HIV prevalence and associated risk factors among female sex workers in Dar es Salaam, Tanzania: tracking the epidemic.

Since 2014, HIV care and treatment services among key populations including female sex workers (FSWs) have intensified in Tanzania. We sought to track the epidemic among FSWs in Dar es Salaam, Tanzania. We conducted a cross-sectional integrated bio-behavioral survey using respondent-driven sampling and a structured questionnaire. Blood was drawn for HIV testing. Modified Poisson regression was used to determine factors associated with HIV infection. We recruited 958 FSWs (median age 26 years) of whom 952 consented to HIV testing. The HIV prevalence was 15.3% (95%CI: 12.5-18.6). Factors associated with higher HIV prevalence included old age (25-34 years: aPR 2.38; 95%CI: 1.23, 4.60 and over 35 years: aPR = 6.08; 95%CI: 3.19, 11.58) and having experienced sexual violence in the past year (aPR = 1.94; 95%CI: 1.34, 2.82). Attaining higher education level was associated with lower HIV prevalence (aPR = 0.51; 95%CI: 0.36, 0.73 for primary school level and aPR = 0.20; 95%CI: 0.08, 0.46 for secondary school level and/or above). The HIV prevalence among FSWs in Dar es Salaam has decreased by half since 2013. Prevention strategies should target older FSWs, aim to educate young girls, and institute approaches to mitigate violence among FSWs.

The effect of a practical nutrition education programme on feeding skills of caregivers of children with cerebral palsy at Muhimbili National Hospital, in Tanzania.

BACKGROUND: Feeding children with cerebral palsy (CP) is challenging and can lead to poor health outcomes. Using a facility-based intervention, we assessed the effect of a practical nutrition programme on feeding skills in caregivers of children with CP attending a pediatric clinic in urban Tanzania. METHODS: A randomized-controlled intervention study, involving 2-block stratified sample of under-5 CP children attending a specialized pediatric clinic at the Muhimbili National Hospital was done. One hundred ten moderate-to-severe, new and follow-up cases of children with CP were randomly allocated to the intervention (N = 63) and control groups (N = 47). A short nutrition education on feeding and positioning skills was provided to caregivers and occupational therapy sessions to CP children. Bivariate and multivariable logistic regression analyses of collected data were done. Statistical significance was assessed at p < .05. FINDINGS: The intervention significantly improved feeding skills of caregiver in the select indicators assessed. More caregivers appropriately positioned the children (AOR = 5.29; 95% CI: 2.00-13.96), fed children slowly (AOR: 5.17, 95% CI: 1.99-13.44), and involved the child during the feeding process (AOR = 3.46; 95% CI: 1.42-8.44). During feeding, caregiver's reported being less stressed (AOR = 2.53, 95% CI: 1.04-6.13) and the child's mood was more likely to be reported as improved (AOR = 3.15, 95% CI: 1.33-7.474). Although changes were observed in oral motor feeding skills (AOR = 1.67; 95% CI: 0.72-3.91) and functional feeding skills (AOR = 2.28; 95% CI: 0.86-6.06), they did not reach statistical significance in the multivariable models. CONCLUSION: Strengthening nutrition education and services for caregivers of children with CP has great value in the care of children with special needs and may improve the health outcomes of children as well as reduce stress among parents/caregivers.

Comparison of HIV-1 prevalence and risk factors between pregnant, non-pregnant, all women and the general population in Tanzania: implications for second-generation surveillance.

The aim of this study was to compare HIV-1 prevalence between pregnant, non-pregnant, all women and the general population (men and women) and investigate how well risk behaviours of pregnant women reflect those of all women in the general population in rural Kilimanjaro, Tanzania. A cross-sectional survey involving all individuals aged 15-44 years was conducted in Oria village between March and May of 2005. All consenting individuals were interviewed and offered HIV-1 and syphilis testing. The response proportion among women was found to be 73.7% (914/1241). Age-adjusted HIV-1 prevalence among pregnant women (n = 92) was 32.5% lower (5.4% versus 8.0%, P < 0.001) than that of all women but only 8.5% (5.4% versus 5.9%, P = 0.639) lower compared with that of the general population. HIV-1 risk factors among pregnant women were comparable to that of all women in the general population. In conclusion, pregnant women in the general population underestimate the HIV-1 magnitude among women but closely approximate that of the general population. HIV-1 risk factors are similar between pregnant and all women in the general population. Second-generation surveillance could utilize pregnant women risk behaviours to approximate that of all women in the general population.

Sexually transmitted infections knowledge and its impact in the practice of risky sexual behaviours and HIV serostatus: results from rural Kilimanjaro, Tanzania.

OBJECTIVES: To investigate the level of knowledge of different categories of sexually transmitted infections (STIs) and their impact on practice of risky sexual behaviours and HIV transmission in rural Kilimanjaro, Tanzania. METHODS: A cross-sectional study, including all individuals aged 15-44 years living in Oria village, Kahe ward, was conducted between March and May 2005. All consenting individuals were interviewed and offered HIV testing. RESULTS: The response rate was 73.0% (1528/2093). Overall, knowledge of STIs was 38.6%. Having a casual partner (59.4%) and multiple sexual partners (50.6%) were mentioned as the most potential sources of STI. Genital ulcers and vaginal discharge were the predominant symptoms noted whereas abstinence and condom use were the preferred preventive measures. Knowledge of STI complications, including HIV transmission, was very low (22.0%) in this community. The low knowledge of STI complications was significantly associated with recent (past 4 weeks) practice of multiple sexual partners (AOR 2.4, 95% CI 1.1 to 8.7), not using condoms with casual partners (AOR, 2.7, 95% CI 1.2 to 7.5) and HIV serostatus (AOR 3.4, 95% CI 1.8 to 14.5). CONCLUSIONS: Overall STI knowledge and its link to HIV transmission was alarmingly low in this community. Knowledge of STI complications may play an important role in inducing safer sexual behaviours and hence HIV prevention. Interventions addressing HIV/STI knowledge should put more emphasis on raising awareness of complications as this may play a major role in HIV/STI prevention.

Food insufficiency in rural Kilimanjaro, Tanzania.

OBJECTIVES: To estimate the prevalence of reported food insufficiency associated socio-demographic factors and health indicators in rural Tanzania. DESIGN: A cross-sectional study. SETTING: A rural community in Kilimanjaro, Tanzania. SUBJECTS: Eight hundred and ninety nine individuals aged 15-36 years. A structured questionnaire was administered to collect information on socio-demographic factors, health indicators and food insufficiency. Participants were tested for HIV-1 using saliva samples. RESULTS: The prevalence of food insufficiency was 25.3% with no sex difference. After controlling for potential confounders age (Adjusted Odds Ratio [AOR] = 1.05; 95% Confidence Interval [CI]: 1.02-1.08), low education level (AOR = 4.73; CI: 1.30-17.11), being a peasant (AOR = 2.29; CI: 1.04-5.04), poor self-rated health status (AOR = 4.35; CI: 1.71-11.00) and having health problems (AOR = 2.23; CI: 1.21-4.08) were associated with food insufficiency among women but not men. In unadjusted analysis, women with food insufficiency had over twice the odds of testing HIV positive although the association did not reach statistical significance (AOR = 2.12; CI: 0.87-5.19) in adjusted analysis. CONCLUSIONS: Food insufficiency was prevalent in rural Tanzania. It was associated with sociodemographic factors and health indicators among women but not men. Our findings suggest that food insufficiency may play a role in increasing vulnerability to HIV infection particularly among women however; more research is needed to explore further this relationship.