Documenting the implementation processes and effects of the data use initiatives in primary health care settings in Tanzania: A before-after mixed methods study protocol.

BACKGROUND: The use of data in decision making and planning in primary health care settings is critical for improving efficiency and health outcomes for patients and communities. Implementation research can be used to fully understand the effects, context, challenges, and facilitators of data use, as well as how to scale up data use interventions. However, in the context of low resource settings, little is known about how implementation research can be employed to assess the implementation and impact of data use interventions. METHODS: We will conduct a hybrid type 2 effectiveness-implementation study employing a mixed method controlled before and after design to measure the effects of data use interventions while simultaneously understanding the implementation of those initiatives. The controlled before and after entails measurement of the effects of the interventions at baseline and end line in a matched intervention and control health facilities using structured questionnaire to health workers (n = 440) and existing patients (n = 422) while also extracting selected health outcome variable from routine data in all participating health facilities (n = 80). The mixed methods component entails measuring the implementation outcomes (adoption, acceptability, fidelity and maintenance) and their moderators entails the integration of both quantitative and qualitative data collection, analysis, and interpretation (i.e. mixed methods) approach by using a structured questionnaire to implementers (health workers and managers) (n = 400). Experiential dimensions of implementation processes and moderators will be explored using qualitative interviews. Guided by implementation research theories and frameworks, a theory of change (TOC) is developed first to guide the evaluation of implementation processes and effects of the interventions. Descriptive and inferential statistics will be employed to analyze quantitative data whereas thematic analysis approach will be employed for qualitative data. DISCUSSION: This study is one of the first to test the simultaneous measurement of effects and implementation processes of data use interventions in the primary health care settings. Findings will support efforts to improve quality of services by optimizing scale up and sustainability of the data use initiatives in primary health care settings.

Factors to determine the adoption of online teaching in Tanzania's Universities during the COVID-19 pandemic.

BACKGROUND: Face to face mode of delivery has been a standard method of teaching courses in the majority of African Universities Tanzania included. The COVID-19 pandemic has caused the closure of all schools and universities worldwide; therefore, face-to-face teaching is no longer the only appropriate and feasible teaching method. This requires changes in the teaching method with the remarkable rise of e-learning, whereby teaching must be undertaken remotely and on digital platforms. OBJECTIVE: The main objective of this study is to determine the perceived factors that hinder the adoption of online teaching in Tanzanian universities. METHOD: A mixed method dominated by a quantitative approach was used to answer the research questions. A total of 173 academic and ICT staff from nineteen universities in Tanzania participated in this study. Descriptive statistics (univariate analysis) and binary logistic regression were applied to analyse the frequency and compare the mean to describe the characteristics of respondents and determine the factors influencing the academic staff to have an online course. This was followed by content analysis to analyse the academic staff's proposed adaptation to online classes. RESULTS: The findings indicated that the main hindrances to online teaching are lack of capacity; knowledge on how to conduct online courses; knowledge and technological factors; environmental factors; staff attitudes towards delivering online courses, and years spent using eLearning. The academic staff proposed improving ICT infrastructure and strengthening the capacity of academic staff to provide online courses. CONCLUSION: The study concludes that most academic staff are willing to adopt online teaching while suggesting improving the organisational and individual factors to enhance online education. The paper recommends that the university use freely available online teaching tools and platforms while simultaneously focusing on addressing the corporate and individual factors identified in this paper to enhance online teaching, which is mandatory in response to lockdown measures.

Vaccine management practices among healthcare workers in Morogoro, Tanzania: a cross-sectional study.

BACKGROUND: Effective vaccine management is essential to maintain the quality of vaccines, minimise wastages, and prevent missed opportunities for vaccination at service delivery points. OBJECTIVES: This study aims to assess vaccine management practices among vaccinators at health facilities in the Morogoro region, Tanzania. METHODOLOGY: A descriptive cross-sectional study design involved health workers from 77 health facilities offering vaccination services. The study population consisted of vaccine handlers and vaccinators working in public health facilities in the Morogoro region. The vaccine management practices were assessed using data collected from ledgers and the Vaccine Information Management System (VIMS). The temperature records were downloaded from the Fridge-tag® 2 and Coldtrace5 devices. RESULTS: The findings indicated that 65 (84%) health facilities had functional refrigerators and are using power from 26 (34%), 28 (36%), and 23 (30%) of grid electricity, solar, and Liquefied Petroleum Gas (LPG), respectively. Besides, 27 (35%) health facilities have an alternative energy source as a backup. In general, healthcare workers had a good knowledge of cold chain management, including the World Health Organization recommended storage temperatures for vaccines. Furthermore, vaccine stockout was found in 12 (15.6%) health facilities for at least one antigen and 4 (5.1%) health facilities for all five antigens under observation. This current study also revealed that the average calculated vaccine wastage rates for DTP, Measles-Rubella and Rotavirus vaccines were 7%, 19%, and 15%, respectively. More than half of health workers did not perform monthly temperature data reviews. In addition, poor performance led to high wastage rates, including the Rotavirus vaccines, and a change in VVM to discard points. Finally, a small number of 5 (6.5%) health facilities consecutively reported temperature exposure beyond + 8 Celsius (between 5.9 and 281 h). CONCLUSIONS: Healthcare workers' vaccine and cold chain management knowledge were good for temperature data reading and documentation. However, the practices were poor for some health facilities. The gaps observed in this study inform health managers and policymakers toward establishing interventions to improve health workers' knowledge and practice, including mentorships, supervision, and training to guarantee that each child in all communities reaps the benefits of immunisation services.

Variation in contraceptive prevalence rates in Tanzania: A multilevel analysis of individual and regional determinants.

OBJECTIVE: The aim of this study was to answer two key questions: (1) what are the individual and regional determinants of contraceptive use; and (2) what are the effect(s) of individual and regional variables on regional differences in contraceptive use? DATA AND METHOD: Multilevel logistic regression was applied on data from the Tanzania Demographic and Health Survey (TDHS) 2010 that allowed us to investigate simultaneously the individual and the regional determinants of contraceptive use and its regional variation. RESULTS: There was significant variation in contraceptive use, both between population groups as well as between regions. A higher number of children ever born, urban residence, and a non-manual occupation are characteristics associated with higher odds of a woman using contraceptives. Women who talk about family planning with community-based distribution workers and clinic staff also have higher odds of using contraceptives. The regional differences in the shares of women with a secondary education or above explain a significant portion of the regional variance in contraceptive use. Having secondary education and above is related to lower contraceptive use. CONCLUSION: This study constitutes a first step towards gaining a better understanding of the macro-level effects on decision-making processes regarding contraceptive use. The regional educational level explains a significant portion of the regional variance in contraceptive use. IMPLICATION STATEMENT: An advantage of our study over other studies in Tanzania is that we extended the determinants of contraceptive use to include not only individual-level factors, but also regional-level factors.