Perceived barriers and factors influencing uptake of breast cancer screening among women: a population-based cross-sectional study.

Breast cancer (BC) screening plays a major role in the prevention of BC through early detection and timely treatment. This study aims to determine the level of uptake of BC screening and associated factors. A community-based analytical cross-sectional study was conducted in Dodoma City, Tanzania from July to December 2020. The study included women aged 8 years and above without a known history of breast cancer. Multivariable logistic regression was used to determine the socio-demographic factors associated with BC screening. P value < 0.05 was considered significant. A total of 354 study participants were included in the present study. The mean age of participants was 31.0 ± 11.8 years. The majority of study participants (67.5%, n = 239) were aware of BC screening. However, only (35.3%, n = 125) reported to have ever practised BC screening. Breast self-examination was the most (16.4%, n = 58) frequently used method for BC screening among study participants. Lack of knowledge of all methods of BC screening was the barrier that was perceived by the vast majority (60.2%, n = 213) of the study participants. Having low family income was the only predictor of failure to practice BC screening. In this study, most of the women were aware of BC, however, few of them had undergone breast cancer (BC) screening at the time of the interview. The study also found that the main barrier to BC screening was the lack of knowledge about BC among the study participants. Immediate measures are necessary to increase women's awareness of BC. Such as community sensitization on the importance of screening, can help improve the uptake of BC screening and the early detection of BC.

Intimate partner violence influences modern family planning use among married women in Tanzania: cross-sectional study.

BACKGROUND: Married women who experience intimate partner violence (IPV) are less likely to negotiate with their partners on modern family planning (FP) use. This study aimed to determine the influence of intimate partner violence and sociodemographics on modern family planning use. METHODS: A community-based cross-sectional study was conducted in the Mara region, Tanzania from April to July 2020. A total of 366 married women were interviewed. Data were collected using a structured interviewer-administered questionnaire. Analysis was done using SPSS version 25, and a binary logistic regression model was used to determine the predictors of modern FP use. The significance level was set at a p-value less than 0.05. RESULTS: The overall prevalence of IPV was 73% with 54.1% physical, 36.3% psychological, and 25.4%, sexual violence. The prevalence of modern FP use was 62%, and the most (49.1%) common method practiced by married women was injection (Depo Provera). Physical violence (AOR = 0.32, p = 0.0056), and psychological violence (AOR = 0.22, p = 0.0022) had significantly reduced odds of modern FP use. Religion (AOR = 4.6, p = 0.0085), and availability of preferred modern FP methods (AOR = 9.27, p < 0.0001) had significantly increased odds of modern FP use. CONCLUSION: In this study, there is a positive association between the use of modern FP methods and IPV. To prevent IPV and its negative health consequences, it is crucial to involve community leaders and primary healthcare workers. They can help in identifying the best strategies to prevent IPV and promote the use of modern FP methods. It is equally important to involve male partners in reproductive health decisions, including the use of modern FP methods. This approach will help reduce reproductive coercion.

"We always felt psychologically unstable": A qualitative study of midwives' experiences in providing maternity care during the COVID-19 pandemic in Tanzania.

AIM: We explored midwives' experiences and challenges in providing maternity care during the period of the first surge of the COVID-19 pandemic in Dodoma. DESIGN: Phenomenological study design was used to explore midwives' experiences and challenges in providing maternity care during the COVID-19 pandemic in Tanzania. METHODS: We conducted interviews with a total of 23 midwives, using semi-structured interviews and an audio recorder. Five focus group discussions (FGDs) were conducted. To analyse the data, we used interpretive phenomenological thematic data analysis with NVivo software. To analyse templates, we followed a step-by-step process, starting with familiarizing ourselves with the data, followed by preliminary coding, organizing themes, developing an initial coding template, using the initial template, refining the template and finally applying it to the entire dataset. RESULTS: It was found that three themes and eight subthemes merged in the current study. The main themes were ① mental health distress, ② work environment challenges and ③ isolation of midwives by different groups. PUBLIC CONTRIBUTION: Reducing risk and protecting midwives from infectious diseases will improve the workforce, reduce the number of hospital stays, reduce the cost of hospital services, improve birth outcomes and indirectly improve family, community and national economies. CONCLUSION: Due to the system's failure to provide psychological support, protective environment and isolation rooms for confirmed or suspected cases put midwives at a higher risk of contracting the virus and had to work in a stressful environment. In addition to having the right tools, midwives must also receive emotional and psychological support in order to be at their best. The system must ensure that midwives are ready for uncertain times, such as pandemic infectious disease outbreaks, by providing protective work place environment such as personal protective equipment, psychological support and isolation room for confirmed COVID-19 cases.

Determinants of knowledge, attitude, and practice among patients with type 2 diabetes mellitus: A cross-sectional multicenter study in Tanzania.

Improvement of primary care for patients with type 2 diabetes mellitus (T2DM) through the promotion of good knowledge, attitude, and practice is of paramount importance for preventing its related complications. This study aimed to assess the levels of knowledge, attitude, and practice and associated factors among patients with T2DM. This was a cross-sectional multicenter hospital-based study that included 979 patients from 8 health facilities in Tanzania. A standardized semi-structured interviewer-administered questionnaire was used to extract the required data. Factor analysis was used to determine the level of knowledge, attitude, and practice. Multivariable analysis under binary logistic regression analysis was used to determine the predictors of knowledge, attitude, and practice. P<0.05 was considered significant. The levels of adequate knowledge, positive attitude, and appropriate practice were 62.1%, 54%, and 30.9%, respectively. Being self-employed (AOR = 1.74, 95% CI = 0.28-0.91, p = 0.040) predicted adequate knowledge. Being male (AOR = 1.46, 95% CI = 1.06-2.01, p = 0.021 and visiting regional hospitals (AOR = 2.17, 95% CI = 1.33-2.51, p = 0.013) were predictors of positive attitude. Residing in rural areas and not having adequate knowledge of diabetes were less likely associated with appropriate practice. This study has shown a significantly low level of appropriate practice among patients with T2DM towards general issues on diabetes, risk factors, and related complications. Therefore, emphasis should be placed on improving good practices that can help prevent related complications.

The effect of low-fidelity simulation training on breastfeeding knowledge, practice, and self-efficacy among young lactating mothers in Tanzania: A quasi-experimental study.

BACKGROUND: Exclusive breastfeeding (EBF) is of paramount importance for the survival, growth, and development of neonates. Lack of EBF puts mothers and their babies at high risk of many complications. Mothers may end up having breast engorgement, cracked nipple, mastitis, breast pain, and backache. Babies may acquire postnatal HIV transmission, reduce weight, stunting, poor cognitive and motor development, and increase the risk of diarrhea disease and respiratory infection. Breastfeeding training has been provided immediately after a women's birth. However, young mothers are still staggering with breastfeeding. RESEARCH AIM: We aim to assess the effect of low-fidelity simulation training on breastfeeding knowledge, practice, and self-efficacy among young lactating mothers and we will also assess the impact of simulation on infants' weight in Tanzania. METHODS: The study will be a health facility-based quasi-experimental design. The study will have four phases: baseline survey, intervention, immediate assessment, and two-month end-line follow-up. The assessment will focus on participants' breastfeeding knowledge, practice, and self-efficacy. Furthermore, infant weight will also be assessed during baseline and end-line. A total of 261 young lactating mothers who have first baby with their infants aged 0 to 2 months will be included, whereby 87 young lactating mothers will be in an interventional group and 174 will be in the control group. The intervention will have four packages: 1) group lecture education and interactive on the importance of breastfeeding 2) videos, 3) pictures, and 4) simulation in the umbrella LVPS using the wearable Lactation Simulation Model (LSM) and newborn manikins (Global Health Media and Laerdal baby). At the end of the study, all groups will be given education brochures which will be in the Swahili language for easy understanding. Data will be analyzed using SPSS version 23. An independent T-test and repeated measures ANOVA will be used in this study to compare the difference between the mean of the 2 groups. DISCUSSION: This study aims to generate evidence of the effect of simulation on improving breastfeeding knowledge, practice, and self-efficacy. We expect the study findings to inform the stakeholders and policymakers on formulating breastfeeding education and simulation training that will improve women's breastfeeding knowledge, practice, and self-efficacy and improve infant health.

Intrapartum violence during facility-based childbirth and its determinants: A cross-sectional study among postnatal women in Tanzania.

BACKGROUND: Violence during childbirth indirectly contributes to maternal and neonatal morbidity and mortality. It also causes intrapartum health consequences such as prolonged labor, postpartum hemorrhage, and postpartum psychological problems, including postpartum depression, post-traumatic stress disorder, and other negative feelings that lead to a decreased desire for facility delivery and increase the events of home deliveries which reduce the quality of life. In Tanzania, several efforts have been made to promote respectful maternity care. However, violence during childbirth continues to create a critical barrier for facility-based delivery and is in need of considerable attention throughout the health system. OBJECTIVES: This study aimed to assess types of intrapartum violence and its determinants among postnatal women in the Dodoma Region, Tanzania. DESIGN: A cross-sectional study using a questionnaire to interview postnatal women at the exit point after being discharged from the health facility to assess intrapartum violence and its determinants. METHODS: This study was conducted in Dodoma Region involving 307 postnatal women from April to June 2022. A simple random method was used to select respondents. The Chi-square and Fisher's exact tests were used to assess the association between the categorical variables. The predictors of intrapartum violence were determined using binary logistic regression analysis. Statistical analysis was performed using Statistical Package for Social Science version 25.0. P < 0.05 was considered to be significant. RESULTS: Overall, 307 postnatal women participated in the study. Among them, 158 (51.5%) postnatal women experienced at least one form of intrapartum violence. The most common forms of intrapartum violence included breach of confidentiality 205 (66.8%), undignified care/verbal abuse 178 (58%), physical abuse 139 (45.3%), and denial or neglected care by midwives 113 (36.8%). Husband employment, urban residence, and being referred from primary hospitals were significant determinants associated with intrapartum violence (adjusted odds ratio = 0.233, 95% confidence interval = 0.057-0.952, p = 0.043, adjusted odds ratio = 2.67, 95% confidence interval = 1.13-10.93, p = 0.026 and adjusted odds ratio = 3.673, 95% confidence interval = 1.131-11.934, p = 0.030, respectively). CONCLUSION: Violence during childbirth was highly prevalent in this study. Understanding the prevalence and types of intrapartum violence is important in order to promote changes in all levels of the health system. This study reveals the need for key interventions to effect change at many levels; including an interventional study to educate women and birth partners on client rights, and strengthening the health system to meet the needs of women during labor and childbirth. Policies and systems that support respectful maternity care are urgently needed in this setting, including universal training of health professionals in respectful maternity care.

Assessing Essential New-Born Care Knowledge, Skills and Associated Factors among Nurses/Midwives in Zanzibar: A Cross-Sectional Study.

Background: Essential newborn care (ENC) is one of the significant strategies for neonatal survival, especially immediately after delivery. Nurses and midwives are the key healthcare providers who care for neonates immediately after birth, their knowledge and skills on ENC are very important for the preventable causes of neonatal deaths. Therefore, this study aimed to assess essential newborn care knowledge and skills among nurses/midwives in Zanzibar. Methods: A hospital-based analytical cross-sectional study that included 246 nurses-midwives was conducted in Zanzibar from January to February 2021. The purposive sampling method was used to select district and regional hospitals. Simple random sampling was used to select primary health facilities. A systematic random sampling technique was used to select study participants. A standard structured self-administered questionnaire was used. Predictors of knowledge and skills of ENC were determined using Binary Logistic regression under multivariate analysis using SPSS version 23.0. P<.05 was considered to be significant. Result: Among the total (246) participants, 89 (36.2%) and 66 (26.8%) had adequate knowledge and appropriate skills of ENC, respectively. Having a BSc in Nursing (AOR = 8.83, 95%CI = 2.00-38.96) and the presence of guidelines (AOR = 3.52, 95%CI = 1.59 -7.80) were significantly associated with knowledge of ENC. Residing in Pemba (AOR = 0.30, 95%CI = 0.11-0.80), availability of staff (AOR = 0.80, 95%CI = 0.02-0.32), adequate knowledge (AOR = 2.80, 95%CI = 1.15-6.84) were factors significantly associated with ENC skills. Conclusion: Generally, nurses-midwives had suboptimal knowledge and skills on essential newborn care. Nurses-midwives are in urgent need of positive supportive supervision and low-dose- high-frequency skills training in ENC for the prevention of neonatal morbidity and mortality. Also, policymakers should be aware of this gap and should plan necessary interventions to close the gap to resecure newborns' survival.

Midwives' Knowledge and Preparedness in Providing Maternity Care During COVID-19 Pandemic in Dodoma Region, Tanzania: A Cross-Sectional Study.

Background: COVID-19 pandemic has a high impact on the health of pregnant women and healthcare providers worldwide. Objective: This study aims to assess midwives' knowledge and preparedness in providing maternity care during COVID-19 pandemic. Methods: A cross-sectional analytical hospital-based study that included 116 midwives, who were working in labor ward, was conducted in the Dodoma region of Tanzania from March to June 2021. The Chi-square test and Fisher's exact test were used to assess the association between the categorical variables. The predictors of midwives' knowledge and preparedness were determined using binary logistic regression analysis. Statistical analysis was performed using SPSS version 23.0; p < .05 was considered to be significant. Results: Of the midwives studied, 63 (54.3%) had adequate knowledge about COVID-19 and only 30 (25.9%) were adequately prepared on provision of maternal care. Having diploma/bachelor level of education (AOR = 2.62, 95%CI = 1.08-6.36, p = .033), being trained on COVID-19 (AOR = 3.65, 95%CI = 1.11-12.00, p = .033) and working in urban health facilities (AOR = 3.65, 95%CI = 1.17-13.98, p = .002) were the significant determinants of midwives' knowledge on COVID-19. Working at a health center (AOR = 0.19, 95%CI = 0.03-1.32. p = .033), being trained on COVID-19 (AOR = 0.04, 95%CI = 0.01-0.14, p = .000 and having adequate knowledge on COVID-19 (AOR = 0.20, 95%CI = 0.03-1.32, p = .032) were determinants of midwives' preparedness on provision of maternal care. Conclusion: Knowledge and preparedness in the provision of maternity care during the COVID-19 pandemic were low. Emphasis should be put on training midwives on IPC when providing maternity care. This may help in preventing the spread of infectious diseases including COVID-19 as we observed in the present study.

Puerperal sepsis-related knowledge and reported self-care practices among postpartum women in Dar es salaam, Tanzania.

BACKGROUND: Knowledge and reported self-care practices of postpartum women are important for early detection, prevention and treatment of puerperal sepsis. OBJECTIVES: This study analyzes the knowledge and self-care practices for prevention of puerperal sepsis and their determinants among postpartum women. METHODS: A hospital-based analytical cross-sectional study which included 343 postpartum women was conducted from February to March 2021. Data were collected using interviewer-administered questionnaire. Predictors of knowledge and self-care reported practice were determined using binary logistic regression. p < 0.05 was considered significant. RESULTS: More than half (n = 213, 62.1%) of the postpartum women had adequate knowledge on prevention of puerperal sepsis. Only 39 (11.4%) of the women reported adequate self-care practices toward prevention of puerperal sepsis. Secondary education (adjusted odds ratio = 0.18, 95% confidence interval = 0.06-0.49, p = 0.001), tertiary education (adjusted odds ratio = 0.52, 95% confidence interval = 0.19-1.38, p = 0.021) and getting information from healthcare providers (adjusted odds ratio = 1.06, 95% confidence interval = 0.55-2.06, p = 0.049) were significant determinants of knowledge on prevention of puerperal sepsis. Also, secondary education (adjusted odds ratio = 0.11, 95% confidence interval = 0.04-0.30, p = 0.001), tertiary education (adjusted odds ratio = 0.16, 95% confidence interval = 0.06-0.39, p = 0.001), and having more than four antenatal care visits (adjusted odds ratio = 1.21, 95% confidence interval = 0.49-3.27, p = 0.041) were significant determinants of reported self-care practices for prevention of puerperal sepsis. CONCLUSION: A significant gap in reported self-care practices to prevent puerperal sepsis was evidence. Secondary and tertiary education were significant predictors for both knowledge and self-care reported practices. Special attention should be given to women with low education level.

Knowledge and skills on active management of third stage of labor for prevention of post-partum haemorrhage among health care providers in Lake Zone, Tanzania: a cross sectional study.

BACKGROUND: Health care providers (HCPs) knowledge and skills are both crucial in saving the lives of mothers and their newborns during childbirth. This study aimed to assess the knowledge and skills of HCPs on active management of third stage of labor (AMTSL) for prevention of PPH in Lake Zone Tanzania. METHODS: A cross-sectional analytical hospital-based study which included 340 HCPs who were randomly selected, the study was conducted from March to May 2019 in lake zone, Tanzania. Data were collected using standardized questionnaire and observational checklist. Predictors of knowledge and skills on AMTSL were determined using binary logistic regression under multivariable analysis using SPSS version 23.0. p-value less than 0.05 was considered significant. RESULTS: Most 200 (58.8%) of the participants were aged between 25 and 34 years with mean age 31.4 ± 6.26 years. Majority 240 (67.6%) were females. Of all HCPs, 171 (50.3%) had adequate knowledge whereas 153 (45.0%) had adequate skills on AMTSL. Males (AOR = 1.96, 95% CI 1.18-3.26), HCPs with University education (AOR = 3.29, 95% CI 1.19-9.13) and previous BEmONC training (AOR = 2.20, 95% CI 1.24-3.91) were found to be the predictors of adequate knowledge on AMTSL. HCPs aged ≥ 45 years (AOR = 9.35, 95% CI 1.74-10.28) and HCPs working at a hospital (AOR = 1.78, 95% CI 1.12-2.82) were associated with having adequate skills on AMTSL. CONCLUSION: HCPs included in this study demonstrated low skills on AMTSL as compared to knowledge which needs immediate attention. We recommend continuous in-service training and supportive supervision among HCPs working in labour wards for improving their knowledge and skills on AMTSL. This will help to reduce maternal morbidity and mortality related to PPH.

Prevalence and risk factors associated with severe pre-eclampsia among postpartum women in Zanzibar: a cross-sectional study.

BACKGROUND: Severe pre-eclampsia is more dominant in low and middle-income countries. In Sub-Saharan Africa, severe pre-eclampsia remains a major public health problem contributing to high rates of maternal mortality. Few studies have investigated the relationship between severe pre-eclampsia and associated factors in East Africa. The aim of this study was to determine the prevalence and risk factors associated with severe pre-eclampsia among postpartum women in Zanzibar. METHODS: A hospital based analytical cross-sectional study design was used. Purposive sampling was utilized for the selection of hospitals. Proportionate sampling was used for selection of representatives from each hospital and participants were selected using systematic random sampling. Postpartum mothers were included in the study. The study was conducted by an interviewer who administered a questionnaire with close ended questions and chart review for data gathering. SPSS version 23 was used for data analysis and descriptive and multiple logistic regression was performed for control of confounders. RESULTS: This study included a total of 400 participants with a 100% response rate. Participants ranged from 17 to 45 years of age with mean age (SD) of 28.78 (±6.296). The prevalence of severe pre-eclampsia among postpartum women was 26.3% (n = 105). After adjusting for the possible confounders, factors associated with severe pre-eclampsia were; maternal age group of 15-20 years (AOR 3.839; 95% C. I 1.037-14.210), pregnancy from new partner/husband (AOR 7.561; 95% C. I 3.883-14.724), family history of high blood pressure (AOR 6.446; C. I 3.217-12.917), diabetes prior to conception (AOR 55.827; 95% C. I 5.061-615.868), having high blood pressure in a previous pregnancy (AOR 19.382; 95% C. I 4.617-81.364), paternal age above 45 (AOR 2.401; 95% C. I 1.044-5.519) and multifetal gestation (AOR 7.62; 95% CI 2.01-28.84). CONCLUSION: The prevalence of severe pre-eclampsia among postpartum women in Zanzibar is high. Common risk factors in this setting include maternal age of 15-20 years, pregnancy with a new partner, family history of high blood pressure, pre-existing diabetes prior to conception, a history of high blood pressure in previous pregnancy paternal age greater than 45 and multifetal gestation.

Predictors of Helping Babies Breathe knowledge and skills among nurses in primary health settings in Dodoma region, Tanzania.

BACKGROUND: Globally, birth asphyxia is one of the leading causes of neonatal death. In Tanzania, neonatal deaths are estimated to be 25 deaths per 1000 live births and birth asphyxia accounts for 31% of those deaths. METHOD: A cross-sectional study was conducted in 40 health centers within 7 districts in Dodoma Region among nurses working in maternity units. Simple random sampling was used to select participants. A knowledge questionnaire and performance skills checklist were used to assess nurses' knowledge and skills respectively. Chi-square and binary logistic regression were employed to test association and identify significant predictors of HBB knowledge and skills. RESULTS: A total of 172 participants completed the study out of 176 recruited. This represents a respondent rate of 98%. Findings indicate that age, duration of professional training, and experience in maternity were significant predictors for knowledge and skills. However, after control of the confounders, experience in the maternity unit was found to be the only significant predictor of knowledge and skills in resuscitation of the neonates (AOR = 2.94; CI: 0.96-8.98; P = 0.05) and (AOR = 4.14; CI: 1.12-15.31; P = 0.03) respectively. Nurses with longer maternity nursing care experience of 5 years and above were better able to answer questions that demonstrated adequate knowledge (53.9%) and perform skills correctly (53.2%) related to HBB. Those with less than 5 years' experience had limited knowledge (20%) and skills (10.5%). CONCLUSION: In this setting, direct work experience in the maternity unit was the main factor influencing knowledge and skills in neonatal resuscitation with HBB.