Epidemiological analysis of tongue lesions in a tertiary health facility in Tanzania

Background: The tongue is susceptible to a multitude of conditions that can be of developmental, neoplastic, or inflammatory nature, whose occurrence varies globally by age, sex, and ethnicity. The objective of the present study was to determine the incidence of tongue lesions among cases managed in a tertiary hospital in Tanzania. Methods: This study analyzed histological results of patients with tongue lesions diagnosed between 2016 and 2021. Data on the age and sex of the patients and histological diagnosis were collected. Data analysis was done using Statistical Package for the Social Sciences version 27. Results: A total of 190 samples of tongue lesions were studied and 18 different histological diagnoses were observed. Generally, a majority (84.2%) of the biopsied tongue lesions were malignant. The most common (74.7%) lesions diagnosed were squamous cell carcinoma followed by hemangioma (5.3%). A significant association was noted between the nature of the lesions and the age group and sex of the patients. Conclusion: This analysis depicts that tongue lesions are frequently encountered in patients managed in tertiary health facilities in Tanzania. A majority of these lesions are malignant tumors. The sex and age of the patients are determining factors for the occurrence of tongue lesions

Knowledge and practices of epistaxis in Eastern Tanzania: A cross-sectional study of an emergency in otorhinolaryngology

Introduction: It's approximated that 60% of the population globally experience epistaxis during lifetime. Despite epistaxis being prevalent in Tanzania, there are limited studies that have explored experience of participants on epistaxis. This study aims to determine knowledge on the causes, first aid management and practices of epistaxis among patients attending a health facility in Eastern Tanzania Methods: A descriptive cross-sectional study was conducted where 371 participants aged 15 years and above were interviewed using structured questionnaires. Data was analyzed using Statistical Package of Social Sciences version 23. Chi-square tests were performed and a p-value <0.05 was considered to be statistically significant Results: About two-thirds (60.9%) of the study participants had good knowledge of the causes of epistaxis. Majority of participants knew excessive nose manipulation (95.1%) to be the commonest cause of epistaxis and the least cause mentioned was chronic liver disease (24.8%). On the other hand, 77.6% of the participants had good knowledge while 22.4% had poor knowledge regarding first aid management of epistaxis. In this study, 328 (88.4%) participants knew pressing the nose could stop epistaxis, while 164(44.2%) knew the best position to stop epistaxis and that is to tilt the head forward and those who had history of epistaxis, 150 (73.2%) out of 205 pinched the nose as the first aid. Similarly, 133(35.8%) participants thought cessation of smoking has effect on decreasing the occurrence of epistaxis. A significant association was noted between knowledge of first aid management of epistaxis and some socio-demographic characteristics such as age and educational level. There was also a significant association between knowledge of the causes of epistaxis and educational level. Conclusion: Majority of the participants had good knowledge of the causes and first aid management of epistaxis.

Perceived COVID-19 vaccine uptake and effect on delivery of health services in Tanzania: A qualitative study of community and health Workers

Background:The World Health Organization (WHO) declared the novel coronavirus a worldwide pandemic in March 2020. Since the coronavirus(COVID-19) is highly contagious, the number of confirmed cases and death rates has increased dramatically. The COVID-19 pandemic has caused significant morbidity and mortality throughout the world, as well as major social, educational and economic disruptions.Studies conducted in other low-and middle-income countries showed that health workers perceived the vaccine as beneficial; the benefits include preventing infection and limiting severity of of the disease. Despite myths and misconceptions which are reported to contribute significantly towards vaccine hesitancy in several African countries, there is a scarcity of systematic documentation of health workers and community perceptions on how the COVID-19 vaccine impactedthe delivery and uptake of other services in Tanzania. Objective: This study assessed and documented health workers' and community perceived uptake and impact of COVID-19 vaccination on the delivery of other services in Tanzania.Methods:A phenomenological cross-sectional study among 632 healthcare workers at all levels and community leaders was conducted using interview guides for key informants, in-depth interviews, and Focus Group Discussions. The collected data were analyzed using a thematic analysis approach.Results:In this study, six themes emerged, namely COVID-19 vaccine uptake, hesitation and awareness, COVID-19 transmission and prevention, and the effect of COVID-19 vaccination on the delivery and uptake of other services. Most study participants indicated that they were aware of COVID-19and could understand the mode of COVID-19 transmission. Participants identified several factors that contribute to vaccine hesitation in the country. Such factors included receiving mixed information on the COVID-, family influence and secretive manner of vaccine delivery. Participants indicated that a shortage of resources affected the delivery of other services. Nevertheless, other participants indicated that the COVID-19vaccination program did not affect the delivery of other health services. Based on the participants' views, the country was unprepared to respond effectively to the pandemic. Conclusion: The Ministry of Health, under the communication section, should raise awareness of COVID-19 and its means of transmission. Using community leaders and champions to deliver appropriate information on COVID-19 vaccination may increase vaccine uptake and prevent misconceptions among community members.

Marburg virus disease: a brief updated overview

The Marburg virus disease made headlines when Tanzania declared an outbreak on the 23rd of March 2023. Five deaths and three further cases were identified at the time of the announcement. Symptoms of Marburg virus can include fever, headache, muscle aches, vomiting, diarrhoea, and bleeding from various parts of the body, hence the similarity to Ebola which also causes a haemorrhagic fever. There is no specific treatment for Marburg virus, but supportive care can help manage symptoms and improve outcomes. This article aims to update physicians working in primary care on the presentation of Marburg virus disease as well as the latest updates in guidelines implemented to help with its management and prevention.

Heroin use among clients receiving methadone treatment in Dar es Salaam Tanzania: a qualitative study

Background: Simultaneous heroin use among methadone-maintained clients is a recognized phenomenon worldwide. Tanzania is the first sub-Saharan African country to offer methadone treatment. This study explored reasons for heroin use among clients on methadone treatment clinics in Dar es Salaam, Tanzania. Methods: This was exploratory cross-sectional study. Purposive sampling was used to select ten study participants. In in-depth interview guide was used to collect data. The interviews were conducted in Kiswahili and lasted for about sixty minutes. Audio-recordings of the interviews were transcribed verbatim and translated into English. Transcribed data was analysed and subjected to thematic analysis with the help of Nvivo 12 software. Results: Many reasons were mentioned for concurrent use of heroin and methadone among clients on methadone treatment. Some of the mentioned reasons were inadequate methadone dose, treatment, healthcare providers’ attitudes, and healthcare provision environment, lack of family support, peer influence homeless and easy availability of heroin. Conclusions: Different measures should be taken by methadone programs and stakeholders to overcome concurrent use of heroin and methadone among clients receiving methadone treatment.

Prevalence of middle ear effusion among children with adenoid hypertrophy at a national referral hospital in Tanzania

Introduction: Middle ear effusion (MEE) is a common childhood disorder that causes hearing impairment due to the presence of fluid in the middle ear which reduces the middle ear's ability to conduct sound. Temporary or persistent hearing loss as a result of MEE causes speech, language and learning delays in children. There are few studies on MEE in Tanzania despite the huge burden of hearing loss among children with adenoid hypertrophy which is a known risk factor for MEE. Method: A cross-sectional study was conducted among 420 children aged nine years and below having adenoid hypertrophy with or without MEE. The diagnosis of adenoid hypertrophy was confirmed with a lateral view x-ray of the nasopharynx and tympanometry for cases with MEE. The primary objective of the study was to assess the prevalence of MEE among children with adenoid hypertrophy. Results: The prevalence of MEE among children with adenoid hypertrophy was 61.7%, with 218 (51.9%) males and 202 (48.1%) females. The most affected age group was 2-4 years with an incidence 193 (46%) and in this age group, males (53.9%) were more affected than females (46.1%). Generally, males, 134 (51.7%) were more affected by MEE than females, 125 (48.3%) of all 259 children with MEE. In terms of age group predominance by MEE, children aged 3-4 years, 107(41.3%) were more affected than all other age groups. Additionally, 4 (1.5%) children with MEE presented with hearing loss. Conclusion: There is a high prevalence of MEE among children with adenoid hypertrophy but no significant association with hearing loss.

The development of a digital NGO mapping platform in Tanzania, as a tool to strengthen civil society engagement, in pursuit of Universal Health Coverage

The role of civil society in economic development, improving livelihoods and in providing pathways towards achieving health for all has become increasingly evident. By mapping these organizations, the scope and scale as well as existing capacities, gaps, and opportunities are brought to light. This paper describes the implementation of a digital mapping platform for NGOs; an interactive site which collects, analyses, and visualizes data from a variety of sources about NGOs in Tanzania, through a series of interactive maps, graphs, and charts. We describe the approach and the technology used to develop the platform and its potential contribution towards improving health outcomes. A situation analysis and needs assessment exercise was conducted in February 2023. The developed system requirement specification document served as the guiding document in the design and development of new modules. Participatory techniques and agile iterative methodologies comprising regular stakeholder engagement were employed. A distributed revision control system was used to keep track of system revisions. The modules were deployed to the production server at the National Internet Data Center (NIDC) server room, followed by a system commissioning activity in October 2023. The NGO Information System, NGO Digital Mapping tool, NGO Analytic tool, NGO Search tool and NGO Opportunities module were designed, developed, and commissioned to support NGO operations in Tanzania. The platform was launched during the annual NGO Forum in Dodoma, Tanzania, on October 5, 2023. The modules are publicly accessible and are housed within the NGO Information System (NIS) platform. Investment in whole-of-society engagement to build health systems resilience for universal health coverage is crucial. Leveraging the unique positioning of NGOs draws us a step closer to the ambitious goal of achieving health for all. Through this one-stop web application system, information on the near real-time status, existing gaps, and opportunities for collaboration to serve communities is readily available for all stakeholders. Wide dissemination and enhancement of utilization of the platform across all sectors is now needed, for data to truly inform action.

Validation of HIV risk screening tool to identify infected adults and adolescents greater than 14 years at community level in Tanzania and Zambia

Introduction: There are several risk factors being used to identify undiagnosed HIV-infected adults. As the number of undiagnosed people gets less and less, it is important to know if existing risk factors and risk assessment tools are valid for use. Methods: Data from the Tanzania and Zambia Population-Based HIV Impact Assessment (PHIA) household surveys which were conducted during 2016 was used. We first included 12 risk factors (being divorced, separated or widowed; having an HIV+ spouse; having one of the following within 12-months of the survey: paid work, slept away from home for ≥1-month, having multiple sexual partners, clients of sex workers, sexually transmitted infection, being tuberculosis suspect, being very sick for ≥3-months; ever sold sex; diagnosed with cervical cancer; and had TB disease into a risk assessment tool and assessed its validity by comparing it against HIV test result. Sensitivity, specificity and predictive value of the tool were assessed. Receiver Operating Characteristic (ROC) curve comparison statistics was also used to determine which risk assessment tool was better. Results: HIV prevalence was 2.3% (2.0%-2.6%) (n=14,820). For the tool containing all risk factors, HIV prevalence was 1.0% when none of the risk factors were present (Score 0) compared to 3.2% when at least one factor (Score ≥1) was present and 8.0% when ≥4 risk factors were present. Sensitivity, specificity, PPV, and NPV were 82.3% (78.6%-85.9%), 41.9%(41.1%-42.7%), 3.2%(2.8%-3.6%), and 99.0%(98.8%-99.3%), respectively. The use of a tool containing conventional risk factors (all except those related with working and sleeping away) was found to have higher AUC (0.65 vs 0.61) compared to the use of all risk factors (p value <0.001). Conclusions: The use of a screening tool containing conventional risk factors improved HIV testing yield compared to doing universal testing. Prioritizing people who fulfill multiple risk factors should be explored further to improve HIV testing yield.

Evaluation of the physiological potential of Panicum maximum seeds by multivariate analysis

The aim of this work was to identify efficient vigor tests for differentiating the seed lots, forecasting seedling emergence in the field and assessing the physiological quality of Panicum maximum seeds. 12 seed lots from the cultivar Tanzania and 11 seed lots from the cultivar Massai were evaluated for water content, germination, first count and germination speed index, emergence and first emergence count of seedlings in sand, root length and shoot length, analysis of SVIS® images (seedling length, vigor and uniformity index) and seedling emergence in the field. The work was conducted in a completely randomized design for tests performed in the laboratory and in randomized blocks for tests in the field. The data were subjected to analysis of variance and the means compared by Scott Knott's test at 5% probability and statistical multivariate clustering analysis and principal components analysis. The shoot and root length tests are efficient for the evaluation of the physiological potential of P. maximum cv. Massai, while the seedling length, vigor index and growth uniformity index tests using image analysis, seedling emergence in sand and first seedling emergence count in sand are efficient in assessing the physiological potential of seeds of P. maximum cv. Tanzania, and providing information similar to that of seedling emergence in the field.

Maternal micronutrient status as a risk factor for perinatal mortality in a Tanzanian randomized controlled trial

The objective of this study was to determine if maternal micronutrient status (specifically iron) during pregnancy is a risk factor for perinatal mortality among women in Tanzania. Secondary analysis of data from a randomized, double-blind, placebo-controlled vitamin A supplementation trial conducted between August 2010-March 2013 was used to assess iron intake among women who experienced a stillbirth or early neonatal death. The mean dietary iron intake (measured using a quantitative Food Frequency Questionnaire) for this population was 12.64 mg/day (SD = 6.32). There were 206 cases of perinatal mortality. Three classifications of dietary iron intake were devised and risk ratios were calculated using the Log Binomial Regression Model: <18 mg/day (RR: 2.13), 18-27 mg/day (RR: 2.63), & >27 mg/day (the reference group to which the first two classification groups were compared).There was neither a significant relationship found among women who consumed iron levels <18 mg/day or between 18-27 mg/day of iron compared to women who consumed more than 27 mg/day of iron, but on average there was twice the risk for perinatalmortality. The current study is consistent with previous literature findings and supports the need for more efficacious nutrition strategies. (Afr J Reprod Health 2022; 26[7]: 38-48).

Strengthening access to long-acting reversible contraception within postabortion care in Tanzania: A pre-post evaluation

Postabortion care services provide lifesaving treatment for abortion-related complications and addresses women's needs by offering family planning (FP) counseling and voluntary access to contraception. Between 2016 and 2020, the Government of Tanzania sought to strengthen its PAC program by enhancing FP counseling and clients' access to a wide range of contraceptive options.The project team conducted a pre-post evaluation in 17 public sector healthcare facilities in mainland Tanzania and 8 in Zanzibar. It comprised structured client exit interviews (CEIs), completed first in 2016 (n=412) and again in 2020 (n=484). These data complemented an evaluation that used routine service statistics to demonstrate the intervention's effects on client-reported outcomes. Primary outcomes of the CEIs reflected client experience and satisfaction with services, and researchers compared prepost differences using chi-square tests. There were improvements in numerous indicators, including client waiting times, recall of emergency procedure counseling, contraceptive uptake, and satisfaction with the quality of overall counseling and FP information and services; however, triangulation of CEI data with service statistics indicated that some outcomes, though still improved since baseline, attenuated. Strengthening the FP component of PAC is feasible in Tanzania and Zanzibar, but strategies to sustain quality improvements over time are needed. (Afr J Reprod Health 2022; 26[5]: 28-40)

Dental fear and its related factors among patients managed in a paediatric dental clinic of a university hospital in Tanzania

Objective: This study aimed to determine the prevalence of dental fear and its related factors among patients managed in a pediatric dental clinic of a university hospital in Tanzania. Material and Methods: This was a cross-sectional study carried out at the paediatric dental clinic of the Muhimbili University of Health and Allied Sciences (MUHAS) between November 2018 and April 2019. It included all paediatric dental patients aged between 6 and 12 years. A questionnaire used in this study captured information regarding patient's socio-demographic characteristics and the number of previous visits to the dental clinic. A fifteen-item Children's Fear Survey Schedule - Dental Subscale (CFSS-DS) was used to assess the dental fear status in these pediatric patients. Results: A total of 223 paediatric dental patients aged between 6 years and 12 years were included in the study. The mean age of participants was 9.52 ± 1.74 years with a male to female ratio ofl: 1.04. The means CFSS-DS score was 31.1 ± 8.57. Fear scores were high for Injections (3.37 ± 1.13), a stranger's touch (2.81 ± 1.08) and choking (2.69 ± 0.99). The presence of dental fear was found to be significantly associated with the parents' education level (p=0.001) and previous dental visits (p < 0.001 ). Conclusion: The results of this study suggest that the prevalence of paediatric dental fear was low among the participants of this study. The education level of parents and previous dental visits were determinants of dental fear in children. Injections, being touched by strangers, and choking were the common fear-provoking factors.

Distinguishing trans women in men who have sex with men populations and their health access in East Africa: A Tanzanian study

Background: Few data are available on the presence and characteristics of transgender populations in sub-Saharan Africa (SSA), which makes the provision of health services for key populations difficult. Aim: This study aimed to ascertain the presence and characteristics of trans women in seven cities in Tanzania, East Africa.Setting: Tanzania, East Africa. Methods: Outreach to men who have sex with men (MSM) in seven large cities in Tanzania was carried out by non-governmental organisation (NGO) staff familiar with this community. Survey questions administered via interviews were used to identify participants who self-identify as trans. From the self-identification data, an estimate of the relative size of the trans women population in this sample was calculated. Results: In the sample of 300 participants, 17.0% of participants were identified as 'transsexual or transgender' (survey wording); 70.1% of these trans participants indicated that they identify themselves as a woman. Of those identifying themselves as transsexual or transgender, 43.1% reported living part- or full-time as a woman and eight (15.0%) reported hormone use. The highest percentage of hormone use (40.0%) was found in those living as a woman full-time. Notably, there was significant ignorance amongst the sample of the terms 'transsexual and transgender' or their explanation in Swahili, reported by interviewers. Conclusion: In this study, it is clear that trans women populations exist in Tanzania, with high levels of stigmatisation and threats to their lives. They should be included in health outreach and services to key populations. One in six self-identified as trans women, although the lack of knowledge of this concept in Swahili or English may have inaccurately represented numbers.

Willingness to HPV self-sampling for cervical cancer screening and its predictors among women attending outpatient clinics in Meru District, Arusha Region, Northern Tanzania

Background: The ability for women to self-collect human papillomavirus (HPV) samples can potentially reduce the risk of cervical cancer and increase screening coverage. Objectives: To assess the willingness to HPV self-sampling for cervical cancer screening and its predictors among women attending outpatient clinics in Arusha region, northern Tanzania. Methods: A hospital-based cross-sectional study was conducted among 706 women aged 18-55 years in Meru District Hospital and Usa River Health Centre from March to April 2019. Face-to-face intervies were conducted using a questionnaire. Data analysis was performed using Stata version 14.0. The log-binomial regression was used to determine factors associated with willingness to self-collection of HPV samples. Results: Majority (70%) of the women were willing to self-collection of HPV samples for cervical cancer screening and was associated with attending Meru District hospital (PR=2.02, 95%CI 1.77-2.31); good knowledge about cervical cancer warning signs (PR=1.11, 95%CI 1.01-1.22), prevention (PR=1.13, 95%CI 1.04-1.20), and symptoms (PR=1.61, 95%CI 1.33-1.93); and having formal employment (PR=1.22, 95%CI 1.07-1.37). Conclusion: The majority of women were willing to self-collect HPV samples for cervical cancer screening. Self-collection is, therefore, an acceptable and viable means of screening for cervical cancer, which has great implications for Tanzania from a health policy perspective.

Factors associated with reduced foetal movements in Iringa, Tanzania

Introduction: Maternal perception of foetal movement ensures foetal wellbeing. Reduced foetal movement is associated with foetal hypoxia, stillbirths, and intrauterine foetal growth restriction (IUFGR). This study aimed at assessing factors that are associated with maternal perception of reduced foetal movements. Method: This was a cross-sectional study that was conducted at Iringa Regional Referral Hospital from 1st January ­ 30th June 2022. A purposive sampling technique was used, and SPSS version 25 software was used for data analysis. Results: 41.3 % of study participants were aged 24 ­ 34 years, with a mean and SD of 29.08 ±7.53. 75% were not employed, 52.8 % of study participants delivered from 37 ­ 42 weeks of gestational age, 66.1% had a posterior placenta and only 24.0 % had an anterior placenta. Women who delivered at 28 ­ 36 weeks of gestational age were about 4 times more likely to experience reduced foetal movement compared to those who delivered at 37 ­ 42 weeks of gestation (AOR=4.162, 95% CI 2.174 - 7.966, p= =0.0067). Conclusion: Reduced foetal movements are associated with lower gestation age at delivery and decreased antenatal clinic attendance in Iringa, Tanzania. All pregnant women should be encouraged to make early antenatal clinic attendance and should attend adequate visits. Healthcare providers should educate and create awareness on methods of assessing foetal movements.

Characteristics of hearing loss in Dar es Salaam, Tanzania

Introduction: Hearing loss is a major public health problem in developed and developing countries. The objective of this study was to determine the causes and patterns of hearing loss at a private hospital that serves the largest number of patients with ear, nose and throat diseases in Tanzania's largest city. Method: This was a hospital based descriptive cross-sectional study that was conducted at a private hospital in Dar es Salaam. Data were collected from January to June 2021 and analysed using Statistical Package for Social Sciences (SPSS) version 20. P-value Results: Of the 250 patients recruited with hearing loss, there were 115 (46%) males and 135 (54%) females (F:M ratio of 1.2:1). The commonest cause of hearing loss was presbyacusis 132 (52.8%) followed by ototoxicity 26 (10.4%) and chronic suppurative otitis media 26(10.4%). Based on laterality, 73.2% of the patients had unilateral hearing loss whereas 26.8% had bilateral hearing loss. Regarding the type of hearing loss, 85.6% of the patients had sensorineural hearing loss followed by conductive type (13.2%) and mixed hearing loss (1.2%). Based on severity, 40.8% of the patients had moderate hearing loss followed by both moderately severe and severe hearing loss each accounting for 18% of cases Conclusion: Sensorineural hearing loss was the commonest type of hearing loss in this study. Both unilateral hearing loss according to laterality and moderate hearing loss upon classifying by severity predominated. Age related hearing loss was the most common cause of hearing loss followed by ototoxicity and chronic suppurative otitis media.

Ivermectin treatment response in two rural villages with a high prevalence of onchocerciasis and epilepsy, Mahenge Tanzania

Background: Despite 20 years of ivermectin mass distribution in the Mahenge area, Tanzania, the prevalence of onchocerciasis and epilepsy has remained high in rural villages. Objectives: We investigated the efficacy of ivermectin in reducing Onchocerca volvulus microfilariae and predictors for parasitic load following ivermectin treatment in persons with (PWE) and without epilepsy (PWOE). Methods: Between April and September 2019, 50 PWE and 160 randomly selected PWOE from Msogezi and Mdindo villages participated in a follow-up study. Skin snips were obtained pre (baseline) and three months post-ivermectin treatment. Results: The overall prevalence of O. volvulus positive skin snips at baseline was 49% (103/210), with no significant difference between PWE (58.0%) and PWOE (46.3%); p=0.197. The overall mean micro filarial density was significantly higher at baseline 1.45(95%CI:0.98-2.04)) than three-month post-ivermectin treatment (0.23(95%CI:0.11-0.37), p<0.001. Three months after ivermectin, the micro filarial density had decreased by ≥80% in 54 (81.8%, 95%CI: 72.3-91.4) of the 66 individuals with positive skin snips at baseline. High micro filarial density at baseline was the only significant predictor associated with higher micro filarial density in the post-ivermectin skin snips. Conclusion: Our study reports a decrease in micro filarial density following ivermectin treatment in most individuals. Optimizing ivermectin coverage will address the ongoing onchocerciasis transmission in Mahenge

Population normative data for three cognitive screening tools for older adults in sub-Saharan Africa / Dados normativos populacionais para três instrumentos de triagem cognitiva para idosos na áfrica subsaariana

ABSTRACT In sub-Saharan Africa (SSA),cognitive screening is complicated by both cultural and educational factors, and the existing normative values may not be applicable. The Identification of Dementia in Elderly Africans (IDEA) cognitive screen is a low-literacy measure with good diagnostic accuracy for dementia. Objective: The aim of this study is to report normative values for IDEA and other simple measures [i.e., categorical verbal fluency, the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) 10-word list] in representative community-dwelling older adults in SSA. Methods: Individuals aged ≥60 years resident in 12 representative villages in Kilimanjaro, Tanzania and individuals aged ≥65 years resident within three communities in Akinyele Local Government Area, Oyo State, Nigeria underwent cognitive screening. The normative data were generated by the categories of age, sex, and education. Results: A total of 3,011 people in Tanzania (i.e., 57.3% females and 26.4% uneducated) and 1,117 in Nigeria (i.e., 60.3% females and 64.5% uneducated) were screened. Individuals with higher age, lower education, and female gender obtained lower scores. The 50th decile values for IDEA were 13 (60-64 years) vs. 8/9 (above 85 years), 10-11 uneducated vs. 13 primary educated, and 11/12 in females vs. 13 in males. The normative values for 10-word list delayed recall and categorical verbal fluency varied with education [i.e., delayed recall mean 2.8 [standard deviation (SD) 1.7] uneducated vs. 4.2 (SD 1.2) secondary educated; verbal fluency mean 9.2 (SD 4.8) uneducated vs. 12.2 (SD 4.3) secondary educated], substantially lower than published high-income country values. Conclusions: The cut-off values for commonly used cognitive screening items should be adjusted to suit local normative values, particularly where there are lower levels of education.

RESUMO Na África Subsaariana (ASS), a triagem cognitiva é complicada por fatores culturais e educacionais, além dos valores normativos existentes poderem não ser aplicáveis. O rastreio cognitivo Identification of Dementia in Elderly Africans (IDEA) é uma medida para níveis baixos de alfabetização com boa acurácia diagnóstica para demência. Objetivo: Relatar os valores normativos para a IDEA e outras medidas simples (fluência verbal categórica, a lista de 10 palavras do Consortium to Establish a Registry for Alzheimer's Disease (CERAD) em idosos residentes na comunidade, representativos da ASS. Métodos: Indivíduos com idade ≥60 residentes em 12 comunidades representativas em Kilimanjaro, Tanzânia e indivíduos com idade ≥65 anos residentes em três comunidades na área governamental de Akinyele, Estado de Oyo, Nigéria, foram submetidos à triagem cognitiva. Os dados normativos foram gerados por faixas etárias, sexo e escolaridade. Resultados: Um total de 3.011 pessoas na Tanzânia (57,3% mulheres, 26,4% sem educação) e 1.117 na Nigéria (60,3% mulheres, 64,5% sem educação) foram examinadas. Os indivíduos com idade mais alta, menor escolaridade e mulheres obtiveram escores mais baixos. Os valores do percentil 50 para a IDEA foram 13 (60-64 anos) vs. 8/9 (85+ anos), 10-11 para analfabetos vs. 13 com educação primária e 11/12 em mulheres vs. 13 em homens. Os valores normativos para a evocação tardia da lista de 10 palavras e a fluência verbal categórica variaram com a educação (evocação tardia 2,8 (SD 1,7) para os sem educação, vs. 4,2 (SD 1,2) para com educação secundária; fluência verbal 9,2 (DP 4,8) para os sem educação vs. 12,2 (SD 4.3) para os com ensino médio, substancialmente inferior aos valores publicados em países de alta renda. Conclusões: Os valores de corte para testes de triagem cognitiva comumente usados devem ser ajustados para se adequar aos valores normativos locais, particularmente em níveis baixos de educação.

The impact of out-of-pocket expenditures on missed appointments at HIV care and treatment centers in Northern Tanzania / 《全球健康杂志（英文）》

Background:Missed clinic appointments negatively impact clinic patient flow and health outcomes of people living with HIV (PLHIV).PLHIV likelihood of missing clinic appointments is associated with direct and indirect expenditures made while accessing HIV care.The objective of this study was to examine the relationship between out-of-pocket (OOP) health expenditures and the likelihood of missing appointments.Method:Totally 618 PLHIV older than 18 years attending two HIV care and treatment centres (CTC) in Northern Tanzania were enrolled in the study.Clinic attendance and clinical characteristics were abstracted from medical records.Information on OOP health expenditures,demographics,and socio-economic factors were self-reported by the participants.We used a hurdle model.The first part of the hurdle model assessed the marginal effect of a one Tanzanian Shillings (TZS) increase in OOP health expenditure on the probability of having a missed appointment and the second part assessed the probability of having missed appointments for those who had missed an appointment over the study period.Results:Among these 618 participants,242 (39％) had at least one missed clinic appointment in the past year.OOP expenditure was not significantly associated with the number of missed clinic appointments.The median amount of OOP paid was 5100 TZS per visit,about 7％ of the median monthly income.Participants who were separated from their partners (adjusted odds ratio[AOR]=1.83,95％ confidence interval[CI]:1.11-8.03) and those aged above 50 years (AOR =2.85,95％ CI:1.01-8.03) were significantly associated with missing an appointment.For those who had at least one missed appointment over the study period,the probability of missing a clinic appointment was significantly associated with seeking care in a public CTC (P =0.49,95％ CI:0.88-0.09) and aged between ＞ 25-35 years (P =0.90,95％ CI:0.11-1.69).Conclusion:Interventions focused on improving compliance to clinic appointments should target public CTCs,PLHIV aged between ＞ 25-35 years,above 50 years of age and those who are separated from their partners.

Immediate Seven Day Outcomes and Risk Factors of Low Birth Weight Neonates at Referral Hospitals in Mwanza City, Tanzania in October 2020

Every year more than 20 million neonates worldwide are born with low birth weight (LBW) per year. Ninety-five percent of LBW births occur in developing countries. The aim of this study was to determine Immediate Seven Day Outcomes and Risk Factors of Low Birth Weight Neonates at Referral Hospitals in Mwanza City. MATERIALS AND METHODS This was a hospital based observational prospective cohort study of neonates with LBW whom were followed up for seven days in the neonatal wards at referral hospitals in Mwanza city. Maternal social-demographic, newborns clinical data and vitality outcomes were collected. Categorical and continuous variables were summarized and presented in tables or bar charts. Any p-value of < 0.05, at 95% confidence interval was regarded as statistically significant. RESULTS Total of 200 neonates with median age of 0.8 days at baseline were enrolled. Amongst 148 (74 %) had prolonged hospitalization; due to sickness 88 (59%), and 60 (40%) due to poor weight gain. Whereas, the remaining 42 (21%) were discharged and 10 (5%) died within seven days. Prolonged hospitalization was associated with family income (p-value= <0.001) and place of delivery (p-value = <0.001). African Journal of Health Sciences Volume 34, Issue No.4, July- August 2021 452 Neonatal death was associated with family income (p-value =0.035) and birth weight (p-value = 0.019). Early discharge associated with gestational age at first antenatal visit, family income, mode of delivery, APGAR score at one minute, time interval between delivery and admission and timing of medication initiation. CONCLUSION LBW neonates are at high risk of death and prolonged hospitalization due to sickness or due to poor weight gain. Associated factors of these outcomes were family income, place of delivery, birth weight, gestation age during first antenatal visit, mode of delivered and low APGAR score.