Alternative community-led intervention to improve uptake of cataract surgery services in rural Tanzania-The Dodoma Community Cataract Acceptance Trial (DoCCAT): a protocol for intervention co-designing and implementation in a cluster-randomized controlled trial.

Age-related lens opacification (cataract) remains the leading cause of visual impairment and blindness worldwide. In low- and middle-income countries, utilization of cataract surgical services is often limited despite community-based outreach programmes. Community-led research, whereby researchers and community members collaboratively co-design intervention is an approach that ensures the interventions are locally relevant and that their implementation is feasible and socially accepted in the targeted contexts. Community-led interventions have the potential to increase cataract surgery uptake if done appropriately. In this study, once the intervention is co-designed it will be implemented through a cluster-randomized controlled trial (cRCT) with ward as a unit of randomization. This study will utilise both the qualitative methods for co-designing the intervention and the quantitative methods for effective assessment of the developed community-led intervention through a cRCT in 80 rural wards of Dodoma region, Tanzania (40 Intervention). The 'intervention package' will be developed through participatory community meetings and ongoing evaluation and modification of the intervention based on its impact on service utilization. Leask's four stages of intervention co-creation will guide the development within Rifkin's CHOICE framework. The primary outcomes are two: the number of patients attending eye disease screening camps, and the number of patients accepting cataract surgery. NVivo version 12 will be used for qualitative data analysis and Stata version 12 for quantitative data. Independent and paired t-tests will be performed to make comparisons between and within groups. P-values less than 0.05 will be considered statistically significant.

Predictors of microvascular complications in patients with type 2 diabetes mellitus at regional referral hospitals in the central zone, Tanzania: a cross-sectional study.

Microvascular complications encompass a group of diseases which result from long-standing chronic effect of diabetes mellitus (DM). We aimed to determine the prevalence of microvascular complications and associated risk factors among patients with type 2 diabetes mellitus (T2DM). A cross-sectional analytical hospital-based study was conducted at Singida and Dodoma regional referral hospitals in Tanzania from December 2021 to September 2022. A total of 422 patients with T2DM were included in the analysis by determining the prevalence of microvascular complications and their predictors using multivariable logistic regression analysis. A two-tailed p value less than 0.05 was considered statistically significant. The prevalence of microvascular complications was 57.6% (n = 243) and diabetic retinopathy was the most common microvascular complication which accounted for 21.1% (n = 89). Having irregular physical activity (AOR = 7.27, 95% CI = 2.98-17.71, p < 0.001), never having physical activity (AOR = 2.38, 95% CI = 1.4-4.01, p = 0.013), being hypertensive (AOR = 5.0, 95% CI = 2.14-11.68, p = 0.030), having T2DM for more than 5 years (AOR = 2.74, 95% CI = 1.42-5.26, p = 0.025), being obese (AOR = 2.63, 95% CI = 1.22-5.68, p = 0.010), and taking anti-diabetic drugs irregularly (AOR = 1.94, 95% CI = 0.15-0.77, p < 0.001) were the predictors of microvascular complications. This study has revealed a significant proportion of microvascular complications in a cohort of patients with T2DM. Lack of regular physical activity, being obese, taking anti-diabetic drugs irregularly, presence of hypertension, and long-standing duration of the disease, were significantly associated with microvascular complications.

Mental health disorders among medical students during the COVID-19 pandemic in the area with no mandatory lockdown: a multicenter survey in Tanzania.

The COVID-19 pandemic brought about a major public health concern worldwide. It forced many countries to enforce lockdowns, leading to the closure of higher learning institutions. The abrupt shift in the lifestyle of students had a profound impact on their mental health. This study aims to determine the prevalence and factors associated with mental health conditions among university students in Tanzania during the COVID-19 pandemic. A sample of 425 students from six medical universities and colleges in Tanzania completed an online survey and was included in the analysis. The questionnaire consisted of validated Depression, Anxiety and Stress Scale-21 Items (DASS-21) questions (Cronbach's alpha = 0.92) assessing the presence of mental health symptoms: depression, anxiety, and stress. Multivariable logistic regression models were fitted to explain the factors associated with mental health conditions. A P-value < 0.05 was considered statistically significant in all inferential analyses. The median age (interquartile range) of the participants was 24 (22-26). The prevalence of mental health conditions was 28.94%, 54.12%, and 15.06% for depression, anxiety, and stress, respectively, while the prevalence of having any mental health condition was 58.59%. In an adjusted regression model, being in the fourth and fifth years of study and living with a spouse were significantly associated with increased odds of depression: AOR = 5.99 (1.31-27.47), AOR = 5.52 (1.18-25.81), and AOR = 1.84 (1.08-3.15), respectively. Moreover, studying in private universities and living with a spouse were significantly associated with an increased likelihood of anxiety: AOR = 2.35 (1.72-2.76), and AOR = 2.32 (1.20-4.50), respectively. The likelihood of stress was only among participants studying in private universities; AOR = 2.90 (1.60-5.27). The study revealed alarmingly high rates of mental health conditions among medical students in Tanzania during the COVID-19 pandemic. The findings suggest the need for regular checkups for medical students regarding their mental health status. Additionally, it recommends that the government and other stakeholders establish mental health services within the universities for the effective prevention of the rising burden of mental health problems among universities in Tanzania and other countries with similar settings.

Knowledge and Practices toward Tuberculosis Case Identification among Accredited Drug Dispensing Outlets Dispensers in Magu District, Northwestern Tanzania.

Accredited Drug Dispensing Outlets dispensers (ADDO dispensers) have a crucial role in detecting and referring TB suspects. However, several studies highlight low knowledge of TB among ADDO dispensers. To facilitate this, the National TB and Leprosy Control Program trained ADDO dispensers on case identification and referral. Hence, this was a community-based cross-sectional study to determine the knowledge and practice of ADDO dispensers in the detection of active tuberculosis suspects in Magu Districts, Mwanza, Tanzania. This was a cross-sectional study that included 133 systematically selected ADDO dispensers. Out of 133 ADDO dispensers, 88 (66.9%) had attended TB training. About 108 (81%) participants had good knowledge of TB. The majority of ADDO dispensers 104 (78.4%) had poor practice toward the identification of TB cases. Attending training (AOR 4.49, CI 1.03-19.47), longer working experience (AOR 4.64, CI 1.99-10.81), and the presence of national TB guidelines (AOR 3.85, CI 1.11-13.34) was significantly associated with good self-reported TB case identification practices. Therefore, the study revealed adequate knowledge but with poor practice. Provisions to train ADDO dispensers in tuberculosis case detection and referral could yield great results.

Low medication adherence and its associated factors among patients with type 2 diabetes mellitus attending Amana Hospital in Dar es Salaam, Tanzania: a cross-sectional study.

BACKGROUND: Low medication adherence among patients with type 2 diabetes mellitus (T2DM) is associated with significant morbidity and mortality globally. We investigated the prevalence of low medication adherence and its associated factors among patients with T2DM. METHODS: We used the Bengali version of the 8-item Morisky Medication Adherence Scale (MMAS-8) in measuring medication adherence among patients with T2DM who were attending the diabetes clinic at Amana Regional Referral Hospital in Dar es Salaam, Tanzania, from December 2021 to May 2022. Binary logistic regression analysis under multivariate analysis was used to determine the predictors of low medication adherence after controlling for confounders. A two-tailed p-value <0.05 was considered significant. RESULTS: The prevalence of low medication adherence was 36.7% (91/248) of the subjects included in the study. Lack of formal education (adjusted odds ratio [AOR] 5.3 [95% confidence interval {CI} 1.717 to 16.312], p=0.004), having comorbidities (AOR 2.1 [95% CI 1.134 to 3.949], p=0.019) and drinking alcohol (AOR 3.5 [95% CI 1.603 to 7.650], p=0.031) were the independent predictors of low medication adherence. CONCLUSION: More than one-third of the patients with T2DM in this study had low medication adherence. Our study also showed that a lack of formal education, having comorbidities and drinking alcohol were significantly associated with low medication adherence.

The effectiveness of interactive mobile health technologies in improving antenatal care service utilization in Dodoma region, Tanzania: A quasi-Experimental study.

Antenatal care (ANC) provides a platform for important health care during pregnancy, including health promotion, screening, diagnosis and disease prevention. Timely and appropriate utilization of antenatal care can prevent complications as well as ensure optimal maternal and newborn health care. This study assessed the effectiveness of interactive (two way communication) mobile health technologies during antenatal period to improve maternal and newborn service utilization in Dodoma region, Tanzania. Using quasi-experimental design, participants were randomly selected to achieve a sample size of 450 pregnant women (Intervention = 150 and Control = 300) in Dodoma city from January to November, 2018. Interventions were matched to controls by gravidity, education level and gestational age at a ratio of 1 to 2. The intervention group received health education messages through their mobile phones, while the control group continued with standard antenatal care services offered in local clinics. Pregnant women were followed from their initial visit to the point of delivery. The Chi-square test was used to establish the association and regression analysis were used to test the effect of the intervention. The median age of participants was found to be 25 years that ranged from 16 to 41 years. Generally, 77.3 percent of participants in the intervention group utilized adequate (i. ANC care provided by skilled health personnel, ii. Sufficient number of ANC visits (4 or more visits during pregnancy), iii. Appropriate ANC contents provided (visits included at least 13 out of 15 of the recommended basic care procedures or contents) ANC services compared to 57.7 percent in the control group. Interactive mobile health technology system was observed to be effective on improving antenatal care service utilization (AOR = 2.164, P<0.05, 95% CI = 1.351-3.466) compared to conventional antenatal care health education given in local health facilities. Use of interactive mobile health technologies during antenatal period has the potential of improving access to information and antenatal care service utilization in the study setting. Trial Registration: PACTR202008834066796 "Retrospectively registered".

Poor glycemic control and associated factors among patients with type 2 diabetes mellitus: a cross-sectional study.

Glycemic control is of paramount importance in care and management for patients with type 2 diabetes mellitus (T2DM). Poor glycemic control is a major health problem that greatly contributes to the development of diabetes related complications. This study aims to assess the prevalence of poor glycemic control and associated factors among outpatients with T2DM attending diabetes clinic at Amana Regional Referral Hospital in Dar-es-salaam, Tanzania from December 2021 to September 2022. A face to face interviewer semi-structured questionnaire was administered during data collection. Binary logistic regression under multivariable analysis was used to determine the independent predictors of poor glycemic control. A total of 248 patients with T2DM were included in the analysis with mean age of 59.8 ± 12.1 years. The mean fasting blood glucose was 166.9 ± 60.8 mg/dL. The prevalence of poor glycemic control was 66.1% (fasting blood glucose > 130 mg/dL or < 70 mg/dL). Failure to adhere to regular follow-up (AOR = 7.53, 95% CI = 2.34-19.73, p < 0.001) and alcoholism (AOR = 4.71, 95% CI = 1.08-20.59, p = 0.040) were the independent predictors of poor glycemic control. The prevalence of poor glycemic control observed in this study was significantly high. Emphasis should be placed on ensuring that patients have regular follow-up for their diabetes clinics and they should also continue modifying some of lifestyle behaviors including refraining from alcoholism, this can help them to have good glycemic control.

Socioeconomic inequalities in maternal healthcare utilization: An analysis of the interaction between wealth status and education, a population-based surveys in Tanzania.

Limited scientific, evidence has so far described the interactions between socioeconomic factors and the gap of inequalities in maternal healthcare utilization. This study assessed the interaction between wealth status and education to identify women with greater disadvantage. This analysis used secondary data from the three most recent rounds (2004, 2010, and 2016) of the Tanzania Demographic Health Survey (TDHS). Maternal healthcare utilization was assessed based on six services (outcomes) which are i) booking during the first trimester (bANC), ii) at least four antenatal visits (ANC4+), iii) adequate antenatal care (aANC), iv) facility-based delivery (FBD), v) skilled birth attendance (SBA), vi) cesarean section delivery (CSD). The concentration curve and the concentration index were used to measure socioeconomic inequality in maternal healthcare utilization outcomes. The interaction coefficients suggest that each unit increase in the wealth status is significantly associated with higher odds of utilizing all maternal healthcare services for women with primary and secondary or higher education compared to those with no education (booking during the first trimester [AOR = 1.30; 95% CI: 1.08-1.57], at least four antenatal visits [AOR = 1.16; 95% CI: 1.01-1.33], facility-based delivery [AOR = 1.29; 95% CI: 1.12-1.48], skilled birth attendance [AOR = 1.31; 95% CI: 1.15-1.49]). The highest wealth-related inequality in bANC (EI: 0.166), at least four antenatal visits (EI: 0.259), FBD (EI: 0.323) and skilled birth attendance (EI: 0.328) (P < 0.05) was observed among women with primary and secondary or higher education. These findings provide strong evidence that there is an interaction effect between education attainment and wealth status in socioeconomic inequalities of maternal health services utilization. Therefore, any approach which will address both women's education and wealth status might be the first step to reducing socioeconomic inequalities in maternal health services utilization in Tanzania.

Patient trust and positive attitudes maximize non-communicable diseases management in rural Tanzania.

The objectives of this study were to identify difficulties and their related contexts non-communicable disease (NCD) patients in rural Tanzania experienced, examine how patients managed the situation by seeking better treatment of the diseases, and propose a realistic approach for optimizing disease management with long-term perspectives in resource-limited settings, based on views of patients (PTs), health-care providers (HPs), and health volunteers (HVs). Nine focus group discussions were performed with 56 participants of PTs, HPs, and HVs in three district hospitals in the Dodoma region. Their views and self-care practices were extracted, and the verbatim data were analyzed to derive codes and categories. The types of NCDs reported by the PTs were hypertension (HT), diabetes mellitus (DM), and HT/DM comorbidity. Reported barriers to disease management included discontinuation of treatment due to various factors and a lack of positive messages regarding disease management in NCD care. The following points were addressed in relation to the improved management of NCDs: (i) positive attitudes and coping skills, (ii) support from family members, (iii) good communication between PTs and HPs, and (iv) trustworthy relationships with HVs. The findings suggest that to gain the trust of PTs in optimizing disease control in overstretched health-care systems, patient support systems should be strengthened by empowering positive attitudes.

Non-communicable diseases (NCDs) are the leading cause of death globally. NCDs are common in low- and middle-income countries and their prevalence has been growing more prominent. In Tanzania, one-third of all deaths are NCD-related. This study aims to identify the factors that may lead to the improved management of NCDs in rural Tanzania based on actual situations in patients' daily lives. We conducted focus group discussions with three different groups (patients with hypertension and/or diabetes mellitus [PTs], health volunteers [HVs], and health-care providers [HPs]). The results revealed that PTs faced various barriers such as treatment discontinuation and a lack of positive messages regarding disease management in NCD care. However, the following points were indicated by the participants for the improved management of NCDs: (i) positive attitudes and coping skills, (ii) support from family members, (iii) good communication between PTs and HPs, and (iv) trustworthy relationships with HVs. Thus, to gain the trust of PTs in optimizing disease control and complications in overstretched health-care systems, patient support systems need to be strengthened by adopting a community empowerment approach, delivering supportive messages, and building reliable relationships.

Progression of chronic kidney disease among black patients attending a tertiary hospital in Johannesburg, South Africa.

BACKGROUND: Chronic kidney disease (CKD) is a major public health issue worldwide and is an important contributor to the overall non-communicable disease burden. Chronic kidney disease is usually asymptomatic, and insidiously and silently progresses to advanced stages in resource limited settings. METHODOLOGY: A prospective longitudinal study was carried out on black patients with CKD attending the kidney outpatient clinic at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in South Africa, between September 2019 to March 2022. Demographic and clinical data were extracted from the ongoing continuous clinic records, as well as measurements of vital signs and interviews at baseline and at follow up. Patients provided urine and blood samples for laboratory investigations as standard of care at study entry (0) and at 24 months, and were followed up prospectively for two (2) years. Data were descriptively and inferentially entered into REDcap and analysed using STATA version 17, and multivariable logistic regression analysis was used to identify predictors of CKD progression. RESULTS: A total of 312 patients were enrolled into the study, 297 (95.2%) patients completed the study, 10 (3.2%) patients were lost to follow and 5 (1.6%) patients died during the study period. The prevalence of CKD progression was 49.5%, while that of CKD remission was 33% and CKD regression was 17.5%. For patients with CKD progression the median age at baseline was 58 (46-67) years, the median eGFR was 37 (32-51) mL/min/1.73 m2, median urine protein creatinine ratio (uPCR) was 0.038 (0.016-0.82) g/mmol and the median haemoglobin (Hb) was 13.1 (11.7-14.4) g/dl; 95.2% had hypertension, 40.1% patients had diabetes mellitus and 39.5% had both hypertension and diabetes mellitus. Almost half (48.3%) of patients with CKD progression had severely increased proteinuria and 45.6% had anaemia. Variables associated with higher odds for CKD progression after multivariable logistic regression analysis were severely increased proteinuria (OR 32.3, 95% CI 2.8-368.6, P = 0.005), moderately increased proteinuria (OR 23.3, 95% CI 2.6-230.1, P = 0.007), hypocalcaemia (OR 3.8, 95% CI 1.0-14.8, P = 0.047), hyponatraemia (OR 4.5, 95% CI 0.8-23.6, P = 0.042), anaemia (OR 2.1, 95% CI 1.0-4.3, P = 0.048), diabetes mellitus (OR 1.8, 95% CI 0.9-3.6, P = 0.047), elevated HbA1c (OR 1.8, 95% CI 1.2-2.8, P = 0.007) and current smoking (OR 2.8, 95% CI 0.9-8.6, P = 0.049). CONCLUSION: Our study identified a higher prevalence of CKD progression in a prospective longitudinal study of black patients with CKD compared with literature reports. CKD Progression was associated with proteinuria, diabetes mellitus, elevated HbA1c, anaemia, hypocalcaemia, hyponatraemia and current smoking in a cohort of black patients with CKD who had controlled hypertension and diabetes mellitus at baseline.

Contribution of between region and neighborhood variation of socioeconomic factors on the practice of female genital mutilation/cutting: a multilevel analysis of Tanzanian national surveys.

This study aimed to assess to what extent differences in socioeconomic factors between regions correlate to dramatic disparities in the prevalence of female genital mutilation/cutting (FGM/C) across Tanzania. The data from the 2004, 2010, and 2016 Tanzania Demographic Health Surveys were used in this analysis. The estimates from multilevel variance components for FGM/C were compared before and after adjusting for socioeconomic variables (residence, marital status, education, and wealth quintile) and age. The three-level structure of the sample sorted women into individual (level-1), neighborhood (level-2), and regional (level-3) categories. The pooled data included a total of 27587 women of reproductive age with a median age (IQR) of 29 (21-36) years. The random-effects results revealed that of the total age-adjusted variance in FGM/C, 76.7% was attributed to the between region and neighborhood differences. Despite the large between region variations, only 3.7% was explained by socioeconomic factors. Despite the large contribution of between region and neighborhood differences to variance in FGM/C prevalence, less of this variation was explained by socioeconomic factors. Therefore, it is possible that maternal and reproductive educational programs tailored to such neighborhood differences, beyond socioeconomic factors alone, could contribute to a radical shift in perspective for regions with high prevalence.

Demographic and clinical profile of black patients with chronic kidney disease attending a tertiary hospital in Johannesburg, South Africa.

BACKGROUND: The prevalence of chronic kidney disease (CKD) is increasing worldwide; black patients have an increased risk of developing CKD and end stage kidney disease (ESKD) at significantly higher rates than other races. METHODS: A cross sectional study was carried out on black patients with CKD attending the kidney outpatient clinic at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in South Africa, between September 2019 to March 2020. Demographic and clinical data were extracted from the ongoing kidney outpatient clinic records and interviews, and were filled in a questionnaire. Patients provided blood and urine for laboratory investigations as standard of care, and data were descriptively and inferentially entered into REDcap and analysed using STATA version 17. Multivariable logistic regression analysis was used to identify demographic and clinical variables associated with advanced CKD. RESULTS: A total of 312 black patients with CKD were enrolled in the study with a median age of 58 (IQR 46-67) years; 58% patients had advanced CKD, 31.5% of whom had grossly increased proteinuria, 96.7% had hypertension, 38.7% had diabetes mellitus and 38.1% had both hypertension and diabetes mellitus. In patients with advanced CKD, the median age was 61 (IQR 51-69) years, eGFR 33 (30-39) mL/min/1.73 m2, serum bicarbonate 22 (IQR 20-24), haemoglobin 12.9 (IQR 11.5-14.0) g/dl and serum uric acid 0.43 (IQR 0.37-0.53). The prevalence of metabolic acidosis was 62.4%, anemia 46.4% and gout 30.9% among those with advanced CKD, while the prevalence of metabolic acidosis and anaemia was 46.6% and 25.9% respectively in those with early CKD. Variables with higher odds for advanced CKD after multivariable logistic regression analysis were hypertension (OR 3.3, 95% CI 1.2-9.2, P = 0.020), diabetes mellitus (OR 1.8, 95% CI 1.1-3.3, P = 0.024), severe proteinuria (OR 3.5, 95% CI 1.9-6.5, P = 0.001), angina (OR 2.5, 95% CI 1.2-5.1, P = 0.008), anaemia (OR 2.9, 95% CI 1.7-4.9, P = 0.001), hyperuricemia (OR 2.4, 95% CI 1.4-4.1, P = 0.001), and metabolic acidosis (OR 2.0, 95% CI 1.2-3.1, P = 0.005). Other associations with advanced CKD were loss of spouse (widow/widower) (OR 3.2, 95% CI 1.4-7.4, P = 0.006), low transferrin (OR 2.4, 95% CI 1.1-5.1, P = 0.028), hyperkalemia (OR 5.4, 95% CI 1.2-24.1, P = 0.029), use of allopurinol (OR 2.4, 95% CI 1.4-4.3, P = 0.005) and doxazosin (OR 1.9, 95% CI 1.2-3.1, P = 0.006). CONCLUSION: Hypertension and diabetes mellitus were strongly associated with advanced CKD, suggesting a need for primary and secondary population-based prevention measures. Metabolic acidosis, anemia with low transferrin levels, hyperuricemia and hyperkalemia were highly prevalent in our patients, including those with early CKD, and they were strongly associated with advanced CKD, requiring clinicians and dietitians to be proactive in supporting the needs of CKD patients in meeting their daily dietary requirements towards preventing and slowing the progression of CKD.

Household Air Pollution from Cooking Fuels Increases the Risk of Under-Fives Acute Respiratory Infection: Evidence from Population-Based Cross-Sectional Surveys in Tanzania.

Background and Aims: Increased risk of acute respiratory infection (ARI) in children has been linked with exposure to household air pollution (HAP) from solid biomass fuels. However, information is limited on the trend use of biomass fuels and their association with ARI among children in Tanzania. The current study analysed nationally representative data from the Tanzania Demographic Health Surveys of the years 2004, 2010, and 2015-16 to explore the prevalence of the trend of cooking fuels and ARI as well as ascertain their association among under-fives. Methods: A total sample of 20,323 under-fives were included in the current analysis. A mixed-effects multilevel logistic regression was fitted to assess the association between unclean fuels (solid biomass fuels and kerosene) and ARI among under-fives. Results: The use of solid biomass fuels has remained persistent high (98.6%) while ARI among under-fives has declined from 16% in 2004 to 9% in 2016; p < 0.001. Furthermore, under-fives exposed to unclean fuel combustion had a significantly higher incidence of ARI (AOR = 3.47; 95% CI, 1.31-9.21). Conclusion: Efforts should be made to switch to alternative sources of clean energy such as natural gas and biogas in Tanzania and other countries with similar settings.

Reaching Patients With Noncommunicable Diseases in Rural Tanzania Using Mobile Devices and Community Trust: Qualitative Study.

BACKGROUND: A health service using mobile devices, mobile health (mHealth), has been widely applied to programs focusing on maternal and child health and communicable diseases in sub-Saharan African countries. However, mHealth apps for noncommunicable disease (NCD) services remain limited. OBJECTIVE: This study aimed to explore the acceptability and potential usability of SMS text messaging for patients and health care providers for the management of NCDs as part of an implementation research in rural Tanzania. METHODS: Nine focus group discussions were conducted with 56 participants (21 community health workers [CHWs], 17 patients, and 18 health care professionals [HPs]) in 3 districts in the Dodoma region, Tanzania. The interview guides were prepared in Swahili, and each session was recorded, transcribed, and translated into English. The focus group discussions consisted of the following topics: (1) perceptions of the participants about the possible use of mobile devices and SMS text messages as an mHealth platform in community health services; and (2) experiences of mobile device use in health activities or receiving health services via a mobile phone in the past. RESULTS: CHWs and HPs reported having familiarity using mobile devices to provide health services, especially for reaching or tracing patients in remote settings; however, patients with NCDs were less familiar with the use of mobile devices compared with the other groups. Hesitation to receive health services via SMS text messaging was seen in the patient group, as they wondered who would send health advice to them. Some patients expected services beyond what mHealth could do, such as aiding in recovery from a disease or sending notifications about the availability of prescription medications. CHWs showed interest in using text messaging to provide health services in the community; however, the concerns raised by CHWs included the cost of using their own mobile devices. Moreover, they demanded training about NCD management before engaging in such an activity. CONCLUSIONS: This study explored views and experiences regarding the possible installation of an mHealth intervention for managing NCDs in rural Tanzania. Although HPs and CHWs had experience using mobile devices to provide health services in non-NCD projects, only a few patients (3/17, 17%) had heard about the use of mobile devices to receive health services. To improve the suitability and acceptability of the intervention design for patients with NCDs, their trust must be earned. Involving CHWs in the intervention is recommended because they have already been appointed in the community and already know how to communicate effectively with patients in the area.

Does facility readiness promote high-quality of provider-initiated HIV testing and counseling to pregnant women? A national survey for improving policy of prevention of mother-to-child transmission of HIV in Tanzania.

BACKGROUND: Provider-initiated HIV testing and counseling (PITC) is a recommended approach to screen for HIV to all pregnant women during antenatal care (ANC) visits, and all with HIV positive results have to be enrolled into prevention of mother-to-child transmission of HIV (PMTCT) program. However, little is known about the relationship between facility readiness and the uptake of PITC to pregnant women attending ANC in Tanzania. Therefore, this study assessed whether the facility readiness promotes the uptake of PITC to the pregnant women attending ANC for the purpose of improving the PMTCT interventions in Tanzania. METHODS: This study analyzed data for health facilities obtained from the 2014-2015 Tanzania service provision assessment survey. The Primary outcome measure was a composite variable (with score of 0-5) in which its higher scores indicates provision of high-quality of PITC. Also, facilities scored higher in the PMTCT service readiness index were considered to have high readiness to provide PMTCT services. In Poisson regression analyses, a series of models were fitted to assess whether there is an association between provision of high-quality of PITC and facility readiness. In all statistical analysis, a P < 0.05 was considered significant. RESULTS: Out of 1853 included first-visit ANC consultations, only about one-third of pregnant women received all five components required for PITC. The mean percentage of PMTCT readiness score was moderate 63.96 [61.32-66.59]%. In adjusted model, we found that facility with high readiness to provide PMTCT services was significantly associated with the provision of high-quality of PITC (model 2: [ß = 0.075, P = 0.00]). CONCLUSION: In order to increase high-quality of PITC services, efforts should be made to improve the PMTCT facility readiness by increasing availability of trained staffs, diagnostic tools, and ARTs among health facilities in Tanzania.

Twelve-year persistence of inequalities in antenatal care utilisation among women in Tanzania: a decomposition analysis of population-based cross-sectional surveys.

OBJECTIVE: This study was undertaken to assess the trend and contributors of socioeconomic inequalities in antenatal care (ANC) utilisation among women of reproductive age in Tanzania from 2004 to 2016. DESIGN: Population-based cross-sectional surveys. SETTING: This study analysed nationally representative data for women of reproductive age obtained from the 2004-2016 Tanzania Demographic Health Surveys. PRIMARY OUTCOME MEASURE: The outcome variables analysed in this study are: (1) attendance of ANC and (2) accessing adequate antenatal care. ANALYTICAL METHODS: The concentration curve and the concentration index were used to measure socioeconomic inequality in attending and accessing adequate ANC. The concentration index was decomposed to identify the factors explaining the observed socioeconomic inequality of these two outcomes. RESULTS: The concentration index for attending at least four ANC visits increased from 0.169 in 2004 to 0.243 in 2016 (p<0.01). Similarly, for accessing adequate care, the index increased from 0.147 in 2004 to 0.355 in 2016 (p<0.01). This indicates the significant increase in socioeconomic inequalities (favouring wealthier women) for these two outcomes over time. Furthermore, the results show that wealth status was the largest contributor to inequality in both attending at least four visits (71%, 50% and 70%) and accessing adequate ANC (50%, 42% and 51%) in 2004, 2010 and 2016, respectively, in favour of wealthier women (p<0.05). The other contributors to socioeconomic inequalities in ANC utilisation were maternal education and type of residence. CONCLUSION: Over the 12 years of surveys, there was no reduction in socioeconomic inequalities in ANC utilisation in Tanzania. Therefore, the efforts of achieving universal health coverage should focus on reducing wealth-related inequality and improving women's education from poor households.

Addressing the huge poor-rich gap of inequalities in accessing safe childbirth care: A first step to achieving universal maternal health coverage in Tanzania.

INTRODUCTION: Despite skilled attendance during childbirth has been linked with the reduction of maternal deaths, equality in accessing this safe childbirth care is highly needed to achieving universal maternal health coverage. However, little information is available regarding the extent of inequalities in accessing safe childbirth care in Tanzania. This study was performed to assess the current extent, trend, and potential contributors of poor-rich inequalities in accessing safe childbirth care among women in Tanzania. METHODS: This study used data from 2004, 2010, and 2016 Tanzania Demographic Health Surveys. The two maternal health services 1) institutional delivery and 2) skilled birth attendance was used to measures access to safe childbirth care. The inequalities were assessed by using concentration curves and concentration indices. The decomposition analysis was computed to identify the potential contributors to the inequalities in accessing safe childbirth care. RESULTS: A total of 8725, 8176, and 10052 women between 15 and 49 years old from 2004, 2010, and 2016 surveys respectively were included in the study. There is an average gap (>50%) between the poorest and richest in accessing safe childbirth care during the study period. The concentration curves were below the line of inequality which means women from rich households have higher access to the institutional delivery and skilled birth attendance inequalities in accessing institutional delivery and skilled birth attendance. These were also, confirmed with their respective positive concentration indices. The decomposition analysis was able to unveil that household's wealth status, place of residence, and maternal education as the major contributors to the persistent inequalities in accessing safe childbirth care. CONCLUSION: The calls for an integrated policy approach which includes fiscal policies, social protection, labor market, and employment policies need to improve education and wealth status for women from poor households. This might be the first step toward achieving universal maternal health coverage.

Disparities in availability of services and prediction of the readiness of primary healthcare to manage diabetes in Tanzania.

BACKGROUND: The burdens of Non-communicable Diseases have overstretched health systems in developing countries. The study explores disparities in the availability of services and predicts the readiness of primary healthcare facilities to manage diabetes in Tanzania. METHODS: The study analyzed data from the 2014-2015 Tanzania Service Provision Assessment Survey. A total of 1142 primary healthcare facilities were included in this analysis. The Negative binomial regression models were fitted to predict each of selected independent variable that is associated with the readiness of primary healthcare to manage diabetes. RESULTS: The overall availability of services was significantly different across the type of facility and managing authority. In an adjusted model, the following were the predictors for a significant increase in readiness to manage diabetes: health center [ß = 0.470], private facilities [ß = 0.252], the performance of management meetings [ß = 0.446], having source of fund other than government [ß = 0.193,], and presence of medical doctors [ß = 0.677]. CONCLUSION: The robust primary care systems to manage diabetes could be achieved by improving the readiness of primary healthcare facilities through optimizing the availability of diagnostic tools, basic medicines, medical doctors, and early release of a government fund to publicly-owned facilities.

Maternal Deaths due to Obstetric Haemorrhage in Dodoma Regional Referral Hospital, Tanzania.

BACKGROUND: Despite the availability of comprehensive emergency obstetric care at Dodoma Regional Referral Hospital, deaths due to obstetric haemorrhage are still high. This study was carried out to analyse the circumstances that had caused these deaths. METHODS: A retrospective review of all files of women who had died of obstetric haemorrhage from January 2018 to December 2019 was made. RESULTS: A total of 18,296 women gave birth at DRRH; out of these, 61 died of pregnancy-related complications of the deceased while 23 (38%) died of haemorrhage, with many of them 10 (44%) between the age of 30 and 34. Many were grand multiparous women 8 (35%) and almost half of them (11 (48%)) had stayed at DRRH for less than 24 hours. More than half (12 (52%)) had delivered by caesarean section followed by laparotomy due to ruptured uterus (8 (35%)). The leading contributing factors to the deaths of these women were late referral (6 (26%)), delays in managing postpartum haemorrhage due to uterine atony (4 (17%)), inadequate preparations in patients with the possibility of developing PPH (4 (17%)), and delay in performing caesarean section (3 (13%)). CONCLUSION: Maternal mortality due to obstetric haemorrhage is high at Dodoma Regional Referral Hospital where more than one-third of women died between 2018 and 2019. Almost all of these deaths were avoidable. The leading contributing factors were late referral from other health facilities, inadequate skills in managing PPH due to uterine atony, delays in performing caesarean section at DRRH, and inadequate preparation for managing PPH in patients with abruptio placentae and IUFD which are risk factors for the condition. There is a need of conducting supportive supervision, mentorship, and other modes of teaching programmes on the management of obstetric haemorrhage to health care workers of referring facilities as well as those at DRRH. Monitoring of labour by using partograph and identifying pregnant women at risk should also be emphasized in order to avoid uterine rupture.

Readiness of health facilities for the outpatient management of non-communicable diseases in a low-resource setting: an example from a facility-based cross-sectional survey in Tanzania.

OBJECTIVE: This study assessed the readiness of health facilities to provide outpatient management of non-communicable diseases using a nationally representative sample of health facilities from Tanzania as an example of a low-resource country. DESIGN: Facility-based cross-sectional survey. SETTING: This study analysed data collected from public and private-owned dispensaries/clinics, health centres and hospitals during the 2014-2015 Tanzania Service Provision Assessment survey. PRIMARY OUTCOME MEASURES: Three outcome variables are included in this study, namely readiness of facilities to provide outpatient management for diabetes, hypertension and chronic respiratory diseases. These were composite variables measured based on availability of indicators identified in the WHO-Service Availability and Readiness Assessment manual. These indicators were grouped into three domains, viz staff training and guidelines, basic diagnostic equipment and basic medicines. Readiness was measured by assessing the presence of required indicators in each of these domains. RESULTS: Out of 1188 health facilities assessed, 52.1%, 64.8% and 60.9% reported providing services related to diabetes, hypertension and chronic respiratory diseases, respectively. A few facilities reported having treatment guidelines (33.2%) or staff trained to provide non-communicable disease services (10.4%). The availability of basic diagnostic equipment and medicines for these diseases was significantly lower in public lower level facilities than in their private counterparts (p<0.05). Facilities located in urban settings as well as higher level (health centre and hospitals) and publicly owned facilities were significantly associated with increased service readiness index for providing outpatient management of non-communicable diseases. CONCLUSION: A fair distribution of resources through the 'push' system of refresher training, treatment guidelines, medicines and diagnostic equipment from higher authorities or other agencies may be one way of strengthening the readiness of lower level and public facilities to cope with the increasing burden of non-communicable diseases in low-resource countries such as Tanzania.