Couple counselling and testing for HIV at antenatal clinics: views from men, women and counsellors.

The purpose of this study was to gain insight from views of Tanzanian men and women on couple voluntary counselling and testing (CVCT) for HIV at antenatal clinics (ANC) in Tanzania. Data collection was through focus group discussions with women aged 25-48 years (n=8), women 18-24 years (n=10), HIV counsellors (n=11), men aged 20-34 (n=8) and men aged 35-75 years (n=8) and in-depth interviews (IDI) with five men and eight women. Participants were asked their views concerning men volunteering for CVCT for HIV, motivation of couples to receive results together and effective ways of counselling sero-discordant couples. Many participants agreed on the importance of incorporating CVCT at ANC, while others expressed reservations due to the cultural belief that ANC is for women. The importance of love, care and respect between sero-discordant couples was stressed; nonetheless, many anticipated that disclosure of HIV-positive status to an HIV-negative spouse could result in abandonment, divorce or violence against the woman whether she was sero-negative or -positive. Couple counselling and testing at ANC incorporating the suggestions made by study participants could become an important intervention for the prevention of HIV transmission and maintenance of good relations between sero-discordant partners.

Use of educational workshop to promote mobility during childbirth.

OBJECTIVE: To evaluate the impact of an educational intervention to introduce the principles of evidence based obstetric care and encourage mobility during labour in government hospitals in Dar es Salaam. DESIGN: An observational study. SETTING: Four government hospitals; two in Dar es Salaam and two in coastal region of Tanzania. RESULTS: Following implementation of the workshops, practice changed significantly for mobility during labour at the district and regional hospitals; midwives at these hospitals appeared to be aware of the benefits and were willing to encourage women to be mobile during labour. Practice changed little at the referral hospital. Most women delivering at the referral hospital had been transferred from regional or district hospitals with complications. CONCLUSION: This small study demonstrates the potential of using educational workshops to change childbirth practice at the district and regional level in Tanzania. Institutionalisation of practice changes involves influencing policy-makers, engaging opinion leaders to disseminate evidence and advocacy for change among their peers, as well as developing mechanisms to overcome barriers to practice change at the hospital level. Results from this study will feed in to a project to develop evidence-based guidelines for childbirth care, involving policy makers, practitioners and hospital managers.

Tanzanian midwives' views on becoming a good resource and support person for postpartum women.

OBJECTIVES: to explore midwives' views in relation to the provision of systematic postpartum care. DESIGN: qualitative focus group study using grounded theory approach. SETTING: Dar es Salaam, Tanzania. PARTICIPANTS: 49 nurse/midwives in five focus group discussions, each having 9-11 participants. FINDINGS: eight categories were identified: 'reflecting', 'getting ready', 'defining abilities', 'networking', 'integrating', 'balancing', 'dealing with reality', and 'caring'. The identified core category that integrated and encapsulated all other categories was 'becoming a good resource and support person for postpartum woman'. The mediating factors found to have potential for influencing how a midwife can function in order to become a good resource and support person were: a) the structure and approach in maternal and child health services, b) midwives' knowledge, attitude and skills, c) informal sources of knowledge to parents, and d) cultural beliefs and practices. CONCLUSION: the findings of this study provide an understanding of the way midwives feel and think about the provision of postpartum care. The findings demonstrate that midwives need support in their efforts to achieve what they consider necessary for postpartum care. Interventions for educating and supporting midwives should be targeted at enabling them to deal with all the factors that influence their role and help them to identify and use better strategies to provide quality care.

Change in maternal concerns during the 6 weeks postpartum period: a study of primaparous mothers in Dar es Salaam, Tanzania.

The purpose of this study was to describe the postpartum concerns of primiparas. A cohort study included 79 mothers in Dar es Salaam, Tanzania. Mothers sorted topics into worry, interest, and confidence. Trends of decreasing worry and increasing interest and confidence for baby-related and mother-related topics were observed from 1 to 6 weeks. At 1 week mothers worried about baby's eyes, respiration, temperature, safety, and crying; but, at 6 weeks only crying was a problem. Need for information was constant about general health, baby behavior, and care of the baby. At 1 week mothers worried about swollen perineum, and feeling tired and nervous. They wanted information about preventing hemorrhage and infection and taking care of the perineum, breasts, and nipples. Trends of increasing worry and decreasing confidence were observed with respect to family relationships. At 6 weeks, mothers worried about the husband/partner's reaction to themselves and to the baby. Confidence in relatives' reaction to themselves and the baby decreased. Being aware of the changes in the way concerns are expressed may guide nursing/midwifery interventions for mothers as to the content and timing.

Postpartum concerns: a study of Tanzanian mothers.

Maternal and child health services in Tanzania have succeeded in implementing health care strategies to improve the health of children under 5 years of age. However, health care for childbearing women has not been a focus (Government of the United Republic of Tanzania/UNICEF, 1990). We examined what Tanzanian women perceive as concerns during the early postpartum period. A card sort was used with 50 primiparas and 50 multiparas from the Dar-es-Salaam urban area. Primiparas had significantly more worries and interests than did multiparas. Multiparas had significantly more confidence than primiparas had. Findings correspond to those of studies conducted on North American populations, suggesting that early postpartum concerns may be cross-cultural.

Factors that influence women's health in Tanzania.

A descriptive account of factors that influence women's health in Tanzania is given. The social and cultural processes that enhance or undermine women's health are emphasized. Recommendations for changes to improve women's health are made.

PIP: Tanzanians have a low life expectancy (49 years), high death rate (15.1/1000), and high fertility rate (6.5). Women have been subject to sexual discrimination even before colonialism. Tradition sustains sexual discrimination today, which keeps women at a low social status and in poor health. Programs need to train women to become more assertive and teach skills which facilitate economic and professional development. Women need to be involved in development. Even though the Tanzanian government has a free health care system, insufficient transportation prevents childbirth emergencies from being managed. Yet, the national health policy calls for the elimination of discrimination against women in health care. Maternal and child health services focus on the baby's health. Breast feeding can further weaken a malnourished woman. Lack of transportation and low contraceptive prevalence (5-7%) restrict women's use of family planning services. Tanzania has officially adopted the Safe Motherhood Initiative, but commitment from all groups is needed. Many women suffer from domestic violence, but the issue is ignored. Some tribes still practice female circumcision. Another form of social control is childhood marriage, which both tradition and the law uphold. Early marriage and teenage pregnancies prevent women from completing their education. The government has a course to train traditional birth attendants which improves their standard of care. Customary marriage laws consider wives to be property. Divorce carries a considerable social stigma. In 1990, the Tanzanian government created a ministry to coordinate women and children issues. Obstacles to improving women's health are poverty, harmful traditional practices, customary laws that support discrimination against women, and Tanzania's poor economy.