"If I die for touching him, let me die": a rapid ethnographic assessment of cultural practices and Ebola transmission in high-risk border regions of Tanzania.

BACKGROUND: Ebola Virus Disease (EVD) is a rare but contagious disease caused by Ebola Virus (EBOV). The first Ebola outbreaks were reported in the Democratic Republic of Congo (DRC) before subsequent reported cases in Western and East African countries, including Uganda, which borders Tanzania. Proximity to EVD-infected countries raises the prospect of cross-border transmission, raising alarm in Tanzania. This study aimed to explore the cultural practices likely to prevent or escalate EVD transmission in the event of its outbreak in the country. METHODS: This rapid ethnographic assessment employed observation, interviews, and focus group discussions to collect data from people with diverse characteristics in five regions of Tanzania Mainland namely, Kagera, Kigoma, Mwanza and Songwe regions and Zanzibar Island. The qualitative data was then subjected to thematic analysis. FINDINGS: Cultural practices may escalate the transmission of EVD and hinder its prevention and control. These cultural practices include caring sick people at home, confirmation of death, mourning, and body preparation for burial. Communal life, ceremonies, and social gatherings were other aspects observed to have the potential for compounding EVD transmission and hindering its containment in case of an outbreak. CONCLUSION: Cultural practices may escalate EVD transmission as identified in the study settings. As such, Risk Communication and Community Engagement (RCCE) activities should be interventionist in transforming cultural practices that may escalate the spread of EVD as part of preparedness, prevention, and control efforts in the event of an outbreak.

Process of developing the National Health in All Policies Framework to address social determinants of health in Tanzania Mainland: lessons learned, 2018 - 2022.

Introduction: social determinants of health (SDH) are the non-medical factors that contribute to various infectious and non-infectious diseases in Tanzania. Studies suggest that SDH account for 30-55% of health outcomes globally. Most SDH are outside the mandate of the health sector; hence, multi-sectoral collaboration through Health in All Policies (HiAP) is critical. Health in All Policies looks at public policies across sectors that consider health implications of decisions, seek synergies, use resources and avoid harmful health impacts to improve population health and health equity. This paper demonstrates lessons learned from the process of developing National HiAP Framework in Tanzania Mainland to address SDH. It is expected that countries will be able to learn and adopt what deems fit in their context as they address SDH to improve population health. Methods: different methods were used to promote multi-sectoral collaboration in addressing SDH through HiAP. They included consultations with Prime Minister's Office (PMO) as the coordinator of Government business for their buy-in. High-level advocacy meetings of Directors of Policy and Planning and Permanent Secretaries from sectoral ministries were conducted to move forward the HiAP agenda. Capacity building was provided for sectoral Ministries to understand HiAP concept and SDH. Interministerial collaboration meetings were convened to bring sectors together to identify SDH issues and key areas for inter-sectoral collaboration and develop National HiAP Framework to address SDH. Health in All Policies Secretariat coordinates the HiAP activities. Results: it has been noted that almost every sectoral ministry has a health component in its policy which contributes to the Tanzanian population's health. In this regard, every sectoral ministry has a role to play in addressing SDH for sustainable development. Political will is key in moving forward the HiAP agenda. The role of PMO is significant to ensure inter-sectoral collaboration. Achieving the national and Sustainable Development Goals require strong collaboration among sectors and stakeholder coordination at all levels through HiAP. Conclusion: implementing HiAP is a win-win situation. It enhances inter-sectoral collaboration, benefiting each sector to achieve its health-related strategic indicators and ultimately achieve national and global goals.

Reducing deaths and injury from road traffic crashes through multisectoral collaboration.

Introduction: road traffic injuries are the eighth cause of mortality globally, killing about 1.35 million people and leaving more than 50 million others with permanent injuries and disabilities yearly. In Tanzania, the impact of road traffic crashes is still high despite a noticeable reduction in the number of associated injuries. This paper seeks to lay the foundation for promoting multisectoral actions and collaborations in dealing with public health concerns due to increased consequences caused by road traffic deaths and injuries. Methods: in 2015, a multisectoral approach was adopted to implement a 5-year (2015-2020) road safety program that aimed to advocate for amendment of the Road Traffic Act of 1973, Chapter 168 Revised Edition 2002. A series of consultative sessions were held between government and non-state actors, including different committees formed to feed each other on the agenda. The program was implemented through the Ministry of Health and the Ministry of Home Affairs in collaboration with World Health Organisation and civil society organisations. Results: it has been noted that there is a direct relation with a set of combined policy-level interactions seeking to improve the legal environment for road safety. The program committee, civil society organisations, and parliamentarians' forum were solicited as essential stakeholders in advancing policy reform. Together they conducted a series of consultative meetings, resulting in having a Bill tabled in the Parliament as a first draft. This informed policymakers and raised their attention to the magnitude of road traffic crashes and the country's social and economic burden. Conclusion: efforts still need to be expanded to analyse the existing data to understand the extent to which risk factors contribute to road crashes, injuries, and deaths. There is a need to have a strong Government involvement in strengthening ownership and sustainability of any public health intervention, such as road safety.

Contribution of community champions to accelerate the uptake of COVID-19 vaccination in Rukwa region, Tanzania, February - October 2022.

Introduction: Tanzania is among the African countries which started COVID-19 vaccination late (August 2021) compared to other countries in the African continent. By mid-March 2022, overall vaccine uptake was 13% of the targeted population, which was very low compared to other countries. We describe the contribution of champions in the Rukwa region that led to an increase in vaccine coverage rate in Tanzania. Methods: a community-based campaign was conducted using community champions from July 15th to August 31st, 2022. A baseline assessment was conducted focusing on the key drivers, barriers, and enablers for COVID-19 vaccine uptake in the region. A working session to develop IEC materials and messages tailored to addressing the issues raised in the community to be used in the campaign in the region was conducted, followed by the campaign's launch. Community engagement and sensitizations, which contributed to the rise of vaccinated people, were based on house-to-house visits, village meetings, and visiting community gatherings such as marketplaces, places of worship, and sports areas, which were done by champions alongside vaccinators. Results: the campaign contributed to the increase of vaccination coverage because, before the start of the campaign, the vaccination coverage was 10% as of July 14th, 2022. After the campaign, which started on July 15th to August 31st, 2022, the coverage increased by 12%. During the post-evaluation exercise after the campaign, the coverage keeps increased and reached 94% by October 2022. The coverage kept increasing even after the intervention's end due to the campaign's positive effect. Conclusion: the community still needs correct information to avoid misinformation and hesitancy, especially when introducing new disease response mechanisms such as vaccines. The community champions who are based in the community play a critical role in addressing community concerns and contribute to the effectiveness of the implementation; hence sustainability is crucial.

The development of a digital NGO mapping platform in Tanzania, as a tool to strengthen civil society engagement, in pursuit of Universal Health Coverage

The role of civil society in economic development, improving livelihoods and in providing pathways towards achieving health for all has become increasingly evident. By mapping these organizations, the scope and scale as well as existing capacities, gaps, and opportunities are brought to light. This paper describes the implementation of a digital mapping platform for NGOs; an interactive site which collects, analyses, and visualizes data from a variety of sources about NGOs in Tanzania, through a series of interactive maps, graphs, and charts. We describe the approach and the technology used to develop the platform and its potential contribution towards improving health outcomes. A situation analysis and needs assessment exercise was conducted in February 2023. The developed system requirement specification document served as the guiding document in the design and development of new modules. Participatory techniques and agile iterative methodologies comprising regular stakeholder engagement were employed. A distributed revision control system was used to keep track of system revisions. The modules were deployed to the production server at the National Internet Data Center (NIDC) server room, followed by a system commissioning activity in October 2023. The NGO Information System, NGO Digital Mapping tool, NGO Analytic tool, NGO Search tool and NGO Opportunities module were designed, developed, and commissioned to support NGO operations in Tanzania. The platform was launched during the annual NGO Forum in Dodoma, Tanzania, on October 5, 2023. The modules are publicly accessible and are housed within the NGO Information System (NIS) platform. Investment in whole-of-society engagement to build health systems resilience for universal health coverage is crucial. Leveraging the unique positioning of NGOs draws us a step closer to the ambitious goal of achieving health for all. Through this one-stop web application system, information on the near real-time status, existing gaps, and opportunities for collaboration to serve communities is readily available for all stakeholders. Wide dissemination and enhancement of utilization of the platform across all sectors is now needed, for data to truly inform action.

The development of a digital NGO mapping platform in Tanzania, as a tool to strengthen civil society engagement, in pursuit of universal health coverage.

The role of civil society in economic development, improving livelihoods and in providing pathways towards achieving health for all has become increasingly evident. By mapping these organizations, the scope and scale as well as existing capacities, gaps, and opportunities are brought to light. This paper describes the implementation of a digital mapping platform for NGOs; an interactive site which collects, analyses, and visualizes data from a variety of sources about NGOs in Tanzania, through a series of interactive maps, graphs, and charts. We describe the approach and the technology used to develop the platform and its potential contribution towards improving health outcomes. A situation analysis and needs assessment exercise was conducted in February 2023. The developed system requirement specification document served as the guiding document in the design and development of new modules. Participatory techniques and agile iterative methodologies comprising regular stakeholder engagement were employed. A distributed revision control system was used to keep track of system revisions. The modules were deployed to the production server at the National Internet Data Center (NIDC) server room, followed by a system commissioning activity in October 2023. The NGO Information System, NGO Digital Mapping tool, NGO Analytic tool, NGO Search tool and NGO Opportunities module were designed, developed, and commissioned to support NGO operations in Tanzania. The platform was launched during the annual NGO Forum in Dodoma, Tanzania, on October 5, 2023. The modules are publicly accessible and are housed within the NGO Information System (NIS) platform. Investment in whole-of-society engagement to build health systems resilience for universal health coverage is crucial. Leveraging the unique positioning of NGOs draws us a step closer to the ambitious goal of achieving health for all. Through this one-stop web application system, information on the near real-time status, existing gaps, and opportunities for collaboration to serve communities is readily available for all stakeholders. Wide dissemination and enhancement of utilization of the platform across all sectors is now needed, for data to truly inform action.

Utilization of cervical cancer screening services and its associated factors among primary school teachers in Ilala Municipality, Dar es Salaam, Tanzania.

BACKGROUND: Worldwide cervical cancer is one of the more common forms of carcinoma among women, causing high morbidity and high mortality. Despite being a major health problem in Tanzania, screening services for cervical cancer are very limited, and uptake of those services is low. We therefore conducted a study to investigate utilization of cancer screening services, and its associated factors among female primary school teachers in Ilala Municipality, Dar es Salaam. METHOD: We conducted a cross-sectional study between May - August 2011 which involved 110 primary schools in Ilala Municipality in Dar es Salaam. Five hundred and twelve female primary school teachers were sampled using a two-stage cluster sampling procedure. Data on utilization of cervical cancer and risk factors were collected using a self-administered questionnaire. Proportional utilization of cervical cancer screening services was identified through a self report. Risk factors for services utilization were assessed using logistic regression analyses. RESULTS: Out of 512 female primary school teachers, only 108 (21 %) reported to ever been screened for cervical cancer. Utilization of cervical cancer screening services was 28 % among those aged 20-29, 22 % among married and 24 % among those with higher level of education. Women were more likely to utilize the cancer-screening service if they were multiparous (age-adjusted OR = 3.05, 95 % CI 1.15-8.06, P value 0.025), or reported more than one lifetime sexual partner (age-adjusted OR 2.17, 95 % CI 1.04-4.54, P value 0.038), or did not involve their spouse in making health decisions (adjusted OR 3.56, 95 % CI 2.05-6.18, P value <0.001). CONCLUSION: The study has demonstrated low level of utilization of cervical cancer screening service among female primary school teachers in Ilala munipality. Female primary school teachers with more than one previous pregnancy and those with more than one life-time sex partners were more likely to report utilization of the service. Spouse or partners support was an important factor in the utilization of cervical cancer screening service amongst the study population.