Willingness of advanced cancer patients to receive palliative care and its determinants: A cross-sectional study in Northern Tanzania.

BACKGROUND: The purpose of this study was to assess willingness of advanced cancer patients to receive palliative care and its determinants at Cancer Care Centre in Kilimanjaro Christian Medical Centre Northern Tanzania. OBJECTIVE: The purpose of this study was to assess willingness of advanced cancer patients to receive palliative care and its determinants at Cancer Care Centre in Kilimanjaro Christian Medical Centre Northern Tanzania. METHODS: This was an institution-based cross-sectional study and the target population was all advanced cancer patients attending care at Cancer care Centre in Northern Tanzania. Data was collected using a structured questionnaire and analysed using Stata for windows 15. A descriptive analysis was conducted to summarize the data using mean standard deviation, while categorical data was summarized using frequency and percentages. Both bivariate and multivariate logistic regression analysis was used to determine the predictors associated with willingness to receive palliative care. RESULTS: The results showed that more than half of the respondents had willingness to accept palliative care. The degree of willingness PC among advanced cancer patients was high 60.6% (95%CI: 55.8-65.3). The predictors which remained significant associated with willingness to receive palliative care in multivariate analysis were the knowledgeable of palliative care [AOR: 2.86; 95%CI: 1.69-4.85] and high perceived benefits of palliative care [AOR: 3.58; 95%CI: 2.12-6.04]. CONCLUSION: Willingness to accept palliative care services was more than half of the patients just 60.6% among patients with advanced cancer from the study site. Advanced age of a patient, occupations, better knowledge, and perceived benefits for palliative care was the significant predictor for patients' willingness to accept palliative care.

Trend in female genital mutilation and its associated adverse birth outcomes: A 10-year retrospective birth registry study in Northern Tanzania.

BACKGROUND: Approximately 200 million women and girls were reported to have undergone female genital mutilation worldwide in 2015.UNICEF's data based on household survey estimates 15% of women from 15-49 years have undergone FGM from year 2004-2015. Despite this, reliable data on trend of prevalence of female genital mutilation and its associated birth outcomes have not been documented in Tanzania. This study aimed at determining the trends of female genital mutilation and associated maternal and neonatal adverse outcomes in northern Tanzania. METHODS: A cross-sectional study was conducted using maternally-linked data from Kilimanjaro Christian Medical birth registry involving 30,286 women who gave birth to singletons from 2004-2014. The prevalence of female genital mutilation was computed as proportion of women with female genital mutilation yearly over 10 years. Odds ratios with 95% confidence intervals for adverse birth outcomes associated with female genital mutilation were estimated using multivariable logistic regression model. RESULTS: Over the 10-year period, the prevalence of female genital mutilation averaged 15.4%. Female genital mutilation decreased from 23.6% in 2005 to 10.6% in 2014. Female genital mutilation was associated with increased odds for caesarean section (aOR1.26; 95% CI: 1.18-1.34), post-partum haemorrhage (aOR 1.31; 95% CI: 1.10-1.57) and long hospital stay (aOR 1.21; 95% CI: 1.14-1.29). Female genital mutilation also increased women's likelihood of delivering an infant with low Apgar score at 5th minute (aOR 1.60; 95% CI: 1.37-1.89).FGM type III and IV had increased odds of caesarean section, episiotomy and prolonged duration of hospital stay as compared to FGM type I and II, although the association was statistically insignificant. CONCLUSION: Female genital mutilation prevalence has declined over the study period. Our study has demonstrated that postpartum haemorrhage, delivery by caesarean section, long maternal hospital stays and low APGAR score are associated with FGM. Initiatives to mitigate FGM practice should be strengthened further to reduce/eliminate this practice. Moreover, surgical interventions to improve severe form FGM are welcomed to improve the aforementioned aspects of obstetric outcome in this locality.

Repetitive Cancer Training for Community Healthcare Workers: an Effective Method to Strengthen Knowledge and Impact on the Communities: Results from a Pilot Training at Kilimanjaro Region, Tanzania.

Cancer is a growing burden in Tanzania with high mortality rates. Low level of cancer awareness in the population and health workforce is one of the reasons. This study aimed to evaluate the effects of a cancer awareness training for community-level healthcare providers in Kilimanjaro Region. Main research interest was to assess the effects of the training on cancer knowledge of the healthcare workers and its application into practice. Community health workers (CHWs) (n = 25) and dispensary healthcare workers (DHCWs) (n = 16) attended cancer awareness trainings. Three training days over a 3-month period were provided for each group. Pre- and post-training assessments of the cancer knowledge were conducted on each training day. Application of the knowledge into practice was assessed at follow-up and complemented with qualitative data. Analysis of the questionnaires was provided by descriptive statistics. Qualitative data were analyzed by semantic thematic analysis. Both groups showed a statistically significant increase in knowledge after the three training days: CHWs + 10% (CI 95% = 2-18%, p = 0.015) and DHCWs 24.4% (CI 95% = 13-36%, p = 0.002). The community-level healthcare providers also started to apply the new cancer knowledge into practice and reported to feel more confident in cancer control. The pilot cancer awareness training was effective in increasing cancer knowledge and its application. It strengthened their confidence in care delivery and referral practices as well as education of the population. This concept of cancer awareness training might be also applicable to other countries in SSA.

Prevalence and factors associated with postpartum use of long-acting reversible contraception in Bukombe District, Geita Region, Tanzania: a community- based study.

BACKGROUND: Globally, approximately half of all pregnancies occur before 24 months after child birth. In Sub Saharan Africa the unmet need for family planning is highest among postpartum women. There is a dearth of information regarding factors associated with postpartum use of long acting reversible contraception (LARC) in Tanzania particularly in the Lake zone. This study aimed to determine the prevalence and factors associated with postpartum use of LARC (< 24 months) in Bukombe District, Geita Region in the Lake zone, in 2018. METHODOLOGY: Community based analytical cross-sectional study was conducted between May and June 2018 among women with less than 24 months since delivery. Multistage sampling technique was used to recruit participants. Face to face interviews with 768 postpartum women was conducted using standardized questionnaire. Data were analyzed using Stata Version 13.0. Multivariable logistic regression model was used to determine factors associated with postpartum use of LARC. RESULTS: Prevalence of postpartum use of LARC was 10.4%. Urban residence (AOR = 2.94, 95% CI: 1.07-8.06), having formal employment (AOR = 4.81, 95% CI: 1.85-12.57) and receiving family planning counseling (AOR = 4.39, 95% CI: 1.89-10.20) were significantly associated with postpartum LARC use. CONCLUSION: The postpartum use of LARC was low in the studied population with implants being the most commonly used method. Urban residency, formal employment and receiving family planning counseling were associated with postpartum LARC use. Improving prenatal and quality of family planning counseling is warranted to increase postpartum LARC utilization in Bukombe.