Health Facility Readiness for Promoting Male Involvement in Family Planning Services in Tanzania: A Qualitative Study on Perspectives of Health Providers in Kibaha District.

Background: The successes and failures of health policies and programs to motivate men to develop interest in positive decision making and actions relating to reproductive and child health services (RCHs) in Tanzania are inadequately documented. Therefore, a study was done to explore the health facility readiness for motivating men to effectively participate in RCHs including Family Planning (FP) in Kibaha District. Methods: This was a cross-sectional qualitative study undertaken in 2014 and involving in-depth interviews (IDIs) with frontline RCH providers at selected Health Facilities (HFs) and their district coordinator. Data were transcribed verbatim, coded and evaluated thematically through a narrative analysis approach. Results: All the respondents admitted the role of men in influencing FP decisions at family and other community levels and the need for engaging them in RCHs. They all reported to have continued to note an increasing attitude and activeness of men to attend the RCH facilities available for RCHs along with their partners despite the remaining ones who still show hesitance. Family Planning interventions supported by the District Council Authority and development partners were reported to contribute in increasing the number of males coming for FP and other RCHs. Nevertheless, some shortcomings were experienced, and were reported to include some HFs providing FP services on selected week days which limit the clients who would need them any day/time; some dispensaries lacking adequate lounges or consultation room spaces for accommodating clients arriving in couples or who would be held for receiving health education in group; and the occasional stock-outs of essential FP commodities and other RCHs at some of the HFs. Conclusions: The study reveals the pleasure frontline RCHs staff had after observing an increasing trend in male involvement in such services and the support given by the government and its allied stakeholders to make this a success. However, the prevailing deficiencies relating to HF infrastructure and FP commodity supplies need to be addressed if a universal health coverage for FP and other RCHs were to be attained as policy and program-wise advocated.

Understanding forgotten exposures towards achieving Sustainable Development Goal 3: a cross-sectional study on herbal medicine use during pregnancy or delivery in Tanzania.

BACKGROUND: In most of the sub-Sahara African countries, use of herbal medications is widely practiced during pregnancy or delivery for various reasons despite uncertainties on their pharmacological profiles. Use of unregistered herbal medicines has the potential of causing adverse health effects to the mother and the newborn, thus deterring achievement of Sustainable Development Goal 3, which aims to "ensure healthy lives and promote well-being for all at all ages". One of the targets is on reduction of morbidity and mortality among mothers and newborns. This study investigated use of herbal medicines and predictors of usage during pregnancy or delivery as a forgotten exposure towards understanding some of the challenges in achieving Sustainable Development Goal 3. METHODS: This cross-sectional quantitative study gathered information from women who delivered a live-born baby in the preceding two years. Using a two-stage-sampling technique, women attending reproductive, maternal and child health clinics in Tabora were selected and interviewed. Proportions were compared using chi-square test and Poisson regression analysis was performed to determine independent correlates of herbal medicine use. RESULTS: Of 340 recruited women, 208 [61.2 %; 95 % confidence interval: 55.4, 66.3 %] used herbal medicines during pregnancy or delivery. Major reasons for use included accelerating labour, 81 (38.9 %) and reducing labour pains, 58 (27.9 %). Women who made less than four antenatal visits had a 24 % higher adjusted prevalence ratio of using herbal medicines as compared to those who had at least four visits [adjusted prevalence ratio:1.24; 95 % confidence interval: 1.02, 1.50, p = 0.03]. Furthermore, the adjusted prevalence ratio of using herbal medicines was 35 % higher among women who were not discouraged by health care providers against their use as compared to those who were discouraged (adjusted prevalence ratio: 1.35; 95 % confidence interval: 1.13, 1.60, p = 0.01). CONCLUSIONS: Use of herbal medicines during pregnancy or delivery among women in Tanzania is common. Independent predictors of herbal medicine use were number of antenatal visits and stance of maternity health care providers on their use. Comprehensive investigations on the magnitude, patterns and predictors of use of herbal medicines during pregnancy or delivery are warranted.

Male partner approval on the use of modern contraceptive methods: factors determining usage among couples in Kibaha district, Tanzania.

BACKGROUND: Men in developing countries play an important role in the adoption of family planning (FP), either as actual users or supporters of their partners. Notwithstanding the universal knowledge on the contraceptive methods, their approval and use have been low among men in Tanzania. This study determined the magnitude and factors that influence men to use or approve the use of modern contraceptive methods with their spouses. METHODS: A cross sectional, community-based study was conducted in Kibaha, Pwani region in 2014. A total of 365 randomly selected married and cohabiting men; aged 18 to 60 years who had at least a child below the age of 5 years were interviewed using a structured questionnaire. Descriptive statistics were performed and associations between status of men using modern FP with their partners and potential factors were tested using Chi-square and Fisher's exact tests as appropriate. Logistic regression model was fitted to determine significant factors associated with male use of the methods with their partners. RESULTS: About 60 % of men (59.7%) reported to use modern FP methods. In the bivariate analysis, education level (odds ratio (OR) = 2.6, CI = 1.4-4.8; p = 0.002); men knowledge on any contraceptive method (OR = 24.1, CI = 7.3-79.9; p < 0.001); awareness of a nearby FP clinic (OR = 6.2, CI = 3.1-12.3; p < 0.001); number of children (OR = 2, CI = 1.1-3.6; p < 0.025) and presence of a provider during clinic visit (OR = 12.0, CI = 2.26-63.7; p < 0.004) were significantly associated with the use of FP. However, in the multivariable analysis, only knowledge on FP methods (adjusted odds ratios (AOR) =26.4; CI = 7.9-88.4, p < 0.001) and number of children a man had (AOR = 1.9; CI = 1.0-3.6, p = 0.039) remained significantly associated with the use of modern FP methods. CONCLUSION: This study has shown that for men to use family planning methods with their partners, knowledge of FP methods and number of children are critical factors. Visiting a FP center alone or with a spouse, and availability of FP provider (during visit) also influence this practice. These findings emphasize a need to increase knowledge on contraception and family planning services access among men.

Prevalence of excess body weight and associated factors among secondary school adolescent girls in northern Tanzania: a cross-sectional study.

INTRODUCTION: excess body weight among adolescents is on the increase and has become a global public health challenge. It is likely to persist to adulthood, exposing to risk of developing chronic diseases. However, there is insufficient information on the prevalence of excess body weight and associated factors among adolescent girls in secondary schools in northern Tanzania. METHODS: this cross-sectional study involved 400 secondary school adolescent girls, selected by multi-stage cluster sampling. A self-administered questionnaire was used to gather information. Anthropometric measurements were taken and body mass index calculated. Descriptive statistics summarized the data. Logistic regression was used to model excess body weight resulting into adjusted odds ratios with their 95% confidence intervals and significant level was set at p-value<0.05. RESULTS: the proportion of adolescents with excess body weight (BMI >+1SD) was 23%. The majority (63%), reported unhealthy dietary habits while half (51.5%) of them had moderate level of knowledge on healthy eating. Compared to working as a civil servant, the odds of having excess body weight among girls whose mothers/female guardians were housewives was less by 60% (aOR=0.4, 95%CI: 0.2, 0.9). Furthermore, the odds of having excess body weight among adolescents eating unhealthy foods were almost six times higher compared to their peers on healthy diet (aOR=5.8, 95%CI: 2.9, 11.3). CONCLUSION: prevalence of excess body weight among adolescent girls in northern Tanzania is high. Unhealthy dietary habits and mother's/female guardian's occupation were significant correlates of excess body weight. We recommend platforms to inform adolescents on the importance of proper food intake and to advance knowledge on dangers of excessive weight gain as a strategy towards prevention of nutrition-related diseases.

Implementation and acceptability of strategies instituted for engaging men in family planning services in Kibaha district, Tanzania.

BACKGROUND: Men as the main decision makers in most of African families have an important role to play towards acceptance of family planning methods. This study sought to identify strategies used to engage men in family planning services and determine the extent to which men in Kibaha district in Tanzania accept these interventions. METHODS: We conducted a cross sectional study using both quantitative and qualitative techniques. We used a questionnaire to interview a random sample of 365 of currently married or cohabiting men who had at least one child under the age of five years. We further conducted in-depth interviews with health workers involved in delivering reproductive health services as well as community dispensers of family planning commodities. Descriptive analysis was used to determine the extent to which men were engaged in family planning services. The data from the indepth interviews were analysed manually according to the predetermined themes, guided by the grounded theory to identify the existing strategies used to encourage male involvement in family planning services. RESULTS: According to the key informants, strategies that are used to encourage men to engage in family planning services include invitations through their spouses, either verbally or by using partner notification cards, incorporating family planning messages during monthly meetings and community outreach reproductive health programs. Of 365 men responding to the questionnaire, only 31 (8.4%) said they were invited to accompany their spouses to family planning clinics. Among them, 71% (22/31) visited family planning clinics. A third (32%) of the respondents had heard of community health meetings and only 20.7% of them attended these meetings. More than a third (12/34) of men who attended these meeting asserted that family planning messages targeting men featured in the agenda and subsequently half of them visited health facilities for family planning services. CONCLUSIONS: Existing strategies such as invitations to clinics and community sensitization have shown to encourage men to engage in family planning services. However, these interventions reach few men and hence there is a need to rolling them up to improve uptake of family planning services.

Prevalence and determinants of stunting in under-five children in central Tanzania: remaining threats to achieving Millennium Development Goal 4.

BACKGROUND: The Millennium Development Goal No 4 (MDG 4) requires countries to scale up interventions addressing malnutrition and other immediate determinants of burden of disease among children to reduce child mortality by two thirds by 2015, which is this year. Whereas globally some achievements have been registered, under-nourishment remains a significant problem in some developing countries such as Tanzania. This study set out to estimate the extent of stunting and its associated determinants to assess the progress made thus far towards achieving MDG 4 in Tanzania. METHODS: A random sample of 678 households with under-five children was selected from two randomly selected wards of Kongwa district in Dodoma region, Tanzania. The WHO anthropometric calculator, which computes Z-scores using a reference population, was used to process the anthropometric measurement data taken from all the participants. Children with height for age Z-score of less than 2 were categorised as stunted and coded as 1 and the rest were coded as 0. Proportions of stunting were compared using the chi-square test to determine the association between stunting and the independent variables. Multivariate logistic regression analysis was carried out to determine the Adjusted Odds Ratio (AOR) of the independent determinants of stunting. The cut-off for significant association was set at p = 0.05. All these analyses used the STATA 12 software. RESULTS: About half (49.7 %) of the children were stunted. This stunting was associated with belonging to households where the head of family was young (<35 years) (AOR = 0.67, 95 % CI 0.47-0.96, p = 0.031), young age of the mothers (AOR = 1.54, 95 % CI 1.06-2.24, p = 0.023), and economic variables such as owning a cellular phone (AOR = 0.66, 96 % CI 0.46-0.94, p = 0.023). CONCLUSIONS: Stunting was highly prevalent in Kongwa district despite general improvements in child nutritional status at the national level. Household characteristics and economic status were found to play a major role in child health. In this regard, disaggregated analyses are therefore important in identifying resilient areas in need of concerted efforts for the MDG 4 to be achieved nationwide.

Social Capital as a Determinant of Pregnant Mother's Place of Delivery: Experience from Kongwa District in Central Tanzania.

INTRODUCTION: Maternal ill health contributes highly to the global burden of diseases in countries South of Sahara including Tanzania. Ensuring that all deliveries take place in health facilities and hence attended by skilled health personnel is one of the strategies advocated by global and national policies, including the Millennium Development Goals (MDGs). However, the number of women delivered by skilled health personnel has remained low in sub Saharan Africa despite of a number of interventions. We sought to determine the role of social capital in facilitating health facility delivery. METHODS: We randomly selected 744 households with children aged less than five years from two randomly selected wards in a rural area in Tanzania. Mothers were enquired about place of delivery of the last child. Social capital was assessed using a modified questionnaire with both structural and cognitive aspects of social capital, administered in face-to-face interviews. Principal Component Analysis (PCA) was used to develop asocial capital index measure. Uni-variate and multivariable regression models were run using STATA 12. RESULTS: Majority (85.9%) of the mothers reported to have delivered in a health facility during their last birth. Compared to the lowest social capital quintile, delivering in a health facility increased significantly with increase in social capital level: low (Adjusted Odds Ratio (AOR) = 2.9; Confidence Interval (CI): 1.4-6.1, p = 0.004); moderate (AOR = 5.5, CI: 2.3-13.3, p-value<0.001); high (AOR = 4.7; CI: 1.9-11.6, p-value<0.001) and highest (AOR = 5.6, CI: 2.4-13.4, p-value<0.001) and χ2-test for the trend was significant (χ2 = 17.21, p<0.001). CONCLUSION: Overall, social capital seems to play an important role in enhancing health facility delivery that may lead to improved maternal and child health. Concerted efforts should focus on promoting and supporting effective social capital and in particular cognitive social capital.