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Mahwera D, Killel E, Jonas N, Hancy A, Zangira A, Lekey A, Msaki R, Katana D, Kishimba R, Charwe D, Abdallah F, Chiduo G, Masumo R, Leyna G, Mchau G. Evaluation of the Universal Salt Iodization (USI) surveillance system in Tanzania, 2022. PLoS One 2024; 19:e0299025. [PMID: 38640102 PMCID: PMC11029623 DOI: 10.1371/journal.pone.0299025] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 02/02/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND The evaluation of surveillance systems has been recommended by the World Health Organization (WHO) to identify the performance and areas for improvement. Universal salt iodization (USI) as one of the surveillance systems in Tanzania needs periodic evaluation for its optimal function. This study aimed at evaluating the universal salt iodization (USI) surveillance system in Tanzania from January to December 2021 to find out if the system meets its intended objectives by evaluating its attributes as this was the first evaluation of the USI surveillance system since its establishment in 2010. The USI surveillance system is key for monitoring the performance towards the attainment of universal salt iodization (90%). METHODOLOGY This evaluation was guided by the Center for Disease Control Guidelines for Evaluating Public Health Surveillance Systems, (MMWR) to evaluate USI 2021 data. The study was conducted in Kigoma region in March 2022. Both Purposive and Convenient sampling was used to select the region, district, and ward for the study. The study involved reviewing documents used in the USI system and interviewing the key informants in the USI program. Data analysis was done by Microsoft Excel and presented in tables and graphs. RESULTS A total of 1715 salt samples were collected in the year 2021 with 279 (16%) of non-iodized salt identified. The majority of the system attributes 66.7% had a good performance with a score of three, 22.2% had a moderate performance with a score of two and one attribute with poor performance with a score of one. Data quality, completeness and sensitivity were 100%, acceptability 91.6%, simplicity 83% were able to collect data on a single sample in < 2 minutes, the system stability in terms of performance was >75% and the usefulness of the system had poor performance. CONCLUSION Although the system attributes were found to be working overall well, for proper surveillance of the USI system, the core attributes need to be strengthened. Key variables that measure the system performance must be included from the primary data source and well-integrated with the Local Government (district and regions) to Ministry of Health information systems.
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Affiliation(s)
- David Mahwera
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
- Tanzania Field Epidemiology and Laboratory Training Program, Tanzania
| | - Erick Killel
- Department of Community Health and Nutrition, Tanzania Food and Nutrition Centre, Dar es salaam, Tanzania
| | - Ninael Jonas
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
- Tanzania Field Epidemiology and Laboratory Training Program, Tanzania
| | - Adam Hancy
- Department of Nutrition Policy and Planning, Tanzania Food and Nutrition Center, Dar es salaam, Tanzania
| | - Anna Zangira
- Department of Community Health and Nutrition, Tanzania Food and Nutrition Centre, Dar es salaam, Tanzania
| | - Aika Lekey
- Department of Community Health and Nutrition, Tanzania Food and Nutrition Centre, Dar es salaam, Tanzania
| | - Rose Msaki
- Department of Community Health and Nutrition, Tanzania Food and Nutrition Centre, Dar es salaam, Tanzania
| | - Doris Katana
- Department of Nutrition Education and Training, Tanzania Food and Nutrition Centre, Dar es salaam, Tanzania
| | - Rogath Kishimba
- Tanzania Field Epidemiology and Laboratory Training Program, Tanzania
- Ministry of Health, Dodoma, Tanzania
| | - Debora Charwe
- Department of Nutrition Policy and Planning, Tanzania Food and Nutrition Center, Dar es salaam, Tanzania
| | - Fatma Abdallah
- Department of Community Health and Nutrition, Tanzania Food and Nutrition Centre, Dar es salaam, Tanzania
| | - Geofrey Chiduo
- Department of Nutrition Policy and Planning, Tanzania Food and Nutrition Center, Dar es salaam, Tanzania
| | - Ray Masumo
- Department of Community Health and Nutrition, Tanzania Food and Nutrition Centre, Dar es salaam, Tanzania
| | - Germana Leyna
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
- Department of Community Health and Nutrition, Tanzania Food and Nutrition Centre, Dar es salaam, Tanzania
| | - Geofrey Mchau
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
- Tanzania Field Epidemiology and Laboratory Training Program, Tanzania
- Department of Community Health and Nutrition, Tanzania Food and Nutrition Centre, Dar es salaam, Tanzania
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Makori N, Masanja H, Masumo R, Rashid S, Jumbe T, Tegeye M, Esau D, Muiruri J, Mchau G, Mafung'a SH, Moshi C, Shosho N, Kwara V, Mshida H, Leyna G. Efficacy of ready-to-use food supplement for treatment of moderate acute malnutrition among children aged 6 to 59 months. Matern Child Nutr 2024; 20:e13602. [PMID: 38192064 PMCID: PMC10981477 DOI: 10.1111/mcn.13602] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/08/2023] [Accepted: 11/22/2023] [Indexed: 01/10/2024]
Abstract
Moderate acute malnutrition (MAM) is a persistent public health problem in Tanzania. The current approach for its management is nutrition counselling. However, there has been no commercial production of ready-to-use supplementary foods for the management of MAM in the country but rather imported from companies outside the country. The objective of the study was to determine the ability of a ready-to-use food supplementation versus corn soya blend (CSB+) to manage MAM. The randomised controlled trial employed three parallel arm approach. The first arm received CSB+ and infant and young child feeding (IYCF) counselling, the second arm received ready-to-use food (RUF) and IYCF counselling and the third arm, a control group, received IYCF as standard care for three consecutive months. Results indicated that the overall proportion of children who recovered from MAM was 65.6%. There was a significant difference (p < 0.001) in the proportion of children who recovered from MAM between the three arms (CSB+, RUF and standard care). Results revealed further a high recovery rate of 83.7% in the RUF arm, followed by 71.9% in the CSB+ arm and 41% in the standard care arm. The risk differences for RUF compared with CSB+ and standard care were 11.8% and 42.7%, respectively. RUFs can be used as an alternative supplement to conventional CSB+ for the management of MAM in children and, thus, has the potential to scale up its use to address the problem of MAM among 6 to 59 months' children.
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Affiliation(s)
- Nyabasi Makori
- Department of Nutrition Education and Training (NET)Tanzania Food and Nutrition CentreDar es salaamTanzania
| | - Hope Masanja
- Department of Nutrition Education and Training (NET)Tanzania Food and Nutrition CentreDar es salaamTanzania
| | - Ray Masumo
- Department of Nutrition Education and Training (NET)Tanzania Food and Nutrition CentreDar es salaamTanzania
| | - Suleman Rashid
- Department of Food Science and AgroprocessingSokoine University of AgricultureMorogoroTanzania
| | - Theresia Jumbe
- Department of Food Science and AgroprocessingSokoine University of AgricultureMorogoroTanzania
| | | | | | | | - Geofrey Mchau
- Department of Nutrition Education and Training (NET)Tanzania Food and Nutrition CentreDar es salaamTanzania
| | - Stanslaus H. Mafung'a
- Department of Nutrition Education and Training (NET)Tanzania Food and Nutrition CentreDar es salaamTanzania
| | - Cypriana Moshi
- Department of Nutrition Education and Training (NET)Tanzania Food and Nutrition CentreDar es salaamTanzania
| | | | - Vera Kwara
- World Food ProgrammeDar Es SalaamTanzania
| | - Hoyce Mshida
- Department of Nutrition Education and Training (NET)Tanzania Food and Nutrition CentreDar es salaamTanzania
| | - Germana Leyna
- Department of Nutrition Education and Training (NET)Tanzania Food and Nutrition CentreDar es salaamTanzania
- Department of Epidemiology and BiostatisticsMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
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Mchau G, Killel E, Azizi K, Henry S, Ainan S, Jumbe T, Bundara N, Kystikila W, Mwingira F, Machafuko P, Wilson B, Paulo HA, Epimack S, Mshinda H, Chacky F, Noor R, Masumo R, Leyna G. Co-occurrence of Overweight, Stunting, and Anemia among Adolescents (10-19 Years) in Tanzania Mainland: A School-Based Cross-Sectional Study. Curr Dev Nutr 2024; 8:102016. [PMID: 38304732 PMCID: PMC10832378 DOI: 10.1016/j.cdnut.2023.102016] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/02/2023] [Accepted: 10/02/2023] [Indexed: 02/03/2024] Open
Abstract
Background Evidence on double and triple burdens of malnutrition among adolescents is an essential key to informing policy design, implementation, and tracking progress of adolescent nutritional programs. Tanzania has a scarcity of studies on the double and triple burden of malnutrition among adolescents. Objective The aim of this study was to assess the co-occurrence of malnutrition (overweight, stunting, and anemia) among adolescents (10-19 y) in mainland Tanzania. Methods A school-based cross-sectional study was conducted among 44,120 primary school adolescents aged 10 to 19 y in mainland Tanzania. Anthropometric assessments (weight, height, and body mass index), dietary assessments, and hemoglobin levels were used to calculate the single, double, and triple burden of malnutrition. Data were analyzed using Stata software 15. The chi-square test was used to test the association between the nutrition condition and social demographic variables, physical activity, and dietary quality. Log-binomial models were used to determine factors associated with stunting, overweight, and anemia. Multivariable log-binomial models were used to control confounders. All analyses were 2-tailed, and the significance level was set at 5%. Results The prevalence of anemia was 34.1%, while stunting and overweight had a prevalence of 32% and 4.2%, respectively. Approximately 41.7%, 13.5%, and 0.3% had single, double, and triple burden malnutrition-related conditions, respectively. Females were found to have a higher risk of being overweight compared with males (relative risk [RR]: 1.33; 95% confidence interval [CI]: 1.21, 1.45), while engaging in moderate to low levels of physical activity was associated with a decreased risk of being overweight. Additionally, residing in urban areas was linked to a decreased risk of stunting (RR: 0.78; 95% CI: 0.75, 0.80) and a 27% lower risk of anemia when compared with participants from rural areas. Conclusion The findings from this study suggest that the complex nature of malnutrition among school adolescents warrants consideration when designing policies and interventions to reduce the burden of malnutrition.
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Affiliation(s)
- Geofrey Mchau
- Department of Community Health and Nutrition, Tanzania Food Nutrition Centre (TFNC), Dar es Salaam, Tanzania
- Department of Epidemiology and Biostatistics, Muhimbili University of Health Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Erick Killel
- Department of Community Health and Nutrition, Tanzania Food Nutrition Centre (TFNC), Dar es Salaam, Tanzania
| | - Kaunara Azizi
- Department of Food Sciences and Nutrition, Tanzania Food Nutrition Centre (TFNC), Dar es Salaam, Tanzania
| | - Stanslaus Henry
- Department of Community Health and Nutrition, Tanzania Food Nutrition Centre (TFNC), Dar es Salaam, Tanzania
| | - Samafilan Ainan
- Department of Pediatric and Child Health, Muhimbili University of Health Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Theresia Jumbe
- Hellen Keller International (HKI), Tanzania
- Department of Human Nutrition and Consumer Studies, Sokoine University of Agriculture (SUA), Tanzania
| | | | - Wiggins Kystikila
- Department of Statistics, University of Dar es Salaam (UDSM), Dar es Salaam, Tanzania
| | | | | | - Bwire Wilson
- Department of Statistics, University of Dar es Salaam (UDSM), Dar es Salaam, Tanzania
| | - Heavenlight A. Paulo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Sauli Epimack
- Department of Community Health and Nutrition, Tanzania Food Nutrition Centre (TFNC), Dar es Salaam, Tanzania
| | - Hoyce Mshinda
- Department of Community Health and Nutrition, Tanzania Food Nutrition Centre (TFNC), Dar es Salaam, Tanzania
| | - Frank Chacky
- National Malaria Control Program, Ministry of Health (MoH), Tanzania
| | | | - Ray Masumo
- Department of Community Health and Nutrition, Tanzania Food Nutrition Centre (TFNC), Dar es Salaam, Tanzania
| | - Germana Leyna
- Department of Community Health and Nutrition, Tanzania Food Nutrition Centre (TFNC), Dar es Salaam, Tanzania
- Department of Epidemiology and Biostatistics, Muhimbili University of Health Allied Sciences (MUHAS), Dar es Salaam, Tanzania
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Said FA, Khamis AG, Salmin AH, Msellem SN, Mdachi K, Noor R, Leyna G, Mchau GJ. Influence of diet quality on nutritional status of school-aged children and adolescents in Zanzibar, Tanzania. PLoS One 2023; 18:e0293316. [PMID: 37862346 PMCID: PMC10588882 DOI: 10.1371/journal.pone.0293316] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/09/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Malnutrition among young children and adolescents poses a serious health challenge in developing countries which results in many health problems during adulthood. Poor diet quality is known as the root cause of malnutrition which is caused by unhealthy food choices and bad eating habits among young children and adolescents. However, limited evidence is available on diet quality and its association with nutrition status among young children and adolescents in Zanzibar. This study examined the diet quality and its relationship with the nutritional status of school-aged children and adolescents in Zanzibar. METHODS Data for this study was obtained from the cross-sectional survey of School Health and Nutrition (SHN) conducted in Zanzibar. The survey recruited children aged 5-19 years from 93 schools in Zanzibar. A seven-day food frequency questionnaire (FFQ) was used to assess dietary intake. Prime Dietary Quality Score (PDQS) consisted of 21 food groups was then constructed to assess the diet quality of school-aged children and adolescents. Body mass index (BMI-for-age Z-score) was used as the indicator of nutrition status. Both linear and logistic regression analysis techniques were used to determine the associations between BMI and PDQS. RESULTS A total data of 2,556 children were enrolled in the survey. The prevalence of thinness was 8.1%, normal 82.1%, overweight 7.2% and obesity 2.6%. The mean (SD) PDQS score was 18.8 (3.2) which ranged from 8 to 33. Consumptions of green leafy vegetables (49.3%), yellow or red fruits (37.8%), legumes (38.3%), fish (36.3%), and vegetable oil (31.5%) were up to three times per week, whereas consumptions of white vegetables (77.3%), cooked vegetables (32.6%), citrus fruits (66.8%), other types of fruits (66.2%), nuts (46.4%), poultry (49.6%), whole grains (61%) and eggs (67.8%) were less than once per week. In terms of unhealthy foods, eating fried foods was reported by 26.3% up to three times per week, and 31.5% reported consuming sweets and ice cream up to three times in the past week. High PDQS was significantly associated with a reduction in BMI of children (p< 0.005). For each unit increase in the consumption of unhealthy foods such as fried foods, cooked vegetables and refined grains there is a significant increase in BMI. The odds of being obese decrease significantly as diet quality increases from the first to third quintile of PDQS (AOR = 0.2, 0.04-0.89 95% CI, p = 0.035). CONCLUSION Consumption of high quality diet was found to be associated with a reduction in excessive weight among school-aged children and adolescents in Zanzibar. There is a need for interventions targeting to reduce unhealthy food consumption in school environment. Further research should be conducted to assess diet quality using PDQS among young children and adolescents.
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Affiliation(s)
- Fatma Ali Said
- Department of Preventive Services and Health Promotion, Ministry of Health Zanzibar, Zanzibar, Tanzania
| | | | - Asha Hassan Salmin
- Department of Preventive Services and Health Promotion, Ministry of Health Zanzibar, Zanzibar, Tanzania
| | | | - Kombo Mdachi
- Office of the Chief Government Statistician, Zanzibar, Tanzania
| | | | - Germana Leyna
- Tanzania Food and Nutrition Centre, Dar-es-salaam, Tanzania
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Mlunde LB, Hirschhorn LR, Nyblade L, Rothrock NE, Mbugi EV, Moskowitz JT, Kaaya S, Hawkins C, Leyna G, Mbwambo JK. Translation and cultural adaptation of drug use stigma and HIV stigma measures among people who use drugs in Tanzania. PLoS One 2023; 18:e0292642. [PMID: 37856437 PMCID: PMC10586607 DOI: 10.1371/journal.pone.0292642] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/26/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION People who use drugs (PWUD) experience stigma from multiple sources due to their drug use. HIV seroprevalence for PWUD in Tanzania is estimated to range from 18 to 25%. So, many PWUD will also experience HIV stigma. Both HIV and drug use stigma have negative health and social outcomes, it is therefore important to measure their magnitude and impact. However, no contextually and linguistically adapted measures are available to assess either HIV or drug use stigma among PWUD in Tanzania. In response, we translated and culturally adapted HIV and drug use stigma measures among Tanzanian PWUD and described that process in this study. METHODS This was a cross-sectional study. We translated and adapted existing validated stigma measures by following a modified version of Wild's ten steps for translation and adaptation. We also added new items on stigmatizing actions that were not included in the original measures. Following translation and back translation, we conducted 40 cognitive debriefs among 19 PWUD living with and 21 PWUD not living with HIV in Dar es Salaam to assess comprehension of the original and new items. For challenging items, we made adaptations and repeated cognitive debriefs among ten new PWUD participants where half of them were living with HIV. RESULTS Most of the original items (42/54, 78%), response options and all items with new 12 stigmatizing actions were understood by participants. Challenges included response options for a few items; translation to Swahili; and differences in participants' interpretation of Swahili words. We made changes to these items and the final versions were understood by PWUD participants. CONCLUSION Drug use and HIV stigma measures can successfully be translated and culturally adapted among Tanzanian PWUD living with and without HIV. We are currently conducting research to determine the stigma measures' psychometric properties and we will report the results separately.
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Affiliation(s)
- Linda B. Mlunde
- Department of Community Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Lisa R. Hirschhorn
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Laura Nyblade
- Health Practice, RTI, International, Washington, DC, United States of America
| | - Nan E. Rothrock
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Erasto V. Mbugi
- Department of Biochemistry, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Judith T. Moskowitz
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Sylvia Kaaya
- Department of Psychiatry and Mental Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Claudia Hawkins
- Department of Medicine, Feinberg School of Medicine Northwestern University, Chicago, Illinois, United States of America
| | - Germana Leyna
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jessie K. Mbwambo
- Department of Psychiatry and Mental Health, Muhimbili National Hospital, Dar es Salaam, Tanzania
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Kalezi ZE, Kisenge R, Naburi H, Simbila AN, Mkony M, Leyna G. Prevalence of anaemia and associated factors among preterm infants at six weeks chronological age at Muhimbili National Hospital, Dar es Salaam, Tanzania: a cross-sectional study. Pan Afr Med J 2023; 44:193. [PMID: 37484596 PMCID: PMC10362685 DOI: 10.11604/pamj.2023.44.193.31190] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 03/15/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction preterm infants are vulnerable to several medical complications including anaemia, a significant public health problem with consequences on neurodevelopment. This study looked at the magnitude of anaemia and its associated factors among preterm infants at 6 weeks chronological age in a paediatric clinic of Muhimbili National Hospital (MNH). Methods this was a hospital based cross-sectional study conducted among preterm infants at 6 weeks chronological age attending follow-up clinic at MNH from October 2019 to March 2020. Parental interviews, medical records reviews and haemoglobin assessment was done during the clinic visits. Logistic regression was used to determine the association between studied factors and anaemia. Results the proportion of preterm infants with anaemia at 6 weeks chronological age was 38.4% (142/370) with 74% of these infants having moderate anaemia. Morphological types of anaemia were normocytic (56.3%) and microcytic anaemia (4.9%). Two-thirds of preterm infants (62%) were on haematinics supplementation. Moderate preterm born at gestation age 32 to <34 weeks (OR=2.21, 95% CI 1.15-4.25, p=0.017), two or less phlebotomies (OR=2.3; 95% CI 1.23-4.30; P=0.010) and more than two phlebotomies (OR=7.2, 95% CI 3.62-14.16, p≤0.001) were significantly associated with anaemia. Conclusion the proportion of preterm infants with anaemia at 6 weeks chronological age is high despite two-thirds being on haematinics supplementation. Moderate preterm and multiple phlebotomies significantly contributed to the occurrence of anaemia. Screening preterm infants for anaemia, appropriate management, and close follow-up are recommended to reduce its burden.
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Affiliation(s)
- Zawadi Edward Kalezi
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Rodrick Kisenge
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Helga Naburi
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Alphonce Nsabi Simbila
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Martha Mkony
- Department of Paediatrics and Child Health, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Germana Leyna
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Msaki RV, Lyimo E, Masumo RM, Mwana E, Katana D, Julius N, Munuo A, Leyna G, Issaka AI, Dhami MV, Agho KE. Predictors of iron deficiency anaemia among children aged 6-59 months in Tanzania: Evidence from the 2015-16 TDHS-MIS cross-sectional household survey. PLOS Glob Public Health 2022; 2:e0001258. [PMID: 36962688 PMCID: PMC10022048 DOI: 10.1371/journal.pgph.0001258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/12/2022] [Indexed: 11/12/2022]
Abstract
Iron deficiency anaemia remains a public health problem, particularly in children aged 6-59 months. This study assessed factors associated with iron deficiency anaemia among children aged 6-23 months, 24-59 months and 6-59 months in Tanzania. Data for this cross-sectional study were extracted from the 2015-16 Tanzania Demographic and Health Survey and Malaria Indicator Survey (2015-16 TDHS-MIS). The study covered 8014 children aged 6-59 months and their mothers. Iron deficiency anaemia was defined (haemoglobin < 11g/dL). Univariable and multivariable logistic regression analyses that adjust for clustering and sampling weights were conducted to describe the associations between anaemia and potential confounding variables. The prevalence of iron deficiency anaemia among children aged 6-23 months, 24-59 months and 6-59 months were 76%, 49% and 59%, respectively. Factors associated with increased odds of iron deficiency anaemia among children aged 6-23 months included a mother being employed, being a male child, child perceived to small size at birth by mothers, a mother being anaemic and children belonging to the poorest socio-economic quintile. In addition, being a mother with no schooling, children not being dewormed, a mother being anaemic, delivering a baby at home, child fever and stunting, were factors associated with increased odds of iron deficiency anaemia among children aged 24-59 months. Factors associated with increased odds of iron deficiency anaemia among children aged 6-59 months were: a mother being employed, being a mother with no schooling, being a male child, belonging to the 6-59 months age bracket, a mother having a BMI of between 19 and 25 kg/m2, a mother being anaemic, having a baby at home, children belonging to bigger households, child fever and stunting. Interventions to minimise the burden of iron deficiency anaemia in children should target employed and/or anaemic mothers, poor and rich households, as well as male children.
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Affiliation(s)
- Rose V. Msaki
- Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
| | | | - Ray M. Masumo
- Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
| | - Eliasaph Mwana
- Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
| | - Doris Katana
- Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
| | - Nyamizi Julius
- Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
| | - Adeline Munuo
- Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
| | - Germana Leyna
- Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
| | - Abukari I. Issaka
- School of Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Mansi V. Dhami
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Penrith, NSW, Australia
| | - Kingsley E. Agho
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Penrith, NSW, Australia
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Penrith, NSW, Australia
- African Vision Research Institute, University of KwaZulu-Natal, Durban, South Africa
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Simbila AN, Kilindimo SS, Sawe HR, Kalezi ZE, Yussuf AO, Manji HK, Leyna G, Mfinanga JA, Weber EJ. Predictors and outcome of time to presentation among critically ill paediatric patients at Emergency Department of Muhimbili National Hospital, Dar es Salaam, Tanzania. BMC Pediatr 2022; 22:441. [PMID: 35864482 PMCID: PMC9306055 DOI: 10.1186/s12887-022-03503-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 07/06/2022] [Indexed: 11/12/2022] Open
Abstract
Background Mortality among under-five children in Tanzania remains high. While early presentation for treatment increases likelihood of survival, delays to care are common and factors causing delay to presentation among critically ill children are unknown. In this study delay was defined as presentation to the emergency department of tertially hospital i.e. Muhimbili National Hospital, more than 48 h from the onset of the index illness. Methodology This was a prospective cohort study of critically ill children aged 28 days to 14 years attending emergency department at Muhimbili National Hospital in Tanzania from September 2019 to January 2020. We documented demographics, time to ED presentation, ED interventions and 30-day outcome. The primary outcome was the association of delay with mortality and secondary outcomes were predictors of delay among critically ill paediatric patients. Logistic regression and relative risk were calculated to measure the strength of the predictor and the relationship between delay and mortality respectively. Results We enrolled 440 (59.1%) critically ill children, their median age was 12 [IQR = 9–60] months and 63.9% were males. The median time to Emergency Department arrival was 3 days [IQR = 1–5] and more than half (56.6%) of critically ill children presented to Emergency Department in > 48 h whereby being an infant, self-referral and belonging to poor family were independent predictors of delay. Infants and those referred from other facilities had 2.4(95% CI 1.4–4.0) and 1.8(95% CI 1.1–2.8) times increased odds of presenting late to the Emergency Department respectively. The overall 30-day in-hospital mortality was 26.5% in which those who presented late were 1.3 more likely to die than those who presented early (RR = 1.3, CI: 0.9–1.9). Majority died > 24 h of Emergency Department arrival (P-value = 0.021). Conclusion The risk of in-hospital mortality among children who presented to the ED later than 48 h after onset of illness was 1.3 times higher than for children who presented earlier than 48 h. It could be anywhere from 10% lower to 90% higher than the point estimate. However, the effect size was statistically not significant since the confidence interval included the null value Qualitative and time-motion studies are needed to evaluate the care pathway of critically ill pediatric patients to identify preventable delays in care.
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Affiliation(s)
- Alphonce N Simbila
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.,Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Said S Kilindimo
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania. .,Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania.
| | - Hendry R Sawe
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.,Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Zawadi E Kalezi
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Amne O Yussuf
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Hussein K Manji
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Germana Leyna
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Juma A Mfinanga
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Ellen J Weber
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania.,Department of Emergency Medicine, University of California, San Francisco, CA, USA
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9
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Mbotwa C, Kazaura M, Moen K, Leshabari M, Metta E, Leyna G, Mmbaga EJ. 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. BMC Health Serv Res 2022; 22:859. [PMID: 35787285 PMCID: PMC9254514 DOI: 10.1186/s12913-022-08245-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 03/19/2022] [Accepted: 06/21/2022] [Indexed: 11/10/2022] Open
Abstract
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. Trial registration International Clinical Trials Registry Platform PACTR202003823226570; 04.03.2020.
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Affiliation(s)
- Christopher Mbotwa
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. .,Mbeya College of Health and Allied Sciences, University of Dar es Salaam, Mbeya, Tanzania.
| | - Method Kazaura
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Kåre Moen
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Melkizedeck Leshabari
- Department of Behavioural sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Emmy Metta
- Department of Behavioural sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Germana Leyna
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
| | - Elia J Mmbaga
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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10
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Ambikapathi R, Irema I, Lyatuu I, Caswell B, Mosha D, Nyamsangia S, Galvin L, Mangara A, Boncyk M, Froese SL, Verissimo CK, Itatiro J, Kariathi V, Kazonda P, Wandella M, Fawzi W, Killewo J, Mwanyika-Sando M, PrayGod G, Leyna G, Patil C, Gunaratna NS. Gender and Age Differences in Meal Structures, Food Away from Home, Chrono-Nutrition, and Nutrition Intakes among Adults and Children in Tanzania Using a Newly Developed Tablet-Based 24-Hour Recall Tool. Curr Dev Nutr 2022; 6:nzac015. [PMID: 35317413 PMCID: PMC8929990 DOI: 10.1093/cdn/nzac015] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/18/2022] [Accepted: 01/26/2022] [Indexed: 12/04/2022] Open
Abstract
Background In many regions of the world, little is known about meal structures, meal patterns, and nutrient intake because the collection of quantitative dietary intake is expensive and labor-intensive. Objectives We describe the development and field feasibility of a tablet-based Tanzania 24-h recall tool (TZ-24hr-DR) and dietary intakes collected from adults and children in rural and urban settings. Methods Using the Tanzanian food-composition table, the TZ-24hr-DR tool was developed on an Android platform using the Open Data Kit. The module provides food lists, meal lists, ingredient lists, quantity and amount consumed, breastfeeding frequency, and a recipe feature. Similar to the USDA Automated Multiple Pass Method, this TZ-24hr-DR contains review features such as time in-between meals, a summary of meals, and portion sizes. Results Dietary intake using TZ-24hr-DR was collected among 1) 845 children 0-18 mo of age enrolled in the Engaging Fathers for Effective Child Nutrition and Development in Tanzania (EFFECTS) trial (ClinicalTrials.gov identifier: NCT03759821) in Mara, Tanzania, and 2) 312 adult families from the Diet, Environment, and Choices of positive living (DECIDE) observational study in peri-urban Dar es Salaam. Interviewers were trained on paper-based methods with food models and tablet-based collection. Conversion to nutrient intake was readily linked and accessible, enabling rapid review and analysis. Overall, 2158 and 8197 dietary meal records were collected from the DECIDE study and EFFECTS trial, respectively. Among adults, 63% of men and 92% of women reported eating at home, and there were differences in protein, fat, and zinc. Food consumed outside the home typically occurs for the first 2 meals. Children's intake of nutrients increased with age; however, median micronutrient intakes for calcium, iron, zinc, and vitamin A remained below recommended nutrient intakes. Conclusions The TZ-24hr-DR is a field- and user-friendly tool that can collect large samples of dietary intakes. Further validation is needed. The tool is available freely for research purposes and can be further adapted to other contexts in East Africa.
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Affiliation(s)
- Ramya Ambikapathi
- Departments of Public Health and Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Imani Irema
- Africa Academy of Public Health, Dar es Salaam, Tanzania
| | - Isaac Lyatuu
- Africa Academy of Public Health, Dar es Salaam, Tanzania
| | - Bess Caswell
- Western Human Nutrition Research Center, Agricultural Research Service, US Department of Agriculture, Davis, CA, USA
| | - Dominic Mosha
- Africa Academy of Public Health, Dar es Salaam, Tanzania
| | | | - Lauren Galvin
- Global Communities, Dar es Salaam, Tanzania and Silver Spring, MD, USA
| | - Ally Mangara
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Morgan Boncyk
- Departments of Public Health and Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Savannah L Froese
- Departments of Public Health and Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Cristiana K Verissimo
- Departments of Public Health and Nutrition Science, Purdue University, West Lafayette, IN, USA
| | | | | | - Patrick Kazonda
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Wafaie Fawzi
- Department of Global Health, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Japhet Killewo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - George PrayGod
- National Institute for Medical Research, Mwanza, Tanzania
| | - Germana Leyna
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Tanzania Food and Nutrition Center, Dar es Salaam, Tanzania
| | - Crystal Patil
- Department of Women, Children and Family Health Science, University of Illinois Chicago, Chicago, IL, USA
| | - Nilupa S Gunaratna
- Departments of Public Health and Nutrition Science, Purdue University, West Lafayette, IN, USA
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11
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Sunguya BF, Ge Y, Mlunde L, Mpembeni R, Leyna G, Huang J. High burden of anemia among pregnant women in Tanzania: a call to address its determinants. Nutr J 2021; 20:65. [PMID: 34238307 PMCID: PMC8268339 DOI: 10.1186/s12937-021-00726-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/03/2021] [Indexed: 11/24/2022] Open
Abstract
Background Anemia in pregnancy is behind a significant burden of maternal mortality and poor birth outcomes globally. Efforts to address it need evidence on trends and its pertinent factors as they vary from one area to another. Methods We pooled data of 23,203 women of reproductive age whose hemoglobin levels were measured from two Tanzania Demographic and Health Surveys (TDHS). Of them, 2,194 women were pregnant. Analyses employed descriptive analyses to determine the burden of anemia, its characteristics, and severity; GIS mapping to determine the regional changes of anemia between 2005 and 2015; and logistic regression to determine the remaining determinants of anemia among pregnant women using Stata 15. Results The burden of anemia among pregnant women in Tanzania has remained unprecedently high, and varies between regions. There was no significant decline of anemia in general between the two periods after adjusting for individual, households, reproductive, and child characteristics [AOR = 0.964, 95% CI = 0.774–1.202, p = 0.747). Anemia is currently prevalent in 57% of pregnant women in Tanzania. The prevalence is more likely to be higher among women aged 15–19 years than those aged between 20–34 years. It is more likely to be prevalent among those within large families, with no formal education, food insecurity, lack of health insurance, had no antimalaria during pregnancy, and had low frequency of ANC attendance. On the other hand, delivery in a health facility may be potentially protective against anemia. Conclusions Anemia in pregnancy remained persistently high and prevalent among 57% of pregnant women in Tanzania. Efforts to address anemia are crucial and need to be focused in regions with increasing burden of anemia among pregnant women. It is imperative to address important risk factors such as food insecurity, strengthening universal health coverage, empowering women of reproductive age with education and especially nutritional knowledge and advocating for early antenatal booking, attendance, and facility delivery. Supplementary Information The online version contains supplementary material available at 10.1186/s12937-021-00726-0.
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Affiliation(s)
- Bruno F Sunguya
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Yue Ge
- Global Health Institute, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health Commission, Shanghai, China
| | - Linda Mlunde
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Implementation Science Tanzania, Dar es Salaam, Tanzania
| | - Rose Mpembeni
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Germana Leyna
- Tanzania Food and Nutrition Center, Dar es Salaam, Tanzania
| | - Jiayan Huang
- Global Health Institute, School of Public Health, Fudan University, Shanghai, China. .,Key Laboratory of Health Technology Assessment, National Health Commission, Shanghai, China.
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12
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Ambikapathi R, Shively G, Leyna G, Mosha D, Mangara A, Patil CL, Boncyk M, Froese SL, Verissimo CK, Kazonda P, Mwanyika-Sando M, Killewo J, Gunaratna NS. Informal food environment is associated with household vegetable purchase patterns and dietary intake in the DECIDE study: Empirical evidence from food vendor mapping in peri-urban Dar es Salaam, Tanzania. Glob Food Sec 2021; 28:100474. [PMID: 33738186 PMCID: PMC7938223 DOI: 10.1016/j.gfs.2020.100474] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 12/02/2022]
Abstract
We study the relationship between the food environment (FE) and the food purchase patterns, dietary intakes, and nutritional status of individuals in peri-urban Tanzania. In Africa, the prevailing high density of informal vendors creates challenges to characterizing the FE. We present a protocol and tool developed as part of the Diet, Environment, and Choices of positive living (DECIDE) study to measure characteristics of the FE. We mapped 6627 food vendors in a peri-urban settlement of Dar es Salaam, of which over 60% were semi-formal and informal (mobile) vendors. We compute and compare four FE metrics inspired by landscape ecology—density, dispersion, diversity, and dominance—to better understand how the informal food environment relates to food purchase patterns, diets, and nutritional status among households with persons living with human immunodeficiency virus (PLHIV). In Tanzania, a high density of informal vendors within this transitioning food system creates challenges to characterizing the food environment. We develop four metrics inspired by landscape ecology to characterize formal, semi-formal, and informal food environments. We use these metrics to evaluate associations to household food purchase patterns, energy intake, and nutritional status. Vegetables, especially green leafy vegetables, were primarily sold by informal mobile food vendors, most of whom were women. A greater density of vegetable vendors or informal vendors within 500 meters of a household is associated with a higher likelihood of vegetable purchases and lower energy intake. The role of informal and semi-formal food vendors in supporting consumption of nutritious diets should not be discounted, and gender sensitive actions to promote their livelihoods is needed.
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Affiliation(s)
| | - Gerald Shively
- Department of Agricultural Economics & International Programs in Agriculture, Purdue University, USA
| | | | | | - Ally Mangara
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Tanzania
| | - Crystal L Patil
- Department of Women, Children & Family Health Science, University of Illinois at Chicago, USA
| | | | - Savannah L Froese
- Department of Public Health, Purdue University, USA.,Department of Nutrition Science, Purdue University, USA
| | | | - Patrick Kazonda
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Tanzania
| | | | - Japhet Killewo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Tanzania
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13
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Wilunda C, Mumba FG, Putoto G, Maya G, Musa E, Lorusso V, Magige C, Leyna G, Manenti F, Dalla Riva D, Ntoga BA, Segafredo G. Effectiveness of screening and treatment of children with severe acute malnutrition by community health workers in Simiyu region, Tanzania: a quasi-experimental pilot study. Sci Rep 2021; 11:2342. [PMID: 33504865 PMCID: PMC7840757 DOI: 10.1038/s41598-021-81811-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/11/2021] [Indexed: 11/09/2022] Open
Abstract
Health system constraints hamper treatment of children with severe acute malnutrition (SAM) in Tanzania. This non-inferiority quasi-experimental study in Bariadi (intervention) and Maswa (control) districts assessed the effectiveness, coverage, and cost-effectiveness of SAM treatment by community health workers (CHWs) compared with outpatient therapeutic care (OTC). We included 154 and 210 children aged 6–59 months with SAM [mid-upper arm circumference (MUAC) < 11.5 cm] without medical complications in the control and intervention districts, respectively. The primary treatment outcome was cure (MUAC ≥ 12.5 cm). We performed costing analysis from the provider’s perspective. The probability of cure was higher in the intervention group (90.5%) than in the control group (75.3%); risk ratio (RR) 1.17; 95% CI 1.05, 1.31 and risk difference (RD) 0.13; 95% CI 0.04, 0.23. SAM treatment coverage was higher in the intervention area (80.9%) than in the control area (41.7%). The cost per child treated was US$146.50 in the intervention group and US$161.62 in the control group and that per child cured was US$161.77 and US$215.49 in the intervention and control groups, respectively. The additional costs per an additional child treated and cured were US$134.40 and US$130.92, respectively. Compared with OTC, treatment of children with uncomplicated SAM by CHWs was effective, increased treatment coverage and was cost-effective.
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Affiliation(s)
- Calistus Wilunda
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box 10787, Nairobi, 00100, Kenya. .,Epidemiology and Prevention Group, National Cancer Center, Tokyo, 104-0045, Japan.
| | | | | | - Gloria Maya
- Doctors with Africa CUAMM, Simiyu, 39101, Tanzania
| | - Elias Musa
- Doctors with Africa CUAMM, Simiyu, 39101, Tanzania
| | | | - Chacha Magige
- Simiyu Regional Medical Officer's Office, Simiyu, 39101, Tanzania
| | - Germana Leyna
- Tanzania Food and Nutrition Centre, Dar es Salaam, 11101, Tanzania
| | | | | | - Bupe Abel Ntoga
- Tanzania Food and Nutrition Centre, Dar es Salaam, 11101, Tanzania
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14
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Muhihi AJ, Anaeli A, Mpembeni RNM, Sunguya BF, Leyna G, Kakoko D, Kessy AT, Sando MM, Njelekela M, Urassa DP. Public knowledge of risk factors and warning signs for cardiovascular disease among young and middle-aged adults in rural Tanzania. BMC Public Health 2020; 20:1832. [PMID: 33256688 PMCID: PMC7708242 DOI: 10.1186/s12889-020-09956-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/19/2020] [Accepted: 11/22/2020] [Indexed: 01/08/2023] Open
Abstract
Background Improving cardiovascular health requires public knowledge and reduction of modifiable cardiovascular disease (CVD) risk factors. This study assessed knowledge of risk factors and warning signs for CVDs among young and middle-aged adults in Morogoro, Tanzania. Methods We conducted a community-based survey as part of cluster randomized controlled study of community health workers (CHWs) intervention for reduction of blood pressure among young and middle-aged adults in rural Morogoro. Information on socio-demographic characteristics, knowledge of risk factors and warning signs for CVDs was collected using an interviewer administered questionaire. Knowledge was assessed using open-ended questions followed by closed-ended questions. Descriptive statistics were used to describe knowledge of risk factors and warning signs. Logistic regression analysis was used to investigate factors associated with adequate knowledge of risk factors and warning signs for CVDs. Results Two-thirds (65.7%) of the participants had heard about CVDs. The main sources of information were mainly relatives/ neighbors (64.8%) and radio (53.0%). Only 28.3% of the participants reported health care providers as source of information about CVDs. More than half of the participants (52.4%) did not mention even one risk factor spontaneously while 55.2% were unable to mention any warning sign. When asked to select from a list, 6.9% were unable to correctly identify any risk factor whereas 11.8% could not correctly identify even a single warning sign. Quarter of participants (25.4%) had good knowledge score of risk factors, 17.5% had good knowledge score of warning signs and 16.3% had overall good knowledge of both risk factors and warning signs. Residing in Ulanga, having higher education level, having ever checked blood pressure and being overweight/obese predicted adequacy of knowledge score for both risk factors and warning signs. Conclusion Knowledge of risk factors and warning signs in this rural population of young and middle-aged adults was generally low. Health care providers were less likely to provide health education regarding risk factors and warning signs for CVDs. Health promotion interventions to increase population knowledge of risk factors and warning signs should be implemented for successful reduction of CVDs in Tanzania.
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Affiliation(s)
- Alfa J Muhihi
- Department of Community Health, Muhimbili University of Health and Allied Sciences, United Nations Road, P. O. Box 65001, Upanga, Dar es Salaam, Tanzania. .,Africa Academy for Public Health, Plot # 802, Mwai Kibaki Road, Mikocheni, Dar es Salaam, Tanzania. .,Lown Scholars Program, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Amani Anaeli
- Department of Development Studies, Muhimbili University of Health and Allied Sciences, United Nations Road, Upanga, Dar es Salaam, Tanzania
| | - Rose N M Mpembeni
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, United Nations Road, Upanga, Dar es Salaam, Tanzania
| | - Bruno F Sunguya
- Department of Community Health, Muhimbili University of Health and Allied Sciences, United Nations Road, P. O. Box 65001, Upanga, Dar es Salaam, Tanzania
| | - Germana Leyna
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, United Nations Road, Upanga, Dar es Salaam, Tanzania
| | - Deodatus Kakoko
- Department of Behavioral Sciences, Muhimbili University of Health and Allied Sciences, United Nations Road, Upanga, Dar es Salaam, Tanzania
| | - Anna Tengia Kessy
- Department of Community Health, Muhimbili University of Health and Allied Sciences, United Nations Road, P. O. Box 65001, Upanga, Dar es Salaam, Tanzania
| | - Mary Mwanyika Sando
- Africa Academy for Public Health, Plot # 802, Mwai Kibaki Road, Mikocheni, Dar es Salaam, Tanzania
| | - Marina Njelekela
- Department of Physiology, Muhimbili University of Health and Allied Sciences, United Nations Road, Upanga, Dar es Salaam, Tanzania.,Deloitte Consulting Limited, Aris House, Plot # 152, Haile Selassie Road, Oysterbay, Dar es Salaam, Tanzania
| | - David P Urassa
- Department of Community Health, Muhimbili University of Health and Allied Sciences, United Nations Road, P. O. Box 65001, Upanga, Dar es Salaam, Tanzania
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15
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Alexander Ishungisa M, Moen K, Leyna G, Makyao N, Ramadhan A, Lange T, Meyrowitsch DW, Mizinduko M, Likindikoki S, Leshabari M, Mmbaga EJ. HIV prevalence among men who have sex with men following the implementation of the HIV preventive guideline in Tanzania: respondent-driven sampling survey. BMJ Open 2020; 10:e036460. [PMID: 33020084 PMCID: PMC7537429 DOI: 10.1136/bmjopen-2019-036460] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To estimate HIV prevalence and associated risk factors among men who have sex with men (MSM) in Dar es Salaam, Tanzania following the implementation of the national comprehensive package of HIV interventions for key population (CHIP). DESIGN A cross-sectional survey using respondent-driven sampling. SETTING Dar es Salaam, Tanzania's largest city. PARTICIPANTS Men who occasionally or regularly have sex with another man, aged 18 years and above and living in Dar es Salaam city at least 6 months preceding the study. PRIMARY OUTCOME MEASURE HIV prevalence was the primary outcome. Independent risk factors for HIV infection were examined using weighted logistics regression modelling. RESULTS A total of 777 MSM with a mean age of 26 years took part in the study. The weighted HIV prevalence was 8.3% (95% CI: 6.3%-10.9%) as compared with 22.3% (95% CI: 18.7%-26.4%) observed in a similar survey in 2014. Half of the participants had had sex with more than two partners in the month preceding the survey. Among those who had engaged in transactional sex, 80% had used a condom during last anal sex with a paying partner. Participants aged 25 and above had four times higher odds of being infected than those aged 15-19 years. HIV infection was associated with multiple sexual partnerships (adjusted OR/AOR, 3.0; 95% CI: 1.8-12.0), not having used condom during last sex with non-paying partner (AOR, 4.1; 95% CI: 1.4-7.8) and ever having engaged in group sex (AOR, 3.4; 95% CI: 1.7-3.6). CONCLUSION HIV prevalence among MSM in Dar es Salaam has decreased by more than a half over the past 5 years, coinciding with implementation of the CHIP. It is nonetheless two times as high as that of men in the general population. To achieve the 2030 goal, behavioural change interventions and roll out of new intervention measures such as pre-exposure prophylaxis are urgently needed.
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Affiliation(s)
- Mwijage Alexander Ishungisa
- Behavioral Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
- Medical Botany, Plant Breeding and Agronomy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Kare Moen
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - Germana Leyna
- Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Neema Makyao
- National AIDS Control Programme, Ministry of Health, Tanzania National AIDS Control Program, Dar es Salaam, United Republic of Tanzania
| | - Angela Ramadhan
- National AIDS Control Programme, Ministry of Health, Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Theis Lange
- Section of Biostatistics, University of Copenhagen, Kobenhavns, Denmark
| | | | - Mucho Mizinduko
- Epidemiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Samuel Likindikoki
- Department of Sychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Melkzedeck Leshabari
- Department of Behavioral Sciences, Muhimbili University College of Health Sciences, Dar es Salaam, United Republic of Tanzania
| | - Elia John Mmbaga
- Epidemiology and Biostatistics, Muhimbili University Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
- Community Medicine and Global Health, Universitetet i Oslo Avdeling for samfunnsmedisin, Oslo, Norway
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Muhihi AJ, Anaeli A, Mpembeni RNM, Sunguya BF, Leyna G, Kakoko D, Kessy AT, Mwanyika Sando M, Njelekela M, Urassa DP. Prevalence, Awareness, Treatment, and Control of Hypertension among Young and Middle-Aged Adults: Results from a Community-Based Survey in Rural Tanzania. Int J Hypertens 2020; 2020:9032476. [PMID: 32963821 PMCID: PMC7491449 DOI: 10.1155/2020/9032476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/25/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hypertension, which is the single most important risk factor for CVDs, is increasing at an alarming rate in most developing countries. This study estimated the prevalence, awareness, treatment, and control of hypertension among young and middle-aged adults in rural Morogoro, Tanzania. Furthermore, it explored factors associated with both prevalence and awareness of hypertension. METHODS A cross-sectional survey was conducted as part of the cluster randomized controlled study of community health workers (CHWs) interventions for reduction of blood pressure in a randomly selected sample of young and middle-aged population in rural Morogoro. Sociodemographics, lifestyle-related factors, history of diagnosis, and treatment for hypertension were collected using a questionnaire adopted from the STEPS survey tool. Blood pressure, height, and weight were measured at home following standard procedures. Descriptive statistics were used to estimate prevalence, awareness, treatment, and control of hypertension. Multiple logistic regression models were used to assess determinants of hypertension and awareness. RESULT The prevalence of hypertension was 29.3% (95% CI: 27.7-31.0). Among individuals with hypertension, only 34.3% were aware of their hypertension status. Only around one-third (35.4%) of those who were aware of their hypertension status were currently on antihypertensive medication. Hypertension control was attained in only 29.9% among those on medications. Older age (p < 0.001), use of raw table salt (p < 0.001), and being overweight/obese (p < 0.001) were associated with hypertension. Predictors of awareness of hypertension status were older age, being a female, higher socioeconomic status, use of raw table salt, a history of diabetes, and overweight/obesity (all p < 0.001). Alcohol drinking was associated with low awareness for hypertension status (p < 0.001). CONCLUSION There is high prevalence of hypertension with low rates of awareness, treatment, and control among young and middle-aged adults in rural Tanzania. Community-level health promotion and screening campaigns for hypertension and other CVD risk factors should be intensified.
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Affiliation(s)
- Alfa J. Muhihi
- Department of Community Health, Muhimbili University of Health and Allied Sciences, United Nations Road, Upanga, Dar es Salaam, Tanzania
- Africa Academy for Public Health, Plot # 802, Mwai Kibaki Road, Mikocheni, Dar es Salaam, Tanzania
- The Lown Scholars Program, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Amani Anaeli
- Department of Development Studies, Muhimbili University of Health and Allied Sciences, United Nations Road, Upanga, Dar es Salaam, Tanzania
| | - Rose N. M. Mpembeni
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, United Nations Road, Upanga, Dar es Salaam, Tanzania
| | - Bruno F. Sunguya
- Department of Community Health, Muhimbili University of Health and Allied Sciences, United Nations Road, Upanga, Dar es Salaam, Tanzania
| | - Germana Leyna
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, United Nations Road, Upanga, Dar es Salaam, Tanzania
| | - Deodatus Kakoko
- Department of Behavioral Sciences, Muhimbili University of Health and Allied Sciences, United Nations Road, Upanga, Dar es Salaam, Tanzania
| | - Anna Tengia Kessy
- Department of Community Health, Muhimbili University of Health and Allied Sciences, United Nations Road, Upanga, Dar es Salaam, Tanzania
| | - Mary Mwanyika Sando
- Africa Academy for Public Health, Plot # 802, Mwai Kibaki Road, Mikocheni, Dar es Salaam, Tanzania
| | - Marina Njelekela
- Department of Physiology, Muhimbili University of Health and Allied Sciences, United Nations Road, Upanga, Dar es Salaam, Tanzania
- Deloitte Consulting Limited, Aris House, Plot # 152, Haile Selassie Road, Oysterbay, Dar es Salaam, Tanzania
| | - David P. Urassa
- Department of Community Health, Muhimbili University of Health and Allied Sciences, United Nations Road, Upanga, Dar es Salaam, Tanzania
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Ambikapathi R, Irema I, Lyaatu I, Mosha D, Nyamsangia S, Kajuna D, Kumalija E, Galvin L, Caswell B, Kazonda P, Leyna G, Killewo J, Patil C, Sando MM, Gunaratna N. Development and Feasibility of Tablet-based 24-hour Recall for Dietary Intake and Recipe Collection Among Adults and Children in Tanzania (P10-018-19). Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz034.p10-018-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
In many regions of the world, little is known about food consumption, meal structures, meal patterns, and nutrient intake. Collection of these data using quantitative dietary intake is expensive and labor intensive. Thus, many programmatic and routine surveillance studies resort to simplified indicators to measure dietary quality. Based on a previous study conducted by Caswell et al. on tablet-based data collection of 24-hour dietary recall (24hr-DR), we have developed and adapted a mobile tool collecting 24hr-DR among adults and children in Tanzania.
Methods
Using the Tanzanian food composition table (FCT), the 24hr-DR was developed on an Android platform in Open Data Kit. The module provides food groups, food lists, meal list, ingredient list, quantity and amount consumed, breastfeeding frequency, and a recipe feature to collect detailed information (such as cooked and uncooked weights). Similar to the USDA Automated Multiple Pass Method, to accurately capture the dietary intake the tool contains summary features such as time in between meals and review of meals and portion size consumed in the previous day.
Results
The mobile tool is currently used to collect dietary intake (1) among 960 children 0–18 months of age enrolled in the EFFECTS trial (ClinicalTrials.gov Identifier: NCT03759821) in Mara, Tanzania, and (2) among adult families enrolled in the DECIDE study in Dar es Salaam. Field workers were first trained on paper-based methods with food models followed by training on tablet-based collection. Because the tool was tailored with the Tanzanian FCT, conversion to nutrient intake for the individual are readily linked. This enables the investigators to look at dietary intake data in real time for quality assurance and analysis. Demonstration of the tool along with dietary profiles and analysis will be compared with the literature. The tool will be made available to the public in December 2019, and can be adapted to different contexts.
Conclusions
Using mobile-based flexible platforms linked to a pre-existing FCT demystifies the “black box” processes of converting dietary intake to nutrient intake, thus reducing the time and labor needed using the traditional paper-based 24hr-DR method.
Funding Sources
This study is funded through the Drivers of Food Choice Grants Program by Bill and Melinda Gates foundation and UK AID.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Bess Caswell
- Program in International and Community Nutrition, University of California, Davis
| | | | | | | | - Crystal Patil
- Department Of Women, Family And Health Sciences, University Of Illinois-Chicago
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Semali IA, Tengia-Kessy A, Mmbaga EJ, Leyna G. Prevalence and determinants of stunting in under-five children in central Tanzania: remaining threats to achieving Millennium Development Goal 4. BMC Public Health 2015; 15:1153. [PMID: 26590803 PMCID: PMC4654796 DOI: 10.1186/s12889-015-2507-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 11/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Millennium Development Goal No 4 (MDG 4) requires countries to scale up interventions addressing malnutrition and other immediate determinants of burden of disease among children to reduce child mortality by two thirds by 2015, which is this year. Whereas globally some achievements have been registered, under-nourishment remains a significant problem in some developing countries such as Tanzania. This study set out to estimate the extent of stunting and its associated determinants to assess the progress made thus far towards achieving MDG 4 in Tanzania. METHODS A random sample of 678 households with under-five children was selected from two randomly selected wards of Kongwa district in Dodoma region, Tanzania. The WHO anthropometric calculator, which computes Z-scores using a reference population, was used to process the anthropometric measurement data taken from all the participants. Children with height for age Z-score of less than 2 were categorised as stunted and coded as 1 and the rest were coded as 0. Proportions of stunting were compared using the chi-square test to determine the association between stunting and the independent variables. Multivariate logistic regression analysis was carried out to determine the Adjusted Odds Ratio (AOR) of the independent determinants of stunting. The cut-off for significant association was set at p = 0.05. All these analyses used the STATA 12 software. RESULTS About half (49.7 %) of the children were stunted. This stunting was associated with belonging to households where the head of family was young (<35 years) (AOR = 0.67, 95 % CI 0.47-0.96, p = 0.031), young age of the mothers (AOR = 1.54, 95 % CI 1.06-2.24, p = 0.023), and economic variables such as owning a cellular phone (AOR = 0.66, 96 % CI 0.46-0.94, p = 0.023). CONCLUSIONS Stunting was highly prevalent in Kongwa district despite general improvements in child nutritional status at the national level. Household characteristics and economic status were found to play a major role in child health. In this regard, disaggregated analyses are therefore important in identifying resilient areas in need of concerted efforts for the MDG 4 to be achieved nationwide.
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Affiliation(s)
- Innocent Antony Semali
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, P.O. Box 65014, Dar es Salaam, Tanzania.
| | - Anna Tengia-Kessy
- Department of Community Health, School of Public Health and Social Sciences, P.O. Box 65014, Dar es Salaam, Tanzania.
| | - Elia John Mmbaga
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, P.O. Box 65014, Dar es Salaam, Tanzania.
| | - Germana Leyna
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, P.O. Box 65014, Dar es Salaam, Tanzania.
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Ngarina M, Kilewo C, Karlsson K, Aboud S, Karlsson A, Marrone G, Leyna G, Ekström AM, Biberfeld G. Virologic and immunologic failure, drug resistance and mortality during the first 24 months postpartum among HIV-infected women initiated on antiretroviral therapy for life in the Mitra plus Study, Dar es Salaam, Tanzania. BMC Infect Dis 2015; 15:175. [PMID: 25886277 PMCID: PMC4392730 DOI: 10.1186/s12879-015-0914-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 03/25/2015] [Indexed: 11/26/2022] Open
Abstract
Background In the Mitra plus study of prevention of mother-to-child transmission of HIV-1, which included 501 women in Dar es Salaam, Tanzania, triple antiretroviral therapy (ART) was given from late pregnancy throughout breastfeeding up to 6 months postnatally. Here we report findings in a sub-cohort of women with ≤200 CD4cells/μL at enrolment who were continued on ART for life and followed up during 24 months after delivery to determine virologic and immunologic responses, drug resistance and mortality. Methods Blood samples for viral load and CD4 counts testing were collected at enrolment and at 3, 6, 12 and 24 months postpartum. HIV drug resistance testing was performed at 12 months. Data analysis included descriptive statistics and multivariate analysis using Generalized Estimated Equations of 73 women with at least two postpartum assessments. The mortality analysis included 84 women who had delivered. Results The proportion of women with a viral load ≥400 copies/mL was 97% (71/73) at enrolment, 16% (11/67), 22% (15/69), 61% (36/59) and 86% (48/56) at 3, 6, 12 and 24 months postpartum, respectively. The proportion of women with immunologic failure was 12% (8/69), 25% (15/60) and 41% (24/58) at 6, 12 and 24 months, respectively. At 12 months, drug resistance was demonstrated in 34% (20/59), including 12 with dual-class resistance. Self-report on drug adherence was 95% (64/68), 85% (56/66), 74% (39/53) and 65% (30/46) at 3, 6, 12 and 24 months, respectively. The mortality rate was 5.9% (95% CI 2.5-13.7%) at 24 months. The probability of virologic and immunologic failure was significantly higher among women who reported non-perfect adherence to ART at month 24 postpartum. Conclusions Following an initial decline of viral load, virologic failure was common at 12 and 24 months postpartum among women initiated on ART for life during pregnancy because of low CD4 cell counts. A high proportion of viremic mothers also had resistance mutations. However, at 24 months follow-up, the mortality rate was still fairly low. Continuous adherence counseling and affordable means of monitoring of the virologic response are crucial for successful implementation of the WHO Option B+ guidelines to start all HIV-infected pregnant women on ART for life.
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Affiliation(s)
- Matilda Ngarina
- Department of Obstetrics and Gynecology, Muhimbili National Hospital, 65000, Dar es Salaam, Tanzania. .,Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden. .,Public Health Agency of Sweden, Stockholm, Sweden.
| | - Charles Kilewo
- Departments of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, 65001, Dar es Salaam, Tanzania.
| | | | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, 65001, Dar es Salaam, Tanzania.
| | - Annika Karlsson
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Gaetano Marrone
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Germana Leyna
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Anna Mia Ekström
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. .,Department of Infectious Diseases, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
| | - Gunnel Biberfeld
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden. .,Public Health Agency of Sweden, Stockholm, Sweden.
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Yonah G, Fredrick F, Leyna G. HIV serostatus disclosure among people living with HIV/AIDS in Mwanza, Tanzania. AIDS Res Ther 2014; 11:5. [PMID: 24450933 PMCID: PMC3900936 DOI: 10.1186/1742-6405-11-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 01/19/2014] [Indexed: 11/20/2022] Open
Abstract
Background Disclosing HIV serostatus is important for HIV prevention and maintenance of health for people living with HIV their spouses and the community, it plays a role in the social relation which is critical in reducing HIV transmission. The process may have positive and negative effects to the HIV infected people who disclose their status. The present study was undertaken to describe HIV serostatus disclosure among HIV infected people attending care and treatment clinic at Sekou-Toure hospital in Mwanza, Tanzania. Methods A cross-sectional study was carried out on 270 HIV infected adults attending Care and Treatment Clinic (CTC) at Sekou-Toure hospital between September and October, 2010. A Swahili questionnaire was used to obtain demographic and HIV disclosure information. Results Hundred and ninety five (72.5%) of all recruited participants were females, 88.1% (238/270) were aged above 30 years and 44.1% (119/270) were married. The prevalence of serostatus disclosure was 93.3% (252/270) with participants aged above 30 years having significantly higher proportion of serostatus disclosure compared to those aged below 30 years (94.5% vs. 84.4%, p < 0.05). Among the participants who disclosed their status, 69.3% reported closeness to the disclosed person as the reason for disclosure while 25.8% (65/252) disclosed because they needed help. Two hundred (79.4%) reported to have received emotional support following disclosure while 25.8% and 29.7% received financial support and freedom to use their anti-retroviral drugs around the person they disclosed their status respectively. Thirty four participants reported to have been discriminated following disclosure and 12 participants reported to have been divorced. Conclusions Rate of disclosure of HIV serostatus was noted to be high in this study. Delayed disclosure was also noted in small proportion of participants. Negative outcomes following disclosure of serostatus were reported by participants. Efforts need to be increased to promote disclosure of HIV serostatus in Tanzania through health education and awareness for both HIV infected individuals and the community.
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Mmbaga E, Helleve A, Leyna G, Masatu M, Onya H, Klepp KI. P1-S5.35 Multiple concurrent sexual partnerships among adolescents in Tanzania and South Africa: a comparison between areas with contrasting level of HIV magnitude. Sex Transm Infect 2011. [DOI: 10.1136/sextrans-2011-050108.213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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