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    Distribution of Adaptation Climate Finance in Africa Region
    (University of Dar es Salaam, 2021-12) Kibona, Shadrack Elia; Pauline, Noah Makula; Hepelwa, Aloyce S
    This study aimed at examining the distribution of adaptation climate finance flowing into the Africa region in order to understand the extent to which vulnerable countries and sectors are targeted. Developing countries receive adaptation climate finance in support of resilience to climate change and variability impacts. The anthropogenic drivers of climate change and variability are from all parts of the world with higher contribution from industrialized countries and less from poor countries - though the impacts are more intense within developing countries. Data were obtained from the Organization for Economic Cooperation and Development and the United Nations Department of Economic and Social Affairs. Cluster analysis, principal component analysis, and correlation analysis were used to understand the distribution of climate finance for adaptation by country and by sector. Adaptation climate finance flows in large amounts to the least developed countries most vulnerable to the impact of climate change and variability. Agriculture, forestry and fisheries; education; general environment protection; industry, minerals and construction; and transport and communication are the leading sectors in receiving adaptation climate finance. The findings reveal that social sectors are positively correlated with vulnerability while sectors related to infrastructure are negatively related with regard to vulnerability index. Optimal distribution of climate finance globally is expected to lead to the attainment of climate change solutions and sustainable development among countries and among sectors of the economy.
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    Predictors of condom use among unmarried sexually active women of reproductive age in Tanzania
    (National Institute of Medical Research, 2022-08) Mbotwa, Christopher H; Moshi, Fabiola V; Mosha, Idda H; Kibona, Shadrack E; Ezekiel, Mangi J; Kazaura, Method R
    Background: Condom is one of the methods for prevention against Human Immunodeficiency Virus and other Sexually Transmitted Infections. It is also considered an effective method for preventing unwanted pregnancies. Despite the several interventions that have been put to promote condom use, still, a large proportion of women do not use condoms during sexual intercourse. Objectives: This study aimed at determining predictors of condom use among unmarried sexually active women of reproductive age in Tanzania. Methods: This study used secondary data from the 2015-16 Tanzania Demographic and Health Survey and Malaria Indicator Survey (2015-16 TDHS-MIS). It involved unmarried sexually active women aged 15-49 years. Multiple binary logistic regression was used to determine predictors for condom use at last sexual intercourse. Results: Overall, a lower proportion (31.1%) of unmarried sexually active women used condoms at last sexual intercourse. The odds of using condoms during last sexual intercourse were lower for older women (aOR=0.67 and aOR=0.65 for women aged 20-24 and 25+ years respectively). Women who reported higher age (18+ years) at first sex had higher odds (aOR=1.65) of using condoms compared to those who started having sex before 15 years old. Women from rich households (aOR=1.5) and those owning phones (aOR=1.44) had higher odds using condoms at their last sexual intercourse. Also, higher odds of using condoms were observed for women in the Southern, South West highlands, and Eastern zones compared to the Central zone. Conclusion: The level of condom use among unmarried women in Tanzania is very low and varies by age, age at sex intercourse, household wealth index status, ownership of a phone and domicile zones. Targeted interventions are needed to promote condom use among unmarried women to mitigate the risk of HIV and unintended pregnancies.
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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.
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    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.
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    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.
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    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.
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    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.
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    4. Arranged Marriages
    (1994) Katapa, R. S.
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    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.
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    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.
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    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.
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    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.
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    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.
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    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
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    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.
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    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.
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    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