Effect of Moringa Oleifera leaf powder supplementation on reducing anemia in children below two years in Kisarawe District, Tanzania.

Anemia is a nutritional disorder that affects mostly children below 2 years and is mainly contributed by iron deficiency. Moringa oleifera leaves are rich in iron and other essential nutrients necessary for iron metabolism. We investigated the effect of M. oleifera leaf powder supplementation on reducing anemia among children below 2 years. A community-based interventional study was conducted that enrolled 95 anemic children who were followed for 6 months. The intervention communities received M. oleifera leaf powder and nutrition education, while control communities only received nutrition education. Changes on mean hemoglobin (Hb) concentration and anemia prevalence were compared between the two groups using t test and proportional test where appropriate. At baseline, the mean Hb concentrations of control and intervention groups were 7.9 g/dl (SD = 1.3) and 8.3 g/dl (SD = 1.6) g/L, respectively (p-value = 0.0943). After 6 months, anemia prevalence significantly decreased in the intervention group by 53.6% (100%-46.4%; p < 0.001) compared to 13.6% (100%-86.4%; p = 0.005) in control community. The mean Hb was 10.9 g/dl (95% CI: 10.2-11.4) for intervention and 9.4 g/dl (95% 7.8-10.1) for control (p-value = 0.002). The effect was also observed in the reduction of the prevalence of moderate and severe anemia in the intervention communities by 68.2% and 77.9%, respectively, and by 23.3% and 56.9%, respectively, in the control communities. Increasing amount and time of using M. oleifera supplementation resulted to significant reduction in anemia cases therefore can be used as complementary solution in addressing anemia among children especially when the use of infant formulas and fortified food product is very poor.

Prevalence and risk factors associated with female anal sex in the context of HIV/AIDS in the selected districts of Tanzania.

BACKGROUND: Female anal sex is a receptive type of sexual practice among heterosexual couples where the penis is inserted into the anus of a female partner. In the Western world, a number of studies and interventions have been carried out on anal sex among men due to its potential risks to HIV transmission. In African countries, including Tanzania, there is dearth of information on the risks inherent in practices associated with female anal sex in the general population. The objective of this study was to determine the prevalence and risk factors associated with female anal sex in fuelling HIV transmission in selected districts of Tanzania. METHODS: This study was conducted in four districts of Tanzania of Kinondoni, Tanga Urban, Makete and Siha. Both quantitative and qualitative methods i.e. household interviews and focus group discussions were employed in data collection. Study participants included community members of aged 15 and above such as heads of the household, adolescents, bar workers and commercial sex workers. FINDINGS: A total of 903 individuals were interviewed, 60.6% of whom were females. When respondents were asked to indicate whether they had ever been tempted to practise FAS, 167 (18.5%) reported to have been tempted in the past 12 months. Of these, 44 (26.3%) respondents had at least practised FAS. Risky practices associated with FAS were forced sex, multiple partners, frequency of engaging in FAS, low use of condoms during FAS, low rates of HIV testing among partakers, poor perception of the risks to acquire HIV through FAS and use of lubricants. CONCLUSIONS: In this population, the frequency of FAS practice was rather low. And yet, FAS practice attendant risk factors are likely to exacerbate HIV transmission. As such, there is a need for further exploratory studies to determine and document drivers of FAS. In addition, public health education should be provided with regard to the risks of contracting HIV associated with FAS practices.

Community knowledge and acceptance of larviciding for malaria control in a rural district of east-central Tanzania.

The use of microbial larvicides, a form of larval source management, is a less commonly used malaria control intervention that nonetheless has significant potential as a component of an integrated vector management strategy. We evaluated community acceptability of larviciding in a rural district in east-central Tanzania using data from 962 household surveys, 12 focus group discussions, and 24 in-depth interviews. Most survey respondents trusted in the safety (73.1%) and efficacy of larviciding, both with regards to mosquito control (92.3%) and to reduce malaria infection risk (91.9%). Probing these perceptions using a Likert scale provides a more detailed picture. Focus group participants and key informants were also receptive to larviciding, but stressed the importance of sensitization before its implementation. Overall, 73.4% of survey respondents expressed a willingness to make a nominal household contribution to a larviciding program, a proportion which decreased as the proposed contribution increased. The lower-bound mean willingness to pay is estimated at 2,934 Tanzanian Shillings (approximately US$1.76) per three month period. We present a multivariate probit regression analysis examining factors associated with willingness to pay. Overall, our findings point to a receptive environment in a rural setting in Tanzania for the use of microbial larvicides in malaria control.

Experiences, opportunities and challenges of implementing task shifting in underserved remote settings: the case of Kongwa district, central Tanzania.

BACKGROUND: Tanzania is experiencing acute shortages of Health Workers (HWs), a situation which has forced health managers, especially in the underserved districts, to hastily cope with health workers' shortages by adopting task shifting. This has however been due to limited options for dealing with the crisis of health personnel. There are on-going discussions in the country on whether to scale up task shifting as one of the strategies for addressing health personnel crisis. However, these discussions are not backed up by rigorous scientific evidence. The aim of this paper is two-fold. Firstly, to describe the current situation of implementing task shifting in the context of acute shortages of health workers and, secondly, to provide a descriptive account of the potential opportunities or benefits and the likely challenges which might ensue as a result of implementing task shifting. METHODS: We employed in-depth interviews with informants at the district level and supplemented the information with additional interviews with informants at the national level. Interviews focussed on the informants' practical experiences of implementing task shifting in their respective health facilities (district level) and their opinions regarding opportunities and challenges which might be associated with implementation of task shifting practices. At the national level, the main focus was on policy issues related to management of health personnel in the context of implementation of task shifting, in addition to seeking their opinions and perceptions regarding opportunities and challenges of implementing task shifting if formally adopted. RESULTS: Task shifting has been in practice for many years in Tanzania and has been perceived as an inevitable coping mechanism due to limited options for addressing health personnel shortages in the country. Majority of informants had the concern that quality of services is likely to be affected if appropriate policy infrastructures are not in place before formalising tasks shifting. There was also a perception that implementation of task shifting has ensured access to services especially in underserved remote areas. Professional discontent and challenges related to the management of health personnel policies were also perceived as important issues to consider when implementing task shifting practices. Additional resources for additional training and supervisory tasks were also considered important in the implementation of task shifting in order to make it deliver much the same way as it is for conventional modalities of delivering care. CONCLUSIONS: Task shifting implementation occurs as an ad hoc coping mechanism to the existing shortages of health workers in many undeserved areas of the country, not just in the study site whose findings are reported in this paper. It is recommended that the most important thing to do now is not to determine whether task shifting is possible or effective but to define the limits of task shifting so as to reach a consensus on where it can have the strongest and most sustainable impact in the delivery of quality health services. Any action towards this end needs to be evidence-based.

The potential of involving traditional practitioners in the scaling up of male circumcision in the context of HIV prevention in Tanzania.

Male circumcision (MC) has been practiced worldwide for religious, cultural, social and medical reasons. Recent studies in Africa have indicated MC to be highly protective against HIV transmission. However, incorporating MC in HIV/AIDS prevention programme will increase its demand in Tanzania where traditional male circumcision is common and the health care system is weak. The objective of this study was to determine the challenges and opportunities of involving traditional practitioners in scaling up safe MC in the context of HIV prevention in Tanzania. The study was conducted in Monduli, Bahi and Mkuranga districts of Tanzania. Both quantitative and qualitative methods were employed. Household survey involved community members from the selected villages. In-depth interviews involved traditional practitioners and key informants at national, district and facility levels. A total of 601 householders were interviewed. Most (71.4%) household respondents preferred traditional MC as it was part of their culture and tradition. A similar response was obtained from other respondents. It was mostly preferred because it was used as an initiation school, turning of boys to warriors and sense of social cohesion. Only 228 (37.9%) of the respondents were aware of the adverse events associated with MC. The most frequently mentioned adverse effects were severe bleeding (65.0%), delayed wound healing (17.5%) and wound sepsis (8.4%). The risk of acquiring HIV through male circumcision practice was poorly known among community members except medical respondents. Single unsterilized local surgical equipment was used to circumcise several initiates. It was observed that interference with traditional values associated with circumcision to be the main hindrance of linkage between traditional and conventional practitioners. On the other hand it was reported that there was no policy or guidelines on Traditional MC (TMC). Most of respondents supported the efforts to establish and promote formal linkages between traditional and conventional practitioners. In conclusion, under the current HIV pandemic and TMC being prevalent in Tanzania, it is high time for the government to establish a linkage between traditional and conventional practitioners for safe practices in order to minimize HIV transmission.

The Potential of Involving Traditional Practitioners in the Scaling Up of Male Circumcision in the Context of HIV Prevention in Tanzania

Abstract:Male circumcision (MC) has been practiced worldwide for religious; cultural; social and medical reasons. Recent studies in Africa have indicated that MC to be highly protective against HIV transmission. However; incorporating MC in HIV/AIDS prevention programme will increase its demand in Tanzania where traditional male circumcision is common and the health care system is weak. The objective of this study was to determine the challenges and opportunities of involving traditional practitioners in scaling up safe MC in the context of HIV prevention in Tanzania. The study was conducted in Monduli; Bahi and Mkuranga districts of Tanzania. Both quantitative and qualitative methods were employed. Household survey involved community members from the selected villages. Indepth interviews involved traditional practitioners and key informants at national; district and facility levels. A total of 601 householders were interviewed. Most (71.4) household respondents preferred traditional MC as it was part of their culture and tradition. A similar response was obtained from other respondents. It was mostly preferred because it was used as an initiation school; turning of boys to warriors and sense of social cohesion. Only 228 (37.9) of the respondents were aware of the adverse events associated with MC. The most frequently mentioned adverse effects were severe bleeding (65.0); delayed wound healing (17.5) and wound sepsis (8.4). The risk of acquiring HIV through male circumcision practice was poorly known among community members except medical respondents. Single unsterilized local surgical equipment was used to circumcise several initiates. It was observed that interference with traditional values associated with circumcision to be the main hindrance of linkage between traditional and conventional practitioners. On the other hand it was reported that there was no policy or guidelines on Traditional MC (TMC). Most of respondents supported the efforts to establish and promote formal linkages between traditional and conventional practitioners. In conclusion; under the current HIV pandemic and TMC being prevalent in Tanzania; it is high time for the government to establish a linkage between traditional and conventional practitioners for safe practices in order to minimize HIV transmission