Relationship Between School Food Environment and Eating Behaviors of Primary School Children in Dodoma: A Cross-Sectional Study.

This cross-sectional study assesses the relationship between school food environment and eating behaviors of primary school children in Dodoma among 248 primary school children aged 6-13 years. School characteristics information and socio-demographic characteristics were collected. Multilevel modeling was employed to assess the individual-level variance in eating behaviors. Most of the variances in the investigated eating behaviors were at the personal level. Significant associations (p < .05) were between protein-rich food intake and fats and sugar-rich food with the death of either parent. And association between intake of vitamin and mineral-rich foods and the number of people living in household.

Impact of behaviour change communication interventions on sales of fortified sunflower oil in Tanzania: A spatial-temporal analysis and association study.

The Masava project was implemented in Manyara and Shinyanga regions in Tanzania to improve vitamin A intake by making available vitamin A-fortified sunflower oil with a subsidy through a mobile phone-based e-Voucher system. This study was conducted to assess the impact of the behaviour change communication (BCC) campaign of the project on volume of sales of vitamin A-fortified sunflower oil. The e-Voucher system provides real-time data on the number of e-Vouchers redeemed. The number, type, and locations of BCC events were obtained from the implementation agency. Multivariate linear regression was used to examine the associations between (a) the number and type of BCC events conducted in a ward and the volume of subsequent fortified oil redeemed in the ward and (b) distance of clinic shows, a component of the BCC campaign, from participating retailers and the volume of fortified oil redeemed in the store. After 1 year of the campaign, the volume of fortified oil redeemed monthly increased by more than 5 times in Manyara and by more than three times in Shinyanga. Among the different types of BCC events conducted, only clinic shows and cooking shows were significantly associated with the volume of redemptions (p < .05). Compared with retailers where at least one clinic show was conducted within 0.5 km from its location, the volume of redemptions was significantly lower at retailers where no clinic show conducted within 3.0 km from its location (p < .05). These findings suggest that future health promotion interventions in rural Africa should involve health clinics.

Cost-effectiveness of sunflower oil fortification with vitamin A in Tanzania by scale.

In 2011, Tanzania mandated the fortification of edible oil with vitamin A to help address its vitamin A deficiency (VAD) public health problem. By 2015, only 16% of edible oil met the standards for adequate fortification. There is no evidence on the cost-effectiveness of the fortification of edible oil by small- and medium-scale (SMS) producers in preventing VAD. The MASAVA project initiated the production of sunflower oil fortified with vitamin A by SMS producers in the Manyara and Shinyanga regions of Tanzania. A quasi-experimental nonequivalent control-group research trial and an economic evaluation were conducted. The household survey included mother and child pairs from a sample of 568 households before the intervention and 18 months later. From the social perspective, the incremental cost of fortification of sunflower oil could be as low as $0.13, $0.06, and $0.02 per litre for small-, medium-, and large-scale producers, respectively, compared with unfortified sunflower oil. The SMS intervention increased access to fortified oil for some vulnerable groups but did not have a significant effect on the prevention of VAD due to insufficient coverage. Fortification of vegetable oil by large-scale producers was associated with a significant reduction of VAD in children from Shinyanga. The estimated cost per disability-adjusted life year averted for fortified sunflower oil was $281 for large-scale and could be as low as $626 for medium-scale and $1,507 for small-scale producers under ideal conditions. According to the World Health Organization thresholds, this intervention is very cost-effective for large- and medium-scale producers and cost-effective for small-scale producers.

Efficacy of Different Doses of Multiple Micronutrient Powder on Haemoglobin Concentration in Children Aged 6-59 Months in Arusha District.

In Tanzania's Arusha District, anaemia is a significant public health problem. Recently, home fortification with multiple micronutrient powder was recommended, and daily use of one sachet has shown to be effective. However, it is a challenge for deprived families with low income to afford the daily sachet. The aim of this study was to compare the efficacy of different administration frequencies of micronutrient powder in reducing anaemia in children aged 6-59 months. This research used a community-based, randomized longitudinal trial design with the intent to treat anaemia. Children aged 6 to 59 months (n=369) were randomly assigned to one of four intervention groups which received, on a weekly basis, either five sachets (n=60), three sachets (n=80), two sachets (n=105), or one sachet (n=124) for six months; 310 children completed the study. Using the HemoCue technique, a finger-prick blood was taken at baseline, middle, and end points of the intervention to determine haemoglobin levels. The effect of treatment on haemoglobin was assessed with analysis of covariates with Bonferroni post hoc to test group difference (p > 0.05) from each other. At the end, haemoglobin levels were significantly higher in participants who received three or five sachets of micronutrient powder per week compared to those who received one or two micronutrient powder sachets per week (p < 0.05). The prevalence of illnesses was reduced from 65% to 30.5% in all groups. This finding indicates that economically challenged families may opt for three times per week sachet administration rather than a more costly daily administration. This trial is registered with PACTR201607001693286.

Effectiveness of social marketing in improving knowledge, attitudes and practice of consumption of vitamin A-fortified oil in Tanzania.

OBJECTIVE: To evaluate the effectiveness of a social marketing intervention in enhancing knowledge, attitudes and practice (KAP) related to consumption of vitamin A-fortified oil. DESIGN: The intervention employed community events, distribution of educational materials and radio broadcasts. The intervention was assessed in a quasi-experimental non-equivalent control group study design by collecting information on KAP regarding vitamin A-fortified oil consumption before and after 9 months of a 13-month intervention. SETTING: Six districts in Manyara and Shinyanga regions in Tanzania were non-randomly selected as the intervention districts and two districts served as the control districts. PARTICIPANTS: At baseline, 568 lactating mothers with children aged <5 years were randomly selected from the intervention and control districts. Of these, 494 mothers were followed up at endline. RESULTS: After 9 months of intervention, knowledge of fortification and actual consumption of adequately fortified oil were significantly higher in the intervention districts compared with the control districts (P <0·05). Knowledge of the health benefits of vitamin A improved significantly from about 33 to 45 % in both the intervention and control districts. The major sources of information for women were health clinics and community health workers (CHW). CONCLUSIONS: The study showed that a social marketing intervention is effective in improving KAP regarding fortified oil consumption at the household level. Clinics and CHW are channels that should be prioritized when communicating health messages, particularly those targeting women.

Prevalence and predictors of undernutrition among underfive children in Arusha District, Tanzania.

Childhood undernutrition is a global health challenge impacting child growth and survival rates. This deficit in nutritional status contributes to the increasing chronic disease prevalence and economic burden in individuals and throughout developing contexts. A community-based cross-sectional study was conducted in Arusha District of Tanzania to determine the prevalence and predictors of undernutrition in 436 children. A structured questionnaire was used to collect data on demographic and socio-economic factors as well as feeding practices and prevalence of preventable childhood diseases. Anthropometric data were collected through the measurement of length/height and weight of all children. The prevalence of undernutrition was estimated based on Z-scores indices below -2SD of the reference population for weight for age (underweight), height for age (stunting), and weight for height (wasting). Fifty percent, 28%, and 16.5% of the children were stunted, underweight, and wasted, respectively. The age above 2 years and being a male were associated with stunting. The age above 2 years, nonexclusive breastfeeding children, and living at Seliani and Oturumeti were associated with being underweight. Similarly, morbidity, none exclusively breastfed children, living at Oturumeti, and being born to a mother 35 years and above were associated with wasting. In this study, we found the prevalence of child undernutrition in Arusha District is high in comparison with national and regional trends and appears to be associated with being a male. It is recommended that nutritionists and health planners should focus on these key predictors when planning nutrition interventions to address the problem of undernutrition among underfive children in Arusha District.

Prevalence and predictors of anemia among children under 5 years of age in Arusha District, Tanzania.

Anemia is a global health problem affecting most developing countries. We examined the prevalence of anemia and its predictors among children under 5 years of age in Arusha District, Tanzania. Random sampling technique was used to identify 436 children aged 6-59 months. Anemia status was assessed by measuring hemoglobin concentration from blood sample obtained from a finger prick and HemoCue® Hb 201+ photometer. Demographic information and dietary intake data were collected using a standardized questionnaire. Anemia cut-off points were defined according to World Health Organization standards for children aged 6-59 months. Logistic regression using backward procedure was used to estimate odds ratios (ORs) at 95% confidence intervals (CIs). Prevalence rate of anemia among under-fives was found to be 84.6% (n=369). Multivariable logistic regression identified the following predictors of anemia; low birth weight (adjusted OR (AOR): 2.1, 95% CI: 1.1-3.8), not consuming meat (AOR: 6.4, 95% CI: 3.2-12.9), not consuming vegetables (AOR: 2.1, 95% CI: 1.1-4.1), drinking milk (AOR: 2.5, 95% CI: 1.1-5.2), and drinking tea (AOR: 4.5, 95% CI: 1.5-13.7). It was concluded that low birth weight and dietary factors (ie, low or nonconsumption of iron-rich foods like meat, vegetables, and fruits) were predictors of anemia among under-five children living in this rural setting. Community education on exclusive breastfeeding and introduction of complementary foods should be improved. Mothers and caretakers should be educated about nutrition, in general, as well as potential use of micronutrient powder to improve the nutritional quality of complementary foods.

Efficacy of a low-dose ferric-EDTA in reducing iron deficiency anaemia among underfive children living in malaria-holoendemic district of Mvomero, Tanzania.

Iron deficiency anaemia is a public health problem in Tanzania especially among children under the age of five years. In malaria holoendemic areas, control of anaemia by supplementation with iron has been reported to increase serious adverse events. The World Health Organization recommends that, programs to control anaemia in such areas should go concurrently with malaria control programmes. The objectives of the study were to: (i) to determine if a supplement providing 2.5 mg of iron as ferric EDTA and 2.5 mg of iron as ferrous lactate (low dose) is as effective in correcting anaemia as a supplement providing the standard 10 mg of iron as ferrous lactate (high dose); and ii) determine if iron supplementation increased the risk of malaria. This study was carried out in Mvomero District of east-central Tanzania. Two groups (69 and 70 subjects per treatment) of moderately anaemic children (7.0-9.1 g of Hb/dl), received one of the two micronutrient supplements differing only in iron content for a period of 60 days. Results showed that, the average haemoglobin (Hb) concentration improved from 8.30 ± 0.60 g/dl to 11.08 ± 1.25 g/dl. The average weight-for-age for all children increased from 16.0 to 20.6% while their weight-for-height increased from 4.0 to 13.3%. The incidence of asymptomatic and symptomatic malaria ranged from 10.0 to 10.4% at all time points with no apparent increase in malaria severity due to iron supplementation. Overall, there was a significant reduction in anaemia during the 60 day supplementation period. This study demonstrated that, micronutrient supplements containing low-dose ferric-EDTA is just as effective as the high dose iron in reducing anaemia and can be safely utilized in malaria holoendemic areas to control iron deficiency anaemia. It is recommended that, a large study should be conducted to affirm the effectiveness of the low-dose ferric-EDTA in controlling iron deficiency anaemia among underfive children.

Prevalence and awareness of type 2 diabetes mellitus among adult population in Mwanza city, Tanzania.

Type 2 diabetes mellitus (T2DM) prevalence is increasing rapidly around the world. This cross-sectional study was conducted to assess the prevalence and awareness of type 2 diabetes mellitus in Mwanza city, Tanzania. A multistage random sampling technique was used to obtain representative subjects. Information about causes and risk factors were collected using structured questionnaire. In addition, community random blood glucose testing was employed to identify those at risk. Subjects with ≥ 200 mg/dl on the following day were subjected to fasting blood glucose testing and they were confirmed to have T2DM if they had blood glucose level of ≥ 126 mg/ dl. In each subject, height, weight, waist and hip circumferences and total fat and fat free mass were measured using standard procedures. A total of 640 participants were included in this study, 55% were females and 45% were males. Mean age of the respondent was 43.84 ± 10.80 years. Most (46.4%) respondents were in the age group 30-40 years. Mean age for females was 44.0 ± 10.31 years while for males was 43.6 ± 11.3 years (Table 1). Overall prevalence of T2DM was 11.9%, (n = 76). Prevalence was high in females (7.2%; n = 46) than in males (4.7%; n = 30). The age between 41-50 years had the highest prevalence of T2DM 28.6% followed by 51-60 years age group (17.2%). Significant independent associations were found for age (OR 3.88, 95% CI: 2.16-6.95) positive first degree relative with T2DM (OR 1.34; 95% C: 1.10-1.64) alcohol intake (OR 1.23; 95% CI: 1.02-1.48,) smoking (OR 3.86; 95% CI: 2.57-5.78) and hypertension (OR 0.096; 95% CI: 1.954-18.251). Only 49.2 (n = 315) of the respondents knew about the causes and symptoms of T2DM. Public education on T2DM should be emphasized and routine measurement of blood glucose levels is recommended among adults.

Availability, preference, and consumption of indigenous forest foods in the Eastern Arc Mountains, Tanzania.

We investigated the availability, preference, and consumption of indigenous forest foods in Uluguru North (UNM) and West Usambara Mountains (WUM) of Tanzania. Data collection techniques involved focus group discussion, structured questionnaires, and botanical identification. Results revealed (1) there were 114 indigenous forest food plant species representing 57 families used by communities living adjacent to the two mountains; (2) sixty-seven species supplied edible fruits, nuts and seeds: 24 and 14 species came from WUM and UNM, respectively, while 29 came from both study areas; (3) of the 57 identified vegetable species, 22 were found in WUM only, 13 in UNM only, and 12 in both areas; (4) there were three species of edible mushrooms and five species of roots and tubers; (5) unlike the indigenous roots and tubers, the preference and consumption of indigenous vegetables, nuts, and seeds/oils was higher than exotic species in both study areas; and (6) UNM had more indigenous fruits compared to WUM, although preference and consumption was higher in WUM. We recommend increased research attention on forest foods to quantify their contribution to household food security and ensure their sustainability.

Prevalence of congenital malaria among neonates at Morogoro Regional Hospital, Morogoro, Tanzania.

Congenital malaria is increasingly reported among babies born to mothers living in malaria endemic areas. The aim of this study was to determine the prevalence of congenital malaria among newborn babies delivered at Morogoro Regional Hospital, Tanzania. A cross-sectional study was conducted among 200 pregnant women attending delivery services at the hospital. Socio-demographic and obstetric information of the mothers was also collected. Samples of the placental, cord and peripheral blood smears of mothers and babies were stained with Giemsa and examined for malaria parasites. Plasmodiun falciparum was the dominant malaria parasite species. The prevalence of congenital malaria among newly born babies was 4.0% (95% CI, 1.2-6.8%). Prevalence of placental parasitaemia was 7.0% (95% CI, 3.3-10.7%), while prevalence of cord parasitaemia was 0.5% (95% CI, 0.0-1.5%). The prevalence of malaria among the mothers at delivery was 11.5% (95% CI, 6.9-16.1%). There was a strong association between placental, cord, maternal and congenital parasitaemia. All babies with congenital malaria had infected mothers and placentas (P<0.01). In conclusion, congenital malaria is still common in Tanzania especially in malaria endemic areas. It is important that blood smear from neonates are taken and examined for malaria parasite soon after birth. Malaria prevention measures such as intermittent preventive treatment, prompt management of all malaria cases and use of insecticide treated bed nets should be emphasized for all pregnant women.

Factors influencing pregnancy outcomes in Morogoro Municipality, Tanzania.

Neonatal, perinatal and infant mortality rates are still high in developing countries despite national and international efforts to redress this problem. This study was conducted to investigate maternal knowledge and attitudes regarding the risk factors that adversely affect pregnancy outcomes in Morogoro municipality, Tanzania. A longitudinal study was conducted among 157 pregnant women attending antenatal clinics from their second trimesters to term. Socio-economic, demographic, anthropometric, biomedical and obstetric information was collected. Results showed that, majority of the pregnant women (> 70%, n = 157) were aware of the risk factors that could adversely affect the pregnancy outcomes, however, they did not know the exact mechanisms by which the risk factors acted to cause the adverse effects. Occurrence of risk factors among pregnant women was severe anaemia - 1.4%, smoking (0.6%), passive smoking (22.9%), alcohol consumption (2.5%), unmarried status (11.5%), under-age (< 20 years) (17.8%), over-age (> 35 years) (4.5%), history of stillbirth (7.0%), history of caesarean section (3.2%) and history of miscarriage (2.5%). Maternal total weight gain in the last two trimesters was 7.76 kg. The average birth weight was 3.05 kg, with male infants being heavier (3.14 kg) than their female counterparts (2.95 kg). The incidence of low birth weight was 11.6%, lower than the national average of 18%. It was concluded from this study that, although most women were aware of the pregnancy risk factors, they lacked the knowledge on how the factors affected the pregnancy outcomes. Occurrence of the pregnancy risk factors was generally low and the pregnancy outcomes were good. It is recommended that, women should be educated more about the pregnancy risk factors and encouraged to begin their antenatal clinic early in pregnancy. A larger study should also be conducted to ascertain the association of the other risk factors with pregnancy outcomes, starting with pregnant women in their first trimester.

Evaluation of self-care practices and emotional distress among people with Type 2 diabetes mellitus in Dar es Salaam, Tanzania.

This study was conducted to determine self-care practices and diabetes related emotional distress among people with Type 2 diabetes mellitus in Dar es Salaam, Tanzania. A cross sectional survey-involving 121 Types 2 diabetics was conducted in 4 diabetic clinics located in Dar es Salaam. Anthropometric and biomedical measurements namely weight, height, waist, hip, mid-upper arm circumference, blood pressure and fasting blood glucose were measured. Self-care practices and diabetic related emotion distress were evaluated by using validated instruments. Results revealed that, the average fasting plasma glucose was 11.2 ± 5.5 mmol/l, blood pressure was 134.7/86.1 mm/Hg and the mean BMI for males and females were 25.0 ± 4.3 and 27.0 ± 5.1 kg/m(2), respectively. Subject's self-care score for general diet, specific diet, physical exercise, foot-care and medication were 4.6 ± 2.4, 3.7 ± 1.5, 3.4 ± 1.8, 3.6 ± 2.8 and 5.5 ± 2.8 days per week, respectively. Self-monitoring of blood glucose was irregular and only 46.3% of the subjects tested their levels of blood glucose at least once in between the appointments (90 days). Low income was the major limitation for complying with the self-care practices related to diet, blood glucose testing and medication. It is recommended that, the Government of Tanzania should in the short run subsidize the prices of diabetes drugs, remove all taxes on the glucose test kits and establish a national diabetes program that would coordinate and oversee provision of the basic services such as screening, glucose testing, medication, counseling and management of the condition. In the long run, the government should establish a preventive public health program in order to curtail the escalation of diabetes. Further research should be conducted to determine how factors such as socio-cultural and demographic, self-care, and psychosocial distress interact to determine biomedical outcomes such as blood pressure, blood glucose and body mass index.

Nutritional value and acceptability of homemade maize/sorghum-based weaning mixtures supplemented with rojo bean flour, ground sardines and peanut paste.

Low nutrient density in weaning foods is the major cause of under-nutrition among infants and young children in developing countries. Ten types of composite weaning diets (namely, maize-rojo beans-peanut, maize-peanut-sardines, maize-peanut-sardine-rojo beans, maize-peanut-soaked rojo beans, maize-peanut-germinated rojo beans, sorghum-rojo beans-peanut, sorghum-peanut-sardines, sorghum-peanut-sardine-rojo beans, sorghum-peanut-soaked rojo beans, and sorghum-peanut-germinated rojo beans) were formulated and assayed for proximate composition, energy, mineral density, tannin content and residual urease activity. The diets were also evaluated for storage stability under ambient conditions, sensory quality and overall acceptability. Results of the study indicated that, concentrations of protein, fat, ash, calcium, iron, zinc and copper were significantly (P<0.05) increased when plain maize and sorghum gruels were enriched with rojo beans, peanut paste and/or ground sardines. Soaking and germinating the rojo beans and dehulling the sorghum reduced the concentration of tannins in the gruels significantly (P<0.05). Residual urease activity ranged between 0.00 and 0.07 units, about 10-fold lower than the maximum level (0.8 units) allowed in weaning foods. Both maize and sorghum-based composite gruels had a short shelf-life under ambient conditions (26.4 degrees C) ranging between 4 and 6 h, with gruels containing ground sardines showing a tendency to spoil faster. All composite gruels except those containing germinated rojo beans were highly liked and accepted by consumers (P<0.05), similar to the plain maize and sorghum gruels. The maize and sorghum-based composite products therefore have a potential for use as weaning and/or supplementary foods for older infants and young children. Further investigations are suggested to extend the shelf-life of the composite products and improve the organoleptic quality of the diets containing germinated rojo beans.