Effect of standardized patient simulation-based pedagogics embedded with lecture in enhancing mental status evaluation cognition among nursing students in Tanzania: A longitudinal quasi-experimental study.

BACKGROUND: Nurses around the world are expected to demonstrate competence in performing mental status evaluation. However, there is a gap between what is taught in class and what is practiced for patients with mental illness among nursing students during MSE performance. It is believed that proper pedagogics may enhance this competence. A longitudinal controlled quasi-experimental study design was used to evaluate the effect of using standardized patient simulation-based pedagogics embedded with a lecture in enhancing mental status evaluation cognition among nursing students in Tanzania. METHODS: A longitudinal controlled quasi-experimental study design with pre-and post-test design studied 311 nursing students in the Tanga and Dodoma regions. The Standardized Patient Simulation-Based Pedagogy (SPSP) package was administered to the intervention group. Both groups underwent baseline and post-test assessments using a Interviewer-adminstered structured questionnaire as the primary data collection tool, which was benchmarked from previous studies. The effectiveness of the intervention was assessed using both descriptive and inferential statistics, specifically the Difference in Difference linear mixed model, and the t-test was carried out using IBM Statistical Package for Social Science (SPSS) software, version 25. RESULTS: The participant's mean age was 21 years ± 2.69 with 68.81% of the students being female. Following the training Students in the intervention group demonstrated a significant increase in MSE cognition post-test, with an overall mean score of (M ± SD = 22.15 ± 4.42;p = < 0.0001), against (M ± SD = 16.52 ± 6.30) for the control group. CONCLUSION: A significant difference exists in the levels of cognition, among nursing students exposed to Mental Status Evaluation (MSE) materials through Standardized Patient Simulation-Based Pedagogy (SPSP) embeded with lectures. When MSE materials are delivered through SPSP along with lectures, the results are significantly superior to using lectures pedagogy alone.

Evaluating health workers attitude towards implementation of maternal and perinatal deaths surveillance and response system in Morogoro region; analytical cross-sectional study.

Maternal and Perinatal Deaths Review and Surveillance (MPDSR) is a technical system which was issued by the World Health Organization in 2013 to help developing countries improve maternal health. The major purpose of the system was to reduce the ongoing high numbers of maternal deaths and perinatal deaths from avertable causes. Tanzania adopted MPDSR system in 2015. The study aimed to assess health workers attitude towards implementation of MPDSR system in Morogoro Region. This analytical cross-sectional study was conducted in three districts of Morogoro region from April 27, 2020 to May 29, 2020 involving 360 health workers from 38 health facilities. A semi-structured questionnaire was used for data collection. SPSS software version 25 was used to analyze the obtained data. Descriptive analysis was done to describe the characteristics of study participants. Binary logistic regression analysis was used to assess predictors of health workers attitude towards the MPDSR system. A total of 255(70.8%) of respondents had positive attitude towards MPDSR system. After controlling of confounders predictor of positive attitude were location of health facility [rural (AOR = 0.216 at 95% CI = 0.121-0.387, p = <0.001)], Age group [Below 30(AOR = 0.459 at 95%CI = 0.264-0.796, p = 0.006)] and status of training on MPDSR [Yes (AOR = 4.892 at 95%CI = 2.187-10.942, P = <0.001)]. Substantial number of health workers had positive attitude towards the MPDSR system. Health workers who were residing in rural settings and younger than 30 years were less likely to have positive attitude towards the system. Health workers who had access to be trained about the system were more likely to have positive attitude towards MPDSR system. The study recommends the training of health workers about the system so as to increase their attitude and hence the use of the system.

Predictors of health workers' knowledge of maternal and perinatal deaths surveillance and response system in Morogoro region, Tanzania: An analytical cross-sectional study.

This study aimed at assessing the predictors of knowledge about the Maternal and Perinatal Deaths Surveillance and Response (MPDSR) system among health workers in the Morogoro region. It was an analytical cross-sectional study, conducted from April 27 to May 29, 2020. A multistage sampling technique was used to recruit 360 health workers. A semi-structured questionnaire was used to collect the data. Statistical Package for Social Science (SPSS v.20) software was used for data entry and analysis. Bivariate and multivariate logistic regression analyses were used to assess factors associated with knowledge of MPDSR. A total of 105 (29.2%) health workers in the Morogoro region had adequate knowledge of the MPDSR system. After controlling for confounders, predictors of knowledge on the MPDSR system were the level of health facility a health worker was working (n [hospital [adjusted odds ratio [AOR] = 2.668 at 95% confidence intervals [CI] = 1.497-4.753, P = .001]), level of education of a health worker (diploma [AOR = 0.146 at 95% CI = 0.038-0.561, P = .005]), and status of training on MPDSR (trained [AOR = 7.253 at 95% CI = 3.862-13.621, P ≤ .001]). The proportion of health workers with adequate knowledge about the MPDSR system in the Morogoro region is unacceptably low. Factors associated with adequate knowledge were those working in hospitals with higher levels of professional training and those who had ever had training in MPDSR. A cost-effective strategy to improve the level of knowledge regarding MPDSR in this region is highly recommended.

Dataset comparing the effectiveness of perineal cold pack application over oral paracetamol 1000mg on postpartum perineal pain among women after spontaneous vaginal delivery in Dodoma region.

The data were collected from the Dodoma Regional Referral Hospital randomized clinical trial among postnatal women. The raw and analyzed data includes 228 postnatal women with the following information: age(years), marital status, education level, occupation, religion, residence, and income. It also includes the number of Antenatal Visits, perineal condition, birth weight of the newborn, and the magnitude of perineal pain at the start(time=zero), at 20,40 and 60 minutes. The participants were randomly allocated to either an intervention or control group. The intervention group received the cold pack, while the control group received the Paracetamol 1000mg start. Data were collected using a standardized questionnaire and then analyzed using Stata™ software (StataCorp LLC, College Station, TX, US) version 14 and IBM SPSS statistics 25. The outcome was pain intensity measured using a pain rating scale at the interval of 20 minutes up to 60 minutes. The intervention's effect was estimated using an analysis of variance(repeated measure ANOVA). Omega square test was used to establish the effect size. These data will help nurse midwives in health facilities analyze data and demonstrate the effectiveness of cold packs in relieving pain instead of oral paracetamol, hence increasing scaling up its utilization.

Nurses' Level of Knowledge on Management of Preeclampsia / Eclampsia and the associated factors in Northern Tanzania: An Analytical Cross-Sectional Study.

Background: Preeclampsia/Eclampsia is among the hypertensive disorder of pregnancy. It is accompanied by high blood pressure, protein in the urine, convulsion, and sometimes oliguria. This condition results in higher maternal morbidity and mortality worldwide. Objectives: The objective of this study was to assess nurses' level of knowledge and factors influencing nurses' knowledge of managing preeclampsia/Eclampsia in Northern Tanzania. Method: The study was analytical cross-sectional study design. A total sample of 176 nurses working in the maternity block was enrolled in the study. A census sampling technique was used to get 176 nurses. A closed-ended structured questionnaire was used to collect data. Statistical Package for the Social Sciences (SPSS) version 26 was used for data analysis. Knowledge was categoried into low and high knowledge, two, less than 50% had low knowledge and above 50% had high knowledge. Inferential analysis using a logistic regression model was used to establish factors associated with knowledge. Results: The study revealed that more than half of interviewed nurses 129(73.3%) had high knowledge while 47(26.7%) had low knowledge on management of preeclampsia/Eclampsia. After controlling for confounders, factors associated with knowledge were nurse who got On job training on Preeclampsia/Eclampsia management. Conclusions: Some essential predictors of knowledge were shown among nurses, but generally, knowledge about the management of preeclampsia/eclampsia among nurses was high. Managing women with preeclampsia/eclampsia and their fetuses, there is a great need for advanced strategies to increase knowledge about the management to nurses.

Level of Knowledge on Kangaroo Mother Care and Its Associated Factors Among Postnatal Mothers With Preterm Babies in Central Tanzania: Hospital-Based Cross-Sectional Study.

Introduction: Kangaroo mother care (KMC) has been proven to reduce preterm babies' deaths by 40%. The study aimed at assessing the prevalence and predictors of knowledge about KMC among postnatal mothers of preterm babies in the Central zone, Tanzania. Objective: To assess the level of knowledge about KMC and its associated factors. Methods: It was an analytical cross-sectional study involving 363 mothers of preterm babies from the Central zone. All mothers admitted during data collection and who met the inclusion criteria were enrolled until the sample size was attained. A structured questionnaire was used for data collection. Data were analyzed using SPSS v23. Descriptive statistics were used to describe the study variable while inferential statistics (univariate and multivariate analyses) were used to determine the predictors of knowledge. Results: Only 138(38%) postnatal mothers had adequate knowledge about KMC. Factors associated with knowledge on KMC were the age of the mother (those aged ≥30 years were almost four times more likely to have adequate knowledge compared to those aged <20 years [P = .044]), level of education of the mother (women who had secondary education and above were six times more likely to have adequate knowledge on KMC compared with those with no formal education [P < .001) and the family type of a postnatal mother living in (those living in a nuclear families were 48% less likely to have adequate knowledge if compared with those living in extended families [P = .012]). Conclusion: Less than half of the interviewed postdelivery women had adequate knowledge of KMC. Postdelivery women who were more likely to have adequate knowledge about KMC were those aged more than 30 years, with a higher level of education, and living in extended families. We recommend a deliberate effort on improving postnatal mothers' knowledge of KMC, one of the strategies being initiating care of preterm babies in the antenatal package to prepare these mothers.

Assessing motivators for utilizing family planning services among youth students in higher learning institutions in Dodoma, Tanzania: Protocol for analytical cross sectional study.

INTRODUCTION: Contraceptive services utilization is an important intervention in averting the impact of unwanted and unplanned pregnancy among youth which is an obstacle to the higher learning institutions youth students in attaining their educational goals. Therefore, the current protocol aims to assess the motivators for family planning service utilization among youth student in higher learning institutions in Dodoma Tanzania. METHODS: This study will be a cross-sectional study with quantitative approach. A multistage sampling technique will be employed in studying 421 youth students aged between 18 to 24 years using structured self-administered questionnaire adopted from the previous studies. The study outcome will be family planning service utilization and independent variables will be family planning service utilization environment, knowledge factors, and perception factors. Other factors such as socio-demographic characteristics will be assessed if they are confounding factors. A factor will be considered as a confounder if it associates with both the dependent and the independent variables. Multivariable Binary logistic regression will be employed in determining the motivators for family planning utilization. The results will be presented using percentages, frequencies, and Odds Ratios and the association will be considered statistically significant at p-value <0.05.

The magnitude of teenage pregnancy and its associated factors among teenagers in Dodoma Tanzania: a community-based analytical cross-sectional study.

BACKGROUND: Teenage pregnancies cause serious health, social and economic consequences including death among adolescent girls worldwide. It is estimated that in 2019 about 55% of unintended pregnancies among adolescent girls aged 15-19 years ended up in abortions, which are often unsafe in developing countries. Little was known about the magnitude of teenage pregnancy and its associated factors in Dodoma Tanzania. Therefore, the study aimed at establishing the magnitude and factors associated with teenage pregnancies among adolescents in Dodoma Region Tanzania. METHOD: It was a community-based analytical cross-sectional study that included 539 adolescent girls aged 15 to 19 years old. A multistage sampling technique was used to recruit study participants. An interviewer-administered structured questionnaire was used to collect data. Data were analyzed by using SPSS v23. Descriptive statistics were used to describe the distribution of the entire study variable while the inferential statistics helped to establish factors associated with teenage pregnancy among adolescent girls and the level of significance was set at two sides of less than 0.05. RESULTS: The magnitude of teenage pregnancy in Dodoma was 29%. After controlling for possible confounders, factors associated with teenage pregnancy were; urban residence [AOR: 3.02, 95%CI: (1.60-5.68), p = 0.001], low mothers' education status [AOR: 3.46, 95%CI: (1.47-8.11), p = 0.004]; Poor knowledge on sexual and reproductive health [AOR: 2.09, 95%CI: (1.2-3.63), p = 0.009]; Low family economic status [AOR: 3.83, 95%CI: (1.77-8.30), p = 0.001]; Peer group [AOR: 2.92, 95%CI: (1.33-6.40), p = 0.007]; Early marriage [AOR: 2.58, 95%CI: (1.57-4.26), p < 0.0001]; and Sexual abuse [AOR: 13.56, 95%CI: (7.98-23.06), p < 0.0001]. CONCLUSION: This study found a high magnitude of teenage pregnancy among youth in Dodoma. Teenagers who were more likely to teenage pregnancy were those with limited knowledge about sexual and reproductive health living in urban, from families with low economic status, their mothers had a low level of education, from a culture that encourage early marriages, with the influence of peer and who experienced sexual abuse. An innovative intervention study to come up with a cost-effective strategy to address the challenge of teenage pregnancy in Dodoma is highly recommended.

Identifying factors associated with neonatal resuscitation skills among nurses and midwives in Tanzania, sub-Saharan Africa.

Objective: The objective of this study was to identify factors associated with nurses' and midwives' skills in performing neonatal resuscitation. Method: Health facility-based analytical cross-sectional study design was employed from January 2021 to April 2021 among 340 nurses and midwives selected by multistage random sampling technique. An observation checklist was used to collect data. Data were coded and entered into SPSS version 20 for analysis. Bivariate and multivariate logistic regression was used to assess factors associated with nurse/midwives' skills in neonatal resuscitation. Results: Among 340 nurses and midwives, 141 (41%) had adequate skills in neonatal resuscitation. After adjusting for confounders, factors associated with adequate skills were; age of the midwives (20-34 (adjusted odds ratio = 0.082, p < 0.008) and 35-49 (adjusted odds ratio = 0.087, p < 0.010)); work experience (worked 4-6 (adjusted odds ratio = 2.905, p < 0.003) and > 10 years and above (adjusted odds ratio = 12.825, p < 0.000)); district hospitals (adjusted odds ratio = 1.544, p = 0.032); distance from place of residence (6-10 km (adjusted odds ratio = 0.090, p < 0.001) and > 16 km (adjusted odds ratio = 0.049, p < 0.001)); number of midwives per shift, ⩾ 4 (adjusted odds ratio = 2.396, p = 0.012) and number of deliveries per day (6-10 (adjusted odds ratio = 1.385, p < 0.031), 11-20 (adjusted odds ratio = 2.693, p < 0.016) and > 20 delivery per day (adjusted odds ratio = 6.007, p < 0.001). Conclusion: Less than half of the observed nurses and midwives had adequate skills in neonatal resuscitation. Nurses and midwives who were younger, less experienced (<4 years of work experience), and work in small, lower volume settings with fewer colleagues and limited births (dispensaries, fewer than four nurses and midwives per shift, less than six deliveries per day) were less likely to have adequate skills in neonatal resuscitation. Knowledge gained from this study may provide future research related to a cost-effective strategy to empower nurses and midwives in neonatal resuscitation.

Exclusive breastfeeding practice among HIV infected mothers in the southern highlands of Tanzania; assessing the prevalence and factors associated with the practice, an analytical cross-sectional survey.

BACKGROUND: There is no other better way to safeguard an infant's health in the first 6 months of life than exclusive breastfeeding (EBF). Breast milk is valuable in all aspects of an infant's physical and mental growth as well as immune development. The study aimed to assess the prevalence and factors associated with EBF practice among HIV-infected mothers in the Southern Highlands of Tanzania. METHOD: A hospital-based analytical cross-sectional study was conducted among lactating HIV-infected mothers. A random sampling procedure was used to obtain 372 HIV-infected mothers of infants from 6 to 12 months of age who were still breastfeeding at the time of data collection. An interviewer-administered structured questionnaire was used for data collection. Bivariate and multivariable logistic regression was used to assess factors associated with EBF practice. Statistical package for social science (SPSS volume 20) software was used for data entry and analysis. RESULTS: The prevalence of EBF practice was 58.1% at 95% Confidence Interval of 52.9% to 63.1%. More than half of the respondents 199 (53.5%) had adequate knowledge while 173(46.5%) had inadequate knowledge about EBF. After adjusting for confounders, factors associated with EBF practice were knowledge about EBF [Adequate knowledge (AOR = 5.11 at 95% CI 3.2-8.17, p < 0.001)], ANC visits [Adequate (AOR = 1.76 at 95% CI 1.09-2.82, p = 0.002)], Income per day [1 0r more USD (AOR = 1.83 at 95% CI 1.14-2.94, p = 0.013)], positive perception of EBF [ positive perception (AOR = 3.51 at 95% CI 2.25-5.47, p < 0.001) and having ever experienced a breast problem AOR = 3.91 at 95% CI 1.89-8.08, p < 0.001. CONCLUSION: More than half of interviewed mothers with HIV practiced EBF. The EBF practice among HIV lactating mothers was significantly influenced by adequate knowledge of EBF, positive perception toward EBF, adequate ANC visits, and having never experienced breast problems. Strengthening adherence to ANC routine visits, counseling on breastfeeding, and improving mothers' knowledge about exclusive breastfeeding would contribute to the enhancement of EBF practice in this region. An innovative interventional study is recommended to develop more effective strategies to improve EBF knowledge and practice among HIV-infected mothers.

Factors associated with the use of deworming drugs during pregnancy in Tanzania; an analysis from the 2015-16 Tanzanian HIV and malaria indicators survey.

BACKGROUND: The use of deworming drugs is one of the important antenatal strategies in preventing anaemia in pregnancy. Little is known about the factors associated with the use of deworming drugs, which accounts for the aim of this study. METHOD: The study used data from the 2015-16 Tanzania HIV Demographic and Health Survey and Malaria Indicators Survey (2015-16 TDHS-MIS). A total of 6924 women of active reproductive age from 15 to 49 were included in the analysis. Both univariate and multiple logistic regression analyses were used. RESULTS: The majority of interviewed women 3864(60.1%) took deworming drugs. In a weighed multiple logistic regression, women residing in urban areas reported greater use of deworming drugs than women residing in rural areas [AOR = 1.73, p = 0.01, 95% CI (1.26-2.38)]. In the four areas of residence, compared to women residing in mainland rural areas, women residing in mainland urban areas and Pemba islands reported greater use of deworming drugs [mainland urban (AOR = 2.56 p < 0.001,95% CI(1.78-3.75), and Pemba Island (AOR = 1.18, p < 0.001, 95% CI(1.17-1.20)]. However, women residing in Zanzibar Island (Unguja) were less likely to use deworming drugs compared to women in mainland rural women (AOR = 0.5, p < 0.001, 95% CI (0.45-0.55). Similarly, compared to women under 20 years of age, women between 20 to 34 years reported significantly greater use of deworming drugs [20 to 34 years (AOR = 1.30, p = 0.03, 95% CI(1.02-1.65). Likewise, greater use of deworming drugs was reported in women with a higher level of education compared to no education [higher education level (AOR = 3.25, p = 0.01,95% CI(1.94-7.92)], rich women compared to poor [rich (AOR = 1.43, p = 0.003, 95% CI (1.13-1.80)] and in women who initiated antenatal care on their first trimester of pregnancy compared to those who initiated later [AOR = 1.37, p < 0.001, 95% CI (1.17-1.61)]. CONCLUSION: Women who were more likely to use the deworming drugs were those residing in urban compared to rural areas, aged between 20 and 34 years, those with a higher level of formal education, wealthier, and women who book the antenatal clinic (ANC) within their first trimester of pregnancy. Considering the outcomes of anaemia in pregnancy, a well-directed effort is needed to improve the use of deworming drugs.

Factors Associated with Uptake of Intermittent Preventive Treatment for Malaria During Pregnancy. Analysis of Data from the Tanzania 2015-2016 Demographic Health Survey and Malaria Indicator Survey.

Background: Malaria is a life-threatening disease caused by parasites that are transmitted to people through bites of infected female Anopheles mosquitoes. Africa is the home to over 90% of malaria burden when compared to other regions of the world. The region is estimated to have a dominance of 94% of maternal deaths occurring in the world. The purpose of this study was to identify factors associated with the uptake of IPTp-SP among pregnant women in Tanzania. Method: The study used data from the 2015-16 Tanzania Demographic and Health Survey and Malaria Indicators Survey (2015-16 TDHS-MIS). A total of 6,885 women of active reproductive age from 15 to 49 were included in the analysis. Both univariate and multiple regression analyses were performed to determine factors associated with uptake of IPTp-SP during pregnancy in Tanzania. Results: A total of 4764(68.6%) of pregnant women took at least one dose of IPTp-SP during Antenatal Care (ANC) visits. After adjusting for confounders, factors which were associated with uptake of IPTp-SP were; early antenatal booking, (AOR=1.495 p<.001); age group of pregnant woman [20 to 34 years (AOR=1.446, p=.001), more than 34 years (AOR=1.648, p<.001)]; wealth index [middle (AOR=1.418, p<.001), rich (AOR=1.589, p<.001)], education level [primary education (AOR=1.457, p<.001), secondary education AOR=1.653, p<.001]; parity [para 2 to 4 (AOR=1.213, p=.014), para 5 and above (AOR=1.226, p=.043)] and zone [Mainland rural (AOR=0.647, p=.019), Unguja (AOR=0.172, p<.001) and Pemba (AOR=0.310, p<0.001)]. Conclusion: Factors associated with uptake of IPTp-SP during pregnancy were; timing for ANC booking, age of pregnant woman, parity, level of education, and place of residence.

Factors Influencing Formal Mental Treatment - Seeking Behaviour among Caretakers of Mentally Ill Patients in Zanzibar.

Background: Mental illnesses are health conditions which are associated with changes in emotion, thinking, or behaviour (or a combination of these). Healthcare-seeking behaviour for formal mental health treatment is lacking all over the world, particularly in low and middle-income countries. Inappropriate health-seeking behaviours are reported to result in delays in seeking appropriate care and thus increase the risk of complications in mentally ill patients. The study aimed to assess factors influencing formal mental treatment-seeking behaviour among caretakers of mentally ill patients in Zanzibar. Methods: A community-based cross-sectional study design was conducted from January to June, 2021. A total of 246 caretakers of mentally ill patients were recruited for the study using multi-stage sampling technique. An interviewer-administered semi-structured questionnaire was used to collect information from caretakers. Bivariate and multivariable logistic regression models were applied to determine the factors influencing formal mental treatment-seeking behaviour. Results: Majority of caretakers 187(76%) were aware of formal mental treatment. Also, majority of the participants 145(58.9%) had appropriate healthcare-seeking behaviour toward formal mental treatment. Factors influencing formal mental treatment-seeking behaviour were; perceived severity (AOR 4.651 at 95% CI 2,397-9.021 p<.001) and being aware (AOR 2.907at 95% CI 2.349-2.326 p=.004). Conclusion: Majority of caretakers were aware of formal mental illness treatment. Also, more than half of the caretakers had appropriate healthcare-seeking behaviour. Factors associated with formal mental treatment-seeking behaviour were awareness of formal mental treatment and perceived severity of mental illness. The study recommends a community sensitisation campaign to raise community awareness and perception towards formal mental treatment. Community sensitisation is crucial for improving formal mental treatment-seeking behaviour.

Implementation of maternal and perinatal death surveillance and response system among health facilities in Morogoro Region: a descriptive cross-sectional study.

BACKGROUND: When used effectively, the Maternal and Perinatal Death Surveillance and Response (MPDSR) system can bring into reality a revolutionary victory in the fight against maternal and perinatal mortality from avoidable causes. This study aimed at determining the status of implementation of the system among health facilities in the Morogoro Region. METHOD: This study was conducted among 38 health facilities from three districts of the Morogoro region, Tanzania, from April 27, 2020, to May 29, 2020. Quantitative data were collected through document review for MPDSR implementation status. The outcome was determined by using a unique scoring sheet with a total of 30 points. Facilities that scored less than 11 points were considered to be in the pre-implementation phase, those scored 11 to 17 were considered in the implementation phase, and those scored 18 to 30 were considered to be in the institutionalization phase. RESULTS: The majority 20(53 %) of health facilities were in the pre-implementation phase, only 15(40 %) of assessed health facilities were in the implementation phase, and few 3(8 %) of health facilities were in institutionalization phase. There was a strong evidence that MPDSR implementation was more advanced in urban compared to rural health facilities (Fisher's test = 6.158, p = 0.049), hospitals compared to health centers (Fisher's test =14.609, p <0.001) and private and faith-based organization than public facilities (Fisher's test, 15.897 = p = 0.002). CONCLUSIONS: The study revealed that health facilities in Morogoro Region have not adequately implemented the MPDSR system. The majority of health facilities in rural settings and owned by the government showed poor MPDSR implementation and hence called for immediate action to rectify the situation. Strengthen MPDSR implementation, health facilities should be encouraged to adhere to the available MPDSR guidelines in the process of death reviews. Transparent systems should also be established to ensure thorough tracking and follow-up of recommendations evolving from MPDSR reviews. Health facilities should also consider integrating MPDSR to other quality improvement teams to maximize its efficiency.

Factors Associated With Uptake of Iron Supplement During Pregnancy Among Women of Reproductive Age in Tanzania: an Analysis of Data From the 2015 to 2016 Tanzania Demographic and Health Survey and Malaria Indicators Survey.

Background: Pregnant women are vulnerable to iron deficiency due to the fact that more iron is needed primarily to supply the growing fetus and placenta and to increase the maternal red cell mass. Little is known on the factors associated with uptake of iron supplement during pregnancy. Methods: The study used data from the 2015 to 2016 Tanzania Demographic and Health Survey and Malaria Indicators Survey. A total of 6,924 women of active reproductive age from 15 to 49 were included in the analysis. Both univariate and multiple regression analyses were used to determine factors associated with uptake of iron supplement during pregnancy. Results: Majority of the interviewed women 5,648 (81.6%) always took iron supplement during pregnancy, while a total of 1,276 (18.4%) women never took iron supplement during pregnancy. After controlling for confounders, the predictors for uptake of iron supplement during pregnancy were early antenatal booking (adjusted odds ratio, AOR = 1.603 at 95% CI = 1.362-1.887, p < 0.001); rural residence (AOR = 0.711 at 95% CI = 0.159-0.526, p = 0.007); wealth index [rich (AOR = 1.188 at 95% CI = 0.986-1.432, p = 0.07)]-poor was the reference population; level of education [primary education (AOR = 1.187 at 95% CI = 1.013-1.391, p = 0.034)]-no formal education was the reference population; parity [para 2 to 4 (AOR = 0.807 at 95% CI = 0.668-0.974, p = 0.026), para 5 and above (AOR = 0.75 at 95% CI = 0.592-0.95, p = 0.017)], para 1 was the reference population; zones [mainland rural (AOR = 0.593 at 95% CI = 0.389-0.905, p = 0.015) and Unguja Island AOR = 0.63 at 95% CI = 0.431-0.92, p = 0.017]-mainland urban was the reference population; and current working status [working (AOR = 0.807 at 95% CI = 0.687-0.949, p = 0.009)]. Conclusion: The study revealed that, despite free access to iron supplement during pregnancy, there are women who fail to access the supplement at least once throughout the pregnancy. The likelihood to fail to access iron supplement during pregnancy was common among pregnant women who initiated antenatal visits late, were from poor families, had no formal education, reside in rural settings, had high parity, were from mainland rural, and were in working status. Interventional studies are recommended in order to come up with effective strategies to increase the uptake of iron supplement during pregnancy.

Prevalence and Predictor of Exclusive Breastfeeding among Mothers of 0 to 6 months Infants from Pastoralists and Hunters' Community in Tanzania; A Community Based Cross-Sectional Study.

BACKGROUND: Initiating breastfeeding during the first hour after birth and continuing breastfeeding exclusively for 6 months prevents childhood infections such as diarrhoea. Exclusive breastfeeding (EBF) for the first 6 months of life of the baby is recognised globally as the best and the most effective intervention to ensure the survival of babies. The aim of this study was to determine the prevalence of EBF and its predictors among mothers of 0 to 6 months infants from pastoralists and hunters' community in Manyara region-Tanzania. METHODS: This was a community-based analytical cross-sectional study that involved 342 mothers of 0 to 6 months infants who were randomly selected through 4 stage multistage sampling technique. Data was collected using an interviewer-administered questionnaire. Collected data was analysed using Statistical Package for Social Sciences (SPSS) version 20. Binary Logistic Regression analysis was used to establish factors associated with EBF practices. RESULTS: The prevalence of EBF among postnatal women from hunters and pastoralists societies was 47.1% at 95% CI=41.7%-52.5%. After adjusted for confounders, the predictors of EBF practice were age of infants (0-1 months, AOR = 2.838 at 95% CI = 1.326-6.075, p=.007), age of mothers (26-35 years, AOR=1.851 at 95% CI= 1.059-3.234, p=.031), Level of education of infants' mothers (primary education, AOR= 2.374 at 95% CI= 1.321-4.265, p=.004) and knowledge on exclusive breast feeding, AOR=2.51 at 95% CI= 1.435-4.393, p=.001. CONCLUSION: Majority of mothers from pastoralists' and hunters' societies were not practising EBF. Predictors of EBF practice were; the age of infants, maternal age, level of education of the mother and knowledge on exclusive breastfeeding. Poor EBF practice was mainly contributed to low level of knowledge about the EBF. The low level of knowledge could have been contributed by poor access to maternal services. Nature of living (lack of permanent settlement) of the study population could have contributed to low access to maternal services. An innovative interventional study is highly recommended to come up with strategies that will improve knowledge on EBF and practice of EBF.

Factors associated with blood pressure check-up during pregnancy among women of reproductive age in Tanzania: an analysis of data from 2015-16 Tanzania Demographic and Health Survey and Malaria Indicators Survey.

BACKGROUND: Hypertensive Disorder of Pregnancy (HDP) is one of the leading causes of maternal mortality and morbidity amongst pregnant women in the world. Blood pressure check-ups during pregnancy are one of the strategies used to identify hypertensive disorders, hence timely management. Little is known about the factors associated with blood pressure check-ups in Tanzania. METHOD: The study used data from 2015-16 Tanzania Demographic and Health Survey and Malaria Indicators Survey (2015-16 TDHS-MIS). A total of 6924 women of active reproductive age from 15 to 49 were included in the analysis. Both univariate and multiple regression analyses were used to determine the association between early antenatal booking and maternal services utilization. RESULTS: The prevalence of blood pressure checkups during pregnancy was 72.17% at 95% confidence interval of 71.1-73.2%. Factors associated with uptake of blood pressure check-ups were; timely antenatal booking, AOR = 1.496, CI = 1.297-1.726, p < 0.001, late booking was a reference population, age group [> 34 years, (AOR = 1.518, CI = 1.149-2.006, p = 0.003)] with < 20 years used as a reference population, wealth index [middle income, (AOR = 1.215, CI = 1.053-1.468, p = 0.008) and rich, (AOR = 2.270, CI = 1.907-2.702, p < 0.001)] reference population being poor; education level [primary education, (AOR = 1.275, CI = 1.107-1.468, p = 0.001); secondary education, (AOR = 2.163, CI = 1.688-2.774, p < 0.001) and higher education, (AOR = 9.929, CI = 1.355-72.76, p = 0.024)] reference population being no formal education; parity [para 2-4, (AOR = 1.190, CI = 1.003-1.412, p = 0.046) with para one used as a reference population and zones [Unguja Island, (AOR = 3.934, CI = 1.568-9.871, p = 0.004), Pemba Island, (AOR = 5.308, CI = 1.808-15.58, p = 0.002)] and Mainland Urban being the reference population. CONCLUSION: The study revealed that rural dwelling pregnant women had higher chance of not getting their BP checked. It was also revealed that maternal age, education level, place of residence, wealth index and timing of ANC services were significantly associated with blood pressure check-ups. The study recommends the need to explore significant factors associated with utilization of available free reproductive health services across all public health facilities. It also recommends the need to address prioritized intensive awareness programs and behavioral change interventions on the significance of BP check-ups among pregnant women of reproductive age.

Prevalence and factors which influence early antenatal booking among women of reproductive age in Tanzania: An analysis of data from the 2015-16 Tanzania Demographic Health Survey and Malaria Indicators Survey.

BACKGROUND: Early initiation of the antenatal clinic is vital as it allows early detection, management, and prevention of problems that may occur during pregnancy time. The analysis aimed to determine the prevalence and factors which influence early antenatal booking among women of reproductive age in Tanzania. METHOD: The study used data from the 2015-16 Tanzania Demographic and Health Survey and Malaria Indicators Survey (2015-16 TDHS-MIS). A total of 6924 women of active reproductive age from 15 to 49 were included in the analysis. Both univariate and multiple regression analyses were used to determine predictors of early antenatal booking. RESULTS: Only 1586 (22.9%) of pregnant women had early antenatal booking. After adjusted for the confounders, factors which influenced early antenatal booking were age of a woman [20 to 34 years, Adjusted Odds Ratio (AOR) = 1.554 at 95% Confidence Interval (CI) = 1.213-1.993, and more than 34 years, AOR = 1.758 at 95% CI = 1.306-2.368]; wealth status [rich, AOR = 1.520 at 95% CI = 1.282-1.802]; education level [higher education, AOR = 2.355 at 95% CI = 1.36-4.079]; parity [Para 2 to 3, AOR = 0.85 at 95% CI = 0.727-0.994 and Para 5+, AOR = 0.577 at 95%CI = 0.465-0.715]; zones [Unguja, AOR = 0.433 at 95% CI = 0.284-0.658 and Pemba, AOR = 0.392 at 95% CI = 0.236-0.649]. CONCLUSION: Early antenatal booking in Tanzania is extremely low. Women who were more likely to initiate antenatal visits within the first 12 weeks are those from well-off families, those with higher education, primiparity women, and those from Tanzania mainland urban. The innovative interventional study is highly recommended to come up with an effective strategy to improve timing for antenatal booking.

Predictors for the uptake of optimal doses of sulfadoxine-pyrimethamine for intermittent preventive treatment of malaria during pregnancy in Tanzania: further analysis of the data of the 2015-2016 Tanzania demographic and health survey and malaria indicator survey.

BACKGROUND: In Tanzania, the uptake of optimal doses (≥ 3) of sulfadoxine-pyrimethamine for intermittent preventive treatment of malaria (IPTp-SP) during pregnancy has remained below the recommended target of 80%. Therefore, this study aimed to investigate the predictors for the uptake of optimal IPTp-SP among pregnant women in Tanzania. METHODS: This study used data from the 2015-16 Tanzania demographic and health survey and malaria indicator survey (TDHS-MIS). The study had a total of 4111 women aged 15 to 49 who had live births 2 years preceding the survey. The outcome variable was uptake of three or more doses of IPTp-SP, and the independent variables were age, marital status, education level, place of residence, wealth index, occupation, geographic zone, parity, the timing of first antenatal care (ANC), number of ANC visits and type of the health facility for ANC visits. Predictors for the optimal uptake of IPTp-SP were assessed using univariate and multivariable logistic regression. RESULTS: A total of 327 (8%) women had optimal uptake of IPTp-SP doses. Among the assessed predictors, the following were significantly associated with optimal uptake of IPTp-SP doses; education level [primary (AOR: 2.2, 95% CI 1.26-3.67); secondary or higher education (AOR: 2.1, 95% CI 1.08-4.22)], attended ANC at the first trimester (AOR: 2.4, 95% CI 1.20-4.96), attended ≥ 4 ANC visits (AOR: 1.9, 95% CI 1.34-2.83), attended government health facilities (AOR: 1.5, 95% CI 1.07-1.97) and geographic zone [Central (AOR: 5, 95% CI 2.08-11.95); Southern Highlands (AOR: 2.8, 95% CI 1.15-7.02); Southwest Highlands (AOR: 2.7, 95% CI 1.03-7.29); Lake (AOR: 3.5, 95% CI 1.51-8.14); Eastern (AOR: 1.5, 95% CI 1.88-11.07)]. CONCLUSIONS: The uptake of optimal IPTp-SP doses is still low in Tanzania. The optimal uptake of IPTp-SP was associated with attending ANC in the first trimester, attending more than four ANC visits, attending government health facility for ANC, having primary, secondary, or higher education level, and geographic zone. Therefore, there is a need for health education and behavior change interventions with an emphasis on the optimal use of IPTp-SP doses.

The impact of community based continuous training project on improving couples' knowledge on birth preparedness and complication readiness in rural setting Tanzania; A controlled quasi-experimental study.

BACKGROUND: It is widely accepted that community-based interventions are vital strategies towards reduction of maternal and neonatal mortalities in developing counties. This study aimed at finding the impact a Community Based Continuous Training (CBCT) project in improving couples' knowledge on birth preparedness and complication readiness in rural Tanzania. METHOD: The quasi-experimental study design with control was adopted to determine the impact of CBCT in improving knowledge on birth preparedness and complication readiness. The study was conducted from June 2017 until March 2018. A multi-stage sampling technique was employed to obtain 561couples. Pre-test and post-training intervention information were collected using semi-structured questionnaires. The impact of CBCT was determined using both independent t-test and paired t-test. Linear regression analysis was used to establish the association between the project and the change in knowledge mean scores. The effect size was calculated using Cohen's d. RESULTS: At post-test assessment, knowledge mean scores were significantly higher in the intervention group among both pregnant women (m = 14.47±5.49) and their male partners (m = 14.1±5.76) as compared to control group among both pregnant women (m = 9.09±6.44) and their male partners (m = 9.98±6.65) with large effect size of 0.9 among pregnant women and medium effect size of 0.66 among male respondents. When the mean scores were compared within groups among both pregnant women and male partners in the intervention group, there were a significant increase in knowledge mean scores at post-test assessment as compared to pre-test assessment with large effect size of Cohen's d = 1.4 among pregnant women and 1.5 among male partners. After adjusting for the confounders, the predictors of change in knowledge among pregnant women were the CBCT project (ß = 0.346, p<0.000) and ethnic group [Mambwe (ß = -0.524, p = 0.001)] and the predictors of change in knowledge among male partners were the CBCT project (ß = 1.058, p<0.001) and walking distance [more than five kilometers (ß = -0.55, p< 0.05)]. CONCLUSION: This interventional study which focused on knowledge empowerment and behavior change among expecting couples was both feasible and effective on improving knowledge about birth preparedness and complication readiness in rural settings of Tanzania.