Key Considerations in Scaling Up Male Circumcision in Tanzania: Views of the Urban Residents in Tanzania

Abstract:Male circumcision (MC) reduces the risk of sexually transmitted infections (STI) including HIV. The WHO and UNAIDS recommend male circumcision as an additional intervention to prevent HIV infection. Tanzania is embarking on activities to scale up safe male circumcision for HIV prevention and other related health benefits. In line with this; it is crucial to assess views of the population using specific groups. This paper describes perceptions on male circumcision and strategies of enhancing uptake of male circumcision in urban Tanzania using members of the police force. This cross sectional survey was conducted among members of the police force in Dar es Salaam Tanzania from January 2010 to July 2010. The police officer serves as a source of the clinical trial participants in on-going phase I/II HIV vaccine trials. Three hundred and thirteen (313) police officers responded to a self-administered questionnaire that comprised of socio-demographic characteristics; reasons for not circumcising; perceptions regarding circumcision; methods of enhancing male circumcision; communication means and barriers to promote circumcision. This was followed by a physical examination to determine male circumcision status. The prevalence of circumcision was 96. Most (69) reported to have been circumcised in the hospital. The reported barriers to male circumcision among adults and children were: anticipation of pain; cost; fear to lose body parts; and lack of advice for adult's circumcision. Sensitization of parents who take children to the reproductive and child health services was recommended by most respondents as the appropriate strategy to promote male circumcision. The least recommended strategy was for the women to sensitize men. Use of radio programs and including male circumcision issues in school curricula as means of enhancing community sensitization regarding male circumcision were also highly recommended. Other recommendations include use of public media; seminars at work and issuance of circumcision regulations by health authorities. In conclusion; the present study reveals male circumcision was common in a selected urban population. There are various barriers and channels of communication regarding male circumcision. In view of scaling male circumcision in Tanzania; use of radio messages; inclusion of male circumcision in the school curricula and sensitization at the reproductive and child health clinics are likely to promote early medical male circumcision

Access to Subsidized Artemether-Lumefantrine from the Private Sector among Febrile Children in Rural Setting in Kilosa; Tanzania

Abstract:The World Health Organization aims at universal access to effective antimalarial treatment by the year 2015. Consequently; an enormous financial resource has been invested on Artemisinin Combination Therapy (ACT))) subsidy. In Tanzania; strategies to increase access of artemether-lumufantrine (ALu) rural areas; where the burden is highest; includes subsidy to the Faith-based Organisations (FBO) facilities and accredited drug dispensing outlets (ADDOs). This study was done to assess the extent to which children suffering from malaria access ALu from the private sector in rural areas. A total of 1;235 under fives randomly selected from 12 rural villages were followed up at home on weekly basis for six months in Kilosa district in 2008. Using a structured questionnaire; caretakers were interviewed about the child's history of fever in the past 7 days; type of treatment given and the source. Baseline data were obtained on demographic characteristics; caretakers' knowledge about malaria and social economic indicators of the household. Of the 1;235 children followed-up; 740 care-seeking visits were recorded; of which; 264 (35.7) were made at government health facilities and nearly a quarter (24.1; 178/740) at ordinary shops that sell general merchandize including rice and sugar. Only 22 of the caretakers sought care from FBO and ADDOs. While 686 (86.6) of the episodes were treated with antimalarials; only 319 (43) received ALu; the recommended antimalarial. Majority (83) of the visits made at government facilities were prescribed with ALu compared to less than half who went to FBO facilities (40.0) and ADDOs (25.0). In conclusion; this study has shown that less than a quarter of fever episodes suspected to be malaria in rural areas were made at FBO facilities and ADDOs; of which; less than half were treated with ALu. This shows that ALu subsidy to formal private sector does not adequately reach children in rural areas; where the malaria burden is highest. This cast some doubts if the target of universal access to effective antimalarial; by 2015; will be reached. There is need to consider enlisting the services of community health workers in the efforts to improve access to ALu in rural areas. Further research is needed to explore providers' / dispensers' preference for non-recommended antimalarials in the private sector and caretakers' preference for ordinary