Factors associated with changes in adequate antenatal care visits among pregnant women aged 15-49 years in Tanzania from 2004 to 2016.

BACKGROUND: Antenatal care (ANC) is crucial for the health of the mother and unborn child as it delivers highly effective health interventions that can prevent maternal and newborn morbidity and mortality. In 2002, the World Health Organization (WHO) recommended a minimum of four ANC visits for a pregnant woman with a positive pregnancy during the entire gestational period. Tanzania has sub-optimal adequate (four or more) ANC visits, and the trend has been fluctuating over time. An understanding of the factors that have been contributing to the fluctuating trend over years is pivotal in increasing the proportions of pregnant women attaining adequate ANC visits in Tanzania. METHODS: The study used secondary data from Tanzania Demographic Health Survey (TDHS) from 2004 to 2016. The study included 17976 women aged 15-49 years. Data were analyzed using Stata version 14. Categorical and continuous variables were summarized using descriptive statistics and weighted proportions. A Poisson regression analysis was done to determine factors associated with adequate ANC visits. To determine factors associated with changes in adequate ANC visits among pregnant women in Tanzania from 2004 to 2016, multivariable Poisson decomposition analysis was done. RESULTS: The overall proportion of women who had adequate ANC visits in 2004/05, 2010 and 2015/16 was 62, 43 and 51% respectively. The increase in the proportion of women attaining adequate ANC from 2010 to 2015/16 was mainly, 66.2% due to changes in population structure, thus an improvement in health behavior. While 33.8% was due to changes in the mother's characteristics. Early initiation of first ANC visit had contributed 51% of the overall changes in adequate ANC attendance in TDHS 2015/16 survey. CONCLUSION: Early ANC initiation has greatly contributed to the increased proportion of pregnant women who attain four or more ANC visits overtime. Interventions on initiating the first ANC visit within the first twelve weeks of pregnancy should be a priority to increase proportion of women with adequate ANC visit.

To the hunter go the spoils? No evidence of nutritional benefit to being or marrying a well-reputed Hadza hunter.

OBJECTIVES: The incentives underlying men's hunting acquisition patterns among foragers are much debated. Some argue that hunters preferentially channel foods to their households, others maintain that foods are widely redistributed. Debates have focused on the redistribution of foods brought to camp, though the proper interpretation of results is contested. Here we instead address this question using two nutritional variables, employed as proxies for longer-term food access. We also report on broader patterns in nutritional status. MATERIALS AND METHODS: We measured male hunting success, hemoglobin concentration and body fatness among bush-living Hadza. Hunting success was measured using an aggregated reputation score. Hemoglobin concentration, a proxy for dietary red meat, was measured from fingerprick capillary blood. Body fatness, a proxy for energy balance, was measured using BMI and bioelectrical impedance. RESULTS: We find no statistically significant relationship between a hunter's success and any measure of his nutritional status or that of his spouse. We further find that: women are, as elsewhere, at greater risk of iron-deficiency anemia than men; men had slightly lower BMIs than women; men but not women had significantly lower hemoglobin levels than in the 1960s. DISCUSSION: The absence of an association between hunting reputation and nutritional status is consistent with generalized food sharing. Null results are difficult to interpret and findings could potentially be a consequence of insufficient signal in the study measures or some confounding effect. In any event, our results add to a substantial corpus of existing research that identifies few nutritional advantages to being or marrying a well-reputed Hadza hunter.

Factors influencing adoption of facility-assisted delivery - a qualitative study of women and other stakeholders in a Maasai community in Ngorongoro District, Tanzania.

BACKGROUND: Tanzania's One Plan II health sector program aims to increase facility deliveries from 50 to 80% from 2015 to 2020. Success is uneven among certain Maasai pastoralist women in Northern Tanzania who robustly prefer home births to facility births even after completing 4+ ANC visits. Ebiotishu Oondomonok Ongera (EbOO) is a program in Nainokanoka ward to promote facility births through a care-group model using trained traditional birth attendants (TBAs) as facilitators. Results to date are promising but show a consistent gap between women completing ANC and those going to a facility for delivery. A qualitative study was conducted to understand psychosocial preferences, agency for decision-making, and access barriers that influence where a woman in the ward will deliver. METHODS: In-depth interviews, focus group discussions and key-informant interviews were conducted with 24 pregnant and/or parous women, 24 TBAs, 3 nurse midwives at 3 health facilities, and 24 married men, living in Nainokanoka ward. Interviews and discussions were transcribed, translated, and analyzed thematically using a grounded theory approach. RESULTS: Most women interviewed expressed preference for a home birth with a TBA and even those who expressed agency and preference for a facility birth usually had their last delivery at home attributed to unexpected labor. TBAs are engaged by husbands and play a significant influential role in deciding place of delivery. TBAs report support for facility deliveries but in practice use them as a last resort, and a significant trust gap was documented based on a bad experience at a facility where women in labor were turned away. CONCLUSIONS: EbOO project data and study results show a slow but steady change in norms around delivery preference in Nainokanoka ward. Gaps between expressed intention and practice, especially around 'unexpected labor' present opportunities to accelerate this process by promoting birth plans and perhaps constructing a maternity waiting house in the ward. Rebuilding trust between facility midwives, TBAs, and the community on the availability of health facility services, and increased sensitivity to women's cultural preferences, could also close the gap between the number of women who are currently using facilities for ANC and those returning for delivery.

Monitoring the body: grandmothers' ability to provide 'expert' care for grandchildren living with HIV in northwest Tanzania.

Drawing on long-term ethnographic fieldwork on older caregivers and their shifting roles since the introduction of antiretroviral therapy in northwest Tanzania, this article explores grandmothers' roles in caring for grandchildren who are HIV positive and on treatment. While AIDS treatment programmes usually focus on cultivating expert patients who can perform self-care, this study focuses on older caregivers and how they become experts in caring for their grandchildren living with HIV. How is expert care enacted and what supports or limits its quality? Based on observations and in-depth interviews, this article argues that grandmothers become 'expert caregivers' by merging knowledge acquired in the clinic and support groups with intimate practices of grandparental care. However, the grandmother's gendered and generational position within kin networks affects her ability to provide expert care. The findings indicate that in analysing treatment outcomes among adolescents, it is important to understand the broader family dynamic that influences the actual possibility of expert caregivers to support children living with HIV.

Maternal perceptions of breastfeeding and infant nutrition among a select group of Maasai women.

BACKGROUND: Adverse health outcomes are higher among Maasai children in the Ngorongoro Conservation Area compared to other co-located ethnic groups and regions of Tanzania. The Mama Kwanza Socioeconomic Health Initiative, a Canadian-Tanzanian partnership delivering healthcare at clinics in this region, gathered perceptions of mothers regarding breastfeeding and infant nutrition in order to inform culturally sensitive, realistic, and effective health promotion efforts. METHODS: A qualitative description approach was used in interviewing 30 Maasai mothers of infants zero to six months of age to explore their infant feeding practices, beliefs, knowledge, and recommendations to support breastfeeding. A local research team was trained to conduct and transcribe the interviews and assist with data interpretation. Qualitative content analysis was used in analyzing the interview transcripts. RESULTS: Lactation is universal in this culture with all the mothers planning to breastfeed for at least one year and most having initiated breastfeeding within one hour of birth. Lactation skills and knowledge are passed down intergenerationally from the elder women. None of the infants less than six months were exclusively breastfed, with a variety of liquid and semi-solid supplements given. Mothers perceived their milk alone was nutritionally insufficient with maternal dietary deficiencies cited as a factor. CONCLUSIONS: While there is a strong breastfeeding culture among the Maasai in Ngorongoro, intersectoral efforts are required to provide culturally respectful health education on the benefits of exclusive breastfeeding and to ensure the maternal dietary adequacy required to achieve this goal. The findings reinforce the importance of international health projects adapting health promotion initiatives to local realities and beliefs in efforts to improve maternal child health.

Similarities in Color Preferences Between Women and Men: The Case of Hadza, the Hunter-Gatherers From Tanzania.

Evidence for cross-cultural patterns of sexual differences in color preferences raised the question of whether these preferences are determined by universal principles. To address this question, we investigated most- and least-favorite color choices in a nonindustrialized community, the Hadza that has an egalitarian hunter-gatherer culture, fundamentally different from those previously investigated. We also compared color preference patterns in the Hadza with published data from Poland and Papua. Our results show that Hadza have very different color preferences than Polish and Papuan Yali respondents. Unlike many industrialized and nonindustrialized cultures, Hadza color preferences are practically the same for women and men. These observations question the idea of universal differences of color preferences between sexes and raise important questions about the determinants of color preferences.

"A child may be tall but stunted." Meanings attached to childhood height in Tanzania.

Stunting affects large numbers of under-fives in Tanzania. But do caretakers of under-fives recognize height as a marker of child growth? What meanings do they attach to linear growth? An ethnographic study using cultural schemas theory was conducted in a rural community in Southeastern Tanzania to investigate caregivers' conceptualizations of child height in relation to growth and the meanings attached to short stature. Data for the study were collected through 19 focus group discussions, 30 in-depth interviews, and five key informant interviews with caregivers of under-fives, including mothers, fathers, elderly women, and community health workers. Principles of grounded theory guided the data management and analysis. Although caregivers could recognize height increments in children and were pleased to see improvements, many held that height is not related to nutrition, health, or overall growth. They referred to short stature as a normal condition that caregivers cannot influence; that is, as a function of God's will and/or heredity. While acknowledging short stature as an indicator of stunting, most participants said it is not reliable. Other signs of childhood stunting cited by caregivers include a mature-looking face, wrinkled skin, weak or copper-coloured hair, abnormal shortness and thinness, delayed ability to crawl/stand/walk, stunted IQ, and frequent illness. Culturally, a child could be tall but also stunted. Traditional rather than biomedical care was used to remedy growth problems in children. Public health programmers should seek to understand the local knowledge and schemas of child stature employed by people in their own context before designing and implementing interventions.

Universal classifications, national approaches and specific situations: a comparative study on the conceptualization of nodding syndrome in Uganda and Tanzania.

This paper presents a comparative study on conceptualizations of the poorly understood nodding syndrome (NS) in Uganda and Tanzania. NS has been constructed as a biomedical category to serve global health discourse as well as national contexts of managing the condition. The paper looks into the shifting meanings and conceptualizations of NS in the affected areas of Kitgum (UG) and Mahenge (TZ) district. The perceived universality of biomedical classifications is problematized as conflicting with the specific contexts of lucluc and kifafa cha kusinzia. Reconciliation proves to be challenging, poignantly evoking the cultural construction as such of any medical condition.

'To be honest, women do everything': understanding roles of men and women in net care and repair in Southern Tanzania.

BACKGROUND: In Tanzania, the roles of men and women are classified based on the local cultural context. While men are usually the breadwinners, women are traditionally responsible for most domestic chores. Particularly for malaria prevention, studies in Africa have revealed women as being responsible for daily up-keep of the net. Using social role theory, this study explored the role of men and women in net care and repair and gender-related motivation and barriers to net care and repair in Tanzania. METHODS: The study was conducted in the two villages of Ruangwa district in Lindi Region. The study applied qualitative approaches and carried out in-depth interviews and focus group discussions with men, women, women with children under the age of five, and village key informants. RESULTS: Mosquito nets were valued by all participants as a protection measure against mosquitoes. Study findings indicate that net care and repair falls under a woman's daily household responsibilities. While men were said to assist in stitching damaged nets, washing dirty bed nets was regarded inappropriate for men and not traditionally accepted. Motivation for net care and repair was reported to come from both men and women; for a woman keeping the net clean defined a caring and responsible woman, while men indirectly promoted net washing when complaining about nets being dirty. Women reported that men could do everything that women do regarding net care and repair, but that it does not fit into societal norms. CONCLUSION: With increased globalization in Tanzania, more women are becoming part of the workforce, which may limit their full commitment to net care and repair activities, leading to increased net damage, malaria incidences and higher costs for malaria treatment. The National Malaria Control Programme should consider incorporating research-informed gender-transformative messages into their behaviour change communication on mosquito nets and work closely with trusted Community Health Workers to inform communities about the importance of sharing responsibilities in net care and repair. It is acknowledged that changing people's behaviour and practices is a long process, which will require a deep cultural and political shift.

Social networks and cooperation in hunter-gatherers.

Social networks show striking structural regularities, and both theory and evidence suggest that networks may have facilitated the development of large-scale cooperation in humans. Here, we characterize the social networks of the Hadza, a population of hunter-gatherers in Tanzania. We show that Hadza networks have important properties also seen in modernized social networks, including a skewed degree distribution, degree assortativity, transitivity, reciprocity, geographic decay and homophily. We demonstrate that Hadza camps exhibit high between-group and low within-group variation in public goods game donations. Network ties are also more likely between people who give the same amount, and the similarity in cooperative behaviour extends up to two degrees of separation. Social distance appears to be as important as genetic relatedness and physical proximity in explaining assortativity in cooperation. Our results suggest that certain elements of social network structure may have been present at an early point in human history. Also, early humans may have formed ties with both kin and non-kin, based in part on their tendency to cooperate. Social networks may thus have contributed to the emergence of cooperation.

Cyberbullying and Cybervictimization Within a Cross-Cultural Context: A Study of Canadian and Tanzanian Adolescents.

This study explored cyberbullying and cybervictimization (CBCV), for adolescents aged 11-15 from Tanzania (N = 426) and Canada (N = 592). Measurement invariance and model invariance was found for CBCV. In addition, multigroup structural equation modeling was used to explore several variables: age, gender, average hours online each day, accessing the Internet in a private location, having online privacy concerns, going online for social purposes, and motivation for cyberbullying. Results found interesting patterns within each country. It was found that cellphone ownership moderated the relation between these predictor variables and reported incidences of CBCV uniquely for each country. These findings provide evidence for the global nature of cyberbullying.

Mental Health Diagnostic Frameworks, Imputed Causes of Mental Illness, and Alternative Treatments in Northern Tanzania: Exploring Mental Health Providers' Perspectives.

In Tanzania, a nation with a large mental health treatment gap, local stakeholders' perspectives are critical for informing effective treatment. The practice-based perspectives of mental health providers may be particularly instructive. Existing foundational literature on the professional population in this region is scarce. We conducted semi-structured interviews with 29 mental health providers in northern Tanzania. Interviews focused on three topics: use of international diagnostic frameworks for mental illness, beliefs about causes of mental health concerns, and alternative treatments sought by clients. Interview data were coded and analyzed using consensual qualitative research and the constant comparative method. Usage of diagnostic frameworks varied widely. Providers believed frameworks accurately described many patients but neglected somatic symptoms and contained diagnoses that they had never witnessed. Providers described supernatural and spiritual attributions of mental illness as substantially impacting treatment decisions. Other notable attributions included physical illness, drug/alcohol use, and heredity. Providers reported their clients routinely sought treatment from traditional and spiritual healers prior to seeking care in the formal health system. This study builds a foundation for the ongoing development of the mental health system in northern Tanzania. Findings also support exploration of integrative models of care and task-shifting to incorporate traditional and spiritual beliefs.

When a rash has two names: pese sorcery and kisigo spirits at Lake Tanganyika.

This explorative and qualitative study, based on 27 interviews during two months of fieldwork, describes pese, an affliction of the skin that has conspicuously stayed under the radar of medico-anthropological research in Kigoma, a rural city in the northwest Tanzania. The condition reminds of a locally better known condition labeled kisigo, raising the question why two concepts of the same affliction exist side by side. It seems indicative that the two illness concepts stem from different cultures and that each specializes in an explanatory model: the former witchcraft (sorcery) and the latter spirit possession. Moreover, a symbiotic relation seems to exist between the healing traditions of the Bembe and the Ha. Government policies prohibiting witchcraft and targeting traditional healers seem to have created a situation where witchcraft practices and beliefs have come to represent the periphery and survive there, clandestinely.

The course of pregnancy and delivery in a patient with malaria.

Malaria is one of the most common lethal parasitic diseases. Infection is transmitted when an infected female mosquito bites a human introducing the sporozoites into human blood. The article presents the course of pregnancy and delivery in a patient complicated by Plasmodium infection. The patient had repetitive several trips to Tanzania over a short time period before she developed the condition. She had been taking antimalarial medication (proguanil-atovaquone) in a prophylactic dose during and after her first travel to Tanzania. Following her first return to Poland she experienced infection-related symptoms.

Hadza hunter-gatherer men do not have more masculine digit ratios (2D:4D).

OBJECTIVES: The ratio between the length of the second and the length of the fourth digit (2D:4D) is sexually dimorphic such that males of many species possess a lower ratio than females, particularly in the right hand. Still, men and women often exhibit overlapping 2D:4D ranges and the ratio is highly variable between populations. In order to further explore populational variability, we chose to analyze 2D:4D in the Hadza, a population of hunter-gatherers living in Tanzania. MATERIALS AND METHODS: Data were collected separately by two researchers over the course of three years (1998, 2001, 2006) from 152 adult participants (male: n = 76, female: n = 76). Independent samples t-tests were used to explore sex differences, paired samples t-tests were used to explore directional effects within each sex, and linear regression and one-way ANOVA were used to test possible age effects. RESULTS: In none of the years, or pooled (n = 152), did we find evidence that adult men have a lower 2D:4D than adult women. If anything, the data suggest that women in this population have a significantly lower right hand 2D:4D than men (P < 0.001, d = 0.57). In contrast, left hand 2D:4D did not exhibit a sex difference (P = 0.862, d = 0.03). DISCUSSION: These findings challenge the current view that lower 2D:4D in men is a uniform characteristic of our species. Cross-populational variance in 2D:4D may be related to known patterns of hormonal variation resulting from both genetic and environmental mechanisms, though this relationship merits further investigation.

Rethinking peer support for diabetes in Vancouver's South-Asian community: a feasibility study.

AIM: To examine the feasibility and potential health impact of a diabetes self-management education and support intervention involving peer support on glycaemic control and diabetes distress. METHODS: A total of 41 South-Asian adults with Type 2 diabetes were recruited for a 24-week diabetes self-management education and support pilot intervention involving peer support. The intervention consisted of six weekly education sessions co-facilitated by a certified diabetes educator and two peer leaders, followed by 18 weekly support sessions facilitated by two peer leaders. Education sessions were guided entirely by participants' self-management questions and also emphasized goal setting and action planning. Support sessions were based on empowerment principles and participants discussed self-management challenges, shared emotions, asked self-management questions, problem-solved in a group, set goals, and developed and evaluated action plans. Feasibility outcomes included recruitment and retention. Primary health-related outcomes included HbA1c levels and diabetes distress (measured at baseline, 6 and 24 weeks). Programme satisfaction was also assessed. RESULTS: Pre-established criteria for recruitment and retention were met. Paired t-tests showed no changes in HbA1c and diabetes distress at 6 weeks. At 24 weeks, HbA1c levels deteriorated [54 mmol/mol (7.1%) vs 61 mmol/mol (7.7%)] while diabetes distress scores improved (2.0 vs 1.7). CONCLUSIONS: Although feasible, findings suggest this peer-support model may have a positive impact on diabetes distress, but not on HbA1c levels. Culturally responsive modifications (e.g. intervention location) to the pilot model are needed and could lead to more favourable health outcomes for this community. Such a re-designed peer-support model will require further investigation.

A Qualitative Study of Mental Health Problems Among Orphaned Children and Adolescents in Tanzania.

Low- and middle-income countries have a high number of orphans, many of whom have unmet mental health needs. Effective mental health interventions are needed; however, it is necessary to understand how mental health symptoms and needs are perceived locally to tailor interventions and refine measurement of intervention effects. We used an existing rapid ethnographic assessment approach to identify mental health problems from the perspective of orphans and guardians to inform a subsequent randomized controlled trial of a Western-developed, evidence-based psychosocial intervention, Trauma-focused Cognitive Behavioral Therapy. Local Kiswahili-speaking interviewers conducted 73 free list interviews and 34 key informant interviews. Results identified both common cross-cultural experiences and symptoms as well as uniquely described symptoms (e.g., lacking peace, being discriminated against) not typically targeted by the intervention or included on standardized measures of intervention effects. We discuss implications for adapting mental health interventions in low- and middle-income countries and assessing effectiveness.

[Comparative Analysis of Polymorphisms of the Serotonin Receptor Genes HTR1A, HTR2A, and HTR1B in Hadza and Datoga Males].

The distribution of the allele and genotype frequencies of polymorphic loci of serotonin receptor genes (HTR1A, rs6295; HTR2A, rs6311; HTR1B, rs6296) in Hadza (n = 197) and Datoga males (n = 230) living in Tanzania was determined. It was shown that the populations significantly differ by the frequencies of alleles and genotypes of the rs6295 locus of the HTR1A gene. The G-allele (0.779) and the genotype G/G (0.590), which are markers of increased risk of suicidal and impulsive behavior, respectively, are revealed in Hadza with high frequency. It was found that the frequency of homozygous G/G of the rs6296 locus of the HTR1B gene, which is a marker of increased risk of outward directed aggression, is higher in Datoga (0.563) than in Hadza (0.457). The allele and genotype frequencies of the rs6311 locus of the HTR2A gene do not differ among the Hadza and Datoga males. The data on the distribution of allele and genotype frequencies of the HTR1A, HTR2A, and HTR1B genes can be used to determine the associations of the identified markers with various forms of human aggressive behavior.

Mapping for maternal and newborn health: the distributions of women of childbearing age, pregnancies and births.

BACKGROUND: The health and survival of women and their new-born babies in low income countries has been a key priority in public health since the 1990s. However, basic planning data, such as numbers of pregnancies and births, remain difficult to obtain and information is also lacking on geographic access to key services, such as facilities with skilled health workers. For maternal and newborn health and survival, planning for safer births and healthier newborns could be improved by more accurate estimations of the distributions of women of childbearing age. Moreover, subnational estimates of projected future numbers of pregnancies are needed for more effective strategies on human resources and infrastructure, while there is a need to link information on pregnancies to better information on health facilities in districts and regions so that coverage of services can be assessed. METHODS: This paper outlines demographic mapping methods based on freely available data for the production of high resolution datasets depicting estimates of numbers of people, women of childbearing age, live births and pregnancies, and distribution of comprehensive EmONC facilities in four large high burden countries: Afghanistan, Bangladesh, Ethiopia and Tanzania. Satellite derived maps of settlements and land cover were constructed and used to redistribute areal census counts to produce detailed maps of the distributions of women of childbearing age. Household survey data, UN statistics and other sources on growth rates, age specific fertility rates, live births, stillbirths and abortions were then integrated to convert the population distribution datasets to gridded estimates of births and pregnancies. RESULTS AND CONCLUSIONS: These estimates, which can be produced for current, past or future years based on standard demographic projections, can provide the basis for strategic intelligence, planning services, and provide denominators for subnational indicators to track progress. The datasets produced are part of national midwifery workforce assessments conducted in collaboration with the respective Ministries of Health and the United Nations Population Fund (UNFPA) to identify disparities between population needs, health infrastructure and workforce supply. The datasets are available to the respective Ministries as part of the UNFPA programme to inform midwifery workforce planning and also publicly available through the WorldPop population mapping project.

[Polymorphism of 5-HTTLPR and Stin2 loci of the serotonin transporter gene in males of African ethnic populations Hadza and Datoga].

A molecular-genetic study of 5-HTTLPR and the Stin2 loci of the serotonin transporter gene (5-HTTL) in males of the African ethnic populations Hadza and Datoga, which differ in the level of culturally acceptable aggression, was carried out. The distribution of allele and genotype frequencies of these two loci was established. It was shown that the frequency distribution of genotypes and alleles among Hadza and Datoga in the examined samples is practically identical by the VNTR-polymorphism of both loci. However, the Hadza populations, as compared to Datoga, showed a significant (p = 0.006) increase in the frequency of the transcriptionally less active allele L(G) of the 5-HTTLPR locus. For the first time, the structure of the allelic variant of locus Stin2 with eight repetitions (Stin2.8) is described and established for African populations. The test for independence of the frequency distribution of the alleles of the studied loci showed highly significant linkage disequilibrium among Hadza (p << 0.001) and Datoga (p = 0.021). In analysis of the genotype combinations of two loci, it was revealed that thestudied populations differed significantly by the L(A)L(G) 10/12 genotype (p << 0.001). When combining the genotypes, no significant differences between the populations based on their expression activity were identified. We assume that the identified combined genotypes reflect the effects of similar behavioral traits for both populations.