Socioeconomic inequalities in maternal healthcare utilization: An analysis of the interaction between wealth status and education, a population-based surveys in Tanzania.

Limited scientific, evidence has so far described the interactions between socioeconomic factors and the gap of inequalities in maternal healthcare utilization. This study assessed the interaction between wealth status and education to identify women with greater disadvantage. This analysis used secondary data from the three most recent rounds (2004, 2010, and 2016) of the Tanzania Demographic Health Survey (TDHS). Maternal healthcare utilization was assessed based on six services (outcomes) which are i) booking during the first trimester (bANC), ii) at least four antenatal visits (ANC4+), iii) adequate antenatal care (aANC), iv) facility-based delivery (FBD), v) skilled birth attendance (SBA), vi) cesarean section delivery (CSD). The concentration curve and the concentration index were used to measure socioeconomic inequality in maternal healthcare utilization outcomes. The interaction coefficients suggest that each unit increase in the wealth status is significantly associated with higher odds of utilizing all maternal healthcare services for women with primary and secondary or higher education compared to those with no education (booking during the first trimester [AOR = 1.30; 95% CI: 1.08-1.57], at least four antenatal visits [AOR = 1.16; 95% CI: 1.01-1.33], facility-based delivery [AOR = 1.29; 95% CI: 1.12-1.48], skilled birth attendance [AOR = 1.31; 95% CI: 1.15-1.49]). The highest wealth-related inequality in bANC (EI: 0.166), at least four antenatal visits (EI: 0.259), FBD (EI: 0.323) and skilled birth attendance (EI: 0.328) (P < 0.05) was observed among women with primary and secondary or higher education. These findings provide strong evidence that there is an interaction effect between education attainment and wealth status in socioeconomic inequalities of maternal health services utilization. Therefore, any approach which will address both women's education and wealth status might be the first step to reducing socioeconomic inequalities in maternal health services utilization in Tanzania.

Gestational trophoblastic disease and associated factors among women experiencing first trimester pregnancy loss at a regional referral hospital in central Tanzania: a cross-sectional study.

BACKGROUND: Gestational trophoblastic diseases (GTDs) may follow any form of pregnancy or a pregnancy loss. Early detection of GTDs is important, as some benign forms of the disease may progress into a chemoresistant and metastatic disease. This study aimed at determining the frequency of GTDs among women experiencing first trimester pregnancy loss and the associated patients' characteristics. METHODS: This was a cross-sectional study that included 200 conveniently sampled women who experienced first trimester pregnancy loss from January to December 2019 at a Regional Referral Hospital in central Tanzania. The specimen obtained from products of conception were collected, formalin-fixed and paraffin-embedded and submitted for histopathological evaluation, for which haematoxylin and eosin stain was used. Data were analysed using SPSS version 23.0. The χ2 test was used to determine the association between categorical variables. p-Values ˂0.05 were considered statistically significant. RESULTS: Among 200 study participants, the overall frequency of GTDs was 42 (21%). Among those with GTDs, the most common histopathological diagnosis was partial hydatidiform mole (18 [42.9%]), followed by complete hydatidiform mole (17 [40.5%]) and choriocarcinoma (7 [16.5%]). In the studied participants, only increased human chorionic gonadotropin hormone levels were found to be statistically significantly associated with GTDs (p=0.000). CONCLUSIONS: Results from this study suggest that routine histopathological evaluation of the products of conception is recommended in order to allow early detection of GTDs, including choriocarcinoma, which usually carries a poor prognosis. The histopathological reporting of choriocarcinoma among first trimester products of conception from Tanzania is novel.

Use of a mHealth System to Improve Antenatal Care in Low and Lower-Middle Income Countries: Report on Patients and Healthcare Workers' Acceptability in Tanzania.

Antenatal care (ANC) is considered a cornerstone of reproductive health programmes, but many women face difficulties in accessing these services, particularly in some sub-Saharan African countries, such as Tanzania. This study aimed to test ANC visit acceptability using mHealth system PANDA (Pregnancy And Newborn Diagnostic Assessment) in the Mufindi district (Tanzania). We investigated the ANC visit acceptability of pregnant women and healthcare workers (HCWs) in an intervention area using the PANDA system compared with a control area. An ad hoc questionnaire was administered to pregnant women in an implementation area (n = 52) and in a control area (n = 46). In the implementation area, group interviews with 50 pregnant women were conducted and five HCWs evaluated ANC visits through a questionnaire. The implementation group was significantly more satisfied with the ANC visit compared with the control group. All the 52 women and the HCWs declared that PANDA icons were useful in understanding and remembering the provided information and the PANDA app was able to improve the ANC quality and to positively influence the relationship of HCWs and pregnant women. HCWs reported that the PANDA app was "easy-to-use" and "able to improve the adherence to ANC WHO recommendations". In underserved areas, many pregnant women could benefit from the PANDA system increasing their access to high-quality ANC and overcoming language and/or literacy barriers.

Role of male partners in the long-term well-being of women who have experienced severe pre-eclampsia and eclampsia in rural Tanzania: a qualitative study.

Men can be essential sources of support in maternal health, even more so in case of severe acute maternal morbidity (SAMM), affecting 1-2% of childbearing women in low-resource settings. In a qualitative study using semi-structured interviews, we explored the perspectives of nine male partners of women who suffered from (pre-)eclampsia six to seven years earlier in rural Tanzania. Male partners considered their role to be pivotal regarding finances, decision-making in healthcare-seeking and family planning and provided physical and emotional support. After SAMM, households may be affected in the long run. Some men took over their female partner's household duties until up to two years after birth. Providing men with more information on complication readiness and birth preparedness would enable them to extend their role in maternal morbidity prevention.IMPACT STATEMENTWhat is already known on this subject? The essential role of male partners in maternal health in low- and middle-income countries is well-studied in relation to its impact on care-seeking behaviour. After childbirth, the long-term role of male partners has not yet been studied.What do the results of this study add? We demonstrated the important role of men during, but also after SAMM. Households may be affected years after women suffered from SAMM. For women with the most urgent support needs, this study suggest that at least some men feel responsible for their partner and have different pivotal roles.What are the implications of these findings for clinical practice and/or further research? Because of their motivation to support their female partner, strategies to reduce recurring complications in subsequent pregnancies should include targeting male partners, for example, by increasing birth preparedness and complication readiness. Further studies should confirm the results from our innovative but small-scale study, as well as investigate the long-term role of male partners after uncomplicated births. Other studies could investigate the separation of couples after SAMM, family planning decisions after SAMM and strategies for involving men and increasing complication readiness and birth preparedness.

Factors associated with reduced foetal movements in Iringa, Tanzania

Introduction: Maternal perception of foetal movement ensures foetal wellbeing. Reduced foetal movement is associated with foetal hypoxia, stillbirths, and intrauterine foetal growth restriction (IUFGR). This study aimed at assessing factors that are associated with maternal perception of reduced foetal movements. Method: This was a cross-sectional study that was conducted at Iringa Regional Referral Hospital from 1st January ­ 30th June 2022. A purposive sampling technique was used, and SPSS version 25 software was used for data analysis. Results: 41.3 % of study participants were aged 24 ­ 34 years, with a mean and SD of 29.08 ±7.53. 75% were not employed, 52.8 % of study participants delivered from 37 ­ 42 weeks of gestational age, 66.1% had a posterior placenta and only 24.0 % had an anterior placenta. Women who delivered at 28 ­ 36 weeks of gestational age were about 4 times more likely to experience reduced foetal movement compared to those who delivered at 37 ­ 42 weeks of gestation (AOR=4.162, 95% CI 2.174 - 7.966, p= =0.0067). Conclusion: Reduced foetal movements are associated with lower gestation age at delivery and decreased antenatal clinic attendance in Iringa, Tanzania. All pregnant women should be encouraged to make early antenatal clinic attendance and should attend adequate visits. Healthcare providers should educate and create awareness on methods of assessing foetal movements.

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.

Effect of nutritional education intervention to reduce anaemia during pregnancy in Dodoma City, Tanzania: protocol for a cluster randomized controlled trial.

The objective of this study is to assess the effectiveness of community-based nutritional intervention in reducing the burden of anaemia during pregnancy. Study design will be a cluster-randomized controlled trial. Study setting will be peri-urban wards of Dodoma City. The study will have two arms (the interventional and the control arms). A total of 400 pregnant women at second trimester will be recruited. The study will consist of four phases in four months for both the interventional and the control arms namely: baseline, first and second follow-up and end-line surveys. During each phase, participants from both arms will be measured for haemoglobin concentration and assessed for gestational age, dietary practices and knowledge about anaemia. Furthermore, all participants will receive iron and folic acid supplements, sulphadoxinepyrimethamine and mebendazole tablets throughout the entire period of the study. Nutritional education will be provided to the interventional arm only during each phase. Main outcomes of the study will be changes in haemoglobin concentration, nutritional knowledge and dietary practices at each phase after the baseline survey in the interventional compared to the control arm. Descriptive statistics will be used to describe the participants. Independent and paired t-tests will be performed to make comparisons between and within groups. P-values less than 0.05 will be considered statistically significant. Trial registration PACTR Registry, PACTR202007617885299. Registered on 28 May 2020.

Rationale of indications for caesarean delivery and associated factors among primigravidae in Tanzania.

OBJECTIVE: This study aimed to determine the prevalence of modes of delivery and associated maternal and newborn outcomes among singleton primigravidae in the Iringa region of Tanzania. METHODS: A cross-sectional, analytical hospital-based study was conducted in the Iringa region among 356 singleton primigravidae between April and August 2018. Convenience sampling and consecutive collection of data using a face-to-face interviewer-administered questionnaire was done. RESULTS: A total of 356 singleton primigravid women with a mean age of 22.0 years (range: 15-49) participated in the study. The majority of the participants (73.0%, n = 250) were in the 20-35 age group. Caesarean and vaginal delivery were performed in 41.3% (n = 147) and 58.7% (n = 209) of the cases, respectively. The maternal height and weight of the newborn were significantly associated with caesarean delivery; (p = 0.001) and (p = 0.029), respectively. After adjusting for all variables, birth asphyxia (AOR = 3.25, 95% CI: 1.867-5.646, p = 0.000) and low birth weight (AOR = 0.03, 95% CI: 0.003-0.211, p = 0.001) were associated with caesarean delivery. CONCLUSIONS: The findings of our study indicated the prevalence of caesarean section to be three times more than that recommended by the World Health Organization. Pregnant women with a height of less than 150 cm should be considered for caesarean section. Therefore, it is necessary for stakeholders in the health sector to formulate guidelines for absolute indications for caesarean section.

Predictors of Helping Babies Breathe knowledge and skills among nurses in primary health settings in Dodoma region, Tanzania.

BACKGROUND: Globally, birth asphyxia is one of the leading causes of neonatal death. In Tanzania, neonatal deaths are estimated to be 25 deaths per 1000 live births and birth asphyxia accounts for 31% of those deaths. METHOD: A cross-sectional study was conducted in 40 health centers within 7 districts in Dodoma Region among nurses working in maternity units. Simple random sampling was used to select participants. A knowledge questionnaire and performance skills checklist were used to assess nurses' knowledge and skills respectively. Chi-square and binary logistic regression were employed to test association and identify significant predictors of HBB knowledge and skills. RESULTS: A total of 172 participants completed the study out of 176 recruited. This represents a respondent rate of 98%. Findings indicate that age, duration of professional training, and experience in maternity were significant predictors for knowledge and skills. However, after control of the confounders, experience in the maternity unit was found to be the only significant predictor of knowledge and skills in resuscitation of the neonates (AOR = 2.94; CI: 0.96-8.98; P = 0.05) and (AOR = 4.14; CI: 1.12-15.31; P = 0.03) respectively. Nurses with longer maternity nursing care experience of 5 years and above were better able to answer questions that demonstrated adequate knowledge (53.9%) and perform skills correctly (53.2%) related to HBB. Those with less than 5 years' experience had limited knowledge (20%) and skills (10.5%). CONCLUSION: In this setting, direct work experience in the maternity unit was the main factor influencing knowledge and skills in neonatal resuscitation with HBB.

Knowledge on Prevention and Management of Preeclampsia and Eclampsia among Nurses in Primary Health Settings: Baseline Findings from an Interventional Study in Dodoma Region, Tanzania.

BACKGROUND: Preeclampsia and eclampsia are conditions which increase maternal and foetal morbidity and mortality worldwide. These conditions are ranked as the second leading cause of maternal deaths. Nurses have a critical role in preventing and managing preeclampsia. However, their knowledge has not been evaluated particularly among those working in primary health facilities, where opportunities for continue education is limited. OBJECTIVE: To assess knowledge on prevention and management of preeclampsia and eclampsia among nurses working in the primary health care settings. METHODS: Analysis of baseline data from an intervention study which test the effectiveness of simulation-based training on obstetric and neonatal emergencies among nurses in managing maternal and newborn emergencies in primary health care settings. A total of 39 primary health centres within 7 districts in Dodoma Region were selected to take part in the interventional study. Individual participants were nurses working in maternity units were involved. 172 nurses were selected using a simple random method. Nurses' knowledge on prevention and management of PEE and its predictors were assessed using a self-administered questionnaire. Descriptive statistics analysis was done to determine the distribution of the background characteristics of nurses and logistic regression analysis was performed to explore predictors of nurses' knowledge. RESULTS: Overall knowledge on preeclampsia and eclampsia was 88 (51.2%). Professional qualification was a predictor associated with a nurse's knowledge about preeclampsia and eclampsia. Registered nurses were more knowledgeable compared to enrolled nurses (AOR3.311; CI, 1.62 to 6.768; P value =.001), years of working experience showed no association with knowledge on preeclampsia and eclampsia (AOR 0.98; CI: 0.39-2.47; P values = 0.970). CONCLUSION: This study showed there is a critical knowledge deficiency in the prevention and management of preeclampsia and eclampsia among nurses working in maternal units of primary health care setting. Effective regular training on prevention and management of preeclampsia and eclampsia for frontline nurses is required in order to improve maternal and neonatal survival.

Characteristics and outcomes of patients with eclampsia and severe pre-eclampsia in a rural hospital in Western Tanzania: a retrospective medical record study.

BACKGROUND: Eclampsia and pre-eclampsia are well-recognized causes of maternal and neonatal mortality in low income countries, but are never studied in a district hospital. In order to get reliable data to facilitate the hospital's obstetric audit a retrospective medical record study was performed in Ndala Hospital, Tanzania. METHODS: All patients diagnosed with severe pre-eclampsia or eclampsia between July 2011 and December 2012 were included. Medical records were searched immediately following discharge or death. General patient characteristics, medical history, obstetrical history, possible risk factors, information about the current pregnancy, antenatal clinic attendance and prescribed therapy before admission were recorded. Symptoms and complications were noted. Statistical analysis was done with Epi Info®. RESULTS: Of the 3398 women who gave birth in the hospital 26 cases of severe pre-eclampsia and 55 cases of eclampsia were diagnosed (0.8 and 1.6%). Six women with eclampsia died (case fatality rate 11%). Convulsions in patients with eclampsia were classified as antepartum (44%), intrapartum (42%) and postpartum (15%). Magnesium was given in 100% of patients with eclampsia and was effective in controlling convulsions. Intravenous antihypertensive treatment was only started in 5% of patients. Induction of labour was done in 29 patients (78% of women who were not yet in labour). Delivery was spontaneous in 67%, assisted vaginal (ventouse) in 14% and by Caesarean section in 19% of women. Perinatal deaths occurred in 30% of women with eclampsia and 27% of women with severe pre-eclampsia and were associated with low birth weight and prolonged time between admission and birth. CONCLUSIONS: 2.4% of women were diagnosed with severe pre-eclampsia or eclampsia. The case fatality rate and overall perinatal mortality were comparable to other reports. Better outcomes could be achieved by better treatment of hypertension and starting induction of labour as soon as possible.

The male circumcision: the oldest ancient procedure, its past, present and future roles.

Circumcision, a surgical removal of male prepuce has existed throughout human history, and it appears it shall exist until humanity ends. During its entire existence, there have been changing reasons or indications from cultural, traditional, religious and currently medical, and it has vehemently been criticized by some individuals for different reasons and in different countries. Emergency of new diseases particularly Human Immunodeficient virus (HIV) has brought the ancient procedure back on spot light, this has come as a result of recent studies which have demonstrated that it does not only reduces significantly the rate of HIV infection, as well as penile cancer and cervical cancer. This has lead to massive male circumcision campaigns in areas with low prevalence of circumcision. On the other hand the socio-cultural and sexual aspects of male circumcision have been studied but often ignored. This article will therefore increase awareness of male circumcision and the increasing roles with time, recommend up scaling of medical male circumcision and possible safe circumcision training to tradition circumcisers.

Morpho-physiological features associated with menopause: recent knowledge and areas for future work.

Menopause is the permanent cessation of menstruation resulting from loss of ovarian follicular activity which happens as a result of depletion of primary follicles which is basically an aging effect. Depletion of ovarian follicles is reflected as declined production of oestradiol which is currently known to be central to the morphologic and physiological changes that happen during the climacteric, menopause and post menopause periods. The cessation of oestradiol production is much more pronounced in tissues with oestrogen receptors such as bones, brain, blood vessels, central nervous system and the skin. But generally little is known on the subject and in particular the bioactive substances involved in the process such that there are some symptoms that menopause women experience which not only defy clinicians but also challenge the management of the condition. This article is presented to shade light to what is currently known, what is not known and stimulate future research which may reveal more understanding and advance our knowledge on management of women throughout the climacteric and menopausal periods.

Imperforate hymen presenting with massive haematocolpos and acute urinary retention in a teenage girl: A case report.

Imperforate hymen is relatively rare but it is the most frequently encountered obstructive anomaly of the female lower genital tract. The clinical presentation vary significantly from patient to patient depending on the age at diagnosis but in most cases the diagnosis is missed in early childhood and therefore the diagnosis is made after puberty when the patient present with haematocolpos, heamatometra.or both. When this happens, the presentation could even be tricky because the patient may presents with unlikely symptoms apart from cryptomenorhoea like, urinary retention or bowel obstruction or both. Here we present a 16 years old girl with imperforate hymen and presented with history of lower abdominal pain and distension associated with acute urinary retention. She was treated by hymenotomy and improved dramatically and was discharge 6th day post operatively. This case report is presented to address to clinicians the possibility of imperforate hymen with haematocolpos as a differential diagnosis in adolescent girls particularly those who have not started having their menses in their teens and present with acute urinary retention so that their external genitalia are carefully examined to exclude the possibility of imperforate hymen as a cause of acute urinary retention due to the haematocolpos.

Uterine rupture: a retrospective analysis of causes, complications and management outcomes at Muhimbili National Hospital in Dar es Salaam, Tanzania.

Rupture of the gravid uterus is an obstetric catastrophe that is associated with complications that include massive blood loss, hysterectomy, and damage to the genitourinary tract. It is a serious complication that is associated with high maternal and perinatal morbidity and mortality. We conducted a retrospective review of case notes (from 2003 to 2009) to determine the incidence, causes, complications and foetal/maternal outcome among women with a diagnosis of ruptured uterus at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania. Case notes with diagnosis of ruptured uterus were retrieved from the records department and information on maternal demographic characteristics, surgical intervention, maternal and perinatal outcome were collected using a check list. Where information was inadequate it was sought from the obstetric database. Obtained data was cleaned and analyzed using PASW statistics 18 software. Out of 72,570 deliveries 163 cases of ruptured uterus were recorded in seven years, making an incidence of 2.25 per 1000 births. Most ruptures (38%) resulted from neglected obstructed labour and scared uterus (33.6%). Major obstetric haemorrhage (>1500 ml) was the most frequently encountered complication followed by sepsis. Subtotal hysterectomy was the most common (73.6%) surgical intervention. Maternal and perinatal case fatality rates were 12.9%, and 96.3% respectively. Ruptured uterus contributed to 6.6% of all maternal deaths. These findings underscores the need for proper monitoring of labour both in the referring facilities and at MNH and improvement of comprehensive emergence obstetric care at all levels of health care to avoid unnecessary delays in care.