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Mwakawanga DL, Massae AF, Kohli N, Lukumay GG, Rohloff CT, Mushy SE, Mgopa LR, Mkoka DA, Mkonyi E, Trent M, Ross MW, Rosser BRS, Connor J. The need for and acceptability of a curriculum to train nursing and medical students in the sexual healthcare of clients with female genital mutilation/cutting in Tanzania. BMC Womens Health 2024; 24:198. [PMID: 38532377 DOI: 10.1186/s12905-024-03034-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 03/18/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Female genital mutilation/cutting (FGM/C) is tied to one of the most conservative cultures in the Mediterranean and Sub-Saharan Africa. More than 200 million girls and women in 30 African, Asian and the middle Eastern countries have undergone FGM/C. However, healthcare professionals are not adequately trained to prevent and manage FGM/C-related complications including sexual health problems. This study aimed to assess the need and acceptability of a curriculum to train nursing and medical students in the sexual healthcare of clients with FGM/C in Tanzania. METHODS We used a descriptive and cross sectional study design to collect and analyse information from 271 medical and 137 nursing students in Tanzania. A Qualtrics online survey was used to obtain quantitative data on training interest, previous training received, and the curriculum delivery method. Open-ended questions were used to explore their insights on significance to obtain the necessary competencies to treat and prevent FGM/C. Descriptive statistics were used to analyze quantitative data while qualitative data were analyzed using a thematic approach. RESULTS Almost half of the participants reported they had little to no training in sexual healthcare for women with FGM/C (47%). In all, 82.4% reported the training to be acceptable. Following thematic analysis of open-ended questions, participants expressed a desire to improve their competencies to meet the current and future sexual and psychological health needs of women and girls who have undergone FGM/C. CONCLUSION It is a necessary and acceptable to develop a curriculum to train healthcare students to diagnose, treat and prevent sexual health complications related to FGM/C. In our study, designing a culturally sensitive curriculum and its delivery method, that includes practical sessions with simulated patients, was considered the most beneficial and favorable.
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Affiliation(s)
- Dorkasi L Mwakawanga
- Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania
| | - Agnes F Massae
- Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania
| | - Nidhi Kohli
- University of Minnesota, #300, 1300 S. 2nd St., Minneapolis, MN, 55454, USA
| | - Gift Gadiel Lukumay
- Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania
| | - Corissa T Rohloff
- University of Minnesota, #300, 1300 S. 2nd St., Minneapolis, MN, 55454, USA
| | - Stella Emmanuel Mushy
- Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania
| | - Lucy R Mgopa
- Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania
| | - Dickson Ally Mkoka
- Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania
| | - Ever Mkonyi
- University of Minnesota, #300, 1300 S. 2nd St., Minneapolis, MN, 55454, USA
| | - Maria Trent
- Johns Hopkins University, 200 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Michael W Ross
- Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania
| | - B R Simon Rosser
- University of Minnesota, #300, 1300 S. 2nd St., Minneapolis, MN, 55454, USA.
| | - Jennifer Connor
- University of Minnesota, #300, 1300 S. 2nd St., Minneapolis, MN, 55454, USA
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Massae AF, Mgopa LR, Bonilla ZE, Mohammed I, Rosser BRS, Mushy SE, Ross MW, Mwakawanga DL, Mkonyi E, Lukumay GG, Wadley J, Mkoka DA, Trent M. Addressing sexual health concerns in Tanzania: perceived barriers among healthcare professionals and students in the "training for health professionals" study. Cult Health Sex 2024:1-15. [PMID: 38284804 DOI: 10.1080/13691058.2024.2306227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 01/12/2024] [Indexed: 01/30/2024]
Abstract
Little is known about the factors that may prevent healthcare professionals as key stakeholders from exploring sexual health issues in Tanzania. This study examined healthcare professionals' perspectives on the barriers to addressing sexual health concerns in practice. In June 2019, we conducted an exploratory qualitative study involving 18 focus group discussions among healthcare professionals (n = 60) and students (n = 61) in the health professions (midwifery, nursing, medicine) in Dar es Salaam, Tanzania. Study participants and design were purposively selected and stratified. We used a focus group discussion guide in Kiswahili. Data were transcribed in Kiswahili and translated into English. A thematic analysis approach was used for data analysis. Two themes were developed: (1) differences between health care professional and patient socio-demographic characteristics; (2) health care system and patients' backgrounds, such as communication barriers, lack of confidentiality and privacy within health facilities, type of clinical presentation and complaint, patient behaviours, and their clinical background. Several key barriers prevented sexual health communication between healthcare professionals and patients, affecting the quality of sexual health service delivery. Additional sexual health clinical training is warranted for health professions students and professionals to optimise sexual health care delivery in a culturally conservative country like Tanzania.
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Affiliation(s)
- Agnes F Massae
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Lucy R Mgopa
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Zobeida E Bonilla
- School of Public Health, Division of Epidemiology and Community Health, University of MN, Minneapolis, MN, USA
| | - Inari Mohammed
- School of Public Health, Division of Epidemiology and Community Health, University of MN, Minneapolis, MN, USA
| | - B R Simon Rosser
- School of Public Health, Division of Epidemiology and Community Health, University of MN, Minneapolis, MN, USA
| | - Stella E Mushy
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Michael W Ross
- School of Public Health, Division of Epidemiology and Community Health, University of MN, Minneapolis, MN, USA
| | - Dorkasi L Mwakawanga
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ever Mkonyi
- School of Public Health, Division of Epidemiology and Community Health, University of MN, Minneapolis, MN, USA
| | - Gift G Lukumay
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - James Wadley
- Counseling and Human Services Department, Lincoln University, Philadelphia, PA, USA
| | - Dickson A Mkoka
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Maria Trent
- Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD, USA
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Mkonyi E, Silla NB, Rohloff CT, Lukumay GG, Ross MW, Kohli N, Mgopa LR, Massae AF, Mohammed IS, Mushy SE, Mwakawanga DL, Rosser BRS, Trent M. Not Lost in Translation: The Use of Standardized Patients Technology among Health Professional Students in Tanzania. East Afr J Health Sci 2023; 6:149-161. [PMID: 38046829 PMCID: PMC10691444 DOI: 10.37284/eajhs.6.1.1243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Health professionals in Tanzania report a perceived need for sexual and reproductive health communication training to meet patient needs and reduce disparities. Simulation optimizes clinical performance and public entrustment. The study describes the development, feasibility, and acceptability measures of evidence-based, Afrocentric, standardized patient scenarios to train nursing, medical, and midwifery students in sexual and reproductive health in Tanzania. Standardized patient simulation cases with embedded cultural, language, gender, age, sexuality, and legal complexity issues were identified by stakeholders in Dar es Salaam centering on;1) adolescent health, 2) women's health, and 3) male health cases. Twenty-four health professional students evenly split across nursing, midwifery, and medicine were recruited and enrolled to participate in a pilot trial of the standardized patient simulations conducted in Kiswahili and the results recorded. Videos were evaluated by trained bilingual research staff using standardized behavioral checklists. Descriptive statistics and bivariate analyses were used to assess the pilot data. The study found that seventy-five percent (N =18) of baseline participants (N=24) returned for the 3-month follow-up simulation assessment. While not powered for statistical significance, students showed improvement in all cases and a significant improvement in the male erectile dysfunction concerns case for both interpersonal communication (t (17) = -3.445, p < .005) and medical history taking checklist (t(17)= -3.259, p < .005). Further, most students found the opportunity to practice using the simulations helpful or very helpful in their sexual and reproductive health education. It was therefore concluded that preliminary sexual and reproductive health simulation data using standardized patients demonstrated feasibility and acceptability among student participants.
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Affiliation(s)
- Ever Mkonyi
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. 2 St., Minneapolis, MN, 55454 USA
| | - Ndeye Boury Silla
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St Suite E8527, Baltimore, MD 21205, USA
| | - Corissa T. Rohloff
- Department of Educational Psychology, University of Minnesota, 250 Education Sciences Bldg, 56 E River Rd, Minneapolis, MN 55455, USA
| | - Gift Gadiel Lukumay
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied, Sciences (MUHAS), United Nations Rd, Dar es Salaam, Tanzania
| | - Michael W. Ross
- Program in Human Sexuality, Department of Family Medicine, University of Minnesota, 420 Delaware St. SE. Minneapolis, MN, 55455 USA
| | - Nidhi Kohli
- Department of Educational Psychology, University of Minnesota, 250 Education Sciences Bldg, 56 E River Rd, Minneapolis, MN 55455, USA
| | - Lucy Raphael Mgopa
- Department of Psychiatry, School of Medicine, Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar Es Salaam, Tanzania
| | - Agnes Fredrick Massae
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied, Sciences (MUHAS), United Nations Rd, Dar es Salaam, Tanzania
| | - Inari S. Mohammed
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. 2 St., Minneapolis, MN, 55454 USA
| | - Stella Emmanuel Mushy
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied, Sciences (MUHAS), United Nations Rd, Dar es Salaam, Tanzania
| | - Dorkasi L. Mwakawanga
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied, Sciences (MUHAS), United Nations Rd, Dar es Salaam, Tanzania
| | - Brian Robert Simon Rosser
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. 2 St., Minneapolis, MN, 55454 USA
| | - Maria Trent
- Division of Adolescent and Young Adult Medicine, Johns Hopkins University Schools of Medicine, 1800 Orleans Street Baltimore, MD, 21287 USA
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Mkonyi E, Trent M, Mwakawanga DL, Massae AF, Ross MW, Bonilla ZE, Mohammed IS, Lukumay GG, Mushy SE, Mgopa LR, Wadley J, Mkoka DA, Simon Rosser BR. Evaluating the History-Taking Process of Sexual Reproductive Health Problems in Tanzania: Lessons from a Study of Health Students and Practitioners. East Afr J Health Sci 2023; 6:133-148. [PMID: 38013881 PMCID: PMC10680495 DOI: 10.37284/eajhs.6.1.1239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Building trust and therapeutic relationships between healthcare providers and patients are crucial for delivering high-quality, comprehensive sexual and reproductive health (SRH) services. Yet, while patients face substantial SRH disparities in Tanzania, little is known about health care professionals' [HCPs] SRH history-taking practices and experiences. This paper describes HCPs' interdisciplinary practices, experience in conducting SRH taking, and the critical lessons learned to optimize quality SRH care. We conducted 18 focus group discussions in June 2019 in Dar es Salaam, Tanzania, with 60 healthcare practitioners and 61 students in midwifery, nursing, and medicine. We implemented a purposive, stratified sampling design to explore the experiences and perspectives of HCPs regarding providing sexual health services. We employed a grounded theory approach to perform the analysis. We provided seven scenarios to participants to discuss how they would manage SRH health problems. The scenarios helped us evaluate the practice and experience of SRH in Tanzania. Four broad themes and sub-themes emerged during the discussion; 1) SRH history-taking practices and experiences in the health care facilities; 2) the perceived benefit of effective SRH history-taking; 3) Factors hindering the SRH history-taking process; 4) The power of confidence. These findings have implications for strengthening a sexual health curriculum for medical students and continuing education programs for practicing health professionals designed to address the observed health disparities in Tanzania. These findings affirm that proper SRH history-taking requires a conducive environment, knowledge of relevant SRH-related laws and regulations; application of evidence-based techniques; and giving patients autonomy to make decisions for their health while making recommendations regarding standard care. Comprehensive SRH history-taking identifies critical data for illness diagnosis, provides foundational information for risk-reduction behavioural change counselling, and reduces medical costs. Therefore, the primary goal is to optimize health professional training on SRH issues and history-taking skills within the medical interview.
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Affiliation(s)
- Ever Mkonyi
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. 2nd St., Minneapolis, MN, 55454 USA
| | - Maria Trent
- Division of Adolescent and Young Adult Medicine, Johns Hopkins University Schools of Medicine, 1800 Orleans Street Baltimore, MD, 21287 USA
| | - Dorkasi L. Mwakawanga
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied, Sciences (MUHAS), United Nations Rd, Dar es Salaam, Tanzania
| | - Agnes Fredrick Massae
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied, Sciences (MUHAS), United Nations Rd, Dar es Salaam, Tanzania
| | - Michael W. Ross
- Program in Human Sexuality, Department of Family Medicine, University of Minnesota, 420 Delaware St. SE. Minneapolis, MN, 55455 USA
| | - Zobeida E. Bonilla
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. 2nd St., Minneapolis, MN, 55454 USA
| | - Inari S. Mohammed
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. 2nd St., Minneapolis, MN, 55454 USA
| | - Gift Gadiel Lukumay
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied, Sciences (MUHAS), United Nations Rd, Dar es Salaam, Tanzania
| | - Stella Emmanuel Mushy
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied, Sciences (MUHAS), United Nations Rd, Dar es Salaam, Tanzania
| | - Lucy Raphael Mgopa
- Department of Psychiatry, School of Medicine, Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar Es Salaam, Tanzania
| | - James Wadley
- Department of Human Service, School of Adult & Continuing Education, 1570 Baltimore Pike Lincoln University, Philadelphia, PA, 19352 USA
| | - Dickson Ally Mkoka
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied, Sciences (MUHAS), United Nations Rd, Dar es Salaam, Tanzania
| | - Brian Robert Simon Rosser
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. 2nd St., Minneapolis, MN, 55454 USA
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Lukumay GG, Mgopa LR, Mushy SE, Rosser BRS, Massae AF, Mkonyi E, Mohammed I, Mwakawanga DL, Trent M, Wadley J, Ross MW, Bonilla Z, Leshabari S. Community myths and misconceptions about sexual health in Tanzania: Stakeholders' views from a qualitative study in Dar es Salaam Tanzania. PLoS One 2023; 18:e0264706. [PMID: 36763616 PMCID: PMC9916544 DOI: 10.1371/journal.pone.0264706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/15/2022] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION Sexual and reproductive health problems are one of the top five risk factors for disability in the developing world. The rates of sexual health problems in most African countries are overwhelming, which is why HIV and other STIs are still such a challenge in sub-Saharan Africa. Talking about sex in most African countries is a taboo, leading to common myths and misconceptions that ultimately impact community sexual health. METHODS In this study, we conducted 11 key stakeholder individual interviews with community, religious, political, and health leaders (sexual health stakeholders) in Tanzania. Qualitative content analysis was used to analyze all the materials. RESULTS Two main categories merged from the analysis. The first category, "Ambiguities about sexual health" focused on societal and political misconceptions and identified ten myths or misconceptions common in Tanzania. Stakeholders highlighted the confusion that happens when different information about sexual health is presented from two different sources (e.g., community leaders/peers and political leaders), which leaves the community and community leaders unsure which one is reliable. The second category, "Practical dilemmas in serving clients", addressed a range of professional and religious dilemmas in addressing sexual health concerns. This included the inability of religious leaders and health care providers to provide appropriate sexual health care because of internal or external influences. CONCLUSION Myths and misconceptions surrounding sexual health can prevent communities from adequately addressing sexual health concerns, and make it more difficult for healthcare providers to comfortably provide sexual health care to patients and communities. Stakeholders affirmed a need to develop a sexual health curriculum for medical, nursing and midwifery students because of the lack of education in this area. Such a curriculum needs to address nine common myths which were identified through the interviews.
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Affiliation(s)
- Gift G. Lukumay
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Lucy R. Mgopa
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Stella E. Mushy
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - B. R. Simon Rosser
- University of Minnesota, School of Public Health, Minneapolis, MN, United States of America
| | - Agnes F. Massae
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Ever Mkonyi
- University of Minnesota, School of Public Health, Minneapolis, MN, United States of America
| | - Inari Mohammed
- University of Minnesota, School of Public Health, Minneapolis, MN, United States of America
| | | | - Maria Trent
- Johns Hopkins Medicine, Baltimore, MD, Washington, DC, United States of America
| | - James Wadley
- School of Adult and Continuing Education, Lincoln University, Baltimore Pike, PA, United States of America
| | - Michael W. Ross
- University of Minnesota, School of Public Health, Minneapolis, MN, United States of America
| | - Zobeida Bonilla
- University of Minnesota, School of Public Health, Minneapolis, MN, United States of America
| | - Sebalda Leshabari
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
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Rosser BRS, Mkoka DA, Rohloff CT, Mgopa LR, Ross MW, Lukumay GG, Mohammed I, Massae AF, Mkonyi E, Mushy SE, Mwakawanga DL, Kohli N, Trent ME, Wadley J, Bonilla ZE. Tailoring a sexual health curriculum to the sexual health challenges seen by midwifery, nursing and medical providers and students in Tanzania. Afr J Prim Health Care Fam Med 2022; 14:e1-e9. [PMID: 35695444 PMCID: PMC9210149 DOI: 10.4102/phcfm.v14i1.3434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/31/2022] [Accepted: 04/05/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Tanzania is a country experiencing multiple sexual health challenges, but providers receive no formal training in sexual health. AIM This study aimed to assess (1) what sexual health challenges are commonly seen in clinics in Tanzania, (2) which are raised by patients, (3) which are not addressed and (4) which topics to prioritise for a sexual health curriculum. SETTING Healthcare settings in Tanzania. METHODS Participants were 60 experienced and 61 student doctors, nurses and midwives working in Dar es Salaam. The authors conducted 18 focus groups stratified by profession (midwifery, nursing or medicine) and experience (practitioners vs. students). RESULTS Providers identified six common sexual health concerns: (1) Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) and sexually transmissible infection (STI) (especially syphilis and gonorrhoea), (2) sexual violence (including intimate partner violence and female genital mutilation), (3) early and unwanted pregnancy (including early sexual debut and complications from abortion), (4) sexual dysfunctions, (5) key population concerns (e.g. lesbian, gay, bisexual, transgender (LGBT); sex work) and (6) non-procreative sexual behaviour (including pornography and masturbation in males and oral and anal sex practices in heterosexual couples). Across professions, few differences were observed. Homosexuality, sex work, masturbation and pornography were identified as taboo topics rarely discussed. Most participants (81%) wanted one comprehensive sexual health curriculum delivered across disciplines. CONCLUSION A sexual health curriculum for health students in Tanzania needs to address the most common sexual health concerns of patients. In addition to teaching sexual science and clinical care, skills training in how to address taboo topics is recommended. Students endorsed almost all sexual health topics, which suggests that a comprehensive curriculum is appropriate.
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Affiliation(s)
- B R Simon Rosser
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, United States of America.
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Mwakawanga DL, Mkonyi E, Mushy SE, Trent M, Bonilla Z, Massae AF, Lukumay GG, Mgopa LR, Mohammed I, Wadley J, Ross MW, Leshabari S, Rosser BRS. Would you offer contraception to a 14-year-old girl? Perspectives of health students and professionals in Dar es Salaam, Tanzania. Reprod Health 2021; 18:245. [PMID: 34895267 PMCID: PMC8665521 DOI: 10.1186/s12978-021-01294-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 11/20/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Rates of unplanned adolescent pregnancy and unsafe induced abortions are very high in Sub-Saharan African countries including Tanzania. Despite their availability and accessibility, modern family planning methods are reported to be critically underutilized by adolescents. This study is part of a broader study that aims to develop a curriculum that will be used in training health professionals by investigating the sexual health training needs of health providers and students in Tanzania. AIM This study describes the perceptions of health professionals and students on the provision of contraceptives to adolescents. METHODS Qualitative formative assessment type of research was conducted using 18 focus groups stratified among health professionals and students (midwives, nurses, and medical doctors). Study participants were presented with the theoretical scenario of a 14-year-old girl who sought contraceptive services at a family planning clinic. This theoretical scenario was used to determine how health professionals and students would handle the case. Thematic analysis guided the examination and determination of data results. RESULTS Three main themes emerged from the data, including (1) knowledge about the provision of contraceptives to adolescents, (2) perception of the adolescents' right to contraceptive use, and (3) barriers to the provision of contraceptives to adolescents. Participants stated that having a baseline knowledge of contraceptive services for adolescents and their rights to contraceptives would trigger their decision on offering the contraceptive. On the other hand, being unaware of the reproductive health rights for adolescents, judgmental behavior of providers, as well as religious and cultural dynamics were all found to be major barriers for providers to offer contraceptive services to the 14-year-old adolescent girl in the theoretical scenario. CONCLUSION These findings support the need for comprehensive sexual health education in Tanzanian health professional training programs.
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Affiliation(s)
- Dorkasi L Mwakawanga
- School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Ever Mkonyi
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. 2nd St. #300, Minneapolis, MN, 55454, USA
| | - Stella E Mushy
- School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Maria Trent
- Schools of Medicine and Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Zobeida Bonilla
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. 2nd St. #300, Minneapolis, MN, 55454, USA
| | - Agnes F Massae
- School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Gift G Lukumay
- School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Lucy R Mgopa
- School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Inari Mohammed
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. 2nd St. #300, Minneapolis, MN, 55454, USA
| | - James Wadley
- School of Adult and Continuing Education, Lincoln University, Philadelphia, PA, USA
| | - Michael W Ross
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Sebalda Leshabari
- School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - B R Simon Rosser
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. 2nd St. #300, Minneapolis, MN, 55454, USA.
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Mkonyi E, Mwakawanga DL, Rosser BRS, Bonilla ZE, Lukumay GG, Mohammed I, Mushy SE, Mgopa LR, Ross MW, Massae AF, Trent M, Wadley J. The management of childhood sexual abuse by midwifery, nursing and medical providers in Tanzania. Child Abuse Negl 2021; 121:105268. [PMID: 34416472 PMCID: PMC8513504 DOI: 10.1016/j.chiabu.2021.105268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 07/28/2021] [Accepted: 08/08/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Child sexual abuse (CSA) is a significant public health problem affecting one billion children aged 2 to 17 globally. The prevalence of CSA in Tanzania is one of the highest; however, how health care providers manage CSA cases has not been studied. OBJECTIVES This study investigated how medical, nursing, and midwifery professionals in Tanzania handle cases of CSA and identified the factors that facilitate or impede the provision of quality care to CSA victims. METHODS Participants were 60 experienced healthcare professionals and 61 health students working in Dar es Salaam, Tanzania. We conducted 18 focus groups stratified by profession (midwifery, nursing, or medicine) and experience (practitioners versus students). RESULTS Three main themes emerged. First, child abuse management involved using a multi-disciplinary approach, including proper history taking, physical assessment, treatment, and referral. Second, factors that enhanced disclosure of CSA included building rapport, privacy, and confidentiality. Third, factors that impeded care included fear of harm to the child if the abuse was reported, abuse reporting being perceived as a "waste of time" for providers, loss of evidence from the victim, family resistance, poverty, corruption and cultural dynamics. CONCLUSIONS Midwives, nurses and doctors were all experienced in and reported similar challenges in addressing CSA. At a structural level, the ratio of providers to patients in health facilities inhibits quality care. These findings have implications for strengthening CSA policy/guidelines and clinical practice in Tanzania. Mandated CSA training is necessary for midwifery, nursing, and medical students as well as in continuing education courses for more experienced providers.
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Affiliation(s)
- Ever Mkonyi
- University of Minnesota, Minneapolis, MN, USA
| | | | | | | | | | | | - Stella E Mushy
- Muhimbili University of Health and Allied Sciences Dar es Salaam, Tanzania
| | - Lucy R Mgopa
- Muhimbili University of Health and Allied Sciences Dar es Salaam, Tanzania
| | | | - Agnes F Massae
- Muhimbili University of Health and Allied Sciences Dar es Salaam, Tanzania
| | - Maria Trent
- Johns Hopkins University, Baltimore, MD, USA
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Mushy SE, Rosser BRS, Ross MW, Lukumay GG, Mgopa LR, Bonilla Z, Massae AF, Mkonyi E, Mwakawanga DL, Mohammed I, Trent M, Wadley J, Leshabari S. The Management of Masturbation as a Sexual Health Issue in Dar es Salaam, Tanzania: A Qualitative Study of Health Professionals' and Medical Students' Perspectives. J Sex Med 2021; 18:1690-1697. [PMID: 37057493 DOI: 10.1016/j.jsxm.2021.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/05/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Across Africa, there are strong cultural taboos against masturbation. AIM As part of a broader study investigating sexual health training needs of the health providers, researchers conducted a study to investigate how masturbation is addressed as a clinical issue in clinics in Dar es Salaam, Tanzania. METHODS An exploratory qualitative study design conducted in June 2019 involving 18 focus groups among health care providers and students in the health professions (midwives, nurses, medical doctors). A total of 61 health care students and 58 health providers were interviewed. The study participants were purposively selected and the design was purposively stratified to examine findings across the 3 main health care providers and by experience (clinicians vs students). A semistructured interview guide in Kiswahili language was used. The study participants were presented a case scenario of a 14-year-old boy who was found masturbating in his room by his father, and asked how this case would be handled in a clinical setting. Data were transcribed in Kiswahili and Translated to English. OUTCOMES Inductive-deductive thematic analysis was performed. Major themes and subthemes were identified. RESULTS Two main themes emerged: (i) knowledge about the management of masturbation and (ii) views about the effects of masturbation. Clinical interventions providers would try to include normalization of masturbation as a pubescent behavior combined with advice to stop the adolescent from masturbating, a recommendation to watch for negative effects immediately postmasturbation, and referral to a psychologist for treatment. Across providers and students, masturbation in adolescence was seen as clinically problematic, potentially leading to multiple issues in adulthood including sexual dissatisfaction with a spouse, psychological dependency, and erectile dysfunction, loss of sexual sensitivity in intercourse, premature ejaculation, and penis size reduction. Several participants mentioned they received no training about masturbation to guide their clinical practice. CLINICAL IMPLICATIONS These findings affirm the need for comprehensive sexual health training in Tanzanian universities. STRENGTHS AND LIMITATIONS Use of stratified design by profession and experience allowed to explore if there appear to be differences between students and experienced providers. The findings cannot be generalizable to all health professional students and providers across Tanzania. CONCLUSION When designing sexual health curricula for Tanzania, it is important to include accurate information about masturbation as a normal and healthy sexual practice to address widely held myths about its effects on health, and to train providers in how to counsel when concerns and inaccurate information are brought to the clinical encounter. Mushy SE, Rosser BRS, Ross MW, et al. The Management of Masturbation as a Sexual Health Issue in Dar es Salaam, Tanzania: A Qualitative Study of Health Professionals' and Medical Students' Perspectives. J Sex Med 2021;18:1690-1697.
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Affiliation(s)
- Stella E Mushy
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | | | | | - Lucy R Mgopa
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Agnes F Massae
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ever Mkonyi
- University of Minnesota, Minneapolis, MN, USA
| | | | | | - Maria Trent
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Sebalda Leshabari
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Mgopa LR, Rosser BRS, Ross MW, Mohammed I, Lukumay GG, Massae AF, Mushy SE, Mwakawanga DL, Mkonyi E, Trent M, Bonilla ZE, Wadley J, Leshabari S. Clinical Care of Victims of Interpersonal Violence and Rape in Tanzania: A Qualitative Investigation. Int J Womens Health 2021; 13:727-741. [PMID: 34335058 PMCID: PMC8318211 DOI: 10.2147/ijwh.s301804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/23/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Africa has high rates of interpersonal violence and rape, although little is known about how these cases are handled in the clinical setting. Methods We enrolled 121 health care professionals and students in Tanzania from the fields of midwifery, nursing and medicine, and conducted 18 focus group discussions stratified by both professional and clinical experience. Two clinical scenarios were presented across all groups and participants were asked to give their opinions on how the hospital they worked in would manage the cases. Case 1 focused on how to address a case of an injured woman beaten by her husband (and whether the perpetrator would be reported to the police). Case 2 focused on how to handle a rape victim who is brought to the hospital by the police. Results Participants considered both cases as emergencies. There was a similarity in the clinical care procedures across both scenarios. This included building rapport with the patient, prioritization of the medical care, history taking, and referring to other specialties for follow-up. Participants differed in how they would handle the legal aspects of both cases, including whether and how to best follow mandated reporting policies. Providers wondered if they should report the husband in case study 1, the criteria for reporting, and where to report. Providers displayed a lack of knowledge about resources needed for sexual violence victim and the availability of resources. Conclusion These findings indicate that cases of intimate partner violence and rape are likely to be under-reported within hospitals and clinics in Tanzania. Health care providers lack training in their required obligations and procedures that need to be followed to ensure victim’s safety. The findings confirm that there is a need for health care students in Tanzania (and possibly Africa) to receive comprehensive training in how to handle such cases.
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Affiliation(s)
- Lucy R Mgopa
- Department of Psychiatry and Mental Health, School of Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar Es Salaam, Tanzania
| | - B R Simon Rosser
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Michael W Ross
- Program in Human Sexuality, Department of Family Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Inari Mohammed
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Gift Gadiel Lukumay
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Agnes F Massae
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Stella E Mushy
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Dorkasi L Mwakawanga
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Ever Mkonyi
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Maria Trent
- Department of Adolescent and Young Adult Medicine, Johns Hopkins University Schools of Medicine and Public Health, Baltimore, MD, USA
| | - Zobeida E Bonilla
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - James Wadley
- Department of Counseling and Health Services, Lincoln University, Philadelphia, PA, USA
| | - Sebalda Leshabari
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
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Mgopa LR, Rosser BRS, Ross MW, Lukumay GG, Mohammed I, Massae AF, Leshabari S, Mkonyi E, Mushy SE, Mwakawanga DL, Trent M, Wadley J, Bonilla ZE. Cultural and clinical challenges in sexual health care provision to men who have sex with men in Tanzania: a qualitative study of health professionals' experiences and health students' perspectives. BMC Public Health 2021; 21:676. [PMID: 33827508 PMCID: PMC8028207 DOI: 10.1186/s12889-021-10696-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/18/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Health care providers across sub-Saharan Africa continue to face challenges while delivering sexual health care services. We explored the experiences, views and challenges of health care professionals and health students across different disciplines in Tanzania, towards delivery of sexual health services to men who have sex with men. METHODS Utilizing a qualitative approach, we recruited 121 health care professionals (providers) and students from the fields of midwifery, nursing and medicine in Dar es Salaam, Tanzania. We conducted 18 focus groups discussions, stratified by profession and experience, to investigate clinical management and challenges while addressing a case of an adult male presenting with rectal gonorrhea. RESULTS Findings indicated this case as extremely sensitive, clinical management involved establishing rapport and consent, medical care from history taking to treatment, and referral to other specialties. However, the illegal status of homosexuality in Tanzania was a primary concern to participants, this triggered the clinical care of this case scenario as challenging. There were uncertainties whether or not that such a case should be reported to the authorities. CONCLUSION Findings from this study revealed a need for training health students in Tanzania to address sexual health issues including accurate information on homosexuality, reporting requirements and clinical management in the legal and socio-cultural context of the African continent.
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Affiliation(s)
- Lucy R Mgopa
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - B R Simon Rosser
- University of Minnesota, School of Public Health, 1300 S. 2nd St., Minneapolis, MN, 55454, USA.
| | - Michael W Ross
- University of Minnesota, School of Public Health, 1300 S. 2nd St., Minneapolis, MN, 55454, USA
| | - Gift Gadiel Lukumay
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Inari Mohammed
- University of Minnesota, School of Public Health, 1300 S. 2nd St., Minneapolis, MN, 55454, USA
| | - Agnes F Massae
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Sebalda Leshabari
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Ever Mkonyi
- University of Minnesota, School of Public Health, 1300 S. 2nd St., Minneapolis, MN, 55454, USA
| | | | - Dorkasi L Mwakawanga
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Maria Trent
- Johns Hopkins University, Washington, DC, USA
| | - James Wadley
- Lincoln University, Counseling and Human Services Department, 1570 Baltimore Pike, Philadelphia, PA, 19352, USA
| | - Zobeida E Bonilla
- University of Minnesota, School of Public Health, 1300 S. 2nd St., Minneapolis, MN, 55454, USA
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Rosser BRS, Mgopa L, Leshabari S, Ross MW, Lukumay GG, Massawe A, Mkonyi E, Mohammed I, Mushy S, Mwakawanga D, Trent M, Wadley J. Legal and Ethical Considerations in the Delivery of Sexual Health Care in Tanzania. Afr J Health Nurs Midwifery 2020; 3:84-102. [PMID: 34723251 PMCID: PMC8553133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Tanzania is a country with multiple sexual health challenges including high rates of HIV/STIs, early sexual debut, forced sex, sexual dysfunction, and teen pregnancy. Training in sexual health care is limited, while courses on how to address the ethical aspects of sexual health are non-existent. To address this gap, this paper explores legal and ethical challenges to providing sexual health care in Tanzania. First, we describe the sexuo-cultural and epidemiologic challenges, and the key laws regulating sexual health. Six case studies identify ethical dilemmas in healthcare delivery. They are: (a) how to address sexual and intimate partner violence; (b) treatment of illegal or stigmatized key populations; (c) treatment of couples in HIV serodiscordant, non-monogamous, and/or polygamous relationships; (d) requests for and participation in illegal healthcare; (e) treatment of women and children in the presence of their husbands and fathers; and (f) addressing child sexual abuse. We apply the ethical principles of autonomy, justice, beneficence and non-malfeasance. A second challenge is ensuring confidentiality in a setting where medical record keeping practices vary widely, and violations to confidentiality are perceived as common. Finally, we identify a set of best practices in sexual healthcare delivery tailored to the Tanzanian context.
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Affiliation(s)
- B R Simon Rosser
- University of Minnesota, School of Public Health, 1300 S. 2 St. #300 Minneapolis, MN, USA
| | - Lucy Mgopa
- Muhimbili University of Health and Allied Sciences (MUHAS), School of Public Health and Social Sciences, PO Box 65015, Dar es Salaam, Tanzania
| | - Sebalda Leshabari
- Muhimbili University of Health and Allied Sciences (MUHAS), School of Public Health and Social Sciences, PO Box 65015, Dar es Salaam, Tanzania
| | - Michael W Ross
- University of Minnesota, School of Public Health, 1300 S. 2 St. #300 Minneapolis, MN, USA
| | - Gift Gadiel Lukumay
- Muhimbili University of Health and Allied Sciences (MUHAS), School of Public Health and Social Sciences, PO Box 65015, Dar es Salaam, Tanzania
| | - Agnes Massawe
- Muhimbili University of Health and Allied Sciences (MUHAS), School of Public Health and Social Sciences, PO Box 65015, Dar es Salaam, Tanzania
| | - Ever Mkonyi
- University of Minnesota, School of Public Health, 1300 S. 2 St. #300 Minneapolis, MN, USA
| | - Inari Mohammed
- University of Minnesota, School of Public Health, 1300 S. 2 St. #300 Minneapolis, MN, USA
| | - Stella Mushy
- Muhimbili University of Health and Allied Sciences (MUHAS), School of Public Health and Social Sciences, PO Box 65015, Dar es Salaam, Tanzania
| | - Dorkas Mwakawanga
- Muhimbili University of Health and Allied Sciences (MUHAS), School of Public Health and Social Sciences, PO Box 65015, Dar es Salaam, Tanzania
| | - Maria Trent
- Johns Hopkins Medicine, 615 N. Wolfe St., Baltimore, MD 21205, Washington, DC, USA
| | - James Wadley
- Lincoln University, School of Adult and Continuing Education, 1570 Baltimore Pike, Lincoln University, PA, USA
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