Associated factors for multidimensional attitudes and behaviors of reproductive health toward pregnancy among early and late adolescents in Tanzania: a cross-sectional study.

BACKGROUND: Adolescent pregnancy is a serious reproductive health problem in Tanzania. However, the risk factors for multidimensional attitudes and behaviors of reproductive health toward pregnancy in Tanzanian adolescents remain unexplored. METHODS: We collected baseline characteristics and information on attitudes and behaviors of reproductive health from 4161 Tanzanian adolescents in all 54 primary and secondary schools in the Korogwe district. We applied mixed effect multiple regression analyses stratified by sex to find the factors related to reproductive health attitudes and behaviors toward pregnancy. RESULTS: In female students, regarding the attitudes of reproductive health, higher age, hope for marriage in the future, a talk with a parent about sex or pregnancy, and a higher hope score were significantly associated with a lower score. For the behaviors of reproductive health, higher age, a talk with a parent about sex or pregnancy, time to talk with a parent about daily life, and a higher hope score were significantly associated with a lower score. In male students, regarding the attitudes of reproductive health, a higher hope score was significantly associated with a lower score. For the behaviors of reproductive health, higher age, time to talk with a parent about daily life, and a higher hope score was significantly associated with a lower score. CONCLUSIONS: The heterogeneous factor-outcomes association between female and male students suggested that sex-specialized interventions may be required to change their risky attitudes or behaviors of reproductive health. Although we cannot conclude as points of intervention, our study suggested that it may be practical to improve parent-adolescents communication about sex or reproductive health and change adolescents' views of pregnancy or marriage for gaining financial or social status.

Secondary school students' and peer educators' perceptions of adolescent education in rural Tanzania: a qualitative study.

BACKGROUND: In many African countries, cultural norms and values hinder conversations about sexuality among adolescents and their parents. Currently, there are no sex education classes in the curriculum at schools in Tanzania. Even when sex education is provided, the content is often abstinence-oriented, and there is a lack of in-depth instruction and exploration on the topic. To help overcome this, peer education is encouraged. After implementing peer-based adolescent education via a non-profit organization, this study aims to (1) identify students' and peer educators' perceptions of adolescent education and (2) identify the changes that occur as a result of adolescent education with peer educators. METHODS: This was a qualitative descriptive study using focus group discussions (FGDs). Secondary school students, including peer educators as well as students who received adolescent education, were asked about their perception of peer-based adolescent education. The FGDs were conducted in Swahili with the support of local collaborators. Data were transcribed and translated into English and Japanese. Content analysis was conducted to merge the categories and subcategories. RESULTS: A total of 92 students (57 girls and 35 boys) were included from three urban and three rural secondary schools where peer education was being implemented. Six FGDs were conducted for girls and four for boys, for a total of 10 FGDs. The students had both positive and negative perceptions of peer-based adolescent education. Both the peer educators and the other students felt that they gained more confidence through the process, based on the conversations they had and the trusting relationship that formed as a result. The peer educators were also successful in eliciting behavioral changes, and the students shared their sex-related knowledge with other peers as well. CONCLUSION: The peer education process helped students gain confidence in teaching their peers and elicit behavioral changes. Adult supervision for peer educators is suggested.

Peer education, such as sharing correct knowledge, skills, and behaviors, is encouraged for maintaining a healthy lifestyle in later life. The non-profit organization Class for Everyone conducted adolescent education in collaboration with a local NGO, the New Rural Children Foundation, to prevent unwanted pregnancy and social isolation among adolescent girls. In secondary schools, the NGO members provided adolescent education led by peer educators.In this study, we conducted focus group discussions to understand how peer educators and other secondary school students perceived peer-based adolescent education. The study included 92 students (57 girls and 35 boys) from three urban and three rural secondary schools where peer education was being implemented. We used content analysis to merge the categories and subcategories.We found that students had both positive and negative perceptions about peer-based adolescent education. The participants felt that they gained more confidence through the peer education process. The peer educators were also successful in eliciting behavioral changes. Moreover, the students receiving peer education shared their sex-related knowledge with other peers as well.In conclusion, the peer education process helped students gain confidence in teaching their peers and elicit behavioral change. Adult supervision for peer educators is suggested.

Perceived differences on the role of traditional birth attendants in rural Tanzania: a qualitative study.

BACKGROUND: In many low to middle income countries, traditional birth attendants (TBAs) play various roles (e.g., provision of health education, referral to hospitals, and delivery support) that can potentially improve women's access to healthcare. In Tanzania, however, the formal healthcare systems have not acknowleded the role of the TBAs. TBAs' contributions are limited and are not well described in policy documents. This study aimed to examine the perspectives of both TBAs and skilled birth attendants (SBAs) to clarify the role of TBAs and issues impacting their inclusion in rural Tanzania. METHODS: We used a qualitative descriptive design with triangulation of investigators, methods, and data sources. We conducted semi-structured interviews with 15 TBAs and focus group discussions with 21 SBAs in Kiswahili language to ask about TBAs' activities and needs. The data obtained were recorded, transcribed, and translated into English. Two researchers conducted the content analysis. RESULTS: Content analysis of data from both groups revealed TBAs' three primary roles: emergency delivery assistance, health education for the community, and referrals. Both TBAs and SBAs mentioned that one strength that the TBAs had was that they supported women based on the development of a close relationship with them. TBAs mentioned that, while they do not receive substantial remuneration, they experience joy/happiness in their role. SBAs indicated that TBAs sometimes did not refer women to the hospital for their own benefit. TBAs explained that the work issues they faced were mainly due to insufficient resources and unfavorable relationships with hospitals. SBAs were concerned that TBAs' lacked formal medical training and their actions could interfere with SBAs' professional work. Although there were no between-group interactions at the time of this study, both groups expressed willingness to collaborate/communicate to ensure the health and lives of mothers and babies. CONCLUSIONS: TBAs and SBAs have different perceptions of TBAs' knowledge and skills, but agreed that TBAs need further training/inclusion. Such collaboration could help build trust, improve positive birth experiences of mothers in rural Tanzania, and promote nationwide universal access to maternal healthcare.

A family-oriented antenatal education program to improve birth preparedness and maternal-infant birth outcomes: A cross sectional evaluation study.

BACKGROUND: In Tanzania, the information on Birth Preparedness and Complication Readiness is insufficiently provided to pregnant women and their families. The aim of this study was to evaluate the maternal and infant outcomes of a family-oriented antenatal group education program that promotes Birth Preparedness and Complication Readiness in rural Tanzania. METHODS: Pregnant women and families were enrolled in a program about nutrition and exercise, danger signs, and birth preparedness. The cross sectional survey was conducted one year later to evaluate if the participants of the program (intervention group) were different from those who did not participate (control group) with respect to birth-preparedness and maternal and infant outcomes. RESULTS: A total of 194 participants (intervention group, 50; control group, 144) were analyzed. For Birth Preparedness and Complication Readiness, the intervention group participants knew a health facility in case of emergency (OR: 3.11, 95% CI: 1.39-6.97); arranged accompaniment to go to a health facility for birth (OR: 2.56, 95% CI: 1.17-5.60); decided the birthplace with or by the pregnant women (OR: 3.11, 95% CI: 1.44-6.70); and attended antenatal clinic more than four times (OR: 2.39, 95% CI: 1.20-4.78). For birth outcomes, the intervention group had less bleeding or seizure during labour and birth (OR: 0.28, 95%CI: 0.13-0.58); fewer Caesarean sections (OR: 0.16, 95% CI: 0.07-0.36); and less neonatal complications (OR: 0.28, 95% CI: 0.13-0.60). CONCLUSIONS: The four variables were significantly better in the intervention group, i.e., identifying a health facility for emergencies, family accompaniment for facility birth, antenatal visits, and involvement of women in decision-making, which may be key factors for improving birth outcome variables. Having identified these key factors, male involvement and healthy pregnant lives should be emphasized in antenatal education to reduce pregnancy and childbirth complications. TRIAL REGISTRATION: No.2013-273-NA-2013-101 . Registered 12 August 2013.

Evaluation of a family-oriented antenatal group educational program in rural Tanzania: a pre-test/post-test study.

BACKGROUND: To increase births attended by skilled birth attendants in Tanzania, studies have identified the need for involvement of the whole family in pregnancy and childbirth education. This study aimed to develop, implement, and evaluate a family-oriented antenatal group educational program to promote healthy pregnancy and family involvement in rural Tanzania. METHODS: This was a quasi-experimental 1 group pre-test/post-test study with antenatal education provided to pregnant women and their families in rural Tanzania. Before and after the educational program, the pre-test/post-test study was conducted using a 34-item Birth Preparedness Questionnaire. Acceptability of the educational program was qualitatively assessed. RESULTS: One-hundred and thirty-eight participants (42 pregnant women, 96 family members) attended the educational program, answered the questionnaire, and participated in the feasibility inquiry. The mean knowledge scores significantly increased between the pre-test and the post-test, 7.92 and 8.33, respectively (p = 0.001). For both pregnant women and family members, the educational program improved Family Support (p = 0.001 and p = 0.000) and Preparation of Money and Food (p = 0.000 and p = 0.000). For family members, the scores for Birth Preparedness (p = 0.006) and Avoidance of Medical Intervention (reversed item) (p = 0.002) significantly increased. Despite the educational program, the score for Home-based Value (reversed item) (p = 0.022) and References of SBA (p = 0.049) decreased in pregnant women. Through group discussions, favorable comments about the program and materials were received. The comments of the husbands reflected their better understanding and appreciation of their role in supporting their wives during the antenatal period. CONCLUSIONS: The family-oriented antenatal group educational program has potential to increase knowledge, birth preparedness, and awareness of the need for family support among pregnant women and their families in rural Tanzania. As the contents of the program can be taught easily by reading the picture drama, lay personnel, such as community health workers or traditional birth attendants, can use it in villages. Further development of the Birth Preparedness Questionnaire is necessary to strengthen the involved factors. A larger scale study with a more robust Birth Preparedness Questionnaire and documentation of skilled care use is needed for the next step. TRIAL REGISTRATION: No.2013-273-NA-2013-101 . Registered 12 August 2013.