Promoting access of hydroxyurea to sickle cell disease individuals: Time to make it an essential medicine.

Hydroxyurea (HU) alone has the potential to prevent one out of every three deaths due to sickle cell disease (SCD) and almost all forms of disabilities caused by SCD. However, in Tanzania, only one out of every six registered SCD patients in the SPARCO-Tanzania Sickle Cell Cohort use HU. We conducted studies to understand factors influencing utilization of HU in Tanzania and discovered that among the reason for low utilization of HU include HU is classified as anticancer medication, only hematologists are supposed to prescribe HU, limited HU prescription to only National and Specialized hospitals, a special permit is required to access HU using National Health Insurance Fund (NHIF) scheme and limited importation and absence of local manufacturing of HU limit availability of this important drug in Tanzania. Therefore, with this brief, the government should allow prescription of HU to the district hospitals level, should allow all clinicians with a minimum of a Bachelor of Medicine to prescribe HU, and accessibility of HU through NHIF should be friendly.

Oral health related behaviors among adult Tanzanians: a national pathfinder survey.

BACKGROUND: The oral health education programs which have been organised and delivered in Tanzania were not based on a thorough understanding of behaviours which influence oral health. Therefore, evaluation of these programs became difficult. This study aimed at investigating the oral health related behaviours and their determinants among Tanzanian adults. METHODS: A national pathfinder cross sectional survey was conducted in 2006 involving 1759 respondents from the six geographic zones of mainland Tanzania. Frequency distributions, Chi square and multiple logistic regression analyses were performed using SPSS version 13.0. RESULTS: The rates of abstinence from alcohol for the past 30 days and life time smoking were 61.6% and 16.7% respectively, with males being more likely to smoke (OR 9.2, CI 6.3 -12.9, p < 0.001) and drink alcohol (OR 1.5, CI 1.2 -1.8, p < 0.001). Multiple regression analysis revealed that; having dental pain (OR 0.7, CI 0.5-0.8; p < 0.001) and being minimally educated (OR 0.48, CI 0.4-0.6; p < 0.001) reduced the likelihood of having a high sugar score. Whereas being male (OR 1.5, CI 1.2- 1.8; p < 0.001), urban (OR 1.9, CI 1.5 -2.3; p < 0.001), and young (OR 1.5, CI 1.2 -1.8; p < 0.001) increased the likelihood of having a high sugar score. Urban residents were less likely to take alcohol (OR 0.7, CI 0.6-0.9; p < 0.01), or smoke cigarette (OR = 0.7, CI = 0.6-0.9); less likely to be those who do not use fruits (OR 0.3, CI 0.2-0.4; p < 0.001); dental clinic (OR 0.5, CI 0.4-0.7; p < 0.001); factory made tooth brushes (OR 0.1, CI 0.08-0.17; p < 0.001) and toothpaste (OR 0.1, CI 0.1-0.2; p < 0.001) than their rural counterparts. More rural (13.2%) than urban (4.6%) residents used charcoal. CONCLUSION: The findings of this study demonstrated social demographic disparities in relation to oral health related behaviors, while dental pain was associated with low consumption of sugar and high likelihood to take alcohol.

Perceived dental treatment need among older Tanzanian adults - a cross-sectional study.

BACKGROUND: Need perceptions for dental care play a key role as to whether people in general will seek dental care. The aim was to assess the prevalence of perceived need of problem based dental care, dental check-ups and any type of dental care. Guided by the conceptual model of Wilson and Cleary, the relationship of perceived need for dental care with socio-demographic characteristics, clinically defined dental problems and self-reported oral health outcomes was investigated. Partial prosthetic treatment need was estimated using a socio-dental approach. METHOD: A cross-sectional survey was conducted in Pwani region and in Dar es Salaam in 2004/2005. Information from interviews and clinical examination became available for 511 urban and 520 rural adults (mean age 62.9 yr). RESULTS: 51.7% (95% CI 46.2, 57.0) urban and 62.5 % (95% CI 53.1, 70.9) rural inhabitants confirmed need for dental check-up, 42.9% (95% CI 36.9, 48.9) urban and 52.7% (95% CI 44.5, 60.6) rural subjects confirmed need for problem oriented care and 38.4% (95% CI 32.4, 44.6) urban versus 49.6% (95% CI 41.8, 57.4) rural residents reported need for any type of dental care. Binary and ordinal multiple logistic regression analyses revealed that adults who reported bad oral health and broken teeth were more likely to perceive need for dental care across the three outcome measures than their counterparts. Socio-demographic factors and clinically defined problems had less impact. Based on a normative and an integrated socio-dental approach respectively 39.5% and 4.7% were in need for partial dentures. CONCLUSION: About half of the participants confirmed need for problem oriented care, dental check-ups and any type of dental care. Need perceptions were influenced by perceived oral health, clinically assessed oral problems and socio-demographic characteristics. Need estimates for partial denture was higher when based on clinical examination alone compared to an integrative socio-dental approach.

Clinical and socio-behavioral correlates of tooth loss: a study of older adults in Tanzania.

BACKGROUND: Focusing 50 year olds and above, this study assessed the frequency, extent and correlates of tooth loss due to various reasons. Frequency and correlates of posterior occluding support was also investigated. METHOD: A cross-sectional household survey was conducted in Pwani region and in Dar es Salaam in 2004/2005. One thousand and thirty-one subjects, mean age 62.9 years participated in a clinical examination and completed interviews. RESULTS: The prevalence of tooth loss due to any reason was 83.5%, due to caries 63.4% and due to other reasons than caries, 32.5%. A total of 74.9% had reduced number of posterior occluding units. Compared to subjects having less than 5 teeth lost due to caries, those with 5 or more lost teeth were more likely to be females, having decayed teeth, confirming dental attendance and to be among the least poor residents. Compared to subjects who had lost less than 5 teeth due to reasons other than caries, those who had lost 5 or more teeth were more likely to be of higher age, having mobile teeth, being males, being very poor and to disconfirm dental attendance when having problems. Predictors of prevalence of tooth loss (1 or more lost tooth) due to various reasons and reduced number of occluding units followed similar patterns of relationships. CONCLUSION: The results are consistent with prevalence and extent of tooth loss due to caries and due to reasons other than caries being differently related to disease- and socio- behavioral risk indicators. Caries was the principle cause of tooth loss and molar teeth were the teeth most commonly lost.

Curricular transformation of health professions education in Tanzania: the process at Muhimbili University of Health and Allied Sciences (2008-2011).

Tanzania requires more health professionals equipped to tackle its serious health challenges. When it became an independent university in 2007, Muhimbili University of Health and Allied Sciences (MUHAS) decided to transform its educational offerings to ensure its students practice competently and contribute to improving population health. In 2008, in collaboration with the University of California San Francisco (UCSF), all MUHAS's schools (dentistry, medicine, nursing, pharmacy, and public health and social sciences) and institutes (traditional medicine and allied health sciences) began a university-wide process to revise curricula. Adopting university-wide committee structures, procedures, and a common schedule, MUHAS faculty set out to: (i) identify specific competencies for students to achieve by graduation (in eight domains, six that are inter-professional, hence consistent across schools); (ii) engage stakeholders to understand adequacies and inadequacies of current curricula; and (iii) restructure and revise curricula introducing competencies. The Tanzania Commission for Universities accredited the curricula in September 2011, and faculty started implementation with first-year students in October 2011. We learned that curricular revision of this magnitude requires: a compelling directive for change, designated leadership, resource mobilization inclusion of all stakeholders, clear guiding principles, an iterative plan linking flexible timetables to phases for curriculum development, engagement in skills training for the cultivation of future leaders, and extensive communication.

Prevalence and correlates of perceived oral malodor among adolescents in Temeke district, Dar es Salaam.

BACKGROUND: The objective of this study was to determine the prevalence of perceived oral malodor and its correlates in terms of self assessed oral health status and reported health behaviors (oral hygiene practice, dental attendance, tobacco use and alcohol consumption) among adolescents in secondary schools in Temeke district, Dar es Salaam. METHODS: Cross-sectional survey data were used. The sample consisted of adolescents (n= 400) 13 years old and above attending secondary schools in Temeke district. Eight schools were selected randomly from the sampling frame of all schools in the district (N=63). Self-administered questionnaires used to collect information from the adolescents included questions on socio-demographic details; perceived oral malodor; self rated oral health status and oral health related behavior (dental attendance, brushing, smoking and alcohol consumption). Data entry and analysis were done using Statistical Package for Social Sciences (SPSS) software version 13.0 .Chi-square and multiple logistic regressions were performed. RESULTS: Seventy two percents of the adolescents perceived oral malodor. More boys (62%) than girls (51%) rated their oral health to be poor. Almost all adolescents (97.5%) reported to brush their teeth; tongue brushing was 62% and 76% for boys and girls respectively. The percentage of adolescents who never attended to a dentist was 57% and 54% for boys and girls, respectively. Bleeding gums on brushing was reported by 64% of boys while in girls the percentage was 63%. Tobacco use was 23% and 16% for boys and girls, respectively and alcohol was consumed by 48% of boys and 31% of girls. Unadjusted logistic regressions revealed that subjects who perceived oral malodor were more likely to report having poor oral health status (OR = 1.5; CL= 1.1-2.3) and bleeding gums during brushing (OR = 1.8; CL = 1.1-2.3). Regarding oral health related behaviors, tongue brushing (OR=0.5; CI = 0.3-0.7), and alcohol consumption (OR = 0.6; CI = 0.4-0.9) did not vary in the expected direction as perceived oral malodor. Smoking habit (OR=0.7; C1=0.4-1.2) did not show a significant correlation with perceived oral malodor among adolescents in the selected schools of Temeke district. CONCLUSION: Oral malodor is prevalent among adolescents in Temeke district in Dar es Salaam. Information about perceived oral malodor and the factors associated with it might help in planning effective strategies to promote oral health and general health among this group of population

Chewing problems and dissatisfaction with chewing ability: a survey of older Tanzanians.

This study assessed the prevalence and correlates of reported chewing problems and dissatisfaction with chewing ability. Discrepancy between reported chewing problems and satisfaction/dissatisfaction with chewing ability was examined. A household survey was conducted in Tanzania in 2004/2005. A total of 1,031 adults (mean age 62.9 yr) underwent clinical examination and a personal interview. Forty per cent [95% confidence interval (CI): 37-43] reported problems with chewing at least one food item, and 25% (95% CI: 22-28) were dissatisfied with their chewing ability. Adjusted odds ratios (OR) for reporting problems with chewing any food were 1.6, 1.2, and 4.2 if having intact anterior/reduced posterior, reduced anterior/intact posterior, and reduced anterior/posterior occluding units, respectively. Subjects dissatisfied with their chewing ability were less likely to be female (OR = 0.6) and more likely to have reduced anterior/posterior occluding units (OR = 3.4), to report dental pain (OR =2.5), chewing problems (OR = 4.7), and oral impacts on daily performances (OIDP) (OR = 3.2). The OIDP scores discriminated between satisfied and dissatisfied groups, irrespective of confirmed chewing problems. Chewing problems and dissatisfaction with chewing ability was prevalent among older Tanzanians. Clinical measures of dentition status, together with reported functional and psychosocial impact scores, determined the subjects' evaluation of their chewing ability and should be taken into account when estimating treatment needs.