Improving social justice in observational studies: protocol for the development of a global and Indigenous STROBE-equity reporting guideline.

BACKGROUND: Addressing persistent and pervasive health inequities is a global moral imperative, which has been highlighted and magnified by the societal and health impacts of the COVID-19 pandemic. Observational studies can aid our understanding of the impact of health and structural oppression based on the intersection of gender, race, ethnicity, age and other factors, as they frequently collect this data. However, the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline, does not provide guidance related to reporting of health equity. The goal of this project is to develop a STROBE-Equity reporting guideline extension. METHODS: We assembled a diverse team across multiple domains, including gender, age, ethnicity, Indigenous background, disciplines, geographies, lived experience of health inequity and decision-making organizations. Using an inclusive, integrated knowledge translation approach, we will implement a five-phase plan which will include: (1) assessing the reporting of health equity in published observational studies, (2) seeking wide international feedback on items to improve reporting of health equity, (3) establishing consensus amongst knowledge users and researchers, (4) evaluating in partnership with Indigenous contributors the relevance to Indigenous peoples who have globally experienced the oppressive legacy of colonization, and (5) widely disseminating and seeking endorsement from relevant knowledge users. We will seek input from external collaborators using social media, mailing lists and other communication channels. DISCUSSION: Achieving global imperatives such as the Sustainable Development Goals (e.g., SDG 10 Reduced inequalities, SDG 3 Good health and wellbeing) requires advancing health equity in research. The implementation of the STROBE-Equity guidelines will enable a better awareness and understanding of health inequities through better reporting. We will broadly disseminate the reporting guideline with tools to enable adoption and use by journal editors, authors, and funding agencies, using diverse strategies tailored to specific audiences.

Association between first birth caesarean delivery and adverse maternal-perinatal outcomes in the second pregnancy: a registry-based study in Northern Tanzania.

BACKGROUND: Caesarean delivery (CD) is the commonest obstetric surgery and surgical intervention to save lives of the mother and/or the new-borns. Despite been accepted as safe procedure, caesarean delivery has an increased risk of adverse maternal and fetal outcomes. The rising rate of caesarean delivery has been a major public health concern worldwide and the consequences that come along with it urgently need to be assessed, especially in resource limited settings. We aimed to examine the relationship between first birth caesarean delivery and adverse maternal and perinatal outcomes in the second pregnancy among women who delivered at a tertiary hospital in Northern Tanzania. METHODS: A retrospective cohort study was conducted using maternally-linked data from Kilimanjaro Christian Medical Centre. All women who had singleton second delivery between the years 2011 to 2015 were studied. A total of 5,984 women with singleton second delivery were analysed. Multivariable log-binomial regression was used to determine the association between first caesarean delivery and maternal-perinatal outcomes in the second pregnancy. RESULTS: Caesarean delivery in the first birth was associated with an increased risk of adverse maternal and perinatal outcomes in the second pregnancy. These included repeated CD (ARR 1.19; 95% CI: 1.05-1.34), pre/eclampsia (ARR 1.38; 95% CI: 1.06-1.78), gestational diabetes mellitus (ARR 2.80; 95% CI: 1.07-7.36), uterine rupture (ARR 1.56; CI: 1.05-2.32), peri-partum hysterectomy (ARR 2.28; CI: 1.04-5.02) and preterm birth (ARR 1.21; CI: 1.05-1.38). CONCLUSION: Caesarean delivery in their first pregnancy had an increased risk of repeated caesarean delivery and other adverse maternal-perinatal outcomes in the following pregnancy. Findings from this study highlight the importance of devising regional specific measures to mitigate unnecessary primary caesarean delivery. Additionally, these findings may help both clinicians and women in deciding against or for trial of labor after previous caesarean delivery in an event of absent direct obstetric indication.

Prediction of low Apgar score at five minutes following labor induction intervention in vaginal deliveries: machine learning approach for imbalanced data at a tertiary hospital in North Tanzania.

BACKGROUND: Prediction of low Apgar score for vaginal deliveries following labor induction intervention is critical for improving neonatal health outcomes. We set out to investigate important attributes and train popular machine learning (ML) algorithms to correctly classify neonates with a low Apgar scores from an imbalanced learning perspective. METHODS: We analyzed 7716 induced vaginal deliveries from the electronic birth registry of the Kilimanjaro Christian Medical Centre (KCMC). 733 (9.5%) of which constituted of low (< 7) Apgar score neonates. The 'extra-tree classifier' was used to assess features' importance. We used Area Under Curve (AUC), recall, precision, F-score, Matthews Correlation Coefficient (MCC), balanced accuracy (BA), bookmaker informedness (BM), and markedness (MK) to evaluate the performance of the selected six (6) machine learning classifiers. To address class imbalances, we examined three widely used resampling techniques: the Synthetic Minority Oversampling Technique (SMOTE) and Random Oversampling Examples (ROS) and Random undersampling techniques (RUS). We applied Decision Curve Analysis (DCA) to evaluate the net benefit of the selected classifiers. RESULTS: Birth weight, maternal age, and gestational age were found to be important predictors for the low Apgar score following induced vaginal delivery. SMOTE, ROS and and RUS techniques were more effective at improving "recalls" among other metrics in all the models under investigation. A slight improvement was observed in the F1 score, BA, and BM. DCA revealed potential benefits of applying Boosting method for predicting low Apgar scores among the tested models. CONCLUSION: There is an opportunity for more algorithms to be tested to come up with theoretical guidance on more effective rebalancing techniques suitable for this particular imbalanced ratio. Future research should prioritize a debate on which performance indicators to look up to when dealing with imbalanced or skewed data.

Development of a women's empowerment index for Tanzania from the demographic and health surveys of 2004-05, 2010, and 2015-16.

BACKGROUND: Women's empowerment is a multidimensional construct which varies by context. These variations make it challenging to have a concrete definition that can be measured quantitatively. Having a standard composite measure of empowerment at the individual and country level would help to assess how countries are progressing in efforts to achieve gender equality (SDG 5), enable standardization across and within settings and guide the formulation of policies and interventions. The aim of this study was to develop a women's empowerment index for Tanzania and to assess its evolution across three demographic and health surveys from 2004 to 2016. RESULTS: Women's empowerment in Tanzania was categorized into six distinct domains namely; attitudes towards violence, decision making, social independence, age at critical life events, access to healthcare, and property ownership. The internal reliability of this six-domain model was shown to be acceptable by a Cronbach's α value of 0.658. The fit statistics of the root mean squared error of approximation (0.05), the comparative fit index (0.93), and the standardized root mean squared residual (0.04) indicated good internal validity. The structure of women's empowerment was observed to have remained relatively constant across three Tanzanian demographic and health surveys. CONCLUSIONS: The use of factor analysis in this research has shown that women's empowerment in Tanzania is a six-domain construct that has remained relatively constant over the past ten years. This could be a stepping stone to reducing ambiguity in conceptualizing and operationalizing empowerment and expanding its applications in empirical research to study different women related outcomes in Tanzania.

Modifiable risk factors for community-acquired pneumonia in children under 5 years of age in resource-poor settings: a case-control study.

OBJECTIVE: Despite the availability of vaccines and antibiotics, pneumonia remains the leading cause of mortality among children under 5 years of age. The objective of this study was to identify modifiable risk factors for community-acquired pneumonia (CAP) in children under 5 years of age in a vaccinated population. METHODS: A case-control study was conducted between January and December 2017. The cases included children aged 2-59 months with X-ray-confirmed pneumonia, whereas the controls were children from the community with no history of respiratory infection. A multivariable logistic regression model was used to determine the modifiable risk factors for CAP. RESULTS: A total of 113 children with X-ray-confirmed pneumonia and 350 healthy children were enrolled in this study. The median ages for the cases and controls were 13.7 (IQR = 7.2-25.3) and 13.4 (IQR = 6.0-24.8) months respectively. One (0.9%) child died after the enrolment. The independent predictors of CAP included a lack of exclusive breastfeeding for 6 months (aOR = 1.7, 95% CI = 1.0-2.9), underweight (aOR = 2.1, 95% CI = 1.0-4.5), unclean cooking fuel (aOR = 1.8, 95% CI = 1.0-3.3) and low income (aOR = 2.9, 95% CI = 1.6-5.4). No association was found between vaccination status and CAP. CONCLUSION: In addition to a lack of exclusive breastfeeding, children from families of low-economic status were at risk of contracting CAP. Since the risk factors are complex, the study results call for more concerted efforts by and collaboration among the health, agriculture and development sectors to address mortality caused by CAP.

OBJECTIF: Malgré la disponibilité des vaccins et des antibiotiques, la pneumonie reste la principale cause de mortalité chez les enfants de moins de cinq ans. L'objectif de cette étude était d'identifier les facteurs de risque modifiables pour la pneumonie acquise en communauté (PAC) chez les enfants de moins de cinq ans dans une population vaccinée. MÉTHODES: Une étude cas-témoins a été menée entre janvier et décembre 2017. Les cas concernaient des enfants âgés de 2 à 59 mois atteints de pneumonie confirmée par la radiographie, alors que les témoins étaient des enfants de la communauté sans antécédents d'infection respiratoire. Un modèle de régression logistique multivariée a été utilisé pour déterminer les facteurs de risque modifiables pour la PAC. RÉSULTATS: Au total, 113 enfants atteints de pneumonie confirmée par la radiographie et 350 enfants en bonne santé ont été inclus dans cette étude. Les âges médians pour les cas et les témoins étaient respectivement de 13,7 (IQR = 7,2 - 25,3) et de 13,4 (IQR = 6,0 - 24,8) mois. Un enfant (0,9%) est décédé après l'inscription. Les prédicteurs indépendants de la PAC comprenaient une absence d'allaitement exclusif pendant six mois (aOR = 1,7; IC95%: 1,0 - 2,9), un poids insuffisant (aOR = 2,1; IC95%: 1,0 - 4,5), un combustible de cuisson non propre (aOR = 1,8; IC95%: 1,0 - 3,3) et un faible revenu (aOR = 2,9; IC95%: 1,6 - 5,4). Aucune association n'a été trouvée entre le statut de vaccination et la PAC. CONCLUSION: Outre l'absence d'allaitement maternel exclusif, les enfants issus de familles à faible statut économique étaient à risque de contracter la PAC. Les facteurs de risque étant complexes, les résultats de l'étude appellent à des efforts plus concertés et une collaboration accrue entre les secteurs de la santé, de l'agriculture et du développement afin de lutter contre la mortalité causée par la PAC.

The association between pre pregnancy body mass index and risk of preeclampsia: a registry based study from Tanzania.

BACKGROUND: Preeclampsia is among the leading causes of maternal mortality and morbidity worldwide, occurs in 2-8% of all pregnancies, and is estimated to account for at least 9 % of maternal deaths in Africa. Studies from developed countries show that high pre pregnancy body mass index (BMI) increases the risk of preeclampsia. We examined the association between pre pregnancy BMI and the risk of preeclampsia in Tanzania, a low income country. METHODS: Data from the Kilimanjaro Christian Medical Center (KCMC) Medical Birth Registry recorded between July 2000 and May 2013 were used. We restricted the study population to singleton deliveries among women with no or one previous pregnancy. Pre pregnancy BMI (kg/m2) was categorized according to the WHO categories of underweight (less than 18.5), normal (18.5 - 24.9), overweight (25.0 - 29.9) and obese (30 or more). Potential confounders were adjusted for in multivariable analyses. RESULTS: Among the 17,738 singleton births, 6.6% of the mothers were underweight, 62.1% were of normal BMI, 24.0% were overweight, and 7.3% were obese. Five hundred and eighty-two pregnancies (3.3%) were affected by preeclampsia. Compared to those with normal BMI, overweight and obese women had a higher risk of preeclampsia (aOR (95% CI) 1.4 (1.2 - 1.8) and 1.8 (1.3 - 2.4)), respectively, while underweight women had a lower risk (0.7 (0.4-1.1)). CONCLUSIONS: Pre pregnancy maternal overweight and obesity were associated with an increased risk of preeclampsia in Tanzania. Risks were similar to those reported in high income countries.

Prevalence of parasitic infections and associations with pregnancy complications and outcomes in northern Tanzania: a registry-based cross-sectional study.

BACKGROUND: Parasitic infection(s) during pregnancy have been associated with increased risk of pregnancy complications and adverse outcomes in low resource settings. However, little is known about their influence on pregnancy outcomes. This study aimed to determine the prevalence of parasitic infections and their association with pregnancy complications and adverse outcomes. METHODS: A retrospective cross-sectional study was conducted using maternally-linked data from Kilimanjaro Christian Medical Center (KCMC) medical birth registry. Birth records from all women who delivered singleton infants from 2000-2011 were utilized. We excluded multiple gestations and rural medical referral for various medical complications. A total of 30,797 births were evaluated. Data analysis was performed using SPSS version 18.0. Odds ratio (ORs) with 95 % confidence intervals (CIs) for adverse pregnancy outcomes and complications associated with parasitic infections were estimated using multiple logistic regression models. A p-value of less than 5 % was considered statistically significant. RESULTS: The most prevalent parasitic infection recorded was malaria (17.0 %), while helminths and amebiasis were infrequently recorded (0.6 % vs. 0.7 %, respectively). Women who had malaria during pregnancy had 13 % increased odds of having a preterm delivery (OR = 1.13; 95 % CI: 1.01-1. 26) as compared to those who were not infected. They also had 33 % increased odds of getting maternal anemia (OR = 1.33; 95 % CI: 1.11-1.72). Likewise, pregnant women who were recorded with helminths infections had 29 % increased odds of having maternal anemia as compared to those who had no helminths infection (OR = 1.29; 95 % CI:0.48-3.53). Moreover, pregnant women who were recorded to have amebiasis had 79 % increased odds of having a preterm delivery as compared to those who had no ameba infection (OR = 1.79; 95 % CI: 1.12-2.91). CONCLUSIONS: Malaria was the prevalent parasitic infection in the studied population while helminth and ameba infections were infrequently reported. These parasitic infections were also associated with increased risk of anemia and delivery of a preterm infant. These were the only three infections/infestations which were evaluated. Our analysis revealed that malaria, helminth and ameba infections during pregnancy is dangerous and has life threatening consequences. This highlight the need to provide early diagnosis and treatment for infected women to prevent pregnancy complications and associated adverse pregnancy outcomes.

Frequency, risk factors and feto-maternal outcomes of abruptio placentae in Northern Tanzania: a registry-based retrospective cohort study.

BACKGROUND: Abruptio placentae remains a major cause of maternal and perinatal morbidity and mortality in developing countries. Little is known about the burden of abruptio placentae in Tanzania. This study aimed to determine frequency, risk factors for abruptio placentae and subsequent feto-maternal outcomes in women with abruptio placentae. METHODS: We designed a retrospective cohort study using maternally-linked data from Kilimanjaro Christian Medical Centre (KCMC) medical birth registry. Data on all women who delivered live infants and stillbirths at 28 or more weeks of gestation at KCMC hospital from July 2000 to December 2010 (n = 39,993) were analysed. Multivariate logistic models were used to calculate odds ratios (OR) and 95% confidence intervals (CIs) for risk factors, and feto-maternal outcomes associated with abruptio placentae. RESULTS: The frequency of abruptio placentae was 0.3% (112/39,993). Risk factors for abruptio placentae were chronic hypertension (OR 4.1; 95% CI 1.3-12.8), preeclampsia/eclampsia (OR 2.1; 95% CI 1.1-4.1), previous caesarean delivery (OR 1.3; 95% CI 1.2-4.2), previous abruptio placentae (OR 2.3; 95% CI 1.8-3.4), fewer antenatal care visits (OR 1.3; 95% 1.1-2.4) and high parity (OR 1.4; 95% CI 1.2-8.6). Maternal complications associated with abruptio placentae were antepartum haemorrhage (OR 11.5; 95% CI 6.3-21.2), postpartum haemorrhage (OR 17.9; 95% 8.8-36.4),), caesarean delivery (OR 5.6; 95% CI 3.6-8.8), need for blood transfusions (OR 9.6; 95% CI 6.5-14.1), altered liver function (OR 5.3; 95% CI 1.3-21.6) and maternal death (OR 1.6; 95% CI 1.5-1.8). In addition, women with abruptio placentae had prolonged duration of hospital stay (more than 4 days) and were more likely to have been referred during labour. Adverse fetal outcomes associated with abruptio placentae include low birth weight (OR 5.9; 95% CI 3.9-8.7), perinatal death (OR 17.6; 95% CI 11.3-27.3) and low Apgar score (below 7) at 1 and 5 min. CONCLUSIONS: Frequency of abruptio placentae is comparable with local and international studies. Chronic hypertension, preeclampsia, prior caesarean section delivery, prior abruptio placentae, poor attendance to antenatal care and high parity were independently associated with abruptio placentae. Abruptio placentae was associated with adverse maternal and foetal outcomes. Clinicians should identify risk factors for abruptio placentae during prenatal care when managing pregnant women to prevent adverse maternal and foetal outcomes.

The effect of mother's age and other related factors on neonatal survival associated with first and second birth in rural, Tanzania: evidence from Ifakara health and demographic surveillance system in rural Tanzania.

BACKGROUND: With a view to improve neonatal survival, data on birth outcomes are critical for planning maternal and child health care services. We present information on neonatal survival from Ifakara Health and Demographic Surveillance System (HDSS) in Tanzania, regarding the influence of mother's age and other related factors on neonatal survival of first and second births. METHODS: The study conducted analysis using longitudinal health and demographic data collected from Ifakara HDSS in parts of Kilombero and Ulanga districts in Morogoro region. The analysis included first and second live births that occurred within six years (2004-2009) and the unit of observation was a live birth. A logistic regression model was used to assess the influence of socio-demographic factors on neonates' survival. RESULTS: A total of 18,139 first and second live births were analyzed. We found neonatal mortality rate of 32 per 1000 live births (95% CI: 29/1000-34/1000). Results from logistic regression model indicated increase in risk of neonatal mortality among neonates those born to young mothers aged 13-19 years compared with those whose mother's aged 20-34 years (aOR = 1.64, 95% CI = 1.34-2.02). We also found that neonates in second birth order were more likely to die than those in first birth order (aOR = 1.85: 95% CI = 1.52-2.26). The risk of neonatal mortality among offspring of women who had a partner co-resident was 18% times lower as compared with offspring of mothers without a partner co-resident in the household (aOR = 0.82: 95% CI = 0.66-0.98). Short birth interval (<33 months) was associated with increased risk of neonatal mortality (aOR = 1.50, 95% CI =1.16-1.96) compared with long birth interval (> = 33 months). Male born neonates were found to have an increased risk (aOR = 1.34, 95% CI =1.13- 1.58) of neonatal mortality as compared to their female counterparts. CONCLUSIONS: Delaying the age at first birth may be a valuable strategy to promote and improve neonatal health and survival. Moreover, birth order, birth interval, mother's partner co-residence and sex of the neonate appeared as important markers for neonatal survival.

Trends and determinants of unmet need for modern contraception among adolescent girls and young women in Tanzania, 2004-2016.

Unintended pregnancy at a young age can lead to poor reproductive health, social and economic outcomes. The high rate of unintended teenage pregnancies in Tanzania is indicative of inadequate availability and uptake of modern contraception. Determining trends and determinants of unmet need for modern contraception among adolescent girls and young women (AGYW) in Tanzania will help address the burden of unintended pregnancies. An analytical cross-sectional study design was conducted using secondary data from three consecutive Tanzania Demographic and Health Surveys (TDHS) 2004/05, 2010 and 2015/6 among AGYW in need of modern contraception. Data analysis considered the complex survey design. Poisson regression model was used to determine factors associated with unmet need for modern contraception. We observed a steady decline in unmet need for modern contraception among sexually active AGYW in need of modern contraception from 31.8% in 2004/05 to 27.5% in 2015/16 survey. In the multivariable analysis, higher prevalence of unmet need for modern contraception was observed among adolescents, participants with at least one live birth, from poor wealth tertile, and those sexually active during the past four weeks compared to their counterparts. Despite declining levels, the unmet need for modern contraception among AGYW in Tanzania remains high. AGYW under 19 years, those from poor households, and those who are postpartum are most at risk. Greater efforts in empowering and educating AGYW at risk on their reproductive health rights and needs will further the uptake of modern contraceptive use, reduce the rates of unintended pregnancies, lower the adolescent fertility rate as a result lower unmet need for modern contraception.

Impact of advanced maternal age on perinatal outcomes in Tanzania: Insights from Kilimanjaro Christian Medical Center Birth Registry.

The increasing prevalence of advanced maternal age (AMA) births necessitates the exploration of associated pregnancy outcomes within the healthcare-limited context of northern Tanzania to elucidate potential region-specific risks and implications. This study explored the influence of AMA on pregnancy outcomes in northern Tanzania, where healthcare resources and infrastructure are constrained in comparison to developed countries. This cross-sectional hospital-based study utilized maternally linked data from the Kilimanjaro Christian Medical Center (KCMC) Medical Registry and included 32,798 women who delivered single infants between 2004 and 2013. Multiple logistic regression models were used to determine adjusted odds ratios (aORs) and 95 % confidence intervals (CIs) for AMA-associated adverse pregnancy outcomes. A total of 16 % of mothers belonged to AMA with increased odds of undergoing a cesarean section (aOR: 1.32; 95%CI [1.24-1.41]; P < 0.001), gestational diabetes (aOR: 13.16; 95%CI [3.28-52.86]; P < 0.001) or pregestational diabetes (aOR: 3.15; 95%CI [1.87-5.31]; P < 0.000), and developing pre-eclampsia (aOR: 1.63; 95%CI [1.41-1.89]; P < 0.000). More women with AMA reported alcohol use during pregnancy and had preexisting conditions before conception than did younger women. Maternal education level, employment status, urban residency, and Christianity were statistically significant. This study establishes a connection between AMA and higher odds of cesarean section, gestational diabetes, pregestational diabetes, and pre-eclampsia. Women with AMA were more inclined to consume alcohol during pregnancy and exhibited preexisting conditions before conception. Moreover, AMA was linked to increased odds of low birth weight, stillbirths, and NICU transfers.

Forgetting to Take Medication, Treatment Adherence and Their Relationship with Viral Load Suppression Among People Living with HIV in the Kilimanjaro Region, Tanzania.

Background: Antiretroviral therapy (ART) adherence is crucial for virological suppression and positive treatment outcomes among people living with HIV (PLHIV), but remains a challenge in ensuring patients achieve and sustain viral load suppression. Despite the recommended use of digital tools medications uptake reminders, the contribution of forgetting to take medication is unknown. This study investigated the contribution of forgetting to take medication on the total missed medication and its effects on detectable viral load (VL). Methods: This mixed-method research was conducted among children, adolescents, pregnant, and breastfeeding women living with HIV on ART in northern Tanzania. Forgetting to take medication constituted reporting to have missed medication due to forgetfulness. A multivariable logistic regression model was used to estimate the adjusted odds ratio (AOR) with a 95% confidence interval (CI) to determine the contribution of forgetting medication intakes on total missed medication and other factors associated with having a detectable VL. Results: Of 427 respondents, 33.3% were children, 33.4% adolescents, and 33.3% pregnant and breastfeeding women, whose median age (interquartile range) was 9 (7-12), 18 (16-18), and 31 (27-36) years, respectively. Ninety-two (22.3%) reported missing medication over the past month, of which 72 (17.9%) was due to forgetting. Forgetting to take medication (AOR: 1.75 95% CI: 1.01-3.06) and being on second-line regimen (AOR: 2.89 95% CI: 1.50-5.55) increased the chances of a detectable VL, while females had lower chances of detectable VL (AOR: 0.62 95% CI: 0.41-0.98). The themes on the reasons for forgetting to take medication from qualitative results included being busy with work and the importance of reminders. Conclusion: Forgetting to take medication is common among PLHIV and an important predictor of a detectable VL. This calls for the use of automated short message services (SMS) reminders or Digital Adherence Tools with reminders to improve and promote good ART adherence among PLHIV.

Reporting of equity in observational epidemiology: A methodological review.

Background: Observational studies can inform how we understand and address persisting health inequities through the collection, reporting and analysis of health equity factors. However, the extent to which the analysis and reporting of equity-relevant aspects in observational research are generally unknown. Thus, we aimed to systematically evaluate how equity-relevant observational studies reported equity considerations in the study design and analyses. Methods: We searched MEDLINE for health equity-relevant observational studies from January 2020 to March 2022, resulting in 16 828 articles. We randomly selected 320 studies, ensuring a balance in focus on populations experiencing inequities, country income settings, and coronavirus disease 2019 (COVID-19) topic. We extracted information on study design and analysis methods. Results: The bulk of the studies were conducted in North America (n = 95, 30%), followed by Europe and Central Asia (n = 55, 17%). Half of the studies (n = 171, 53%) addressed general health and well-being, while 49 (15%) focused on mental health conditions. Two-thirds of the studies (n = 220, 69%) were cross-sectional. Eight (3%) engaged with populations experiencing inequities, while 22 (29%) adapted recruitment methods to reach these populations. Further, 67 studies (21%) examined interaction effects primarily related to race or ethnicity (48%). Two-thirds of the studies (72%) adjusted for characteristics associated with inequities, and 18 studies (6%) used flow diagrams to depict how populations experiencing inequities progressed throughout the studies. Conclusions: Despite over 80% of the equity-focused observational studies providing a rationale for a focus on health equity, reporting of study design features relevant to health equity ranged from 0-95%, with over half of the items reported by less than one-quarter of studies. This methodological study is a baseline assessment to inform the development of an equity-focussed reporting guideline for observational studies as an extension of the well-known Strengthening Reporting of Observational Studies in Epidemiology (STROBE) guideline.

Time trends in perinatal outcomes among HIV-positive pregnant women in Northern Tanzania: A registry-based study.

INTRODUCTION: Maternal HIV infection is associated with increased risk of having a preterm delivery, low birth weight baby, small for gestational age baby and stillbirth. Maternal use of combination antiretroviral treatment is also associated with preterm delivery and low birth weight, although the effects vary by the type of drugs and timing of initiation. OBJECTIVE: To examine time trends in adverse perinatal outcomes among HIV-positive compared with HIV-negative women. DESIGN: Registry-based cohort study. SETTING: Northern Tanzania, 2000-2018. STUDY SAMPLE: Mother-baby pairs of singleton deliveries (n = 41 156). METHODS: Perinatal outcomes of HIV-positive women were compared with HIV-negative women during time periods representing shifts in prevention of mother-to-child transmission guidelines. Monotherapy was used as first-line therapy before 2007 while combination antiretroviral treatment was routinely used from 2007. Log binomial and quantile regression were used to analyze the data. MAIN OUTCOME MEASURES: Preterm delivery, low birth weight, perinatal death, stillbirth, low Apgar score, transfer to neonatal care unit and small for gestational age. RESULTS: Overall, maternal HIV infection was associated with a higher risk of low birth weight and small for gestational age. Moreover, this pattern became more pronounced over time for low birth weight, the last time period being an exception. For other outcomes we found none or only a small overall association with maternal HIV infection, although a trend towards higher risk over time in HIV-positive compared with HIV-negative women was observed for preterm delivery and perinatal death. Quantile regression showed an increase in birth weight in babies born to HIV-negative women over time and a corresponding decline in birth weight in babies born to HIV-positive women. CONCLUSION: Unfavourable trends in some of the selected perinatal outcomes were seen for HIV-positive compared with HIV-negative women. Potential side-effects of combination antiretroviral treatment in pregnancy should be further explored.

Recurrence of post-term pregnancy and associated factors among women who delivered at Kilimanjaro Christian Medical Centre in northern Tanzania: A retrospective cohort study.

BACKGROUND: Post-term pregnancy is a health problem of clinical importance and; tends to recur in subsequent pregnancies. Maternal age, height, and male fetal sex are risk factors associated with Post-term pregnancy. The study aimed to determine the recurrence risk of post-term pregnancy and associated factors among women delivered at KCMC referral hospital. METHODOLOGY: This retrospective cohort study used KCMC zonal referral hospital medical birth registry cohort data for 43472 women delivered between 2000 and 2018. Data were analyzed using STATA version 15 software. Log-binomial regression with robust variance estimator determined the factors associated recurrence of post-term pregnancy adjusted for other factors. RESULTS: A total of 43472 women were analyzed. The proportion of post-term pregnancy was 11.4%, and the recurrence was 14.8%. The recurrence risk of post-term pregnancy was increased when a woman had a history of previous post-term pregnancy (aRR: 1.75; 95%CI: 1.44, 2.11). Advanced maternal age, i.e., ≥35years (aRR: 0.80; 95%CI: 0.65, 0.99), having secondary and higher education (aRR: 0.8; 95%CI: 0.66, 0.97), and being employed (aRR: 0.68; 95%CI: 0.55, 0.84) decreased the recurrence risk of post-term pregnancy. Women with recurrence of post-term pregnancy had a higher risk of delivering newborns weighed ≥4000gm (aRR: 5.05; 95% CI: 2.80, 9.09). CONCLUSION: Post-term pregnancy is associated with recurrence risk in subsequent pregnancies. A history of previous post-term pregnancy is associated risk factor and these women are at increased risk of delivering newborns weighed ≥4000gm. Clinical counselling of women at risk of post-term pregnancy and timely management is recommended to prevent adverse neonatal and maternal outcomes.

"Caring for Breast Cancer Patients Is a Work That Brings Sorrow": A Qualitative Interview Study with Nurses in Tanzania.

Introduction: Breast cancer is increasing in sub-Saharan Africa (SSA), and most women are diagnosed at a late stage. This leads to increased suffering for the patients and challenging care situations for nurses. Limited resources in healthcare, lack of oncology training, and low health literacy in society result in even more demanding situations for nurses. Objective: The objective was to explore nurses' experiences of caring women for with breast cancer in Tanzania. Methods: The study employed a descriptive qualitative design. Fifteen nurses, working in oncology units in three major hospitals in Tanzania were interviewed using a semistructured interview guide. The participants had a minimum of 6 months experience of caring for breast cancer patients. Purposive sampling was used. Data were analyzed by qualitative content analysis. Results: Two main themes emerged: Challenges in caring for breast cancer patients and Nurses' psychological distress. The late diagnosis was very challenging for the nurses. Low health literacy regarding breast cancer disease and treatment, patients' financial difficulties, minimal oncology nursing education, and technology in healthcare systems were also major challenges. The nurses experienced psychological distress, lost hope, and faced ethical dilemmas while providing cancer care. Conclusion: The findings of this study conclude that nurses face emotional distress and ethical dilemmas while caring for patients with breast cancer. Late diagnosis, lack of infrastructure and resources, and low health literacy among patients, family, and healthcare providers have a great impact on the stress that the nurses experience.

Trends and factors associated with adolescent pregnancies in Tanzania from 2004-2016: Evidence from Tanzania Demographic and Health Surveys.

Background: Adolescent pregnancy increases the risk of maternal and child morbidity and mortality. We aimed to determine trends and factors associated with adolescent pregnancy in Tanzania from 2004 to 2016 using the Tanzania Demographic and Health surveys (TDHS). Methods: We carried out an analytical cross-sectional study using the TDHS data for the years 2004 to 2005, 2010 and 2015 to 2016 among adolescent girls aged 15 to 19 years. Data analysis was performed using STATA version 15. Data analysis considered the complex survey design inherent in the demographic and health survey (DHS) data. The Poisson regression model was used to estimate Prevalence Ratios (PR) and 95% confidence intervals for factors associated with adolescent pregnancy. Results: We analysed data for a total of 10,972 adolescents for the three TDHS rounds. The proportion of adolescent pregnancy significantly decreased from 26% to 22.8% from the year 2004/05 to 2010 and then increased again to 26.7% in 2015/16. Adolescents who were aged 18 to 19 years (APR 1.52; 95% CI, 1.38 to 1.68) married or cohabiting with their partners (APR 2.15; 95% CI, 1.93 to 2.40; P<.001), widowed/divorced/separated (APR 2.32; 95% CI, 2.03 to 2.66; P<.001), and among those who started sexual activity before 15 years of age (APR 1.20; 95% CI, 1.11 to 1.31; P<.001) were more likely to become pregnant during adolescence. In contrast, adolescents with secondary school education level and above were the least likely to become pregnant (APR 0.62; 95% CI, 0.51 to 0.75; P<.001) compared to those with no formal education. Conclusion: One in four adolescent girls aged 15 to 19 in Tanzania have already started childbearing and despite fluctuation, high rate of adolescent pregnancy persists. Preventive interventions should focus on adolescents with low education level, married/cohabiting with their partners, and who have started sex before 15 years of age. We advocate for the increase of school attendance until high school level to reduce the risk of early pregnancy in adolescents. Furthermore, qualitative studies are crucial to explore reasons for the rising trend of adolescent pregnancy in most zones of Tanzania, particularly between 2010 and 2015/16.

A scoping review establishes need for consensus guidance on reporting health equity in observational studies.

OBJECTIVES: To evaluate the support from the available guidance on reporting of health equity in research for our candidate items and to identify additional items for the Strengthening Reporting of Observational studies in Epidemiology-Equity extension. STUDY DESIGN AND SETTING: We conducted a scoping review by searching Embase, MEDLINE, CINAHL, Cochrane Methodology Register, LILACS, and Caribbean Center on Health Sciences Information up to January 2022. We also searched reference lists and gray literature for additional resources. We included guidance and assessments (hereafter termed "resources") related to conduct and/or reporting for any type of health research with or about people experiencing health inequity. RESULTS: We included 34 resources, which supported one or more candidate items or contributed to new items about health equity reporting in observational research. Each candidate item was supported by a median of six (range: 1-15) resources. In addition, 12 resources suggested 13 new items, such as "report the background of investigators". CONCLUSION: Existing resources for reporting health equity in observational studies aligned with our interim checklist of candidate items. We also identified additional items that will be considered in the development of a consensus-based and evidence-based guideline for reporting health equity in observational studies.

Causes of perinatal death at a tertiary care hospital in Northern Tanzania 2000-2010: a registry based study.

BACKGROUND: Perinatal mortality reflects maternal health as well as antenatal, intrapartum and newborn care, and is an important health indicator. This study aimed at classifying causes of perinatal death in order to identify categories of potentially preventable deaths. METHODS: We studied a total of 1958 stillbirths and early neonatal deaths above 500 g between July 2000 and October 2010 registered in the Medical Birth Registry and neonatal registry at Kilimanjaro Christian Medical Centre (KCMC) in Northern Tanzania. The deaths were classified according to the Neonatal and Intrauterine deaths Classification according to Etiology (NICE). RESULTS: Overall perinatal mortality was 57.7/1000 (1958 out of 33 929), of which 1219 (35.9/1000) were stillbirths and 739 (21.8/1000) were early neonatal deaths. Major causes of perinatal mortality were unexplained asphyxia (n=425, 12.5/1000), obstetric complications (n=303, 8.9/1000), maternal disease (n=287, 8.5/1000), unexplained antepartum stillbirths after 37 weeks of gestation (n= 219, 6.5/1000), and unexplained antepartum stillbirths before 37 weeks of gestation (n=184, 5.4/1000). Obstructed/prolonged labour was the leading condition (251/303, 82.8%) among the obstetric complications. Preeclampsia/eclampsia was the leading cause (253/287, 88.2%) among the maternal conditions. When we excluded women who were referred for delivery at KCMC due to medical reasons (19.1% of all births and 36.0% of all deaths), perinatal mortality was reduced to 45.6/1000. This reduction was mainly due to fewer deaths from obstetric complications (from 8.9 to 2.1/1000) and maternal conditions (from 8.5 to 5.5/1000). CONCLUSION: The distribution of causes of death in this population suggests a great potential for prevention. Early identification of mothers at risk of pregnancy complications through antenatal care screening, teaching pregnant women to recognize signs of pregnancy complications, timely access to obstetric care, monitoring of labour for fetal distress, and proper newborn resuscitation may reduce some of the categories of deaths.

Cause-specific neonatal mortality in a neonatal care unit in Northern Tanzania: a registry based cohort study.

BACKGROUND: The current decline in under-five mortality shows an increase in share of neonatal deaths. In order to address neonatal mortality and possibly identify areas of prevention and intervention, we studied causes of admission and cause-specific neonatal mortality in a neonatal care unit at Kilimanjaro Christian Medical Centre (KCMC) in Tanzania. METHODS: A total of 5033 inborn neonates admitted to a neonatal care unit (NCU) from 2000 to 2010 registered at the KCMC Medical Birth Registry and neonatal registry were studied. Clinical diagnosis, gestational age, birth weight, Apgar score and date at admission and discharge were registered. Cause-specific of neonatal deaths were classified by modified Wigglesworth classification. Statistical analysis was performed in SPSS 18.0. RESULTS: Leading causes of admission were birth asphyxia (26.8%), prematurity (18.4%), risk of infection (16.9%), neonatal infection (15.4%), and birth weight above 4000 g (10.7%). Overall mortality was 10.7% (536 deaths). Leading single causes of death were birth asphyxia (n = 245, 45.7%), prematurity (n = 188, 35.1%), congenital malformations (n = 49, 9.1%), and infections (n = 46, 8.6%). Babies with birth weight below 2500 g constituted 29% of all admissions and 52.1% of all deaths. Except for congenital malformations, case fatality declined with increasing birth weight. Birth asphyxia was the most frequent cause of death in normal birth weight babies (n = 179/246, 73.1%) and prematurity in low birth weight babies (n = 178/188, 94.7%). The majority of deaths (n = 304, 56.7%) occurred within 24 hours, and 490 (91.4%) within the first week. CONCLUSIONS: Birth asphyxia in normal birth weight babies and prematurity in low birth weight babies each accounted for one third of all deaths in this population. The high number of deaths attributable to birth asphyxia in normal birth weight babies suggests further studies to identify causal mechanisms. Strategies directed towards making obstetric and newborn care timely available with proper antenatal, maternal and newborn care support with regular training on resuscitation skills would improve child survival.