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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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Berner-Rodoreda A, McMahon S, Eyal N, Hossain P, Rabbani A, Barua M, Sarker M, Metta E, Mmbaga E, Leshabari M, Wikler D, Bärnighausen T. Consent Requirements for Testing Health Policies: An Intercontinental Comparison of Expert Opinions. J Empir Res Hum Res Ethics 2022; 17:346-361. [PMID: 35617114 PMCID: PMC9136368 DOI: 10.1177/15562646221076764] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Individual informed consent is a central requirement for clinical research on
human subjects, yet whether and how consent requirements should apply to health
policy experiments (HPEs) remains unclear. HPEs test and evaluate public health
policies prior to implementation. We interviewed 58 health experts in Tanzania,
Bangladesh and Germany on informed consent requirements for HPEs. Health experts
across all countries favored a strong evidence base, prior information to the
affected populations, and individual consent for ‘risky’ HPEs. Differences
pertained to individual risk perception, how and when consent by group
representatives should be obtained and whether HPEs could be treated as health
policies. The study adds to representative consent options for HPEs, yet shows
that more research is needed in this field – particularly in the present
Covid-19 pandemic which has highlighted the need for HPEs nationally and
globally.
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Affiliation(s)
| | - Shannon McMahon
- Heidelberg Institute of Global Health, Heidelberg University, Germany
- Social and Behavioral Interventions, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Nir Eyal
- Department of Health, Behavior, Society and Policy, Rutgers University, Piscataway, USA
- Center for Population-Level Bioethics, New Brunswick, USA
| | - Puspita Hossain
- McMaster University, Hamilton, Canada
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Atonu Rabbani
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Department of Economics, University of Dhaka, Dhaka, Bangladesh
| | - Mrittika Barua
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Radboud Universiteit, Nijmegen, Netherlands
| | - Malabika Sarker
- Heidelberg Institute of Global Health, Heidelberg University, Germany
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Emmy Metta
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Elia Mmbaga
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Melkizedeck Leshabari
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Daniel Wikler
- Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, USA
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Germany
- Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, USA
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Berner-Rodoreda A, Bärnighausen T, Eyal N, Sarker M, Hossain P, Leshabari M, Metta E, Mmbaga E, Wikler D, McMahon SA. “Thought provoking”, “interactive”, and “more like a peer talk”: Testing the deliberative interview style in Germany. SSM - Qualitative Research in Health 2021; 1:None. [PMID: 34977853 PMCID: PMC8688150 DOI: 10.1016/j.ssmqr.2021.100007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/31/2021] [Accepted: 09/15/2021] [Indexed: 11/17/2022]
Abstract
Proponents of the newly-developed “deliberative interview” argue that examining complex issues requires more dynamic and engaging interview exchanges. Unlike traditional qualitative interviews, deliberative interviewing champions opinion sharing, active debates and similar speaking times by both sides throughout the interview. Drawing on 20 interviews with health experts in Germany, we examined the process and outcome of deliberative versus conventional interviews on the topic of informed consent. The deliberative interview expedited clarity on the issue, led to more nuanced discussion and generated more knowledge overall, but was challenging because it broke the mold for traditional interviewing. Alignment in terms of gender, age, personality and professional background facilitated rapport, regardless of interview style. To manage expectations, we recommend a thorough, perhaps video-based explanation of the deliberative style prior to the interview. Deliberative interviews can bolster knowledge generation for complex issues and can be applied in public health and beyond.
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Affiliation(s)
- Astrid Berner-Rodoreda
- Heidelberg Institute of Global Health, Heidelberg University, Germany
- Corresponding author. Institute of Global Health, Heidelberg University, Germany.
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Germany
- Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, USA
| | - Nir Eyal
- Department of Health, Behavior, Society and Policy, Rutgers University, Piscataway, USA
- Center for Population-Level Bioethics, New Brunswick, USA
| | - Malabika Sarker
- Heidelberg Institute of Global Health, Heidelberg University, Germany
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Puspita Hossain
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- McMaster University, Hamilton, Canada
| | - Melkizedeck Leshabari
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Emmy Metta
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Elia Mmbaga
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Daniel Wikler
- Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, USA
| | - Shannon A. McMahon
- Heidelberg Institute of Global Health, Heidelberg University, Germany
- Social and Behavioral Interventions, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Saronga HP, Duysburgh E, Massawe S, Dalaba MA, Wangwe P, Sukums F, Leshabari M, Blank A, Sauerborn R, Loukanova S. Cost-effectiveness of an electronic clinical decision support system for improving quality of antenatal and childbirth care in rural Tanzania: an intervention study. BMC Health Serv Res 2017; 17:537. [PMID: 28784130 PMCID: PMC5547541 DOI: 10.1186/s12913-017-2457-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 07/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND QUALMAT project aimed at improving quality of maternal and newborn care in selected health care facilities in three African countries. An electronic clinical decision support system was implemented to support providers comply with established standards in antenatal and childbirth care. Given that health care resources are limited and interventions differ in their potential impact on health and costs (efficiency), this study aimed at assessing cost-effectiveness of the system in Tanzania. METHODS This was a quantitative pre- and post- intervention study involving 6 health centres in rural Tanzania. Cost information was collected from health provider's perspective. Outcome information was collected through observation of the process of maternal care. Incremental cost-effectiveness ratios for antenatal and childbirth care were calculated with testing of four models where the system was compared to the conventional paper-based approach to care. One-way sensitivity analysis was conducted to determine whether changes in process quality score and cost would impact on cost-effectiveness ratios. RESULTS Economic cost of implementation was 167,318 USD, equivalent to 27,886 USD per health center and 43 USD per contact. The system improved antenatal process quality by 4.5% and childbirth care process quality by 23.3% however these improvements were not statistically significant. Base-case incremental cost-effectiveness ratios of the system were 2469 USD and 338 USD per 1% change in process quality for antenatal and childbirth care respectively. Cost-effectiveness of the system was sensitive to assumptions made on costs and outcomes. CONCLUSIONS Although the system managed to marginally improve individual process quality variables, it did not have significant improvement effect on the overall process quality of care in the short-term. A longer duration of usage of the electronic clinical decision support system and retention of staff are critical to the efficiency of the system and can reduce the invested resources. Realization of gains from the system requires effective implementation and an enabling healthcare system. TRIAL REGISTRATION Registered clinical trial at www.clinicaltrials.gov ( NCT01409824 ). Registered May 2009.
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Affiliation(s)
- Happiness Pius Saronga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Els Duysburgh
- International Centre for Reproductive Health (ICRH), Ghent University, Ghent, Belgium
| | - Siriel Massawe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Maxwell Ayindenaba Dalaba
- Navrongo Health Research Centre, Navrongo, Ghana
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Peter Wangwe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Felix Sukums
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | | | - Antje Blank
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Rainer Sauerborn
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Svetla Loukanova
- Department of General Medicine and Implementation Research, University of Heidelberg, Heidelberg, Germany
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Saronga HP, Dalaba MA, Dong H, Leshabari M, Sauerborn R, Sukums F, Blank A, Kaltschmidt J, Loukanova S. Cost of installing and operating an electronic clinical decision support system for maternal health care: case of Tanzania rural primary health centres. BMC Health Serv Res 2015; 15:132. [PMID: 25888762 PMCID: PMC4391308 DOI: 10.1186/s12913-015-0780-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 10/13/2014] [Accepted: 03/09/2015] [Indexed: 11/30/2022] Open
Abstract
Background Poor quality of care is among the causes of high maternal and newborn disease burden in Tanzania. Potential reason for poor quality of care is the existence of a “know-do gap” where by health workers do not perform to the best of their knowledge. An electronic clinical decision support system (CDSS) for maternal health care was piloted in six rural primary health centers of Tanzania to improve performance of health workers by facilitating adherence to World Health Organization (WHO) guidelines and ultimately improve quality of maternal health care. This study aimed at assessing the cost of installing and operating the system in the health centers. Methods This retrospective study was conducted in Lindi, Tanzania. Costs incurred by the project were analyzed using Ingredients approach. These costs broadly included vehicle, computers, furniture, facility, CDSS software, transport, personnel, training, supplies and communication. These were grouped into installation and operation cost; recurrent and capital cost; and fixed and variable cost. We assessed the CDSS in terms of its financial and economic cost implications. We also conducted a sensitivity analysis on the estimations. Results Total financial cost of CDSS intervention amounted to 185,927.78 USD. 77% of these costs were incurred in the installation phase and included all the activities in preparation for the actual operation of the system for client care. Generally, training made the largest share of costs (33% of total cost and more than half of the recurrent cost) followed by CDSS software- 32% of total cost. There was a difference of 31.4% between the economic and financial costs. 92.5% of economic costs were fixed costs consisting of inputs whose costs do not vary with the volume of activity within a given range. Economic cost per CDSS contact was 52.7 USD but sensitive to discount rate, asset useful life and input cost variations. Conclusions Our study presents financial and economic cost estimates of installing and operating an electronic CDSS for maternal health care in six rural health centres. From these findings one can understand exactly what goes into a similar investment and thus determine sorts of input modification needed to fit their context. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0780-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Happiness Pius Saronga
- Behavioural Sciences Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. .,Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
| | - Maxwell Ayindenaba Dalaba
- Navrongo Health Research Centre, Navrongo, Ghana. .,Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
| | - Hengjin Dong
- Centre for Health Policy Studies, Zhejiang University, Hangzhou, China.
| | - Melkizedeck Leshabari
- Behavioural Sciences Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Rainer Sauerborn
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
| | - Felix Sukums
- Behavioural Sciences Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. .,Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
| | - Antje Blank
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
| | - Jens Kaltschmidt
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
| | - Svetla Loukanova
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
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Loukanova S, Prytherch H, Blank A, Duysburgh E, Tomson G, Gustafsson LL, Sié A, Williams J, Leshabari M, Haefeli WE, Sauerborn R, Fonn S. Nesting doctoral students in collaborative North-South partnerships for health systems research. Glob Health Action 2014; 7:24070. [PMID: 25030216 PMCID: PMC4101456 DOI: 10.3402/gha.v7.24070] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [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: 02/13/2014] [Revised: 06/16/2014] [Accepted: 06/20/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The European Union (EU) supports North-South Partnerships and collaborative research projects through its Framework Programmes and Horizon 2020. There is limited research on how such projects can be harnessed to provide a structured platform for doctoral level studies as a way of strengthening health system research capacity in sub-Saharan Africa (SSA). OBJECTIVE The aim of this study was to explore the challenges of, and facilitating factors for, 'nesting' doctoral students in North-South collaborative research projects. The term nesting refers to the embedding of the processes of recruiting, supervising, and coordinating doctoral students in the overall research plan and processes. DESIGN This cross-sectional qualitative study was undertaken by the EU-funded QUALMAT Project. A questionnaire was implemented with doctoral students, supervisors, and country principal investigators (PIs), and content analysis was undertaken. RESULTS Completed questionnaires were received from nine doctoral students, six supervisors, and three country PIs (86% responses rate). The doctoral students from SSA described high expectations about the input they would receive (administrative support, equipment, training, supervision). This contrasted with the expectations of the supervisors for proactivity and self-management on the part of the students. The rationale for candidate selection, and understandings of the purpose of the doctoral students in the project were areas of considerable divergence. There were some challenges associated with the use of the country PIs as co-supervisors. Doctoral student progress was at times impeded by delays in the release of funding instalments from the EU. The paper provides a checklist of essential requirements and a set of recommendations for effective nesting of doctoral students in joint North-South projects. CONCLUSION There are considerable challenges to the effective nesting of doctoral students within major collaborative research projects. However, ways can be found to overcome them. The nesting process ultimately helped the institutions involved in this example to take better advantage of the opportunities that collaborative projects offer to foster North-South partnerships as a contribution to the strengthening of local research capacity.
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Affiliation(s)
- Svetla Loukanova
- Department of Public Health, University of Heidelberg, Heidelberg, Germany;
| | - Helen Prytherch
- Department of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Antje Blank
- Department of Clinical Pharmacology and Pharmacoepidemiology, Internal Medicine Department, Heidelberg University Hospital, Heidelberg, Germany
| | - Els Duysburgh
- International Centre for Reproductive Health (ICRH), Ghent University, Ghent, Belgium
| | - Göran Tomson
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre (MMC), Karolinska Institutet, Stockholm, Sweden; Department of Public Health Sciences, Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden
| | - Lars L Gustafsson
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | - Melkizedeck Leshabari
- Department of Behavioral Sciences, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Internal Medicine Department, Heidelberg University Hospital, Heidelberg, Germany
| | - Rainer Sauerborn
- Department of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Sharon Fonn
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Prytherch H, Kakoko D, Leshabari M, Sauerborn R, Marx M. Maternal and newborn healthcare providers in rural Tanzania: in-depth interviews exploring influences on motivation, performance and job satisfaction. Rural Remote Health 2012. [DOI: 10.22605/rrh2072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Outwater A, Nkya L, Lwihula G, O'Connor P, Leshabari M, Nguma J, Mwizarubi B, Laukamm-Josten U, Green EC, Hassig SE. Patterns of partnership and condom use in two communities of female sex workers in Tanzania. J Assoc Nurses AIDS Care 2000; 11:46-54. [PMID: 10911593 DOI: 10.1016/s1055-3290(06)60395-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Two rapid ethnographic studies have found that commercial sex workers (CSWs) and other high-risk women in Tanzania have different categories of partners, ranging from single-time contacts to long and enduring relationships. Since the advent of HIV/AIDS prevention programs in Tanzania in the late 1980s, CSWs and their clients have been aware of the multiple benefits of condom use for the prevention of pregnancy and STDs including HIV. These women often use condoms for the single-time contact. However, since the HIV/AIDS epidemic, casual partners have decreased in number. These days, most of their sexual contacts occur within long-term partnerships, and within these relationships, condom use is rare. Although the message that condoms should be used during high-risk behavior has been largely accepted, the definition of a high-risk relationship needs to be extended from casual partnerships to include multiple long-term partnerships. In addition, men and women's empowerment through education, business, and equal rights needs to be addressed at all levels of society.
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Klepp KI, Ndeki SS, Thuen F, Leshabari M, Seha AM. Predictors of intention to be sexually active among Tanzanian school children. East Afr Med J 1996; 73:218-24. [PMID: 8706602] [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] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This paper presents the results from a study of human immunodeficiency virus/AIDS risk behaviour conducted among primary school children in the Kilimanjaro and Arusha regions of northern Tanzania. The study was guided by the theory of reasoned action, and the decision to have or abstain from sexual intercourse was studied. All sixth and seventh grade pupils at eighteen schools were invited to participate. A total of 2,026 pupils (mean age 14.0 years) participated (participation rate of 85%), representing a wide variety of ethnic, socio-economic and urban-rural groups. Sixty-three percent of the boys and 24% of the girls reported having had their sexual debut. Attitudes, subjective norms and self-efficacy were all predictors of intention to have sexual intercourse within the next three months, but prior behaviour emerged as the strongest predictor of intention. Primary schools appear to be an important arena for HIV/AIDS education in Tanzania and it is recommended that such education be directed toward young adolescents.
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Affiliation(s)
- K I Klepp
- Centre for International Health, University of Bergen, Norway
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