Meals, Education, and Gardens for In-School Adolescents: A Cluster Randomized Trial of an Adolescent Nutrition Intervention Package in Tanzania.

PURPOSE: This study aimed to implement and evaluate integrated, school-based nutrition intervention packages for adolescents in Dodoma, Tanzania. METHODS: A cluster randomized controlled trial was conducted among six secondary schools in Dodoma, Tanzania. Two schools received the full-intervention package of school meals, nutrition education, school gardens, and community workshops. Two schools received the partial-intervention package without the school meals component. Two schools served as the controls and did not receive any intervention. The intervention was implemented over one academic year. The analytical sample included 534 adolescents aged 14 to 17 at baseline and 286 parents. Outcomes included nutrition knowledge, food preferences, diet quality, food insecurity, physical activity, growth, and anemia. Linear models were used to estimate mean differences, and logistic regression models were used to estimate odds ratios (ORs). RESULTS: Compared to the control, both the partial (OR: 0.59; 95% confidence interval [CI]: 0.35, 1.00) and full (OR: 0.49; 95% CI: 0.40, 0.59) interventions were associated with lower odds of poor diet quality among adolescents. Among the parents, both the partial (OR: 0.28; 95% CI: 0.20, 0.40) and full (OR: 0.28; 95% CI: 0.13, 0.58) interventions were associated with lower odds of poor diet quality. The partial (OR: 0.29; 95% CI: 0.18, 0.47) and full (OR: 0.47; 95% CI: 0.30, 0.72) interventions were associated with lower odds of adolescent overweight or obesity. DISCUSSION: School-based nutritional intervention packages incorporating multiple actions may improve the diet quality of adolescents and their household members and reduce the double burden of adolescent malnutrition.

Effects of engaging fathers and bundling nutrition and parenting interventions on household gender equality and women's empowerment in rural Tanzania: Results from EFFECTS, a five-arm cluster-randomized controlled trial.

Advancing gender equality and women's empowerment (GE/WE) may contribute to better child nutrition and development in low-resource settings. However, few empirical studies have generated evidence on GE/WE and examined the potential of engaging men to transform gender norms and power relations in the context of nutrition and parenting programs. We tested the independent and combined effects of engaging couples and bundling nutrition and parenting interventions on GE/WE in Mara, Tanzania. EFFECTS (ClinicalTrials.gov, NCT03759821) was a cluster-randomized 2 × 2 factorial trial plus control. Eighty village clusters were randomly assigned to one of five intervention conditions: standard of care, mothers nutrition, couples nutrition, mothers bundled nutrition and parenting, or couples bundled nutrition and parenting. Between October 2018-May 2019, 960 households were enrolled with children under 18 months of age residing with their mother and father. Community health workers (CHWs) delivered a bi-weekly 24-session hybrid peer group/home visit gender-transformative behavior change program to either mothers or couples. GE/WE outcomes were analyzed as intention-to-treat and included time use, gender attitudes, social support, couples' communication frequency and quality, decision-making power, intimate partner violence (IPV), and women's dietary diversity (WDD). Data were collected from 957 to 815 mothers and 913 and 733 fathers at baseline and endline, respectively. Engaging couples compared to mothers only significantly increased paternal and maternal gender-equitable attitudes, paternal time spent on domestic chores, and maternal decision-making power. Bundling increased maternal leisure time, decreased maternal exposure to any IPV, and increased WDD over 7 days. A combination of engaging couples and bundling was most effective for paternal gender attitudes, couples communication frequency, and WDD over 24 h and 7 days. Our findings generate novel evidence that CHWs can deliver bundled nutrition and parenting interventions to couples in low-resource community settings that advance GE/WE more than nutrition interventions targeting only women.

Design and Field Methods of the ARISE Network COVID-19 Rapid Monitoring Survey.

The coronavirus disease 2019 (COVID-19) pandemic has significant health and economic ramifications across sub-Saharan Africa (SSA). Data regarding its far-reaching impacts are severely lacking, thereby hindering the development of evidence-based strategies to mitigate its direct and indirect health consequences. To address this need, the Africa Research, Implementation Science, and Education (ARISE) Network established a mobile survey platform in SSA to generate longitudinal data regarding knowledge, attitudes, and practices (KAP) related to COVID-19 prevention and management and to evaluate the impact of COVID-19 on health and socioeconomic domains. We conducted a baseline survey of 900 healthcare workers, 1,795 adolescents 10 to 19 years of age, and 1,797 adults 20 years or older at six urban and rural sites in Burkina Faso, Ethiopia, and Nigeria. Households were selected using sampling frames of existing Health and Demographic Surveillance Systems or national surveys when possible. Healthcare providers in urban areas were sampled using lists from professional associations. Data were collected through computer-assisted telephone interviews from July to November 2020. Consenting participants responded to surveys assessing KAP and the impact of the pandemic on nutrition, food security, healthcare access and utilization, lifestyle, and mental health. We found that mobile telephone surveys can be a rapid and reliable strategy for data collection during emergencies, but challenges exist with response rates. Maintaining accurate databases of telephone numbers and conducting brief baseline in-person visits can improve response rates. The challenges and lessons learned from this effort can inform future survey efforts during COVID-19 and other emergencies, as well as remote data collection in SSA in general.

Public knowledge of risk factors and warning signs for cardiovascular disease among young and middle-aged adults in rural Tanzania.

BACKGROUND: Improving cardiovascular health requires public knowledge and reduction of modifiable cardiovascular disease (CVD) risk factors. This study assessed knowledge of risk factors and warning signs for CVDs among young and middle-aged adults in Morogoro, Tanzania. METHODS: We conducted a community-based survey as part of cluster randomized controlled study of community health workers (CHWs) intervention for reduction of blood pressure among young and middle-aged adults in rural Morogoro. Information on socio-demographic characteristics, knowledge of risk factors and warning signs for CVDs was collected using an interviewer administered questionaire. Knowledge was assessed using open-ended questions followed by closed-ended questions. Descriptive statistics were used to describe knowledge of risk factors and warning signs. Logistic regression analysis was used to investigate factors associated with adequate knowledge of risk factors and warning signs for CVDs. RESULTS: Two-thirds (65.7%) of the participants had heard about CVDs. The main sources of information were mainly relatives/ neighbors (64.8%) and radio (53.0%). Only 28.3% of the participants reported health care providers as source of information about CVDs. More than half of the participants (52.4%) did not mention even one risk factor spontaneously while 55.2% were unable to mention any warning sign. When asked to select from a list, 6.9% were unable to correctly identify any risk factor whereas 11.8% could not correctly identify even a single warning sign. Quarter of participants (25.4%) had good knowledge score of risk factors, 17.5% had good knowledge score of warning signs and 16.3% had overall good knowledge of both risk factors and warning signs. Residing in Ulanga, having higher education level, having ever checked blood pressure and being overweight/obese predicted adequacy of knowledge score for both risk factors and warning signs. CONCLUSION: Knowledge of risk factors and warning signs in this rural population of young and middle-aged adults was generally low. Health care providers were less likely to provide health education regarding risk factors and warning signs for CVDs. Health promotion interventions to increase population knowledge of risk factors and warning signs should be implemented for successful reduction of CVDs in Tanzania.

Prevalence and risk factors associated with malnutrition among adolescents in rural Tanzania.

OBJECTIVE: To determine the prevalence and risk factors associated with malnutrition among adolescents in a rural Tanzanian community. METHODS: Cross-sectional survey of 1226 randomly selected adolescents from the Dodoma Health and Demographic Surveillance System (HDSS) in the Chamwino district in the Dodoma region. Anthropometric measurements for weight and height were collected. Height-for-age-z-scores (HAZs) and body mass index (BMI)-for-age-z-scores (BAZs) were computed. Descriptive estimates were documented in graphs and tables, and weighted linear regression models were used to examine predictors of malnutrition. RESULTS: Stunting prevalence was 18%, and thinness prevalence was 14%. Overweight and obesity affected 5.23% of participants. Girls had higher HAZs (ß: 0.46, 95% CI 0.33, 0.59, P < 0.0001) and BAZs (ß: 0.20, 95% CI 0.05, 0.35, P = 0.0098) than boys. Age was inversely associated with HAZs (ß: -0.13, 95% CI -0.17, -0.08, P < 0.0001) and BAZs (ß: -0.05, 95% CI -0.10, -0.004, P = 0.0327). Wealth score (ß: 0.10, 95% CI 0.04, 0.16, P = 0.0009) and dietary diversity score (ß: 0.04, 95% CI 0.01, 0.07, P = 0.0080) were positively associated with HAZs and BAZs. Out-of-school adolescents had higher HAZs (ß: -0.49, 95% CI -0.75, -0.23, P = 0.0003) and BAZs (ß: -0.68, 95% CI -0.99, -0.37, P < 0.0001) than adolescents who attended school. CONCLUSION: There are substantial variations of HAZs and BAZs across gender, age, education and wealth, with an emerging burden of overweight and obesity among adolescents in this rural population. Interventions are urgently required to curb both ends of the malnutrition spectrum.

OBJECTIF: Déterminer la prévalence et les facteurs de risque associés à la malnutrition chez les adolescents d'une communauté rurale en Tanzanie. MÉTHODES: Enquête transversale auprès de 1.226 adolescents choisis au hasard dans le Système de Surveillance Démographique et de Santé (SSDS) de Dodoma dans le district de Chamwino, dans la région de Dodoma. Des mesures anthropométriques du poids et de la taille ont été recueillies. Les scores z de la taille pour l'âge (HAZ) et les scores z d'indice de masse corporelle (IMC) pour l'âge (BAZ) ont été calculés. Des estimations descriptives ont été documentées dans des graphiques et des tableaux, et des modèles de régression linéaire pondérés ont été utilisés pour analyser les prédicteurs de la malnutrition. RÉSULTATS: La prévalence du retard de croissance était de 18% et la prévalence de la maigreur était de 14%. Le surpoids et l'obésité touchaient 5,23% des participants. Les filles avaient des scores HAZ (ß: 0,46, IC95%: 0,33-0,59 ; P < 0,0001) et des scores BAZ (ß: 0,20 ; IC95%: 0,05-0,35 ; P = 0,0098) plus élevés que les garçons. L'âge était inversement associé au score HAZ (ß: −0,13, IC95%: −0,17, −0,08, P < 0,0001) et au score BAZ (ß: −0,05 ; IC95%: −0,104, −0,004 ; P = 0,0327). Le score de richesse (ß: 0,10 ; IC95%: 0,04-0,16; P = 0,0009) et le score de diversité alimentaire (ß: 0,04 ; IC95%: 0,01-0,07 ; P = 0,0080) étaient positivement associés aux scores HAZ et BAZ. Les adolescents non scolarisés présentaient des scores HAZ (ß: −0,49 ; IC95%: −0,75, −0,23 ; P = 0,0003) et des scores BAZ plus élevés (ß: −0,68 ; IC95%: −0,99 −0,37 ; P < 0,0001) que les adolescents qui fréquentaient l'école. CONCLUSION: Il existe des variations substantielles dans les scores HAZ et BAZ selon le sexe, l'âge, l'éducation et la richesse, avec une charge émergente de surpoids et d'obésité chez les adolescents dans la population rurale. Des interventions urgentes sont nécessaires pour réduire les deux extrémités du spectre de la malnutrition.

Antiretroviral Therapy in Relation to Birth Outcomes among HIV-infected Women: A Cohort Study.

Although the beneficial effects of antiretroviral (ARV) therapy for preventing mother-to-child transmission are indisputable, studies in developed and developing countries have reported conflicting findings on the association between ARV exposure and adverse birth outcomes. We conducted a prospective observational study at 10 human immunodeficiency virus (HIV) care and treatment centers in Dar es Salaam, Tanzania. Multivariate log-binomial regression was used to investigate the associations between ARV use and adverse birth outcomes among HIV-negative HIV-exposed infants. Our findings demonstrate an increased risk of adverse birth outcomes associated with the use of highly active antiretroviral therapy during pregnancy. Further studies are needed to investigate the underlying mechanisms and identify the safest ARV regimens for use during pregnancy.