RESUMEN
Numerous challenges, such as lengthy treatment course, side effects, and distance to healthcare facilities contribute to suboptimal Tuberculosis (TB) treatment completion. Digital adherence technologies (DATs), such as smart pillboxes and medication labels, could be an alternative to facilitate TB treatment continuation. In-depth interviews with people undergoing treatment for drug susceptible TB, health care providers (HCPs) and other key actors were conducted to evaluate their experiences with DATs in ten health facilities across four different regions in Tanzania. This study is part of a multi country cluster randomized trials conducted under the ASCENT consortium. Interviews were conducted with a total of 41 individuals, 19 people with TB and 22 HCPs and key actors. One of the main findings indicates that participants found that the daily reminders provided by the DATs, particularly the alarm from the smart pillboxes, helped in supporting treatment continuation and establishing a routine around medicine intake. DATs use was linked with reducing the financial burden of treatment, improving people with TB-HCPs relationship, and decreasing workload for HCPs. Although DATs were generally perceived as reliable, occasional technical malfunctions, such as battery depletion in smart pillboxes, were reported. The requirement of having access to a cellphone and a power source emerged as specific barriers for medication label users. This study highlights the initial willingness and sustained enthusiasm for using DATs among respondents. DATs were perceived as useful tools, aiding individuals with treatment continuation through daily reminders and fostering stronger connections with HCPs. Nevertheless, issues such as poor network connectivity and the need for access to a working cellphone posed difficulties in usage. Findings from this study suggest the potential for improvements in the technologies and indicate that a thorough assessment of people's life conditions and needs prior to treatment initiations is important to determine the suitability of providing a DAT.
RESUMEN
Digital adherence technologies (DATs) have emerged as an alternative to directly observed therapy (DOT) for supervisions of tuberculosis (TB) treatment. We conducted a meta-analysis of implementation feedback obtained from people with TB and health care workers (HCWs) involved in TB REACH Wave 6-funded DAT evaluation projects. Projects administered standardized post-implementation surveys based on the Capability, Opportunity, Motivation, Behavior (COM-B) model to people with TB and their health care workers. The surveys included questions on demographics and technology use, Likert scale questions to assess capability, opportunity, and motivation to use DAT and open-ended feedback. We summarized demographic and technology use data descriptively, generated pooled estimates of responses to Likert scale questions within each COM-B category for people with TB and health care workers using random effects models, and performed qualitative analysis of open-ended feedback using a modified framework analysis approach. The analysis included surveys administered to 1290 people with TB and 90 HCWs across 6 TB REACH-funded projects. People with TB and HCWs had an overall positive impression of DATs with pooled estimates between 4·0 to 4·8 out of 5 across COM-B categories. However, 44% of people with TB reported taking TB medications without reporting dosing via DATs and 23% reported missing a dose of medication. Common reasons included problems with electricity, network coverage, and technical issues with the DAT platform. DATs were overall perceived to reduce visits to clinics, decrease cost, increase social support, and decrease workload of HCWs. DATs were acceptable in a wide variety of settings. However, there were challenges related to the feasibility of using current DAT platforms. Implementation efforts should concentrate on ensuring access, anticipating, and addressing technical challenges, and minimizing additional cost to people with TB.
RESUMEN
Background: It is perceived that children living in peasants' households are protected from undernutrition owing to a relative better food availability. However, evidence suggests an increased vulnerability that is not conforming to such norm and varies from one region to another. To address this research gap, we examined the magnitude and factors associated with stunting among under-5 children from peasant's households and compared them with children of other households in a rural district in Tanzania. Methods: This cross-sectional study was conducted in Bukombe district, Tanzania, among the randomly selected 358 under-5 child-caregiver pairs. We collected data through face-to-face interviews and took anthropometric measurements, which were converted to height for age Z-score. Data were analyzed using both descriptive and logistic regression methods to compare the nutrition status of children in two contexts and determine other factors associated with stunting among children in Bukombe district. Results: Under-5 children in Bukombe district succumbed to a higher magnitude of stunting (52.8%) compared to the national average. In comparison to the children from the other households, those residing in peasant households succumbed to even higher burden of stunting (46 vs. 56%). Poor feeding practices were common in these communities and more pronounced among peasant communities. About 71% of children in peasants' households had lower dietary diversity compared to 55% of other households (p = 0.003). Other factors associated with stunting included older age (AOR = 2.74, p = 0.003), severe food insecurity (AOR = 3.34, p = 0.002), and birth weight (AOR = 0.31, p = 0.02). Conclusion: Children of peasants' households in Bukombe district are at a higher risk of stunting compared to households with other occupations despite their engagement in farming. In addressing this persistent challenge in rural Tanzania and areas with similar context, efforts should be streamlined to address poor feeding practices, food insecurity, and the interventions tailored for maternal nutrition to ameliorate low birth weight.