Cash transfers to enhance completion of TB screening among household contacts in rural Tanzania.

Tanzanian TB guidelines recommend facility-based TB screening for symptomatic household contacts (HHCs) or those aged <5 years, but cost remains a major barrier. In this study, we evaluate the use of unconditional cash transfers (UCTs) to facilitate completion of HHC TB screening.In this prospective interventional study, we enrolled index people diagnosed with TB (PWTB) within 8 weeks of TB treatment initiation from the TB clinic at Haydom Lutheran Hospital, Haydom, Tanzania, and surrounding TB dispensaries in rural Tanzania. The study provided at the time of enrollment an UCT up to 40,000 Tanzanian shillings (USD16.91) directly to heads of households with PWTB, covered medical costs from screening activities and provided three bi-weekly phone reminders to facilitate HHC TB screening. The primary outcome was TB screening completion for all HHCs compared to the same period of the preceding year.We enrolled 120 index PWTB, including 398 HHCs between July and December 2022. The median age for index PWTB was 35 years; 38% were females. Sixty-five (54%) households completed screening for all HHCs, compared to 7% during the same period of the preceding year.These interventions may considerably improve completion of HHC TB screening in rural Tanzania..

Metabolic maturation in the first 2 years of life in resource-constrained settings and its association with postnatal growths.

Malnutrition continues to affect the growth and development of millions of children worldwide, and chronic undernutrition has proven to be largely refractory to interventions. Improved understanding of metabolic development in infancy and how it differs in growth-constrained children may provide insights to inform more timely, targeted, and effective interventions. Here, the metabolome of healthy infants was compared to that of growth-constrained infants from three continents over the first 2 years of life to identify metabolic signatures of aging. Predictive models demonstrated that growth-constrained children lag in their metabolic maturity relative to their healthier peers and that metabolic maturity can predict growth 6 months into the future. Our results provide a metabolic framework from which future nutritional programs may be more precisely constructed and evaluated.

Timing of cord clamping in relation to start of breathing or ventilation among depressed neonates-an observational study.

OBJECTIVES: The optimal timing of cord clamping (CC) in nonbreathing neonates needing stabilisation/resuscitation remains unclear. The objective was to describe the relationship between time to CC, initiation of breathing or positive pressure ventilation (PPV) after stimulation/suction and 24-hour neonatal mortality/morbidity. DESIGN: Observational study. SETTING: A rural Tanzanian referral hospital. POPULATION: Depressed nonbreathing newborns. METHODS: Trained research assistants have observed every delivery (November 2009 through January 2014) using stop-watches and recorded data including fetal heart rate; time intervals from birth to CC and start of breathing or PPV and perinatal characteristics. MAIN OUTCOME MEASURES: Twenty-four-hour neonatal outcome (dead, admitted, normal). RESULTS: There were 19 863 liveborn infants; 16 770 (84.4%) initiated spontaneous respirations, 3093 (15.6%) received stimulation/suctioning to initiate breathing. However, 1269 (41.0%) neonates failed to breath and received PPV at 98 ± 66 seconds and CC at 39 ± 35 seconds after birth. Adverse outcomes in neonates receiving PPV included 126 (9.9%) deaths and 100 (7.8%) neonatal admissions. In 1146/1269 (90%) neonates, CC occurred before PPV and was associated with 209 (18%) deaths/admissions. In 98 (8%) neonates, CC followed initiation of PPV with 14 (14%) deaths/admissions (P = 0.328). By logistic modelling, initiation of PPV before versus after CC was not associated with death/admission when adjusted for time to PPV. The risk for death/admission increased by 12% for every 30-second delay in PPV (P = 0.001). CONCLUSIONS: This observational study failed to demonstrate any relationship between time to CC and onset of breathing or initiation of PPV following stimulation/suction, and 24-hour outcome. Delay in initiation of PPV was significantly associated with death/admission. TWEETABLE ABSTRACT: No relationship between time to cord clamp, breathing or ventilation and 24-hour deaths in depressed neonates.

A one-day "Helping Babies Breathe" course improves simulated performance but not clinical management of neonates.

OBJECTIVE: "Helping Babies Breathe" (HBB) is a simulation-based one-day course developed to help reduce neonatal mortality globally. The study objectives were to (1) determine the effect on practical skills and management strategies among providers using simulations seven months after HBB training, and (2) describe neonatal management in the delivery room during the corresponding time period before/after a one-day HBB training in a rural Tanzanian hospital. METHODS: The one-day HBB training was conducted by Tanzanian master instructors in April 2010. Two simulation scenarios; "routine care" and "neonatal resuscitation" were performed by 39 providers before (September 2009) and 27 providers after (November 2010) the HBB training. Two independent raters scored the videotaped scenarios. Overall "pass/fail" performance and different skills were assessed. During the study time period (September 2009-November 2010) no HBB re-trainings were conducted, no local ownership was established, and no HBB action plans were implemented in the labor ward to facilitate transfer and sustainability of performance in the delivery room at birth. Observational data on neonatal management before (n=2745) and after (n=3116) the HBB training was collected in the delivery room by observing all births at the hospital during the same time period. RESULTS: The proportion of providers who "passed" the simulated "routine care" and "neonatal resuscitation" scenarios increased after HBB training; from 41 to 74% (p=0.016) and from 18 to 74% (p≤0.0001) respectively. However, the number of babies being suctioned and/or ventilated at birth did not change, and the use of stimulation in the delivery room decreased after HBB training. CONCLUSION: Birth attendants in a rural hospital in Tanzania performed significantly better in simulated neonatal care and resuscitation seven months after one day of HBB training. This improvement did not transfer into clinical practice.