Department of Statistics

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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.
Predictors of mHealth use in promoting adherence to pre-exposure prophylaxis among female sex workers: an evaluation of the Jichunge intervention in Dar es Salaam, Tanzania
(Springer Nature, 2022-07-04) Mbotwa, Christopher; Kazaura, Method; Leshabari, Melkizedeck; Metta, Emmy; Leyna, Germana; Mmbaga, Elia J
Background There is evidence that pre-exposure prophylaxis (PrEP) is effective in preventing HIV transmission, and PrEP is recommended by the World Health organization (WHO) for use by individuals at high risk of HIV infection. However, low adherence has been reported to hamper its effectiveness. Some evidence indicates that mHealth interventions may be a promising way of promoting PrEP adherence. Nevertheless, evaluations of mHealth interventions in Africa, the region most affected by HIV, are scarce. This study aimed at identifying the extent of and predictors for use of a smartphone based mHealth application among female sex workers in Dar es Salaam, Tanzania. Methods As part of a quasi-experimental study in Tanzania, 470 female sex workers who were eligible for PrEP and who owned a smartphone were recruited using respondent driven sampling. All participants were provided with an mHealth application called Jichunge, a smartphone-based app designed to promote adherence to PrEP by offering users information, advise and support during start-up and use of PrEP. We collected data through structured interviews at baseline and extracted user data from the app for a period of 30 days. Modified Poisson regression model with robust standard errors was used to identify predictors for the optimal use of the Jichunge app. Results Overall, the optimal use of the Jichunge app was 46.4%. Optimal use was significantly higher among women who were older (aPR = 1.3, 95% CI: 1.10-1.65, p = 0.004 for age 25-34 years, and aPR = 1.6, 95% CI: 1.19-2.07, p = 0.001 for age at least 35 years), who had secondary education or higher (aPR = 1.8, 95% CI: 1.08-2.94, p = 0.023), who had suboptimal social support (aPR = 1.2, 95% CI: 1.02-1.48, p = 0.030), who had high awareness of PrEP (aPR = 1.3, 95% CI: 1.08-1.55, p = 0.005), and who had experience using common mainstream social media applications (aPR = 1.4, 95% CI: 1.08-1.71, p = 0.009). Conclusion Optimal use of the Jichunge app was substantially higher among women with higher age, higher education, higher PrEP awareness, less social support, and experience using common social media applications. Individual and interpersonal factors should be considered in planning mHealth interventions. Further studies to determine predictors of longer-term mHealth engagement are needed.
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.
Predictors of mHealth use in promoting adherence to pre‑exposure prophylaxis among female sex workers: an evaluation of the Jichunge intervention in Dar es Salaam, Tanzania
(Springer Nature, 2021-07-04) Mbotwa, Christopher; Method, Kazaura; Moen, Kåre; Leshabari, Melkizedeck; Metta, Emmy; Leyna, Germana; Mmbaga, Elia J.
Background There is evidence that pre-exposure prophylaxis (PrEP) is effective in preventing HIV transmission, and PrEP is recommended by the World Health organization (WHO) for use by individuals at high risk of HIV infection. However, low adherence has been reported to hamper its effectiveness. Some evidence indicates that mHealth interventions may be a promising way of promoting PrEP adherence. Nevertheless, evaluations of mHealth interventions in Africa, the region most affected by HIV, are scarce. This study aimed at identifying the extent of and predictors for use of a smartphone based mHealth application among female sex workers in Dar es Salaam, Tanzania. Methods As part of a quasi-experimental study in Tanzania, 470 female sex workers who were eligible for PrEP and who owned a smartphone were recruited using respondent driven sampling. All participants were provided with an mHealth application called Jichunge, a smartphone-based app designed to promote adherence to PrEP by offering users information, advise and support during start-up and use of PrEP. We collected data through structured interviews at baseline and extracted user data from the app for a period of 30 days. Modified Poisson regression model with robust standard errors was used to identify predictors for the optimal use of the Jichunge app. Results Overall, the optimal use of the Jichunge app was 46.4%. Optimal use was significantly higher among women who were older (aPR = 1.3, 95% CI: 1.10-1.65, p = 0.004 for age 25-34 years, and aPR = 1.6, 95% CI: 1.19-2.07, p = 0.001 for age at least 35 years), who had secondary education or higher (aPR = 1.8, 95% CI: 1.08-2.94, p = 0.023), who had suboptimal social support (aPR = 1.2, 95% CI: 1.02-1.48, p = 0.030), who had high awareness of PrEP (aPR = 1.3, 95% CI: 1.08-1.55, p = 0.005), and who had experience using common mainstream social media applications (aPR = 1.4, 95% CI: 1.08-1.71, p = 0.009). Conclusion Optimal use of the Jichunge app was substantially higher among women with higher age, higher education, higher PrEP awareness, less social support, and experience using common social media applications. Individual and interpersonal factors should be considered in planning mHealth interventions. Further studies to determine predictors of longer-term mHealth engagement are needed.
Social Factors Associated with Female Household Headship in Tanzania.
(1994) Katapa, R. S.
The Tanzania Health and Demographic Survey (TDHS) conducted in 1991/92 shows that 18.5% of Tanzanian households are headed by women. Using the TDHS household questionnaire data, logit regression model analysis have shown that female heads of households are older and less educated than the male heads of households. The models have also shown that female headed households are smaller in size and have fewer adult males than the male headed ones. Female headed households are over-represented in urban areas.
Teenage Mothers in Their Second Pregnancies
(1998) Katapa, R. S.
Gender Differences in School Performance: Evidence Form the National Form IV Examination Result and Implications for Poverty
(1999) Katapa, R. S.
Mother's Marital Status as a Correlate of Child Welfare in Tanzania
(1993) Katapa, R. S.
4. Arranged Marriages
(1994) Katapa, R. S.
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.
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.
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.
Knowledge on HIV/AIDS and Sexual Behaviour among Youths in Kibaha District, Tanzania
(2008) Lema, L. A.; Katapa, R. S.; Musa, A. S.
Sub-Saharan Africa is more heavily affected by HIV/AIDS than any other region in the World. Half of all new HIV infections occur in young people. Identifi cation of the associated factors is likely to be useful in designing effective interventions. This cross-sectional study aimed to investigate the determinants of high-risk sexual behaviours among youths in Kibaha District, Tanzania. Data was collected using a structured questionnaire. The survey gathered data pertaining to the sexual healthy behaviours among youths, including condom use, number of sexual partners, age at fi rst sexual involvement and knowledge on sexually transmitted diseases and HIV/AIDS. A total of 322 individuals aged 15-24 years were involved in the study. More than 69% had sex at least once in their life time. Only about one-third (32.3%) of the youths reported to have used condom during the fi rst sexual intercourse and 37% during the last sex. About 21.7% of the respondents acknowledged having more than one sexual partner in the last 12 months. The majority (98.4%) of the respondents have heard of HIV/AIDS. About three quarters (74.8%) of the respondents knew where to get HIV testing services but only a small proportion (28.9%) had tested for HIV infection. Of those not yet tested, 38.2% admitted that they were ready to do so. Although 317 (98.4%) respondents were aware of HIV/AIDS, and majority, 65.2% mentioned condom as the method used to prevent its transmission, only 117 (36.3%) acknowledged using them. In conclusion, despite good knowledge on transmission of HIV among youths in Kibaha district, only a small proportion of them practices safe sex. Education programmes on safe sex practices should be strengthened to provide skills that could be effective in changing and maintaining safe sex behaviours among youths 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.
Time Use Comparison of Female and Male Teenagers in Tanzania
(2005) Katapa, R. S.
A study on phase-1 time use in Tanzania was carried out by the Department of Statistics between January and February 2005. The phase-2 study was conducted between March and August 2005. The questionnaire method was employed in collecting data for the phase-1 study and data for the phase-2 study was collected by the diary method. In both phases, youths including teenage girls and boys were among people from whom data was collected. This paper is concerned with analysing data on teenagers from the phase-1 study
A Test of Hypothesis on Familial Correlations
(1993) Katapa, R. S.
When familial data are analysed, the model usually employed assumes independence of family observations and constancy of interclass and intraclass correlations. A statistic for testing the validity of the assumptions of family independence and constant interclass and intraclass correlations is developed. The test statistic is for constant family size; it has an asymptotic chi-square distribution. An example to illustrate the theory is given using Frets's data on head lengths. A recommendation is made on how to apply the test to the general case of varying family sizes. Another recommendation is made on models to be tried once the null hypothesis is rejected.
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.
Prevalence of Bacterial Febrile Illnesses in Children in Kilosa District, Tanzania
(2015-04) Chipwaza, Beatrice; Mhamphi, Ginethon G.; Ngatunga, Steve D.; Selemani, Majige; Amuri, Mbaraka; Mugasa, Joseph P.; Gwakisa, Paul S.
Bacterial etiologies of non-malaria febrile illnesses have significantly become important due to high mortality and morbidity, particularly in children. Despite their importance, there are few reports on the epidemiology of these diseases in Tanzania, and the true burden of such illnesses remains unknown. This study aimed to identify the prevalence of leptospirosis, brucellosis, typhoid fever and urinary tract infections and their rate of co-infections with malaria. A cross-sectional study was conducted at Kilosa district hospital in Tanzania for 6 months. Febrile children aged from 2-13 years were recruited from the outpatient department. Patients were screened by serological tests such as IgM and IgG ELISA, and microscopic agglutination test. A total of 370 patients were enrolled; of these 85 (23.0%) had malaria parasites, 43 (11.6%) had presumptive acute leptospirosis and 26/200 (13%) had confirmed leptospirosis. Presumptive acute brucellosis due to B. abortus was identified among 26 (7.0%) of patients while B. melitensis was detected in 57 (15.4%) of the enrolled patients. Presumptive typhoid fever due to S. Typhi was identified in thirty eight (10.3%) of the participants and 69 (18.6%) had urinary tract infections. Patients presented with similar symptoms; therefore, the identification of these diseases could not be done based on clinical ground alone. Co-infections between malaria and bacterial febrile illnesses were observed in 146 patients (39.5%). Although antibacterials and/or anti-malarials were prescribed in most patients, some patients did not receive the appropriate treatment. The study has underscored the importance of febrile bacterial diseases including zoonoses such as leptospirosis and brucellosis in febrile children, and thus such illnesses should be considered by clinicians in the differential diagnoses of febrile diseases. However, access to diagnostic tests for discrimination of febrile illnesses is needed. This would allow febrile patients to receive the correct diagnoses and facilitation of accurate and prompt treatment. Discover the world's research
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
The Influence of Weather on Mortality in Rural Tanzania: A Time-Series Analysis 1999–2010
(2012-11) Mrema, Sigilbert; Shamte, Amri; Selemani, Majige; Masanja, Honorati
Background: Weather and climate changes are associated with a number of immediate and long-term impacts on human health that occur directly or indirectly, through mediating variables. Few studies to date have established the empirical relationship between monthly weather and mortality in sub-Saharan Africa. Objectives: The objectives of this study were to assess the association between monthly weather (temperature and rainfall) on all-cause mortality by age in Rufiji, Tanzania, and to determine the differential susceptibility by age groups. Methods: We used mortality data from Rufiji Health and Demographic Surveillance System (RHDSS) for the period 1999 to 2010. Time-series Poisson regression models were used to estimate the association between monthly weather and mortality adjusted for long-term trends. We used a distributed lag model to estimate the delayed association of monthly weather on mortality. We stratified the analyses per age group to assess susceptibility. Results: In general, rainfall was found to have a stronger association in the age group 0-4 years (RR=1.001, 95% CI=0.961-1.041) in both short and long lag times, with an overall increase of 1.4% in mortality risk for a 10 mm rise in rainfall. On the other hand, monthly average temperature had a stronger association with death in all ages while mortality increased with falling monthly temperature. The association per age group was estimated as: age group 0-4 (RR=0.934, 95% CI=0.894-0.974), age group 5-59 (RR=0.956, 95% CI=0.928-0.985) and age group over 60 (RR=0.946, 95% CI=0.912-0.979). The age group 5-59 experienced more delayed lag associations. This suggests that children and older adults are most sensitive to weather related mortality. Conclusion: These results suggest that an early alert system based on monthly weather information may be useful for disease control management, to reduce and prevent fatal effects related to weather and monthly weather.

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