EA Health Research Journal

Secondary Cutaneous Endometriosis of the Umbilicus in Tanzania: A Case Report

Isaac H. Makanda — 2023-11-30

Introduction: Endometriosis is characterised by endometrial tissue outside the endometrial cavity. The implantation sites may be pelvic or extrapelvic in nature. Umbilical endometriosis is a rare type of cutaneous endometriosis, accounting for 0.5-1% of extrapelvic endometriosis cases. Current literature on umbilical endometriosis is absent in the Tanzanian population.
Case Report: A 30-year-old woman with prior caesarean deliveries presented with a 3-year history of umbilical swelling, cyclical pain, and menses-related bleeding. Examination revealed a firm brown umbilical lesion measuring 5x4centimetres (cm). Wide excisional biopsy was performed. Histopathological examination confirmed endometriosis and ruled out malignancy. The postoperative follow-up revealed no signs of recurrence.
Conclusions: This case report highlights the need for high clinical vigilance and comprehensive differential diagnosis, especially for recurring and cyclical abdominal symptoms. Despite resource limitations, accurate diagnosis and appropriate treatment can result in the successful management of this rare condition. The report emphasises the urgency for clinicians to boost awareness, promote research, and advocate for better resources to ensure optimal patient outcomes.

Review of Rapid Diagnostic Methods for Vibrio Cholerae Detection in the Last Decade (2011-2022)

Mwangi Harrison Ndung’u — 2023-11-30

Introduction: Cholera epidemic poses a global public health threat, heavily impacting the global economy and societies, with Africa and Asia particularly affected due to factors like; inadequate sanitation, contaminated water, and overcrowding. The associated high rates of morbidity and mortality strain productivity and healthcare costs while complicating control measures. Consequently, the World Health Organization’s cholera control initiative and the Diarrhoeal Diseases Laboratory Network advocate for rapid responses to outbreaks and continuous environmental surveillance, since traditional cholera detection methods relying on phenotypic fingerprinting, although considered the gold standard, suffer from labour-intensiveness, time-consumption, and skill requirements. This results in inadequate surveillance and delayed treatment in remote areas lacking well-equipped laboratories.
Methods: A systematic review was conducted to evaluate the development and performance of cholera rapid diagnostic techniques for detecting cholera in clinical samples and for environmental surveillance purposes over the past decade.
Results: Twenty-four commercially produced diagnostics were identified in January 2011. Ten more were mentioned in the literature and yet did not provide enough relevant data due to suspected production withdrawal or fall-back. The vast bulk of tests were discovered to be based on antigen or antibody detection, with DNA accounting for a large proportion of the residual tests. This study revealed a plethora of diagnostic methods, some of which have not yet made it to the commercial market. Promising approaches, such as; Loop-mediated isothermal amplification (LAMP), ELISA, and simplified PCR protocols, are likely to play a significant role in future cholera screening. Findings are herein summarised in tables and figures.
Conclusion: Cholera epidemic continues to present a formidable global health challenge with economic and social repercussions. Traditional detection methods fall short in resource-limited areas, necessitating the exploration of advanced molecular techniques, like aptamers, to improve diagnosis, surveillance, and control measures, especially in regions vulnerable to cholera outbreaks.

Women’s Perception of Using Modern Family Planning Methods in Wete District, Pemba, Tanzania

Sabra S. Suleiman — 2023-11-30

Background: Only 11% of women use family planning in Pemba, Tanzania. Among them, 9% use modern family planning (FP). Inadequate use of modern FP in the area may result in rapid population increase and attendant negative impact on social and economic development in the country.
Methods: An exploratory descriptive study was conducted in Wete District, Pemba. Thirty-eight women aged between 20 to 49 years were conveniently recruited for the study. The saturation was achieved with 4 FGDs and thematic framework guided analysis of data.
Results: Modern FP methods are available and accessible in all government healthcare facilities in Pemba. However, some women perceived that modern FP are effective and others think they are ineffective in preventing pregnancy. Male dominancy, religious beliefs, polygamy, and the economy influence the low uptake of modern FP.
Conclusion: Modern FP methods are widely accessible for free in Wete Pemba; however, their low uptake is influenced by social-cultural and economic factors. Community-based education on the benefit of Modern FP will facilitate positive perceptions of using modern FP and increase its use by women in Wete Pemba.

Factors Associated with Short-Term Surgical Outcomes Among Women Presenting with Pelvic Peritonitis at Bugando Medical Centre Mwanza, Tanzania

Hija Hamadi — 2023-11-30

Background: Pelvic peritonitis is a rarely reported pathological condition in literature and emergency laparotomies are a common surgical procedure performed for these conditions in developing countries. This study was designed to investigate factors that are associated with short-term surgical outcomes among women with pelvic peritonitis.
Methods: The study included retrospective and prospective data obtained between November 2021 and May 2022 from Bugando Medical Centre (BMC). Standardized data collection tool was used to capture clinical, surgical and laboratory data. Descriptive data analysis was done using STATA version 13.
Results: A total of 101 participants were recruited; 22 prospectively and 79 retrospectively. The median age was 29[Interquartile range (IQR) 24 to 35] years. Majority (76.2%) of participants were referred patients. Obstetric related peritonitis 82.2% (83/101) was the most frequently detected with a necrotic and or dehiscent lower uterine segment (LUS) that necessitated a subtotal abdominal hysterectomy (STAH) being the commonest (40.8%) intraoperative finding. Postoperative complications were reported in 36.7% (36/98) and were significantly associated with pulse rates >100b/min (P=.041) and platelets <150 x 103mm3 (P=.049). The median length of hospital stay was 19[IQR: 7 to 35] days and temperature >37.5℃ (aOR=5.08, 95% CI 1.23-20.97, P=.025) independently predicted prolonged hospital stay. Death occurred in 9.2% of patients and having ASA score of 5 (P=.045) was associated with death. Multi-drug resistant (MDR) gram-negative bacteria (85.2%) were the predominant pathogens causing pelvic peritonitis.
Conclusion: A significant proportion of patients with pelvic peritonitis and deranged sepsis markers develop short-term surgical complications with a significant number of those with fever stay more than 14 days. There is a need of timely complete sepsis work up of the patients with pelvic peritonitis to ensure appropriate management is instituted to prevent associated morbidity and mortality.

Maternal Factors Associated with Dietary Diversity Scores of Children aged 6-23 Months in Kwale County, Kenya

Francesca Chepkirui — 2023-11-30

Background: Dietary Diversity (DD) is an important component of Infant and Young Child Nutrition (IYCN). Globally, it is recommended that children aged 6-23 months be fed on diverse diets as a public health measure in curbing malnutrition. In Kenya, stunting rates among children below the age of five years is 26% and diversifying of diets is still sub-optimal. The study sought to assess maternal factors associated with dietary diversity scores among children aged 6-23 months in Kwale County, where stunting stands at 29%.
Methods: A cross sectional study design was adopted and a random sample of 244 mothers with children aged 6-23 months, residing in locations under Health and Demographic System Surveillance (HDSS) program participated in the study.
Results: Mothers aged 17- 68 years were interviewed. Children’s DD scores ranged from 0 to 5 with a mean of 2.2±0.9, only 8.2% of the children met the Minimum Dietary Diversity score (MDDs) of 4 food groups or more in a day. A bivariate regression analysis to determine factors associated with children’s dietary diversity scores showed significant positive relationship with mother’s educational level (r=0.186, P<.000, α=.01), household wealth index (r=0.163, P<.000, α=.01) and the child’s age (r=0.396, P<.004, α=.01).
Conclusion: The study concludes that mothers’ level of education, households’ wealth index and child’s age are factors associated with dietary diversity scores of children. Higher dietary diverse scores were observed among older children in the study age categories, from wealthy families and under care of mothers with higher education levels. In the study area however, only 8.2% of children met the minimum dietary diversity score necessitating targeted nutrition education of mothers and implementation of economic development initiatives to boost availability and consumption of diverse diets. A consideration of child age specific interventions will also address nutritional needs and preferences at different stages.

Trend Analysis of Maternal Mortality in Kenya: Post-Devolution Empirical Results

Oluwafunmilola Deborah Awe — 2023-11-30

Introduction: Kenya has taken significant steps to improve Reproductive Maternal Neonatal Child Adolescent Health (RMNCAH) services, with a vision to prevent preventable deaths of women and newborns. This study seeks to fill a crucial gap in understanding the dynamics of maternal mortality in Kenya, post-devolution
Materials and Methods: The study spans all the 47 counties of the Republic of Kenya, using county as the unit of analysis. MMR data was extracted from the District Health Information Software (DHIS), which was created to evaluate the level of progress in coverage of RMH service in Kenya. Changes in the MMR Indicator was modelled over time using Repeated measures one-way ANOVA in the 47 counties in Kenya.
Results: A descriptive study uncovered an average reduction in the Maternal Mortality Ratio (MMR), which decreased from approximately 170 to 130 per 100,000 live births between 2012 and 2018. There was a steady decrease in MMR in Garisa, Mombasa, Busia, Elgeyo, Samburu and Uasin. Tables and figures were used to visualise findings.
Conclusions: Our findings revealed that although there has been continuous improvement of relative equity over the last quarter-century in all the 47 counties in Kenya, uneven coverage remains within each county. This lack of equity differs from one county to another. There was a significant difference within each year and among the years, and pairwise comparison revealed a significant difference in the Maternal Mortality Ratio between 2012 and all the years except 2016 and 2017.

Factors Associated with Male Partner Involvement in Maternity Care in Mbeya, Tanzania

Getruda Kazimili — 2023-11-30

Background: Male partner involvement in maternity care is critical to improving neonatal and maternal health by reducing maternal mortality, particularly in settings where males play a significant role in decision-making. This study aimed to assess factors associated with male partners involvement in maternity care in Mbeya, Tanzania.
Methods: A community-based cross-sectional study was conducted among men in Mbeya city, Tanzania, from April to June 2021. A semi-structured questionnaire was used to collect information from participants. Male involvement level was measured as low, moderate or high. X2 test and multinomial logistic regression models were applied to determine association between male involvement levels and related factors.
Results: A total of 201 males participated in the study. The overall level of male involvement during antenatal care, labour and delivery and postnatal care indicated that 44 (21.7%) had a high level of involvement, 116 (58%) had a moderate level of involvement and 41 (20.3%) had a low level of involvement. Demographic and health facilities factors indicated a significant association with male partner level of participation (P<.001). The likelihood of a man accompanying the partner was significantly associated with staff attitude and the time spent at the health facility (AOR 1.726 at 95% CI 1,394-2.136 P<.001).
Conclusions: Findings indicated a generally moderate level of male partner involvement as a critical concern that can accelerate the decline in maternal mortality and improve maternal health. Enhancing the male-friendliness of health facilities in terms of infrastructure, organisation of services and staff attitudes, as well as educating the community, particularly men, to sensitise them to the negative attitudes toward male participation in maternity care, can increase male participation.

Risk Factors for Neonatal Mortality in Rural Iganga District, Eastern Uganda: A Case Control Study

Bruce Donald Ndyomugyenyi — 2023-11-30

Background: Reducing Neonatal Mortality (NM) is vital in decreasing mortality in children below 5 years. Uganda has reported a significant reduction in under 5 and infant mortality over the past decade while NM has stagnated at 27 deaths per 1,000 live births. The NMR of 34 deaths per 1,000 live births in Eastern Uganda is higher than the national rate.
Objective: To determine risk factors for neonatal mortality in rural Iganga district, Eastern Uganda.
Methods: A matched case-control study was conducted between February and July 2019 in Nakigo and Nakalama sub-counties of Iganga district. Cases (n=91) were neonates that died and the controls (n=182) were live neonates at 1 month. Data on maternal, social demographic and neonatal variables were collected from mothers of neonates at household level. Descriptive analysis was performed to determine the social demographic profile of study participants. Data was presented as mean (and standard deviation) for continuous variables, and frequencies with percentages for categorical variables. A conditional logistic regression was performed to calculate Odds Ratios and to establish factors that were independently associated with risk of neonatal Mortality.
Results: Giving birth to 5 or more children (AOR=2.88, 95% CI =1.25-6.63), attending less than 4 antenatal care visits (AOR= 2.27, 95% CI= 1.14-5.54), and giving birth to twins (AOR= 6.30, 95% CI=1.24-32.0) were the risk factors for neonatal mortality while delivering from health facilities was protective (AOR= 0.26, 95% CI= 0.12-0.56).
Conclusion: The risk factors for NM are: - giving birth to 5 or more children, attendance of less than 4 antenatal care visits and giving birth to twins. To reduce the risk of NM, the study re-emphasises the need to put more focus on neonatal care during pregnancy and child birth. The study findings can be utilised to determine priorities for reducing the risk of NM in rural settings.

Caregivers’ Experiences Regarding Antibiotic Usage in Treating Children’s Upper Respiratory Tract Infections in Southern Tanzania

Zephania Saitabau Abraham — 2023-11-30

Introduction: Upper respiratory tract infections (URTIs) are common illnesses, especially in children and account globally for a substantial proportion of consultations with family doctors. The objective of this study was to assess knowledge, attitude and practice of caretakers regarding antibiotic usage in treating upper respiratory tract infections (URTIs) in Southern Tanzania
Methods: A cross-sectional hospital-based study was conducted at Iringa Regional Referral Hospital in Southern Tanzania from March to June 2022 involving 300 caregivers. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 23.
Results: About two-thirds (71.7%) of the caregivers had poor knowledge regarding antibiotic usage in treating children’s URTIs. In this study, 96.7% of the caregivers correctly identified amoxicillin as the most prescribed medication for treatment of children’s URTIs. However, about two-thirds (65.0 %) of the parents were aware of the antibiotic resistance that could be caused by misuse of antibiotics. In this study 50.7% of the respondents had poor attitude while 49.3% had good attitude regarding antibiotic usage in treating children’s URTIs. Similarly, 53% of the respondents thought local medications are better than antibiotics in treatment of URTIs. Regarding practices, 75.3% of the respondents used to complete the dose of antibiotics when prescribed for treatment of URTIs and 69.7% used to treat their children at home when having URTIs. A significant association was found between the majority of the socio-demographic characteristics of the respondents and the level of knowledge. Similarly, there was a statistically significant association between knowledge and attitude of caregivers pertaining to antibiotic usage in treating children’s URTIs.
Conclusions: There is lack of knowledge among caregivers regarding antibiotic usage for treating children’s URTIs at the regional hospital and also more than half of the caregivers had poor attitude towards antibiotic usage. Therefore, caregiver’s educational interventions should be implemented through health promotions and educational campaigns that should be mainly conducted by medical doctors since they were reported by the caregivers to be the commonest source of information.

Knowledge and Utilisation of Lodised Salt by School Children and Food Vendors in Dar es Salaam,Tanzania

Mario Sibamenya Venance — 2023-11-30

Background: Universal Salt Iodisation (USI) is globally accepted as a cost-effective strategy for controlling Iodine Deficiency Disorders (IDD). However, there is a paucity of data on the proper use of iodised salt among food vendors. Thus, the present study assessed the School food environments and iodised salt practices among school food vendors in Tanzania.
Methods: A cross-sectional study was conducted involving 322 school children and 30 school food vendors. A stratified multistage followed by a systematic random sampling technique was used to recruit schools and children. Salt samples were collected from food vendors and analyzed using the iodine rapid field test kit and then analyzed quantitatively using an iodometric titration method. The data on knowledge, attitude, and practices was collected using customized Iodine deficiency-related questionnaires recommended by FAO to assess iodine deficiency-related factors. For school food environments, three tools were designed and used to get information; the teachers, students, and school food vendors’ tools. A chi-square test was used to establish an association between variables.
Results: About 76.7% of the salt samples from school food vendors were adequately iodised (≥15 ppm) with the mean iodine content of 39.26 ±11.06. More than half (70%) of the food sold around school compound were junk food. Half (63.3%) of the food vendors had poor practices of iodised salt utilisation.
Conclusion: A substantial achievement has been made in awareness creation of the importance of using iodised salt. Nonetheless, there is a limited knowledge on salt handling practices including discretionary salt use exacerbated by poor school food environment. To optimally eliminate IDDs, the government should now place more emphasis on proper salt handling practices from the production site, food handlers, and much more to consumers. School children should be encouraged on healthy eating habits, by improving school feeding programs and change the current food environments in schools

Challenges and Stakeholders’ Views on Achievements of Multi-Sectoral Governance in Improving Child Nutrition in Buhigwe District, Tanzania

Zidikheri Mziray — 2023-11-30

Background: In recent years, Tanzania has made good progress in addressing the problem of chronic malnutrition in children, but the levels are still unsatisfactory, at almost three in ten of its children are stunted. The government of Tanzania has taken significant measures to establish and strengthen multi-sectoral governance as part of national efforts to reduce the unacceptably high level of malnutrition. However, few studies have qualitatively documented stakeholder’s perspectives at sub-national and community level with regards to performance of multi-sectoral governance in improving nutrition status of children in Tanzania.
Objective: This study aimed to explore the achievements, facilitating factors and challenges of multi-sectoral governance in improving child nutrition in Buhigwe District Council.
Methods: This was cross-sectional study, which employed qualitative method of data collection whereby semi-structured interviews were used to conduct in-depth interviews with members of the multisectoral steering committee for nutrition in Buhigwe Council and parents/caregivers of under-five children.
Results: There is significant improvement in allocating funds for multisectoral governance interventions targeting under five children across sectors, improved inter-sectoral coordination and increased knowledge on feeding practices among parents/caregivers. Strong leadership and political commitment, inter-sectoral linkage and Presence of Non-Governmental Organizations (NGOs) supporting nutrition were identified as factors for improving child nutrition in the context of multisectoral governance. The issue of insufficient funding, inadequate spending of allocated funds, inadequate capacity, lack of cross-sectional financial mechanism and tools to collect nutrition information were raised by stakeholders as factors hindering the implementation of multi-sectoral governance in improving child nutrition.
Conclusion: Smooth implementation of multi-sectoral interventions targeting under-five children requires strong multi-sectoral governance, which is supported by adequate spending of the allocated funds, strong leadership and political commitment, presence of NGOs supporting nutrition and inter-sectoral linkage among line sectors. However, key stakeholders including central and local government authorities should address the challenge of insufficient funds, inadequate capacity, lack of cross-sectoral co-financing mechanism and tools to collect nutrition information, which were reported as barriers to the implementation of multi-sectoral governance in improving child nutrition.

Early Sexual Debut and the Associated Factors among School Going Adolescents in Selected Schools in Kenya

Gideon Mauti Ogutu — 2023-11-30

Background: Early sexual debut among adolescents’ results in sexual and reproductive health consequences including unplanned pregnancies, pregnancy complications and sexually transmitted diseases.
Objective: This study investigated the factors influencing early sexual debut among 13-19 years old students in secondary schools in Kiambu County, Kenya.
Methodology: A descriptive cross-sectional study was carried out in two secondary schools in Kiambu County. A sample of 208 was calculated using Fischer’s two stage formula and proportionately distributed per school population size. Students in each school were stratified into classes and respondents were selected by simple random sampling from each stratum. Responses were sought using self-administered questionnaires.
Results: Among the respondents 11(66.5%), 48(28.7%) and 8(4.8%) were aged 13-15, below 13 and above 15 years, respectively. Eighty-four (50.2%) respondents were male, 105(62.9%) lived with both parents while 41(24.6%) lived with mothers. Early sexual debut was (60.5%), being higher in males, 57 (67.9 %) compared to females, 44 (39.6 %). More than half of the respondents, 117(69.6%), thought sex before marriage was appropriate, among whom 75(64.1%), have had sex. Most of those who reported sexual debut, 69.9%, said that sexual encounter happened during school breaks. Reasons for refraining included fear of guardian (49.4%) and fear of HIV/AIDS 89(52.7%). However, more than two thirds, 71(70.3%) of those who feared HIV/AIDS and STI as a consequence of early sexual debut have had sex. Gender (P=.032), knowledge on sex (P=.025), use of mobile phones (P=.019), peer pressure (P=.046) and poverty (P =.037) were significantly associated with early sexual debut.
Conclusion: A significant proportion of secondary school adolescents were engaged in early sexual debut. Thus, public health interventions should consider the broader determinants of early sexual debut, including the ecological factors in which the behavior occurs.

Presence of Teen Clubs and its Association with Clinic Attendance among Adolescents Living with HIV in Tanzania: A Retrospective Cohort Study

Ephrasia Hugho — 2023-11-30

Introduction: Adolescent’s living with HIV are widely reported to have poor adherence to antiretroviral therapy (ART) due to stigma and fear of discrimination. A “Teen club” is an adolescent centered intervention designed to reduce social stigma and improve adherence and retention in HIV care. In this study we determined how the availability of teen clubs within routine HIV care and treatment facilities affects adolescents’ clinic attendance.
Methods: We conducted a retrospective cohort study using secondary data from routine clinic records on adolescents (10-19 years) who started ART between 2010 and 2016, and had documented clinic visits between March 2017 and September 2017 at HIV care and treatment clinics (CTC) in northern and central Tanzania. Good clinic attendance was defined as attending at least four monthly clinic visits during the 7-month follow-up period. A Poisson model with robust standard errors was used to assess the relationship between presence of a teen club at health facilities and good clinic attendance adjusting for other factors including sex, age at ART initiation, duration on ART, WHO clinical stage and health facility level.
Results: Of the 2839 adolescents, 73.1% had good clinic attendance. Good clinic attendance was independently associated with availability of a teen club at the health facility (aRR=1.16, 95%CI:1.09-1.21) and been on ART for >2 years (aRR=1.15, 95%C1.02-1.30). Adolescents aged 15-19 years during this study were less likely to have good clinic attendance (aRR= 0.93, 95%CI:0.88-0.98) than those aged <15 years. Sex and WHO clinical stage were not associated with good clinic attendance.
Conclusion: Teen clubs improved visit adherence among adolescents in HIV care and treatment. Further qualitative research should be conducted to explore adolescents’ perception of teen clubs as well as other enablers to clinic attendance.

Role of Mobile Phone Use in Spreading Multi-Drug Resistant Bacteria Implicated in Causation of Diarrheal and Nosocomial Infections at Kitale County Hospital

Jumba Sande Godfrey — 2023-11-30

Background: Rapid advancement and penetration of mobile phone technology has made the devices indispensable professional, social, and networking tools. However, the impact of their use in the spread of multi-drug resistant diarrheal-causing bacteria is less understood.
Objective: The aim of this study was to determine the practices of mobile phone use among healthcare workers, paediatric patients’ caretakers, and paediatric inpatients with diarrhoea at Kitale County Referral Hospital, and identify the associated risk of spread of bacteria, including multi-drug resistant strains on the mobile phones.
Method: Questionnaires were administered to research participants and swabs were collected from mobile phones of consenting healthcare workers and paediatric patients’ caretakers for further analysis. Stool samples were also collected from paediatric study participants diagnosed with gastroenteritis. Culture was done following standard microbiological procedures. Isolate identification, antibiotic susceptibility profile, and MDR phenotypes were tested using the Vitek 2 Compact microbiology analyzer. Gram-negative MDR isolates were then screened for selected carbapenemase genes using multiplex real-time PCR.
Results: Only 38% of healthcare workers sanitize their handsets during or after work. The most common mobile phone bacterial isolate was Enterococcus faecalis (28.95%) followed by Staphylococcus aureus (18.42%). 58% of stool sample isolates were Vibrio cholera 01 serotype followed by Escherichia coli 0157.H7 (20%). Methicillin-resistant Staphylococcus aureus (43%) and Vancomycin Resistant Enterococcus (6%). BlaVIM was the most commonly detected gene from five isolates, including Vibrio cholera 01
Conclusion: The most common pathogen circulating on the mobile phones of healthcare workers and patients’ caretakers at Kitale County Hospital is Enterococcus faecalis

Clinical Audit for Integration of Communicable and Non-Communicable Diseases at the Primary Health Care Level in Tanzania

Stellah G Mpagama — 2023-11-30

Introduction: Poor quality of health care services remains an important challenge in health care delivery systems. Here, we validate clinical audit tools and describe audit results of selected clinical standards related to communicable disease (CD) and non-communicable disease (NCD) integration at the primary health care level.
Methodology: A multi-methods approach, including a retrospective cohort and cross-sectional design, was deployed concurrently at Health Centres. Separate evaluators assessed the Health Centres using an audit tool and the inter-rater/inter-observer reliability was estimated. The extent of adherence to clinical standards was measured in proportions for: infection prevention control, tuberculosis (TB) diagnosis including advanced TB/HIV, the diagnosis of chronic lung diseases, and the bidirectional screening and clinical management of TB and Diabetes Mellitus (DM).
Results: The inter-rater reliability for the clinical audit tools based on 130 individuals’ charts was 99.5% (CI:99-100). The total estimated maximum score for infection prevention control was 114 and on average health centres scored 42 (37%). Only 3 (4%) of 80 individuals’ medical charts with unexplained productive cough were evaluated for TB. None of the 24 individuals with HIV infection medical charts had vitals measured and only 6 (25%) patients with advanced HIV had a TB test performed, whereas 4 (17%) had a cryptococcal antigen test, and 1 (4%) had a chest radiograph. Also, 24 patients’ chart from documented HIV negative with chronic cough had no records of spirometry or peak flowmeter or a chest radiograph. However, a diagnosis of asthma and chronic obstructive pulmonary disease as made in 17 (71%) and 7 (29%), respectively. TB was confirmed for 102 patients among whom only 12(12%) were screened for DM. The DM clinics had no TB presumptive registers. Patients with TB/DM (n=2) had a glycated haemoglobin (HbA1c) measurement done and received appropriate management.
Conclusion and recommendation: The developed clinical audit tools were reliable and could contribute to quality measurement for metrics-related integration of CD and NCD in Tanzania. Further investigations will determine if the clinical audit tools widely used in cycles can improve the quality of care in health care delivery systems.

Knowledge, Attitude and Practices Towards COVID-19 Vaccination Among Students and Staff at the Islamic University in Uganda

Naziru Rashid — 2023-11-30

Background: Whereas the burden of COVID-19 has greatly reduced worldwide in terms of morbidity and mortality, its impact is still affecting many countries economically, politically as well as in the healthcare systems. There is therefore a need to ensure that the community is protected and safe against the resurgence of the COVID-19 by embracing the vaccination against the disease. Taking up campaign messages about the COVID-19 vaccine, requires the community to have a certain level of understanding and have a good or positive attitude towards the vaccines, all of which influence good practices.
Aim of the Study: This study therefore, aimed at establishing the knowledge, attitude and practices towards COVID-19 vaccination among students and staff at the Islamic University in Uganda (IUIU).
Methods: The study used a cross-sectional design, and employed quantitative methods to collect data with semi-structured questionnaire. Data were analyzed using the IBM SPSS Statistics for Windows, Version 27.0. (IBM Corp, Armonk, NY, USA).
Results: A total of 397 respondents participated in the study. The mean knowledge score on COVID-19 Vaccination was 57.5%. All respondents had ever heard about COVID-19 vaccine. More than half of the respondents (54.2%) knew the vaccination site for COVID-19 vaccine. Few respondents (38.5%) knew the different brands of COVID-19 Vaccines. Only 34.1% of the respondents agreed that the COVID-19 vaccine was very effective; while 37.8% of the respondent’s preferred vaccination as a control measure for COVID-19, and the rest preferred other means including face masks and hand washing.
Conclusion: Health education targeting the safety and efficacy of the vaccine will most likely impact knowledge, attitude and practice of respondents and eventual uptake, especially if messaging comes from trusted sources.

Self-Reported Hepatitis B Vaccination Uptake and Associated Factors Among Adults Attending Budwale Health Center in Mbale District Uganda

Naziru Rashid — 2023-11-30

Introduction: The introduction of Hepatitis B vaccination in the general community requires understanding the factors that determines its uptake. This is specifically essential for planning, implementation and evaluation of the effectiveness of the program. This study investigated the uptake and associated factors of Hepatitis B Vaccination among clients attending Budwale Health Center in Eastern Uganda.
Methods: Facility based cross-sectional study was conducted from July to December, 2022. Interviewer administered questionnaire was used to collect data from 403 respondents who were aged 18 years and above attending a government health facility. Data was analyzed using SPSS version 20. Vaccination uptake was determined by descriptive statistics, measures of association were done using modified Poisson regression to estimate the association between the factors and vaccination uptake. Scores on knowledge questions were categorized using bloom’s cut off point into good knowledge (>80%), moderate knowledge (60-79%) and poor knowledge (< 60 %).
Results: Vaccination uptake was at 68.7% which is the recommended 90% required to achieve herd immunity. Slightly above half of the participants (51.8%) and 35.7% had moderate and good and knowledge about HBV vaccination and infection respectively. Age category (28-37 years) were more likely to be vaccinated than other age categories. PR=1.21 95% CI:(1.025, 1.418) P=0. 024.Clients who had moderate knowledge were more likely to be vaccinated compared to those with poor knowledge PR=2.81,95%CI:(1.830,4.306) P=0.001. The study also found that the cost of vaccines, presence of health workers, distance of health facilities from the home, long waiting queues and occupational risks were the main reasons for low uptake of vaccine.
Conclusion and recommendation: The uptake of HB vaccination was moderate among the studied group which was influenced by individual factors such as knowledge on HB as well as health services access factors. Therefore, due attention should be given to filling the knowledge gaps through education and sensitization, and addressing the barriers to accessing vaccination services.

An Assessment of Success Factors and Challenges in Implementation of Electronic Medical Record System in Referral Hospital in Northern Tanzania

Emanuel Q. Nuwas — 2023-11-30

Introduction: The Electronic Medical Record (EMR) has significant benefits in improving the quality of hospital services in low resources settings. Despite efforts to implement various EMRs in different health facilities, there is scarce information on the challenges and success factors regarding EMR Implementation in Regional hospitals. The aim of this study is to assess the success and challenging factors in the implementation of an electronic medical record system at the regional referral Hospital.
Methodology: This was a cross-sectional design study involving qualitative and quantitative approaches that was conducted at Haydom Lutheran Hospital a Regional Referral Hospital in northern Tanzania. The semi-structured questionnaires and the Key Informant Interview Guide questions were used for quantitative and qualitative data collection respectively. The quantitative data were analyzed using Stata Version 13.0. The quantitative data was summarized using descriptive statistics. Thematic method was used to analyze the qualitative data.
Results: Among 303 participants more than half were male 167(55.1%) and 119 (39.3%) aged between 31 and 40 years. The nurses and medical attendants were the predominant group 188(62%). Most of the staff were on full-time employment 273(90.1%) and more than thirty percent 118 (38.09%) have worked for over 10 years. The age group of between 31-60 years had a higher influence on the EMR net benefit compared to respondents aged 20 to 30 years and 60 years. The easy use, learning, usefulness, and relevance to work as well as leadership, staff involvement in processes, and use of champions were among of success factors for EMR implementation. Challenges include inadequate training, lack of funding, and inadequate IT equipment. The net benefit includes increases in efficiency in service delivery and better resource management.
Conclusion: Staff involvement, use of champions and the fact that the system is easy to use contributed to the success of EMR system. In order to scale up and sustain the EMR system in hospitals, adequate funding, training as well as continuous support to all staff in the hospital is required.

A Door-to-Door Prevalence Survey of Dental Fluorosis in Tindigani, a Village in the Hai District of Northern Tanzania

Claire Stevens — 2023-11-30

Fluoride in excess of the World Health Organisation limit of 1.5mg/L in drinking water can cause dental fluorosis (DF) in developing teeth. DF is a significant problem in the Hai District of Northern Tanzania, where there is limited access to safe piped water and groundwater is high in fluoride. A door-to-door prevalence survey of residents of Tindigani village was undertaken to assess current prevalence and severity of DF in the Hai District, and the effectiveness of previous interventions to promote low-fluoride drinking water, following a prevalence survey in 2009. DF was graded by trained assessors, utilising dental photography, and drinking water sources were sampled for chemical analysis. DF was endemic in the 563 people assessed, with a prevalence of 79.4% (CI=76.1-82.7%). Prevalence and severity were found to be higher in permanent teeth than deciduous teeth. Fluoride concentrations in non-piped water sources ranged from 2.5-38.6mg/L. Despite more households reporting the use of low-fluoride, piped water sources, compared to 2009 (82.8% versus 62%), DF remains a significant problem in Tindigani and other such communities where low-fluoride drinking water is not easily and reliably accessible. Policy makers must prioritise reliable access to low-fluoride water, especially for children as their permanent dentition develops.

The Potential Effect of Sugar-Sweetened Beverages Tax on Obesity Prevalence in Tanzania

Martin Julius Chegere — 2023-11-30

Background: Obesity and the associated non-communicable diseases contribute significantly to the disease burden in Tanzania. Obesity can be attributed to the consumption of Sugar Sweetened Beverages (SSB) due to their high sugar content that leads to high caloric intakes. This study estimates the effect of SSB tax on the prevalence of obesity.
Methods: A mathematical model that compares the reference population which is unchanged and a counterfactual population in which tax intervention has been introduced is developed. Changes in price and consumption of SSBs, and subsequent changes in energy intake are applied to estimate the body mass change by age groups. The change in body mass by age groups is merged with the reference population to estimate changes in body mass index and obesity.
Results: Imposing a 20% SSB tax in Tanzania is estimated to reduce the average overall energy intake by 76.1 kJ per person per day. This change is associated with an overall reduction of prevalence of obesity by 6.6%; and by 12.9% and 5.2% in adult males and adult females, respectively. The number of obese people will potentially decrease by about 47,000 among adult males and about 85,000 among adult females from the current levels.
Conclusions: The SSB tax is a potential strategy to complement efforts to reduce obesity prevalence in Tanzania. The revenue generated from the tax should be channelled towards public health promotion programs.