Advances in training of the specialized human resources for health in Tanzania: the case of Muhimbili University of Health and Allied Sciences.

BACKGROUND: Increasing the number of specialized human resources for health is paramount to attainment of the United Nations sustainable development goals. Higher learning institutions in low-and middle-income countries must address this necessity. Here, we describe the 5-years trends in accreditation of the clinical and non-clinical postgraduate (PG) programmes, student admission and graduation at the Muhimbili University of Health and Allied Sciences (MUHAS) in Tanzania, highlighting successes, challenges and opportunities for improvement. METHODS: This was a retrospective longitudinal study describing trends in PG training at MUHAS between 2015 and 2016 and 2019-2020. Major interventions in the reporting period included university-wide short course training programme to faculty on curricula development and initiation of online application system. Data were collected through a review of secondary data from various university records and was analyzed descriptively. Primary outcomes were the number of accredited PG programmes, number of PG applicants as well as proportions of applicants selected, applicants registered (enrolled) and students graduated, with a focus on gender and internationalization (students who are not from Tanzania). RESULTS: The number of PG programmes increased from 60 in 2015-2016 to 77 in 2019-2020, including programmes in rare fields such as cardiothoracic surgery, cardiothoracic anesthesia and critical care. The number of PG applications, selected applicants, registered applicants and PG students graduating at the university over the past five academic years had steadily increased by 79, 81, 50 and 79%, respectively. The average proportions of PG students who applied, were selected and registered as well as graduated at the university over the past five years by gender and internationalization has remained stably at 60% vs. 40% (male vs. female) and 90% vs. 10% (Tanzanian vs. international), respectively. In total, the university graduated 1348 specialized healthcare workers in the five years period, including 45 super-specialists in critical fields, through a steady increase from 200 graduates in 2015-2016 to 357 graduates in 2019-2020. Major challenges encountered include inadequate sponsorship, limited number of academic staff and limited physical infrastructure for teaching. CONCLUSION: Despite challenges encountered, MUHAS has made significant advances over the past five years in training of specialized and super-specialized healthcare workforce by increasing the number of programmes, enrollment and graduates whilst maintaining a narrow gender gap and international relevance. MUHAS will continue to be the pillar in training of the specialized human resources for health and is thus poised to contribute to timely attainment of the health-related United Nations sustainable development goals in Tanzania and beyond, particularly within the Sub-Saharan Africa region.

Discriminative ability of the generic and condition-specific Child-Oral Impacts on Daily Performances (Child-OIDP) by the Limpopo-Arusha School Health (LASH) project: a cross-sectional study.

BACKGROUND: Generic and condition-specific (CS) oral-health-related quality-of-life (OHRQoL) instruments assess the impacts of general oral conditions and specific oral diseases. Focusing schoolchildren from Arusha and Dar es Salaam, in Tanzania, this study compared the discriminative ability of the generic Child OIDP with respect to dental caries and periodontal problems across the study sites. Secondly, the discriminative ability of the generic-and the CS Child OIDP attributed to dental caries, periodontal problems and malocclusion was compared with respect to various oral conditions as part of a construct validation. METHODS: In Arusha, 1077 school children (mean age 14.9 years, range 12-17 years) and 1601 school children in Dar es Salaam (mean age 13.0 years, range 12-14 years) underwent oral clinical examinations and completed the Kiswahili version of the generic and CS Child-OIDP inventories. The discriminative ability was assessed as differences in overall mean and prevalence scores between groups, corresponding effect sizes and odd ratios, OR. RESULTS: The differences in the prevalence scores and the overall mean generic Child-OIDP scores were significant between the groups with (DMFT > 0) and without (DMFT = 0) caries experience and with (simplified oral hygiene index [OHI-S] > 1) and without periodontal problems (OHI-S ≤ 1) in Arusha and Dar es Salaam. In Dar es Salaam, differences in the generic and CS Child-OIDP scores were observed between the groups with and without dental caries, differences in the generic Child-OIDP scores were observed between the groups with and without periodontal problems, and differences in the CS Child-OIDP scores were observed between malocclusion groups. The adjusted OR for the association between dental caries and the CS Child-OIDP score attributed to dental caries was 5.4. The adjusted OR for the association between malocclusion and CS Child-OIDP attributed to malocclusion varied from 8.8 to 2.5. CONCLUSION: The generic Child-OIDP discriminated equally well between children with and without dental caries and periodontal problems across socio-culturally different study sites. Compared with its generic form, the CS Child-OIDP discriminated most strongly between children with and without dental caries and malocclusion. The CS Child OIDP attributed to dental caries and malocclusion seems to be better suited to support clinical indicators when estimating oral health needs among school children in Tanzania.

Prevalence of malocclusion and its relationship with socio-demographic factors, dental caries, and oral hygiene in 12- to 14-year-old Tanzanian schoolchildren.

The aim of this study was to assess the prevalence of malocclusion and its association with socio-demographic characteristics, caries experience, and level of oral hygiene in 12- to 14-year-old schoolchildren residing in two socio-economically different districts of Tanzania. A total of 1601 children (mean age 13 years, 60.5 per cent girls) attending 16 primary schools in Kinondoni and Temeke districts participated in a clinical examination and were interviewed in school settings. Chi-square and multiple logistic regression models were used to test for statistically significant differences between different groups. The results showed that 63.8 per cent (62.6 per cent in Kinondoni and 66.0 per cent in Temeke) of the subjects had at least one type of anomaly, with a midline shift (22.5 per cent), spacing of at least 2 mm (21.9 per cent), and an open bite (16.1 per cent) being the most frequently recorded. The majority (93.6 per cent) of the children showed a Class I molar relationship. Class II and Class III malocclusions were registered in 4.4 and 2.0 per cent, respectively. Multiple logistic regression analyses, controlling for socio-demographic factors, showed that the odds ratio for having an open bite was 1.8 if residing in a less socio-economically privileged district. Subjects with decayed, missing, and filled teeth (DNFT) (>0) were 1.7, 2.1, 2.4, and 1.7, respectively, more likely to be diagnosed with a malocclusion, a midline shift, Angle Class II and III, and an open bite. Schoolchildren with fair/poor oral hygiene were less likely than their counterparts with good oral hygiene to be diagnosed with a midline shift. Malocclusions were prevalent in the Tanzanian children investigated and were associated with environmental factors in terms of caries experience and residing in a less affluent district. Preventive programmes to combat the prevalence of malocclusion are recommended.

Malocclusion, psycho-social impacts and treatment need: A cross-sectional study of Tanzanian primary school-children.

BACKGROUND: studies on the relationship between children's malocclusion and its psycho-social impacts are so far largely unexplored in low-income countries. This study aimed to assess the prevalence of malocclusion, reported dental problems and dissatisfaction with dental appearance among primary school children in Tanzania. The relationship of dissatisfaction with socio-demographic characteristics, clinically defined malocclusion and psychosocial impacts of dental anomalies was investigated. Orthodontic treatment need was estimated using an integrated socio-dental approach. METHOD: One thousand six hundred and one children (mean age 13 yr) attending primary schools in the districts of Kinondoni and Temeke completed face to face interviews and a full mouth clinical examination. The survey instrument was designed to measure a Kiswahili translated and culturally adapted Child Oral Impact on Daily Performance (Child-OIDP) frequency score, reported dental problems, dissatisfaction with dental appearance/function and socio-demographic characteristics. RESULTS: The prevalence of malocclusion varied from 0.9% (deep bite) to 22.5% (midline shift) with a total of 63.8% having at least one type of anomaly. Moderate proportions of children admitted dental problems; ranging from 7% (space position) to 20% (pain). The odds ratio of having problems with teeth position, spaces, pain and swallowing if having any malocclusion were, respectively 6.7, 3.9, 1.4 and 6.8. A total of 23.3% children were dissatisfied with dental appearance/function. Children dissatisfied with their dental appearance were less likely to be Temeke residents (OR = 0.5) and having parents of higher education (OR = 0.6) and more likely to reporting problem with teeth position (OR = 4.3) and having oral impacts (OR = 2.7). The socio-dental treatment need of 12% was five times lower than the normative need assessment of 63.8%. CONCLUSION: Compared to the high prevalence of malocclusion, psycho social impacts and dissatisfaction with appearance/function was not frequent among Tanzanian schoolchildren. Subjects with malocclusion reported problems most frequently and malocclusion together with other psycho-social impact scores determined children's satisfaction with teeth appearance- and function.

Applicability of an abbreviated version of the Child-OIDP inventory among primary schoolchildren in Tanzania.

BACKGROUND: There is a need for studies evaluating oral health related quality of life (OHRQoL) of children in developing countries. AIM: to assess the psychometric properties, prevalence and perceived causes of the child version of oral impact on daily performance inventory (Child-OIDP) among school children in two socio-demographically different districts of Tanzania. Socio-behavioral and clinical correlates of children's OHRQoL were also investigated. METHOD: One thousand six hundred and one children (mean age 13 yr, 60.5% girls) attending 16 (urban and rural) primary schools in Kinondoni and Temeke districts completed a survey instrument in face to face interviews and participated in a full mouth clinical examination. The survey instrument was designed to measure a Kiswahili translated and culturally adapted Child-OIDP frequency score, global oral health indicators and socio-demographic factors. RESULTS: The Kiswahili version of the Child-OIDP inventory preserved the overall concept of the original English version and revealed good reliability in terms of Cronbach's alpha coefficient of 0.77 (Kinondoni: 0.62, Temeke: 0.76). Weighted Kappa scores from a test-retest were 1.0 and 0.8 in Kinondoni and Temeke, respectively. Validity was supported in that the OIDP scores varied systematically and in the expected direction with self-reported oral health measures and socio-behavioral indicators. Confirmatory factor analyses, CFA, confirmed three dimensions identified initially by Principle Component Analysis within the OIDP item pool. A total of 28.6% of the participants had at least one oral impact. The area specific rates for Kinondoni and Temeke were 18.5% and 45.5%. The most frequently reported impacts were problems eating and cleaning teeth, and the most frequently reported cause of impacts were toothache, ulcer in mouth and position of teeth. CONCLUSION: This study showed that the Kiswahili version of the Child-OIDP was applicable for use among schoolchildren in Tanzania.

Socio-demographic and behavioural correlates of oral health related quality of life among Tanzanian adults: A national pathfinder survey.

In response to the growing recognition of quality of life measurement in health care, indicators that address the social and psychological consequences of oral disorders have been developed to complement conventional clinical assessment. The objective of this study was to determine socio-demographic and behavioural correlates of oral health related quality of life (OHRQoL) among Tanzanian adults. The national pathfinder survey methodology described in the WHO Oral Health Surveys - Basic Methods was used to obtain a total of 1,759 Tanzanian adults aged 18 years and above. In line with the pathfinder methodology clusters were purposively selected to represent cities, towns and rural areas. In each cluster individuals were stratified by age and sex. The outcome variable was the OHRQoL in terms of oral impacts on daily performances (OIDP). Frequency distribution, bivariate analyses, and generalized linear models using log binomial regression models were performed by SPSS version 15. About half (49.1%) of the respondents reported at least one oral impact during a period of three months before the survey. Difficulty in chewing was the most prevalent impact affecting 3 9.9% of participants. A higher proportion of those who reported poor conditions of teeth had difficulties in chewing and sleeping was often interrupted. Multivariate analysis indicated that those who perceived their teeth conditions to be good (PR=0.38; CI: 0.32-0.44), were of younger age (PR=0.84; CI: 0.77-0.90), and had visited a dentist during the past five years or more (PR=0.84; CI: 0.77-0.90) and were less likely to have an oral impact. On the other hand those who restricted their sugar consumption (PR=1.12; CI: 1.03-0.1.22) were more likely to have an impact on at least one daily performance. It is concluded that the prevalence of OIDP was high while perceived teeth conditions and age varied with OHRQoL in terms of OIDP in the expected direction. Those who visited the dental clinic in the recent past had more impacts than those who did not. The findings of this study confirm the usefulness of subjective indicators in explaining peoples' suffering. In this regard it is recommended that in the next national pathfinder survey traditional clinical oral health indicators should be complemented with subjective indicators in order to obtain triangulated data for planning oral health services in Tanzania.