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Ngowi K, Msoka P, Mtesha B, Kwayu J, Mappi T, Kiwango K, Kiwelu E, Mmasi T, Sichalwe A, Shayo BC, Maro E, Marion Sumari-de Boer I. "The phone number tells us good things we didn't know before." Use of interactive voice response calling for improving knowledge and uptake of family planning methods among Maasai in Tanzania. PLOS Digit Health 2023; 2:e0000254. [PMID: 37205646 DOI: 10.1371/journal.pdig.0000254] [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: 03/03/2022] [Accepted: 04/11/2023] [Indexed: 05/21/2023]
Abstract
Maasai living in the Arusha region, Tanzania, face challenges in feeding their children because of decreasing grazing grounds for their cattle. Therefore, they requested birth control methods. Previous studies have shown that lack of knowledge about, and poor access to, family planning (FP) may worsen the situation. We developed an interactive voice response calling (IVRC) platform for Maasai and health care workers (HCW) to create a venue for communication about FP to increase knowledge and access to FP. The objective of this study was to explore the effect of the platform on knowledge, access and use of family planning methods. We applied a participatory action research approach using mixed methods for data collection to develop and pilot-test an mHealth-platform with IVRC using Maa language. We enrolled Maasai-couples and HCW in Monduli District (Esilalei ward), Arusha Region, and followed them for 20 months. A baseline assessment was done to explore knowledge about FP. Furthermore, we abstracted information on FP clinic visits. Based on that, we developed a system called Embiotishu. A toll-free number was provided to interact with the system by calling with their phone. The system offers pre-recorded voice messages with information about FP and reproductive health to educate Maasai. The system recorded the number of calls and the type of information accessed. We measured the outcome by (1) a survey investigating the knowledge of contraceptive methods before and after Embiotishu and (2) counting the number of clinic visits (2018-2020) from medical records and feedback from qualitative data for FP used among Maasai. The acceptability and feasibility were explored through focus group discussions (FGDs) with Maasai and in-depth interviews (IDIs) with HCW. We recruited 76 Maasai couples whom we interviewed during the baseline assessment. The overall knowledge of contraceptives increased significantly (p<0.005) in both men and women. The number of clinic visits rose from 137 in 2018 to 344 in 2019 and 228 in the first six months of 2020. Implants were the most prescribed family planning method, followed by injections and pills, as found in medical records. The number of incoming calls, missed calls, and questions were 24,033 over 20 months. Out of these calls, 14,547 topics were selected. The most selected topics were modern contraceptives (mainly implants, condoms, tubal ligation, and vasectomy). Natural methods of contraception (vaginal fluid observations, calendar, and temperature). Our study has shown that the IVRC system led to an improvement in knowledge about and access to contraceptives. Furthermore, it has potential to increase access to health information as well as improve dialogue between Health workers and Maasai.
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Affiliation(s)
- Kennedy Ngowi
- Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Perry Msoka
- Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- Amsterdam Institute for Social Science Research (AISSR), Amsterdam, The Netherlands
| | - Benson Mtesha
- Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
| | - Jacqueline Kwayu
- Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
- Kilimanjaro Christian Medical Center, Moshi, United Republic of Tanzania
| | - Tauta Mappi
- Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
| | - Krisanta Kiwango
- Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
| | - Ester Kiwelu
- Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
| | - Titus Mmasi
- The office of District Medical office, Monduli, Arusha, United Republic of Tanzania
| | - Aifello Sichalwe
- The office of Regional Medical office, Arusha, United Republic of Tanzania
| | - Benjamin C Shayo
- Kilimanjaro Christian Medical Center, Moshi, United Republic of Tanzania
- Baylor College of Medicine, Houston, Texas, United States of America
| | - Eusebious Maro
- Kilimanjaro Christian Medical Center, Moshi, United Republic of Tanzania
| | - I Marion Sumari-de Boer
- Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
- Knowledge, Technology and Innovation Group, Wageningen University & Research, Wageningen, the Netherlands
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Tamarozzi F, Kibona T, de Glanville WA, Mappi T, Adonikamu E, Salewi A, Misso K, Maro V, Casulli A, Santoro A, Santolamazza F, Mmbaga BT, Cleaveland S. Cystic echinococcosis in northern Tanzania: a pilot study in Maasai livestock-keeping communities. Parasit Vectors 2022; 15:396. [PMID: 36307877 PMCID: PMC9616617 DOI: 10.1186/s13071-022-05518-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 06/12/2022] [Accepted: 09/29/2022] [Indexed: 12/03/2022] Open
Abstract
Background There are close similarities between the life-cycles of Echinococcus granulosus sensu lato (E. granulosus s.l.) that causes cystic echinococcosis (CE) in humans and Taenia multiceps/Coenurus cerebralis that causes cerebral coenurosis in small ruminants. Recent evidence highlights that livestock in Maasai communities of northern Tanzania are suffering from increases in the prevalence of cerebral coenurosis, leading to concerns about a possible concurrent increased risk of human CE. The aim of this study was to estimate the prevalence of human abdominal CE and the prevalence and species/genotypes of E. granulosus s.l. in livestock in Maasai communities. Methods Human CE was diagnosed by abdominal ultrasound on volunteers aged ≥ 7 years in five villages in the Longido and Ngorongoro Districts in northern Tanzania. Infection in ruminants was evaluated through inspection in local abattoirs, followed by molecular identification of one cyst per animal, with a priority for hepatic cysts, using PCR targeting of the cytochrome c oxidase I gene (COX1), followed by restriction fragment length polymorphism and multiplex PCR, and sequencing of non-E. granulosus s.l. samples. Results Ultrasound was performed on 823 volunteers (n = 352 in two villages in Longido District, and n = 471 in three villages of Ngorongoro). Hepatic CE cases were diagnosed only in Ngorongoro (n = 6; 1.3%), of which three had active cysts. Village-level prevalence of CE ranged between 0 and 2.4%. Of the 697 ruminants inspected, 34.4% had parasitic cysts. Molecular identification was achieved for 140 of the 219 (63.9%) cysts sampled. E. granulosus s.l. and T. hydatigena/Cysticercus tenuicollis were identified in 51.4% and 48.6%, respectively, of livestock cysts. E. granulosus s.l. was identified in livestock from both Longido (35.3% of 116 genotyped cysts) and Ngorongoro (91.2% of 34 genotyped cysts). Of the total of 72 E. granuslosus s.l. cysts identified in livestock, 87.5% were E. granulosus sensu stricto (G1–G3 genotypes), 9.7% were E. ortleppi (G5) and one cyst was E. canadensis (G6–10). The three active human cysts, which were removed surgically, were G1–G3 genotypes. Conclusions Multiple species/genotypes of E. granulosus s.l. are circulating in Maasai communities of northern Tanzania. Human CE was detected in villages of Ngorongoro District and a high prevalence of echinococcal cysts was observed in livestock in both districts. More precise estimation of the prevalence in this area and a better understanding of the specific risk factors for CE among Maasai communities in northern Tanzania is needed. Interventions targeting transmission routes common to both E. granulosus s.l. and T. multiceps would have dual benefits for preventing both human and livestock disease. Graphical Abstract ![]()
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Affiliation(s)
- Francesca Tamarozzi
- IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy.
| | - Tito Kibona
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | - Tauta Mappi
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | - Anande Salewi
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Kennedy Misso
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Venance Maro
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | | | | | - Blandina T Mmbaga
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Davis A, Virhia J, Buza J, Crump JA, de Glanville WA, Halliday JEB, Lankester F, Mappi T, Mnzava K, Swai ES, Thomas KM, Toima M, Cleaveland S, Mmbaga BT, Sharp J. " He Who Relies on His Brother's Property Dies Poor": The Complex Narratives of Livestock Care in Northern Tanzania. Front Vet Sci 2021; 8:749561. [PMID: 34805339 PMCID: PMC8595325 DOI: 10.3389/fvets.2021.749561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Endemic zoonoses have important impacts for livestock-dependent households in East Africa. In these communities, people's health and livelihoods are severely affected by livestock disease losses. Understanding how livestock keepers undertake remedial actions for livestock illness has the potential for widespread benefits such as improving health interventions. Yet, studies about livestock and human health behaviours in the global south tend to focus on individual health choices. In reality, health behaviours are complex, and not solely about individualised health experiences. Rather, they are mediated by a range of “upstream” factors (such as unequal provision of services), which are beyond the control of the individual. Methods: This paper presents qualitative research conducted from 2014 to 2019 for a study focused on the Social, Economic, and Environmental Drivers of Zoonoses in Tanzania (SEEDZ). Qualitative data were collected via focus group discussions, community meetings, informal interviews, formal in-depth interviews, observations and surveys that addressed issues of health, disease, zoonotic disease risks, and routes for treatment across 21 villages. Thematic analysis was carried out on in-depth interviews and focus group discussions. Conceptual analyses and observations were made through application of social science theories of health. Findings: Livestock keepers undertake a range of health seeking strategies loosely categorised around self and formal treatment. Two key themes emerged that are central to why people make the decisions they do: access to resources and trust in health care providers. These two issues affect individual sense of agency which impacts their ability to act to improve livestock health outcomes. We suggest that individual choice and agency in veterinary health seeking decisions are only beneficial if health systems can offer adequate care and health equity is addressed. Significance: This study demonstrates the value of in-depth qualitative research which reveals the nuance and complexity of people's decisions around livestock health. Most importantly, it explains why “better” knowledge does not always translate into “better” practise. The paper suggests that acknowledging and addressing these aspects of veterinary health seeking will lead to more effective provision.
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Affiliation(s)
- Alicia Davis
- Social and Political Sciences/Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Jennika Virhia
- Social and Political Sciences/Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Joram Buza
- The Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - John A Crump
- Centre for International Health, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - William A de Glanville
- Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Jo E B Halliday
- Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Felix Lankester
- Paul G. Allen School for Global Health, Pullman, WA, United States
| | - Tauta Mappi
- The Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Kunda Mnzava
- Kilimanjaro Christian Medical Centre, Kilimanjaro Clinical Research Institute, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Kate M Thomas
- Centre for International Health, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Mamus Toima
- The Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Sarah Cleaveland
- Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical Centre, Kilimanjaro Clinical Research Institute, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Jo Sharp
- School of Geography and Sustainable Development, University of St. Andrews, St. Andrews, United Kingdom
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