Department of Social Sciences

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Use of mHealth to improve retention to pre-exposure prophylaxis for HIV prevention among female sex workers: an evaluation of the Jichunge intervention in Dar es Salaam, Tanzania.
(National Insititute of Medical Research (NIMR), 2022-05-19) Mbotwa, Christopher; Kazaura, Method; Mmbaga, Elia J.
Abstract: Background: Female sex workers are among groups at increased risk of HIV infection. Pre-exposure prophylaxis (PrEP) has been proven to be effective in preventing HIV transmission, but low retention to services poses a challenge to its effectiveness. Innovative interventions to tackle the problem and help achieve universal health coverage goals are called for. Objective: To determine the effect of smartphone based mHealth application on retention to PrEP among female sex workers in Dar es Salaam. Methods: Using respondent driven sampling, 470 female sex workers eligible for PrEP and who owned a smartphone were recruited. All participants were provided with a smartphone-based mHealth app (Jichunge app) which has multiple functionalities designed to promote PrEP use and retention among HIV at risk population. We utilized information collected during the baseline, month 1 follow-up, and data on the use of Jichunge app for a period of 30 days. Associations between PrEP retention and optimal use of different functionalities of the app was assessed using modified Poisson regression model with robust standard errors. Results: Of 470 recruited participants, 253 (53.8%) were retained to PrEP services at month 1. Retention to PrEP services was significantly higher among those who opened the Jichunge app after installation (APR=1.4, 95% CI: 1.13-1.85), used gamification functions (APR=1.5, 95% CI: 1.18-1.89), visited PrEP editorial contents (APR=1.4, 95% CI:1.16-1.67), consulted a doctor or peer educator (APR=1.5, 95% CI:1.29-1.79), or engaged in the discussion with other PrEP users (APR=1.4, 95% CI:1.17-1.62). Conclusion: The use of Jichunge mHealth application significantly increased retention to PrEP among female sex workers in Dar es Salaam. The results indicate that use of mHealth interventions hold potential to promote universal health coverage in a cascade of PrEP and other related interventions.
Acceptability of an mHealth intervention to promote the use of pre-exposure prophylaxis among individuals at increased risk of HIV. The case of the Jichunge smartphone app in Dar es Salaam, Tanzania.
(IAS, 2022-07-29) Mbotwa, Christopher; Kazaura, Method; Moen, Kåre; Leshabari, Melkizedeck; Metta, Emmy; Mmbaga, Elia J.
Background: Reducing HIV infection rates among at-risk populations is more likely to contribute to achieving the 2030 goal of ending the epidemic. Countries in sub-Saharan Africa, including Tanzania, have started rolling out pre-exposure prophylaxis (PrEP), but adherence to the daily pills poses a challenge. Evidence indicates that mHealth is a promising solution for promoting uptake, retention, and adherence to PrEP. However, evaluation data of its implementation in Africa settings are scarce. This study aimed at assessing acceptability and initial use of mHealth in promoting PrEP use among female sex workers (FSW) and men who have sex with men (MSM) in Dar es Salaam, Tanzania. Methods: FSW and MSM residing in Dar es Salaam who owned smartphones and were eligible for PrEP were recruited using respondent-driven sampling and provided with the Jichunge, a smartphone-based application designed to promote adherence to PrEP and retention in PrEP services. The app offers users information about HIV and PrEP, reminds them to take their daily pill, allows them to consult a doctor and peer educator, and includes an online forum where may engage in discussions with other PrEP users. Results: A total of 885 participants (470 FSW and 415 MSM) with a median age of 26 and 21 years, respectively, were recruited. Most (559; 63.2%) opened the app and registered pill-taking (523; 59.1%) at least once. About a third of the participants accessed the app’s PrEP and HIV editorial contents (348; 39.3%) and participated in the discussion forum (277; 31.3%). A total of 172(19.4%) consulted a doctor or peer educator via the app. FSW were significantly more likely than MSM to open the app (FSW:74%; MSM: 50.8%; p<0.001), register daily pill use (FSW:71.7%; MSM: 44.8%; p<0.001), access editorial contents (FSW:47.0%; MSM: 30.6%; p<0.001), and engage in the discussion forum (FSW:34.3%; MSM: 27.9%; p=0.044). Online consultation was not statistically significant different between the two populations (FSW:20.1%; MSM: 18.1%; p=0.336). Conclusion: The use of different services of Jichunge was significantly high. This suggests that mHealth is acceptable and can be a valuable platform to promote the use of PrEP and other services among HIV at-risk populations in Tanzania.
Principal Components and Factor Analysis of Fertility Differentials in Tanzania
(Refaad, 2018-04-01) Mbotwa, Christopher; Akarro, Rocky R.
The objective of this paper is to apply principal components and factor analysis techniques in assessing factors associated with fertility differentials in Tanzania. The study utilized secondary data from 2010 Tanzania Demographic and Health Survey (2010 TDHS) dataset. Three factors were identified as the main factors associated to fertility differentials in Tanzania. The first factor was woman’ education and awareness, the second factor was woman’ demographic characteristics and the third factor was woman’ economic status. Among those factors, woman’ education and awareness was found to contribute more than all other factors in explaining fertility differentials in Tanzania. The study concluded that, in order to attain a desirable fertility level in the country, woman’ education especially on the issue of family planning needs to be improved.
Comparison of Mortality by Gender and Regions in Tanzania using Direct Standardized Death Rates (DSDR) Method
(National Insititute of Medical Research (NIMR), 2020-07-24) Kibona, Shadrack E.; Mbotwa, Christopher H.
Background: Comparison of mortality is very useful in assessing population health. Crude rates can easily be computed from the mortality but they are not good for comparison across groups of the population. The aim of this paper was to compare mortality in Tanzania by region and gender using the 2012 Tanzania Population and Housing Census. Methods: Age-specific death rates for regions, Tanzania Mainland, Tanzania Zanzibar and entire Tanzania were obtained from Mortality and Health monograph data downloadable from the National Bureau of Statistics website. The direct standardization method was used to compare the mortality for male and female populations across all regions of Tanzania Mainland and Zanzibar. Results: Findings show that the mortality is low in Arusha, Manyara, and Kilimanjaro compared to other regions in Tanzania mainland implying that health status for both male and female population in those regions is better than the other regions while it is the worst in Njombe, Iringa, and Kagera implying the poor health status for those regions as compared to the rest regions in Tanzania Mainland. In Tanzania Zanzibar, high mortality was observed in Kusini Unguja and the lowest in Kaskazini Unguja for both male and female populations. By national wise and for almost all regions, the mortality for the male population is higher than that for the female population. Conclusion: Direct standardization methods can save as the best way for comparing mortality because it takes into consideration both the population at risk and the age structure. However, in estimating mortality, crude death rates should be used to give the magnitude while direct standardized death rates should be used for comparison purposes.
Factors associated with uptake of postpartum family planning services in Dodoma City Council, Tanzania: A cross-section study
(National Insititute of Medical Research (NIMR), 2022-06-13) Ezekiel, Mangi J; Akwary, Elibariki R; Mbotwa, Christopher; Mosha, Idda H
Background: Postpartum family planning is very essential to mothers’ health. However, its utilization remains low in developing countries. Objective: To determine the proportion and factors associated with uptake of PPFP services in Dodoma Tanzania. Methods: A cross-sectional study employing a quantitative approach was conducted among women who gave birth one year before the study period (June 2020) in Dodoma city council. A two-stage sampling technique was employed to recruit a total number of 209 participants. An interviewer-administered questionnaire was used to collect data. Data were entered and cleaned using Epi Info 7 and later exported to and analyzed using SPSS version 25.0. Bivariate and multiple logistic regression models were employed during data analysis. Odds ratios with 95% confidence intervals were computed to identify factors associated with postpartum family planning. Results: Majority (53.6%) of women used contraceptives within one year after delivery. Three factors were significantly associated with the uptake of postpartum family planning. Lower odds for uptake of PPFP were found among self-employed women (AOR: 0.5, 95% CI 0.25–0.74) and unemployed women (AOR: 0.2, 95% CI 0.05–0.31) when compared with employed women. Using community health fund insurance (AOR: 2.4, 95% CI 1.09–6.42) and National Health Insurance Fund (AOR: 2.7, 95% CI 1.54–5.99) as a mode of payments for health had higher odds for uptake of PPFP compared to cash mode. Women with an adequate number of antenatal care visits had higher odds (AOR: 2.9, 95% CI 1.24–6.89) of uptake of PPFP compared to women with an inadequate number of antenatal care visits. Conclusion: The uptake of PPFP among women was not adequate and was associated with being employed, being covered by health insurance and adequate antenatal care visits. More interventions are needed to enhance PPFP use among women.
Predictors of condom use among unmarried sexually active women of Reproductive age in Tanzania
(National Insititute of Medical Research (NIMR), 2022-08-10) 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.
Sexual harassment in public transport among female university students in Dar es Salaam, Tanzania
(National Insititute of Medical Research (NIMR), 2022-09-27) Mosha, Idda; Mapunda, Grace; Mbotwa, Christopher; Nyamhanga, Tumaini
Background: Globally, women and girls are subjected to various forms of sexual harassment while using public transport daily. Objective: To determine the prevalence of sexual harassment and identify different forms and associated risk factors among female university students who use public transport in Dar es Salaam, Tanzania. Methods: A cross-sectional study design using a questionnaire was employed to collect data. Data were collected from female first-year undergraduate students, who use public transport and are aged 18 years and above studying at the University of Dar es Salaam and Muhimbili University of Health and Allied Sciences. Results: The overall prevalence of sexual harassment on public transport was 88%. Study participants reported the highest levels of sexual harassment (91%). Verbal harassment was the most common form of sexual harassment (95%), and being called names such as baby, sweet, honey or love was reported by most students (78%). Factors associated with sexual harassment on public transport were: overcrowded vehicles (AOR=2.90, 95% CI: 0.09-4.50) and use of public transport as a form of transport (AOR=4.54, 95% CI: 0.40-8.90). Conclusion: The study findings highlight the need for the implementation of plausible interventions on the issue of sexual harassment through awareness campaigns and the implementation of modern surveillance and reporting systems in public spaces.
Absence of Germline BRCA1 c.68_69delAG and c.5266dupC Mutations among Hormone Receptor-negative Breast Cancer Patients: A First Impression at a Tertiary Cancer-care Facility in Tanzania
(University of Dar es Salaam, 2021-12-29) Rweyemamu, Linus P; Akan, Gokce; Mbotwa, Christopher H; Dharsee, Nazima; Namkinga, Lucy A; Lyantagaye, Sylvester L; Mselle, Ted F; Atalar, Fatmahan
The germline BRCA1 c.68_69delAG (185delAG) and c.5266dupC (5382insC) mutations are associated with hormone receptor-negative breast cancer (BC). Limited studies have examined their contribution to alarming BC incidence in Sub Saharan Africa (SSA). Our study aimed to examine the contribution of germline BRCA1 c.68_69delAG and c.5266dupC mutations to BC incidence among hormone receptor-negative BC patients admitted to Ocean Road Cancer Institute in Tanzania. Face-to-face interviews were conducted to capture socio-demographic characteristics, anthropometric measurements, family history of cancer and reproductive information from each patient. Their histopathological data were extracted from the hospital medical records. The germline BRCA1 founder mutations were analyzed on blood samples using Sanger sequencing technology. The patients mean age at diagnosis was 47.05 ± 12.82 years. A family history of cancer was observed in 13.6% of patients. The germline BRCA1 c.68_69delAG and c.5266dupC mutations were not detected in the study group. Our findings indicate that the germline BRCA1 c.68_69delAG and c.5266dupC mutations do not contribute to BC manifestation in hormone receptor-negative BC patients in Tanzania. Thus, screening BC patients for these mutations has no clinical relevance. Our data further suggest that the c.68_69delAG and the c.5266dupC mutations should not be considered when developing genetic testing guidelines in Tanzania.
Determinants for choice of home birth over health 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, 2020-08-24) 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; Kazaura, Method; 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.
Predictors for the uptake of optimal doses of sulfadoxine-pyrimethamine for intermittent preventive treatment of malaria during pregnancy in Tanzania: further analysis of the data of the 2015–2016 Tanzania demographic and health survey and malaria indicator survey
(Springer Nature, 2021-12-06) Mushi, Vivian; Mbotwa, Christopher H; Zacharia, Abdallah; Ambrose, Theresia; Moshi, Fabiola V
Background In Tanzania, the uptake of optimal doses (≥ 3) of sulfadoxine-pyrimethamine for intermittent preventive treatment of malaria (IPTp-SP) during pregnancy has remained below the recommended target of 80%. Therefore, this study aimed to investigate the predictors for the uptake of optimal IPTp-SP among pregnant women in Tanzania. Methods This study used data from the 2015–16 Tanzania demographic and health survey and malaria indicator survey (TDHS-MIS). The study had a total of 4111 women aged 15 to 49 who had live births 2 years preceding the survey. The outcome variable was uptake of three or more doses of IPTp-SP, and the independent variables were age, marital status, education level, place of residence, wealth index, occupation, geographic zone, parity, the timing of first antenatal care (ANC), number of ANC visits and type of the health facility for ANC visits. Predictors for the optimal uptake of IPTp-SP were assessed using univariate and multivariable logistic regression. Results A total of 327 (8%) women had optimal uptake of IPTp-SP doses. Among the assessed predictors, the following were significantly associated with optimal uptake of IPTp-SP doses; education level [primary (AOR: 2.2, 95% CI 1.26–3.67); secondary or higher education (AOR: 2.1, 95% CI 1.08–4.22)], attended ANC at the first trimester (AOR: 2.4, 95% CI 1.20–4.96), attended ≥ 4 ANC visits (AOR: 1.9, 95% CI 1.34–2.83), attended government health facilities (AOR: 1.5, 95% CI 1.07–1.97) and geographic zone [Central (AOR: 5, 95% CI 2.08–11.95); Southern Highlands (AOR: 2.8, 95% CI 1.15–7.02); Southwest Highlands (AOR: 2.7, 95% CI 1.03–7.29); Lake (AOR: 3.5, 95% CI 1.51–8.14); Eastern (AOR: 1.5, 95% CI 1.88–11.07)]. Conclusions The uptake of optimal IPTp-SP doses is still low in Tanzania. The optimal uptake of IPTp-SP was associated with attending ANC in the first trimester, attending more than four ANC visits, attending government health facility for ANC, having primary, secondary, or higher education level, and geographic zone. Therefore, there is a need for health education and behavior change interventions with an emphasis on the optimal use of IPTp-SP doses.
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, 2021-10-07) 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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