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Marandu G, Malale K, Laisser R, Mwanga J, Sabuni PA, Rambau P. Evaluation of Breast Health Promotion Intervention Among Catholic Nuns in Lake Zone 'Tanzania. Eur J Breast Health 2024; 20:129-135. [PMID: 38571689 PMCID: PMC10985581 DOI: 10.4274/ejbh.galenos.2024.2024-1-10] [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: 02/09/2024] [Accepted: 02/27/2024] [Indexed: 04/05/2024]
Abstract
Objective Despite facing unique barriers, Catholic nuns in Tanzania require accessible breast health promotion. This study explores interventions to empower nuns through knowledge, improved attitudes, and positive practices, ultimately promoting well-being and early detection for better breast cancer outcomes. Materials and Methods A quasi-experimental design study guided by the Health Belief Model was conducted to monitor the implementation of a breast health intervention program aimed at increasing breast cancer screening knowledge among 385 Catholic nuns aged 20 to over 60 years old within Lake Zone, Tanzania. Data were collected at two-time points: pre-intervention (baseline) and implementation phase intervention (after three months). The intervention consisted of a 2-hour educational session. Participants had opportunities to ask questions and provide feedback. Results The breast health promotion intervention was well-received by Catholic nuns, with 339 (88%) expressing strong motivation to learn and promote awareness. The training effectively increased knowledge and positive attitudes towards breast cancer screening. Researcher assistants successfully delivered the program, and 354 (92%) of participants expressed interest in continued education and support. The intervention addressed cultural barriers and empowered nuns to take charge of their health, though some challenges remain meanwhile 158 (41%) had limited prior knowledge, 81 (21%) hesitated to discuss breast health due to religious beliefs, and some faced difficulty applying the learnings. Conclusion Overall, the breast health promotion intervention had a positive outcome on the Catholic nuns' awareness and knowledge of breast health. However, addressing the identified barriers and challenges is crucial to further enhance the intervention's effectiveness and sustainability.
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Affiliation(s)
- Gotfrida Marandu
- Archbishop Anthony Mayala School of Nursing, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Kija Malale
- Archbishop Anthony Mayala School of Nursing, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Rose Laisser
- Archbishop Anthony Mayala School of Nursing, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Joseph Mwanga
- Department of Community Medicine, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
| | - Paul Alikado Sabuni
- Public Health Consultant, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Peter Rambau
- Department of Pathology, Catholic University of Health and Allied Sciences Bugando, Mwanza, Tanzania
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Sado K, Keenan K, Manataki A, Kesby M, Mushi MF, Mshana SE, Mwanga J, Neema S, Asiimwe B, Bazira J, Kiiru J, Green DL, Ke X, Maldonado-Barragán A, Abed Al Ahad M, Fredricks K, Gillespie SH, Sabiiti W, Mmbaga BT, Kibiki G, Aanensen D, Smith VA, Sandeman A, Sloan DJ, Holden MT. Treatment seeking behaviours, antibiotic use and relationships to multi-drug resistance: A study of urinary tract infection patients in Kenya, Tanzania and Uganda. medRxiv 2023:2023.03.04.23286801. [PMID: 36945627 PMCID: PMC10029025 DOI: 10.1101/2023.03.04.23286801] [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: 03/11/2023]
Abstract
Antibacterial resistance (ABR) is a major public health threat. An important accelerating factor is treatment-seeking behaviours, including inappropriate antibiotic (AB) use. In many low- and middle-income countries (LMICs) this includes taking ABs with and without prescription sourced from various providers, including health facilities and community drug sellers. However, investigations of complex treatment-seeking, AB use and drug resistance in LMICs are scarce. The Holistic Approach to Unravel Antibacterial Resistance in East Africa (HATUA) Consortium collected questionnaire and microbiological data from 6,827 adult outpatients with urinary tract infection (UTI)-like symptoms presenting at healthcare facilities in Kenya, Tanzania and Uganda. Among 6,388 patients we analysed patterns of self-reported treatment seeking behaviours ('patient pathways') using process mining and single-channel sequence analysis. Of those with microbiologically confirmed UTI (n=1,946), we used logistic regression to assessed the relationship between treatment seeking behaviour, AB use, and likelihood of having a multi-drug resistant (MDR) UTI. The most common treatment pathways for UTI-like symptoms included attending health facilities, rather than other providers (e.g. drug sellers). Patients from the sites sampled in Tanzania and Uganda, where prevalence of MDR UTI was over 50%, were more likely to report treatment failures, and have repeated visits to clinics/other providers, than those from Kenyan sites, where MDR UTI rates were lower (33%). There was no strong or consistent relationship between individual AB use and risk of MDR UTI, after accounting for country context. The results highlight challenges East African patients face in accessing effective UTI treatment. These challenges increase where rates of MDR UTI are higher, suggesting a reinforcing circle of failed treatment attempts and sustained selection for drug resistance. Whilst individual behaviours may contribute to the risk of MDR UTI, our data show that factors related to context are stronger drivers of ABR.
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Affiliation(s)
- Keina Sado
- University of St Andrews, St Andrews, UK
| | | | | | - Mike Kesby
- University of St Andrews, St Andrews, UK
| | - Martha F Mushi
- Catholic University Of Health And Allied Sciences, Mwanza, Tanzania
| | - Stephen E Mshana
- Catholic University Of Health And Allied Sciences, Mwanza, Tanzania
| | - Joseph Mwanga
- Catholic University Of Health And Allied Sciences, Mwanza, Tanzania
| | | | | | - Joel Bazira
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - John Kiiru
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Xuejia Ke
- University of St Andrews, St Andrews, UK
| | | | | | | | | | | | - Blandina T Mmbaga
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Moshi Tanzania
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Meaney PA, Hokororo A, Masenge T, Mwanga J, Kalabamu FS, Berg M, Rozenfeld B, Smith Z, Chami N, Mkopi N, Mwanga C, Agweyu A. Development of pediatric acute care education (PACE): An adaptive electronic learning (e-learning) environment for healthcare providers in Tanzania. Digit Health 2023; 9:20552076231180471. [PMID: 37529543 PMCID: PMC10387696 DOI: 10.1177/20552076231180471] [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: 06/20/2022] [Accepted: 05/19/2023] [Indexed: 08/03/2023] Open
Abstract
Globally, inadequate healthcare provider (HCP) proficiency with evidence-based guidelines contributes to millions of newborn, infant, and child deaths each year. HCP guideline proficiency would improve patient outcomes. Conventional (in person) HCP in-service education is limited in 4 ways: reach, scalability, adaptability, and the ability to contextualize. Adaptive e-learning environments (AEE), a subdomain of e-learning, incorporate artificial intelligence technology to create a unique cognitive model of each HCP to improve education effectiveness. AEEs that use existing internet access and personal mobile devices may overcome limits of conventional education. This paper provides an overview of the development of our AEE HCP in-service education, Pediatric Acute Care Education (PACE). PACE uses an innovative approach to address HCPs' proficiency in evidence-based guidelines for care of newborns, infants, and children. PACE is novel in 2 ways: 1) its patient-centric approach using clinical audit data or frontline provider input to determine content and 2) its ability to incorporate refresher learning over time to solidify knowledge gains. We describe PACE's integration into the Pediatric Association of Tanzania's (PAT) Clinical Learning Network (CLN), a multifaceted intervention to improve facility-based care along a single referral chain. Using principles of co-design, stakeholder meetings modified PACE's characteristics and optimized integration with CLN. We plan to use three-phase, mixed-methods, implementation process. Phase I will examine the feasibility of PACE and refine its components and protocol. Lessons gained from this initial phase will guide the design of Phase II proof of concept studies which will generate insights into the appropriate empirical framework for (Phase III) implementation at scale to examine effectiveness.
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Key Words
- eHealth, general, digital health, general education, lifestyle, smartphone, media paediatrics, medicine, mHealth, psychology, mixed methods, studies
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Affiliation(s)
- Peter Andrew Meaney
- Department of Pediatrics, Stanford University School of Medicine, Pediatrics, Palo Alto, CA, USA
| | - Adolfine Hokororo
- Department of Pediatrics, Catholic University of Health and Allied Sciences Bugando, Pediatrics, Mwanza, Tanzania
| | | | - Joseph Mwanga
- Catholic University of Health and Allied Sciences School of Public Health, Mwanza, Tanzania
| | | | - Marc Berg
- Department of Pediatrics, Stanford University School of Medicine, Pediatrics, Palo Alto, CA, USA
| | | | - Zachary Smith
- Department of Pediatrics, Stanford University School of Medicine, Pediatrics, Palo Alto, CA, USA
| | - Neema Chami
- Department of Pediatrics, Catholic University of Health and Allied Sciences Bugando, Pediatrics, Mwanza, Tanzania
| | - Namala Mkopi
- Department of Pediatrics, Muhimbili University of Health and Allied Sciences School of Medicine, Pediatrics, Dar Es Salaam, Tanzania
| | - Castory Mwanga
- Department of Pediatrics, Simiyu District Hospital, Pediatrics, Simiyu, Tanzania
| | - Ambrose Agweyu
- Department of Infectious Disease and Epidemiology, London School of Hygiene and Tropical Medicine, Infectious Disease Epidemiology, Nairobi, Kenya
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Mtemisika CI, Nyawale H, Benju RJ, Genchwere JM, Silago V, Mushi MF, Mwanga J, Konje E, Mirambo MM, Mshana SE. Epidemiological Cut-Off Values and Multidrug Resistance of Escherichia coli Isolated from Domesticated Poultry and Pigs Reared in Mwanza, Tanzania: A Cross-Section Study. Animals (Basel) 2022; 12:835. [PMID: 35405825 PMCID: PMC8996986 DOI: 10.3390/ani12070835] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/12/2022] [Accepted: 03/18/2022] [Indexed: 12/21/2022] Open
Abstract
Increasing antimicrobial resistance (AMR) colonizing domesticated animals is a global concern threatening food safety. This study aimed at determining the prevalence of multidrug resistance (MDR) and epidemiological cut-off values (ECVs) of E. coli isolated from poultry and pigs in Mwanza, Tanzania. This cross-sectional study was conducted between June and August 2021, involving 297 pigs, 191 broilers, and 203 layers. Rectal and cloacal swabs were collected and processed following standard guidelines. ECVs were determined using normalized resistance interpretation (NRI), a computer software, and descriptive analysis was performed using STATA version 13.0. The overall prevalence of MDR E.coli was 63.2%, whereas poultry (87.5% layers and 86.3% broilers) were more colonized than pigs (31.8%) (p < 0.001). Based on ECVs of antibiotics tested, E. coli from broilers, layers, and pigs exhibited different resistance patterns hence different populations. Exotic breed (p < 0.001) and recent antimicrobial use (p < 0.001) significantly predicted colonization with MDR E. coli. Veterinary officers should implement regulations that prohibit the inappropriate use of antimicrobial agents in livestock keeping.
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Affiliation(s)
- Conjester I. Mtemisika
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (H.N.); (V.S.); (M.F.M.); (M.M.M.); (S.E.M.)
- Bugando Medical Centre, Molecular Biology Laboratory, Mwanza P.O. Box 1370, Tanzania
| | - Helmut Nyawale
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (H.N.); (V.S.); (M.F.M.); (M.M.M.); (S.E.M.)
| | - Ronald J. Benju
- Tanzania Veterinary Laboratory Agency, Ministry of Livestock and Fisheries, Mwanza P.O. Box 129, Tanzania; (R.J.B.); (J.M.G.)
| | - Joseph M. Genchwere
- Tanzania Veterinary Laboratory Agency, Ministry of Livestock and Fisheries, Mwanza P.O. Box 129, Tanzania; (R.J.B.); (J.M.G.)
| | - Vitus Silago
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (H.N.); (V.S.); (M.F.M.); (M.M.M.); (S.E.M.)
| | - Martha F. Mushi
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (H.N.); (V.S.); (M.F.M.); (M.M.M.); (S.E.M.)
| | - Joseph Mwanga
- Department of Epidemiology, Biostatistics and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (J.M.); (E.K.)
| | - Eveline Konje
- Department of Epidemiology, Biostatistics and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (J.M.); (E.K.)
| | - Mariam M. Mirambo
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (H.N.); (V.S.); (M.F.M.); (M.M.M.); (S.E.M.)
| | - Stephen E. Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (H.N.); (V.S.); (M.F.M.); (M.M.M.); (S.E.M.)
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Ndomba ALM, Laisser RM, Silago V, Kidenya BR, Mwanga J, Seni J, Mshana SE. Urinary Tract Infections and Associated Factors among Patients with Indwelling Urinary Catheters Attending Bugando Medical Centre a Tertiary Hospital in Northwestern Tanzania. Microorganisms 2022; 10:microorganisms10020473. [PMID: 35208927 PMCID: PMC8879566 DOI: 10.3390/microorganisms10020473] [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] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 12/10/2022] Open
Abstract
Complications of indwelling urinary catheterization (IUC) are associated with significant morbidity and mortality, thus affecting patient's well-being. Understanding the magnitude and factors associated with complications is crucial in designing appropriate preventive strategies. A cross-sectional study was conducted at Bugando Medical Centre, involving patients with long-term and short-term IUC from December 2016 to September 2017. The data were analyzed by STATA 13.0. Catheter-associated urinary tract infection (CA-UTI) was the leading (56.8%; 250/440) complication among patients with IUC. Gram-negative bacteria were predominantly isolated (98.1%, 252/257), whereas E. coli (30.7%, 79/257) and Klebsiella spp. (29.6%, 76/257) were the leading pathogens. CA-UTI was significantly higher among out-patients than in-patients (82.2% v 35.3%, p < 0.001). Older age (OR: 1.3, (95%CI: 1.1-1.5), p < 0.001), level of education (OR: 1.8, (95%CI: 1.1-3.1), p = 0.029) and catheter duration of ≥6 weeks (OR: 2.43, (95%CI: 1.1-5.5), p = 0.031) independently predicted CA-UTI among outpatients, while female gender (OR: 2.1, (95%CI: 1.2-3.7), p = 0.014), catheter bags not freely hanging (OR: 0.4, (95%CI: 0.2-0.7), p = 0.002) and residing outside Mwanza region (OR: 0.4, (95%CI: 0.2-0.6), p < 0.001) predicted CA-UTI among in-patients. CA-UTI is the common complication among patients with IUC, significantly higher in out-patients than in-patients. We recommend involving patients and carers in infection prevention and control measures in out-patients living with IUC.
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Affiliation(s)
- Asteria L. M. Ndomba
- Archbishop Anthony Mayala School of Nursing, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
- Correspondence:
| | - Rose M. Laisser
- Archbishop Anthony Mayala School of Nursing, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
| | - Vitus Silago
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (V.S.); (J.S.); (S.E.M.)
| | - Benson R. Kidenya
- Department of Biochemistry and Molecular Biology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
| | - Joseph Mwanga
- Department of Biostatistics, Epidemiology and Behavioral Sciences, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
| | - Jeremiah Seni
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (V.S.); (J.S.); (S.E.M.)
| | - Stephen E. Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (V.S.); (J.S.); (S.E.M.)
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Hampshire K, Hamill H, Mariwah S, Mwanga J, Amoako-Sakyi D. The application of Signalling Theory to health-related trust problems: The example of herbal clinics in Ghana and Tanzania. Soc Sci Med 2017; 188:109-118. [PMID: 28738317 PMCID: PMC5559643 DOI: 10.1016/j.socscimed.2017.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 05/04/2017] [Revised: 07/13/2017] [Accepted: 07/14/2017] [Indexed: 01/19/2023]
Abstract
In contexts where healthcare regulation is weak and levels of uncertainty high, how do patients decide whom and what to trust? In this paper, we explore the potential for using Signalling Theory (ST, a form of Behavioural Game Theory) to investigate health-related trust problems under conditions of uncertainty, using the empirical example of ‘herbal clinics’ in Ghana and Tanzania. Qualitative, ethnographic fieldwork was conducted over an eight-month period (2015–2016) in eight herbal clinics in Ghana and ten in Tanzania, including semi-structured interviews with herbalists (N = 18) and patients (N = 68), plus detailed ethnographic observations and twenty additional key informant interviews. The data were used to explore four ST-derived predictions, relating to herbalists' strategic communication (‘signalling’) of their trustworthiness to patients, and patients' interpretation of those signals. Signalling Theory is shown to provide a useful analytical framework, allowing us to go beyond the primary trust problem addressed by other researchers – cataloguing observable indicators of trustworthiness – and providing tools for tackling the trickier secondary trust problem, where the trustworthiness of those indicators must be ascertained. Signalling Theory also enables a basis for comparative work between different empirical contexts that share the underlying condition of uncertainty. Applies Signalling Theory (ST) to patient-herbalist trust in Ghana & Tanzania. Herbalists communicate trustworthiness to patients via observable ‘signals’. Patients interpret signal reliability based on perceived costs and pay-offs. In conditions of uncertainty, informational mismatches result in misplaced trust. ST allows us to go beyond description, enabling prediction and comparative work.
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Affiliation(s)
| | | | - Simon Mariwah
- Dept of Geography and Regional Planning, University of Cape Coast, Ghana
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Watson-Jones D, Lees S, Mwanga J, Neke N, Changalucha J, Broutet N, Maduhu I, Kapiga S, Chandra-Mouli V, Bloem P, Ross DA. Feasibility and acceptability of delivering adolescent health interventions alongside HPV vaccination in Tanzania. Health Policy Plan 2016; 31:691-9. [PMID: 26768827 PMCID: PMC4916316 DOI: 10.1093/heapol/czv119] [Citation(s) in RCA: 16] [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] [Subscribe] [Scholar Register] [Accepted: 11/03/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) vaccination offers an opportunity to strengthen provision of adolescent health interventions (AHI). We explored the feasibility of integrating other AHI with HPV vaccination in Tanzania. METHODS A desk review of 39 policy documents was preceded by a stakeholder meeting with 38 policy makers and partners. Eighteen key informant interviews (KIIs) with health and education policy makers and district officials were conducted to further explore perceptions of current programs, priorities and AHI that might be suitable for integration with HPV vaccination. RESULTS Fourteen school health interventions (SHI) or AHI are currently being implemented by the Government of Tanzania. Most are delivered as vertical programmes. Coverage of current programs is not universal, and is limited by financial, human resource and logistic constraints. Limited community engagement, rumours, and lack of strategic advocacy has affected uptake of some interventions, e.g. tetanus toxoid (TT) immunization. Stakeholder and KI perceptions and opinions were limited by a lack of experience with integrated delivery and AHI that were outside an individual's area of expertise and experience. Deworming and educational sessions including reproductive health education were the most frequently mentioned interventions that respondents considered suitable for integrated delivery with HPV vaccine. CONCLUSIONS Given programme constraints, limited experience with integrated delivery and concern about real or perceived side-effects being attributed to the vaccine, it will be very important to pilot-test integration of AHI/SHI with HPV vaccination. Selected interventions will need to be simple and quick to deliver since health workers are likely to face significant logistic and time constraints during vaccination visits.
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Affiliation(s)
- Deborah Watson-Jones
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK, Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, P O Box 11936, Tanzania
| | - Shelley Lees
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Joseph Mwanga
- National Institute for Medical Research, Mwanza, P O Box 1462, Tanzania
| | - Nyasule Neke
- National Institute for Medical Research, Mwanza, P O Box 1462, Tanzania
| | - John Changalucha
- National Institute for Medical Research, Mwanza, P O Box 1462, Tanzania
| | | | - Ibrahim Maduhu
- Immunization and Vaccine Development, Ministry of Health & Social Welfare, Dar es Salaam, Tanzania and
| | - Saidi Kapiga
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK, MRC Tropical Epidemiology Group, Faculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | | | - Paul Bloem
- World Health Organization, Geneva, Switzerland
| | - David A Ross
- MRC Tropical Epidemiology Group, Faculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Whaling MA, Luginaah I, Reid G, Hekmat S, Thind A, Mwanga J, Changalucha J. Perceptions about probiotic yogurt for health and nutrition in the context of HIV/AIDS in Mwanza, Tanzania. J Health Popul Nutr 2012; 30:31-40. [PMID: 22524117 PMCID: PMC3312357 DOI: 10.3329/jhpn.v30i1.11273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Recently, the food and malnutrition issues have taken centre stage within the arena of HIV/AIDS epidemic, with several calls being made for context-specific health and nutrition interventions to deal with the emerging food insecurity and malnutrition issues in settings with high burdens of HIV/AIDS. The use of probiotics as nutritional supplements in HIV/AIDS-affected and resource-poor settings has also been advocated. This paper presents the results of a qualitative study on community knowledge and perceptions about probiotics and their potential impact on people's everyday life in the context of the HIV/AIDS epidemic. In-depth interviews (n=26) were conducted with residents in Mwanza, Tanzania. The results showed that people living with HIV/AIDS, who were using probiotic yogurt produced through a joint partnership of Western Heads East, Tanzania Medical Research Institute and the Tukwamune Women's Group, reported perceived beneficial effects, such as gain in weight and improved health and well-being. Yet, these beneficial effects might be resulting in growing misconceptions about probiotic yogurt being 'medicine' for the treatment of HIV/AIDS; this is leading some people living with HIV/AIDS to abandon taking their antiretroviral medications based on the view that the probiotic yogurt is making them feel much better. The findings illustrate the potential challenges with regard to the introduction of nutritional food supplements into new contexts plagued by malnutrition and infectious diseases. Public-health education and awareness programmes are needed when introducing novel foods into such contexts.
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Affiliation(s)
- Melissa A. Whaling
- Department of Geography, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Isaac Luginaah
- Department of Geography, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Gregor Reid
- Departments of Microbiology and Immunology and Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Sharereh Hekmat
- Department of Food and Nutritional Sciences, Brescia University College, University of Western Ontario, London, Ontario, Canada
| | - Amardeep Thind
- Department of Family Medicine, Schulich School of Medicine and Dentistry University of Western Ontario, London, Ontario, Canada
- University of Western Ontario, London, Ontario, Canada
| | - Joseph Mwanga
- National Institute for Medical Research, Mwanza, Tanzania
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Mshana G, Wambura M, Mwanga J, Mosha J, Mosha F, Changalucha J. Traditional male circumcision practices among the Kurya of North-eastern Tanzania and implications for national programmes. AIDS Care 2011; 23:1111-6. [PMID: 21476151 DOI: 10.1080/09540121.2011.554518] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The World Health Organisation and the Joint United Nations Programme on AIDS recommend male circumcision (MC) as an additional intervention against HIV infection. Various sub-Saharan African countries are at different stages of rolling out MC programmes. Despite initial fears, studies conducted among traditionally non-circumcising communities in Africa have shown that MC is widely accepted as a biomedical intervention. However, little is known on how traditionally circumcising communities where MC carries considerable social meaning and significance would respond to such programmes. This study was conducted among a traditionally circumcising community in Tarime district in Tanzania as part of a national situation analysis prior to initiating a national MC programme. It employed key informant interviews and focus group discussions for data collection. Results show that the Kurya ethnic group practice MC as a rite of passage from childhood to adulthood. Each clan organises its own circumcision ceremony, which takes place every even numbered years. Clan leaders and traditional circumcisers are central to its organisation. Among the Kurya, there is high regard for traditional MC as it is perceived as upholding cultural practice and identity. It also embodies notions of bravery since anaesthetics are not used. On the other hand, medical MC is not viewed as prestigious since anaesthetics are used to suppress pain. Social pressure for traditional MC is applied through ridiculing of those uncircumcised or circumcised at health facilities. In general, there are positive attitudes towards MC as it is perceived as enhancing personal hygiene and having a protective effect against sexually transmitted infections. For the success of nation-wide MC programmes, there is need to develop programmes that incorporate both clinical and sociocultural interests.
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Affiliation(s)
- Gerry Mshana
- Health Systems and Policy Research, National Institute for Medical Research, Mwanza, Tanzania.
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Kiwanuka JP, Mwanga J. Childhood bacterial meningitis in Mbarara Hospital, Uganda: antimicrobial susceptibility and outcome of treatment. Afr Health Sci 2001; 1:9-11. [PMID: 12789126 PMCID: PMC2704445] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND The recommended antibiotic treatment of bacterial meningitis has come under scrutiny following frequent reports of in-vitro resistance by the common causative organisms to penicillin and chloramphenicol. OBJECTIVE The study recorded the causative organisms, antibiotic sensitivity patterns and outcome of treatment of bacterial meningitis in children and examined the impact of various factors on the recorded outcome. DESIGN This was a retrospective review of all case records of patients treated for bacterial meningitis over a one year period. SETTING The study was set in the paediatric wards of Mbarara University Teaching Hospital, in south western Uganda. RESULTS A total of 77 patients were treated. Among 56 patients with available CSF results the frequency of bacterial causes was as follows: H. influenzae 13(23.2%), coliforms 7(12.5%), uncultured Gram-negative bacilli 7(12.5%), S. pneumoniae 5(8.9%) and N. meningitidis 3(5.4%). Most isolates tested were resistant to both penicillin and chloramphenicol, but all were sensitive to ciprofloxacin and perfloxacin. Twenty eight(36.8%) patients died, 22(28.9%) survived with sequelae and 15(19.7%) improved without sequelae. 14/18 who received perfloxacin and/or ciprofloxacin survived compared with 23/47 who did not: p=0.04). CONCLUSIONS The high case-fatality rates and the high frequency of resistance to penicillin and chloramphenicol make a case for a review of the currently recommended antibiotic treatment of bacterial meningitis in this region. Fluoroquinolones need further evaluation as potential alternatives to chloramphenicol in the treatment of bacterial meningitis.
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Affiliation(s)
- J P Kiwanuka
- Mbarara University of Science and Technology, Mbarara, Uganda.
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