown; Njozi, Mustafa; Masanja, Irene M.; Selemani, Majige; Dan, Kajungu; Khatib, Rashid A.; Adounvo, Sharon A.; Abdulla, Salim; Binka, Fred; Dodoo, Alexander
The recommended artemisinin combination therapy (ACT) for treatment of uncomplicated malaria in Tanzania is artemether-lumefantrine (AL). Although Artemisinin and its derivatives are generally thought to be safe, there is currently little or no data on its safety among populations in Tanzania. In view of this INESS established a phase IV study to evaluate safety of AL through comprehensive pharmacovigilance in large populations with the aim of documenting rare adverse drug reactions and to characterize known effects in ‘real-life’. The methodology employed is cohort event monitoring which is observational, longitudinal and prospective. Patients with diagnosis of malaria for whom AL was prescribed were recruited into the cohort from four health facilities in each HDSS. Information on demographics, use of all medicines, mode of diagnosis of malaria, presenting signs and symptoms, co-diagnoses, events suspected as adverse drug reactions, reasons for stopping the drug and cause of death (if any) were collected using standardized questionnaire. They were followed up on 7 to 10 days after AL was dispensed. This report is on the number recruited so far and the challenges in getting the cohort going. 9028 patients were recruited. 9016 (99.8%) completed follow-up on day 7, of which 668 (7.4%) were done by telephone calls. 12 (0.13%) were lost during follow-up. The main challenges encountered are getting enough trained staff to recruit and follow up patients since CEM is quite labour intensive. 38 health providers and 10 field workers were recruited and offered the relevant training in collaboration with regulatory authorities. This helped to overcome the human resource challenge. Another challenge involved is the difficult to reach areas which are cut off especially during the rainy season. Follow up by telephone was adopted for these areas and this helped to reduce number of lost to follow-up. Setting up a cohort event monitoring program takes time and is demanding in terms of human resource. Training is very important in overcoming this. Involvement of all stakeholders and sponsors is a key to success
Clinician’s Awareness and Knowledge on the Management of Differentiated Thyroid Cancer and the Use of Radioactive Iodine in Tanzania
(2016) Sakafu, Lulu; Mselle, Teddy; Mwaiselage, Julius; Msengwa, Amina S.; Maunda, Khamza; Eddin, Bouyoucef S.
Introduction: Thyroid cancer is the most common endocrine malignancy worldwide with better outcome if timely and properly managed. Surgery followed by radioactive iodine (RAI) ablation remains the mainstay in the management of differentiated thyroid cancer (DTC). In Tanzania however, few patients with DTC receive RAI ablation post-surgery, and most of these present late, with advanced disease resulting in poor treatment outcome. The objective of this study was to determine the cause for late referral by assessing clinician’s awareness and knowledge on the management of DTC and the use of RAI in Tanzania. Methods: This descriptive cross sectional study was carried out in referral hospitals in Tanzania. Data collection used a standardized self-administered questionnaire. Information sought included awareness, knowledge and practices of clinicians on the management and the use of RAI on patients with DTC was explored. Results: Majority of clinicians managing DTC patients were males (86%), in-training surgeons (54%), and attended less than ten DTC patients per year (62%). About 44% of in-training surgeons never heard of nuclear medicine (p=0.04), and 20% were not aware of the role of RAI in the management of DTC (p=0.031). Only 7.3% of surgeons were aware of the role of thyroxine therapy, or RAI ablation post-surgery. Of all DTC patients managed surgically, only 16% had total thyroidectomy with lymphadenectomy (p=0.05). Conclusion: The findings of this study indicate there is insufficient knowledge on proper management and use of RAI on patients with DTC among clinicians in Tanzania.
Comparison of Estimators of Interclass and Intraclass Correlations from Familial Data
(Wiley, 1986) Srivastava, M. S.; Katapa, R. S.
When familles have different numbers of offspring, Srivastava (1984) gave an alternative approach to deriving the maximum-likelihood estimators of inter- and intraclass correlations, which requires solving only one equation. Since the procedure is iterative and requires considerable computation, several alternative estimators have been proposed in the literature. In this paper, a comparison is made between the maximum-likelihood estimator and two alternative estimators proposed by Srivastava (1984). By obtaining the asymptotic normal distributions of the estimators, it is shown that one of the easily computable estimators is comparable to the maximum-likelihood estimator.
A Comparison of Female-and Male-Headed Households in Tanzania and Poverty Implications
(Cambridge University Press, 2006) Katapa, R. S.
Female- and male-headed households were compared using data from a Demographic and Health Survey conducted in Tanzania in 1996. Chi-squared tests showed that sex of head of household was highly significantly associated with: residence, household size and composition, radio ownership, having enough food to eat, and age and marital status of head of household. An analysis by the logit regression model showed that female-headed households were more likely than male-headed households to be in rural areas, be small, have fewer men, not have radios and not have enough food to eat. The majority of female heads of households were unmarried and older than male heads of households. The implication is that female-headed households are poorer than male-headed households.
Correct Dosing of Artemether-Lumefantrine For Management of Uncomplicated Malaria in Rural Tanzania: Do Facility And Patient Characteristics Matter?
(2013-12) Masanja, Irene M.; Selemani, Majige; Khatib, Rashid A.; Amuri, Mbaraka; Kuepfer, Irene; Dan, Kajungu; De Savigny, Don; Kachur, Patrick S.; Skarbinski, Jacek
Use of artemisinin-based combination therapy (ACT), such as artemether-lumefantrine (AL), requires a strict dosing schedule that follows the drugs' pharmacokinetic properties. The quality of malaria case management was assessed in two areas in rural Tanzania, to ascertain patient characteristics and facility-specific factors that influence correct dosing of AL for management of uncomplicated malaria. Exit interviews were conducted with patients attending health facilities for initial illness consultation. Information about health workers' training and supervision visits was collected. Health facilities were inventoried for capacity and availability of medical products related to care of malaria patients. The outcome was correct dosing of AL based on age and weight. Logistic regression was used to assess health facility factors and patient characteristics associated with correct dosing of AL by age and weight. A total of 1,531 patients were interviewed, but 60 pregnant women were excluded from the analysis. Only 503 (34.2%) patients who received AL were assessed for correct dosing. Most patients who received AL (85.3%) were seen in public health facilities, 75.7% in a dispensary and 91.1% in a facility that had AL in stock on the survey day. Overall, 92.1% (463) of AL prescriptions were correct by age or weight; but 85.7% of patients received correct dosing by weight alone and 78.5% received correct dosing by age alone. In multivariate analysis, patients in the middle dosing bands in terms of age or weight, had statistically significant lower odds of correct AL dosing (p < 0.05) compared to those in the lowest age or weight group. Other factors such as health worker supervision and training on ACT did not improve the odds of correct AL dosing. Although malaria treatment guidelines indicate AL dosing can be prescribed based on age or weight of the patient, findings from this study show that patients within the middle age and weight dosing bands were least likely to receive a correct dose by either measure. Clinicians should be made aware of AL dosing errors for patients aged three to 12 years and advised to use weight-based prescriptions whenever possible.
Correlates of Knowledge of Prevention of Sexually Transmitted Diseases among Primary School Pupils in Tanzania
(2003) Mbago, Maurice C. Y.; Sichona, Francis J.
In this paper we attempt to identify factors that determine knowledge on prevention of sexually transmitted diseases (STDs) among primary school pupils in Tanzania using data extracted from the Family Life Education KAP Survey conducted in 1999. The data used consist of a sample of 18,564 pupils (about 50% males and 50% females) from all the 20 regions of Tanzania mainland. There were significant differences between boys and girls as regards knowledge of family life education in general. Boys tended to be more knowledgeable than girls about many aspects of family life education. The findings show that only 40.1% of the respondents were able to identify all the three STDs given in the questionnaire namely gonorrhoea, syphilis and AIDS. As regards modes of HIV transmission only 37.5% had full knowledge of these, while 48.8% knew condom use and abstinence as methods of STD prevention. The bivariate analysis showed significant relationships between knowledge of condom use and abstinence as methods of STD prevention with knowledge of STDs, HIV transmission, education level of the respondents, residence and parents' education for both boys and girls. However, knowledge of STDs, HIV transmission and residence came out clearly in the logistic regression as predictors of knowledge of condom use as a method of STD prevention for both sexes. For males, mother's education was also a significant predictor of knowledge of condom use as a method of STD prevention. Furthermore, a significant predictor of knowledge of condom use for female respondents was found to be the respondent's educational level. On the other hand, predictors of knowledge of abstinence as a method of STD prevention were knowledge of STDs and HIV transmission.
Dengue And Chikungunya Fever Among Viral Diseases in Outpatient Febrile Children in Kilosa District Hospital, Tanzania
(2014-11) Chipwaza, Beatrice; Mugasa, Joseph P.; Selemani, Majige; Amuri, Mbaraka; Mosha, Fausta; Ngatunga, Steve D.; Gwakisa, Paul S.
Viral etiologies of fever, including dengue, Chikungunya, influenza, rota and adeno viruses, cause major disease burden in tropical and subtropical countries. The lack of diagnostic facilities in developing countries leads to failure to estimate the true burden of such illnesses, and generally the diseases are underreported. These diseases may have similar symptoms with other causes of acute febrile illnesses including malaria and hence clinical diagnosis without laboratory tests can be difficult. This study aimed to identify viral etiologies as a cause of fever in children and their co-infections with malaria.
Design, Implementation and Evaluation of a National Campaign to Deliver 18 Million Free Long-Lasting Insecticidal Nets to Uncovered Sleeping Spaces in Tanzania
(2013) Renggli, Sabine; Mandike, Renata; Kramer, Karen; Patrick, Faith; Brown, Nick J.; McElroy, Peter D.; Rimisho, Wilhelmina; Msengwa, Amina S.; Mnzava, Ally; Nathan, Rose; Mtung’e, Romanus; Mgullo, Rita; Lweikiza, Jane; Lengeler, Christian
Background: Since 2004, the Tanzanian National Voucher Scheme has increased availability and accessibility of insecticide-treated nets (ITNs) to pregnant women and infants by subsidizing the cost of nets purchased. From 2008 to 2010, a mass distribution campaign delivered nine million long-lasting insecticidal nets (LLINs) free-of -charge to children under-five years of age in Tanzania mainland. In 2010 and 2011, a Universal Coverage Campaign (UCC) led by the Ministry of Health and Social Welfare (MoHSW) was implemented to cover all sleeping spaces not yet reached through previous initiatives. Methods: The UCC was coordinated through a unit within the National Malaria Control Programme. Partners were contracted by the MoHSW to implement different activities in collaboration with local government authorities. Volunteers registered the number of uncovered sleeping spaces in every household in the country. On this basis, LLINs were ordered and delivered to village level, where they were issued over a three-day period in each zone (three regions). Household surveys were conducted in seven districts immediately after the campaign to assess net ownership and use. Results: The UCC was chiefly financed by the Global Fund to Fight AIDS, Tuberculosis and Malaria with important contributions from the US President’s Malaria Initiative. A total of 18.2 million LLINs were delivered at an average cost of USD 5.30 per LLIN. Overall, 83% of the expenses were used for LLIN procurement and delivery and 17% for campaign associated activities. Preliminary results of the latest Tanzania HIV Malaria Indicator Survey (2011–12) show that household ownership of at least one ITN increased to 91.5%. ITN use, among children under-five years of age, improved to 72.7% after the campaign. ITN ownership and use data post-campaign indicated high equity across wealth quintiles. Conclusion: Close collaboration among the MoHSW, donors, contracted partners, local government authorities and volunteers made it possible to carry out one of the largest LLIN distribution campaigns conducted in Africa to date. Through the strong increase of ITN use, the recent activities of the national ITN programme will likely result in further decline in child mortality rates in Tanzania, helping to achieve Millennium Development Goals 4 and 6.
Determinants of extramarital sex by men in Tanzania: A case study of Mbeya region
(SAMA Health and Medical Publishing Group (HMPG), 2010-12) Mbago, Maurice; Sichona, Francis
This paper attempts to identify some factors associated with extramarital sex by men in the Mbeya region of Tanzania using data from a survey conducted in 2003/2004. The choice of Mbeya region was prompted by the fact that it has been found by previous studies to be one of the regions with the highest HIV prevalence rate in Tanzania. Correlates of extramarital sex that were considered include current age, education, residence, age at first sexual intercourse, age at first marriage and sex before marriage. A bivariate analysis of the survey data, which comprised a sample size of 568 married men aged between 15 and 62 years revealed statistically significant association between extramarital sex with current age, education, age at first intercourse and sex before marriage. The effect of these variables was tested through a multivariate logistic regression analysis and all the four independent variables were found to be statistically significant predictors of extramarital sex in Mbeya region.
Development of a Mobile Health Application for HIV Prevention Among At-Risk Populations in Urban Settings in East Africa: A Participatory Design Approach
(JMIR Publications, 2021-07-07) Mauka, Wilhellmuss; Mbotwa, Christopher; Moen, Kåre; Lichtwarck, Hanne Ochieng; Haaland, Inga; Kazaura, Method; Leyna, Germana H; Leshabari, Melkizedeck T; Mmbaga, Elia J
Background: There is limited evidence in Africa on the design and development of mobile health (mHealth) applications to guide best practices and ensure effectiveness. A pragmatic trial for HIV pre-exposure prophylaxis roll-out among key populations in Tanzania is needed. Objective: We present the results of the development of a mobile app (Jichunge) intended to promote adherence to pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) and female sex workers (FSW) in Tanzania. Methods: A participatory design approach was employed and guided by the information system research framework. MSM and FSW were the target populations. A total of 15 MSM and 15 FSW were engaged in the relevance and design cycles, while the piloting phase included 10 MSM and 20 FSW. Results: The relevance cycle enabled the description of the existing problem, provided the compatible app features for the target population, and identified the need to develop an mHealth app that provides health services in a stigmatizing and discriminating environment. User involvement in the app’s design and evaluation provided an opportunity to incorporate social, cultural, and community-specific features that ensured usability. In addition, the participants suggested valuable information to inform the app, text message services, medication registration, and chat platform designs. Conclusions: The participatory design approach in the development of mHealth apps is useful in identifying and validating population-specific functional features, improve usability, and ensuring future health impacts. Through this participatory process, the Jichunge app took end-user needs, perspectives, and experiences into account, eliciting enthusiasm regarding its potential role in supporting pre-exposure prophylaxis adherence for HIV and related behavioral change promotion.
The Effect of Mother’s Age and Other Related Factors On Neonatal Survival Associated With First And Second Birth In Rural, Tanzania: Evidence From Ifakara Health and Demographic Surveillance System in Rural Tanzania
(2014-07) Selemani, Majige; Mwanyangala, Mathew A.; Mrema, Sigilbert; Shamte, Amri; PhD, Dan K.; Mkopi, Abdallah; Mahande, Michael J.; Rose, Nathan
Background With a view to improve neonatal survival, data on birth outcomes are critical for planning maternal and child health care services. We present information on neonatal survival from Ifakara Health and Demographic Surveillance System (HDSS) in Tanzania, regarding the influence of mother’s age and other related factors on neonatal survival of first and second births. Methods The study conducted analysis using longitudinal health and demographic data collected from Ifakara HDSS in parts of Kilombero and Ulanga districts in Morogoro region. The analysis included first and second live births that occurred within six years (2004–2009) and the unit of observation was a live birth. A logistic regression model was used to assess the influence of socio-demographic factors on neonates’ survival. Results A total of 18,139 first and second live births were analyzed. We found neonatal mortality rate of 32 per 1000 live births (95% CI: 29/1000-34/1000). Results from logistic regression model indicated increase in risk of neonatal mortality among neonates those born to young mothers aged 13–19 years compared with those whose mother‘s aged 20–34 years (aOR = 1.64, 95% CI = 1.34-2.02). We also found that neonates in second birth order were more likely to die than those in first birth order (aOR = 1.85:95%CI = 1.52-2.26). The risk of neonatal mortality among offspring of women who had a partner co-resident was 18% times lower as compared with offspring of mothers without a partner co-resident in the household (aOR = 0.82: 95%CI = 0.66-0.98). Short birth interval (<33 months) was associated with increased risk of neonatal mortality (aOR = 1.50, 95% CI =1.16-1.96) compared with long birth interval (> = 33 months). Male born neonates were found to have an increased risk (aOR = 1.34, 95% CI =1.13- 1.58) of neonatal mortality as compared to their female counterparts. Conclusions Delaying the age at first birth may be a valuable strategy to promote and improve neonatal he
Enhancing HIV Status Disclosure and Partners' Testing Through Counselling in Tanzania
(2015-07) Idindili, Boniphace; Selemani, Majige; Bakar, Fakihi; Thawer, Sumaiyya G.; Gumi, Abdallah; Mrisho, Mwifadhi; Kahwa, Amos M.; Massaga, Julius J.
Background: In Tanzania HIV Testing and Counselling (HTC) is being implemented through voluntary counselling and testing (VCT), provider initiated counselling and testing (PITC) and work place counselling and testing (HTC). Within these programmes, HIV status disclosure is emphasized. However, among persons who test HIV positive, many do not disclose their status to their partners and social networks. However, data are lacking on the effectiveness of the different HTC strategies on HIV positive status disclosure. Objective: To investigate which of the three HIV Testing and Counselling (HTC) strategies: Voluntary Counselling and Testing (VCT), Provider Initiated Counselling and Testing (PITC) and work place Counselling and testing is associated with improved HIV-positive status disclosure in Eastern Tanzania. Methods: Structured interviews were conducted with 455 newly diagnosed HIV-positive clients at 6 HTC sites during enrolment and at three months follow-up to collect data on disclosure status. Results: We found that PITC strategy attended a relatively higher proportion of clients 182/455(40.1%) as compared to VCT 169/455 (37.1%) and work place HTC strategies 104/455(22.9%) respectively. Among clients, about one third 130/455(28.6%) were found to be HIV-positive. HIV status disclosure rates were variable and were in order of preference of disclosing to family members 86/130(66.2 %), followed by relatives 74/130(56.9%) and sexual partners 71/130(54.6%). A high proportion of participants 77/130(59.2%) experienced violence acts from sexual partners in form of stigma and discrimination, abuse, divorce and termination from employment. In the multivariate logistic regression, disclosure to sexual partners was associated with violence acts of about two times higher (Disclosure to Partners OR=1.89) when compared to the group that did not disclose to their partners. Conclusion: PITC strategy was found to result into higher rates of HIV positive status disclosure when compared to VCT and work place HTC strategies. Stigma, discrimination and violence acts are still prevalent in Tanzania and discourages HIV positive status disclosure. Based on these findings, there is an urgent need of promoting public education on HIV transmission, prevention and treatment and enhancing strategies to reduce risky sexual behaviour and increase condom use.
Estimation of Interclass and Intraclass Correlations in Multivariate Familial Data
(1988) Srivastava, M. S.; Keen, K. J.; Katapa, R. S.
Asymptotically normal estimators of interclass and intraclass correlations are derived for more than two quantitative characteristics of parent and siblings in a simple random sampling of families that have different numbers of offspring. These estimators are proposed as an alternative to the maximum likelihood estimators, which can be found only by iterative methods requiring prohibitively large amounts of computation. The asymptotic variances of the proposed estimators are also given. In an illustrative example, these easily computable estimators are seen to be comparable to the corresponding maximum likelihood estimators.
facility birth among women of reproductive age in Tanzania: an analysis of data from the 2015-16 Tanzania demographic and health survey and malaria indicator survey
(Springer Nature, 2020-09-24) Moshi, Fabiola V; Mbotwa, Christopher H
Background While evidence has shown an association between place of birth and birth outcomes, factors contributing to the choice of home birth have not been adequately investigated in Tanzania while more than 30% of deliveries occur outside of health care facilities, and more than 95% of those deliveries are assisted by non-medical providers who are often unskilled. The use of unskilled birth attendants has been cited as a factor contributing to the high maternal and neonatal mortalities in low-resources countries. This study aimed to identify determinants of choice for home birth over health care facility birth in Tanzania. Method: This study used the 2015-16 Tanzania Demographic and Health Survey and Malaria Indicator Survey (2015-16 TDHS-MIS) dataset. A total of 2286 women of reproductive age (15–49 years) who gave birth within one year preceding the survey were included in the analysis. Both univariate and multivariable regression analyses were used to determine predictors for the choice of home-based childbirth over health care facility delivery. Results A total of 805 (35.2%) women had a home birth. After adjusting for confounders, the determinants for choice of home birth were: the level of education (primary education [AOR = 0.666; p = 0.001]; secondary and higher education [AOR = 0.417; p < 0.001]), in reference to no formal education; not owning a mobile phone (AOR = 1.312; p = 0.018); parity (parity 2–4 [AOR = 1.594; p = 0.004], parity 5 and above [AOR = 2.158; p < 0.001] in reference to parity 1); inadequate antenatal visits (AOR = 1.406; p = 0.001); wealth index (poorest (AOR = 9.395, p < 0.001); poorer (AOR = 7.701; p < 0.001); middle (AOR = 5.961; p < 0.001); richer (AOR = 2.557; p < 0.001)] in reference to richest women; and Zones (Southern Highlands, [AOR = 0.189; p < 0.001]; Southern, [AOR = 0.225; p < 0.001]; Zanzibar, [AOR = 2.55; p < 0.001]) in reference to Western zone. Conclusions A large proportion of women birth at home. Unskilled providers such as traditional birth attendants (TBAs), relatives or friends attend most of them. Predictors for home-based childbirth included lack of formal education, poor access to telecommunication, poor uptake of antenatal visits, low socio-economic status, and geographical zone. Innovative strategies targeting these groups are needed to increase the use of health care facilities for childbirth, thereby reducing maternal and neonatal mortality in Tanzania.
Framework for Enhancing E-Health Data Integration and Sharing in Distributed Environments
(2014-06) Ndume, Vitalis A.; Gyekye, Yaw N.; Ko, Jesuk; Selemani, Majige
This paper describes a proposed conceptual framework for integrating e-Health records for health research institutions. The framework is based on a cross-sectional study at Ifakara Health Institute in Tanzania. It is developed by identifying both social and technical aspects associated with intra-organization data integration and sharing. The two major questions answered in this research are: i) what are the principal socio-technical factors in a value chain of intra-organization data integration? and ii) what is the intensity and strength of these factors in influencing the effectiveness of health data integration and sharing between and across a network of collaborators? The specific objective of the study focuses on the impact of socio-technical factors on intra-organization data integration and sharing. Technical and social factors were analyzed as service requirements to enhance data integration in health research institutions. The significance of each domain in respect to data integration was identified. Finally, a conceptual framework was proposed to address the gap in the process of intra-organization data integration.

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