Trends in Utilization of Emergency Contraceptives in Tanzania: A Retrospective Longitudinal Study From 2018 to 2023.

Introduction Emergency contraceptives (ECs) are a critical method for preventing unwanted pregnancies following unprotected sexual intercourse. However, Tanzania is experiencing an alarming surge in the misuse of ECs among reproductive-aged females, particularly younger girls and women. Reports of their use as regular contraceptives are a rising concern. Deviations from their intended use in emergencies may not only increase the risk of contraceptive failure but also increase the risk of adverse health events. This study aims to delineate and evaluate the utilization patterns of ECs over six consecutive years using importation data obtained from the Tanzania Medicines and Medical Devices Authority (TMDA). Materials and methods We analyzed the EC data collected by TMDA over six consecutive years using a retrospective longitudinal design. Microsoft Power BI (Microsoft® Corp., Redmond, WA) was used to clean, organize, and aggregate the data. IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States) was used to analyze annual trend utilization using linear regression. Results We analyzed 114 importation consignments for ECs, identifying 95.6% (109 records) as oral ECs and 4.4% (five records) as intrauterine devices (IUDs) between 2018 and 2023. This data revealed a significant increase in the volume of EC imports, with its contribution increasing from 1.9% in 2018 to 60.1% in 2023. This highlights the marked increase in EC consumption in Tanzania. In 2023, the defined daily dose per 1000 inhabitants per year (DID) peaked at 3.917826, indicating an unprecedented increase of 4,983.06% compared to the lowest DID observed in 2019 at 0.0873552. The year 2023 alone accounted for 41.63% of the total DID (9.43) over the entire study period. In 2019 and 2020, there was a decrease in EC consumption, followed by a rapid increase from 2021 to 2023. The reduction in EC consumption from 2019 to 2020 was 36.9% compared to that between 2021 and 2022. Conclusions The significant rise in EC importation and utilization in Tanzania between 2018 and 2023, marked by fluctuating consumption trends and a notable surge, highlights the urgent need for targeted educational and policy intervention. This will guide the rational and informed use of ECs, ensuring access aligns with best practices for reproductive health.

Utilization Trends of Phosphodiesterase Type-5 Inhibitors for Erectile Dysfunction Between 2019 and 2023 in Tanzania.

Introduction Erectile dysfunction (ED) profoundly affects millions of people globally, including interfering with mental health and quality of life. Phosphodiesterase type-5 inhibitors (PDE5Is) such as sildenafil are pivotal in ED treatment. This study aimed to examine the utilization patterns of PDE5Is in Tanzania. Materials and methods In this retrospective longitudinal study, data on sildenafil and other similar PDE5Is imported between 2019 and 2023 were sourced from the Tanzania Medicines and Medical Devices Authority (TMDA). Pre-processing and visualization were performed using Microsoft Power BI Desktop, and further analysis was performed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States). Utilization trends were ascertained through curve fitting, Holt's linear trend model, and autoregressive integrated moving average (ARIMA) models. The defined daily doses (DDDS) per 1000 inhabitants (DID) were calculated using the World Health Organization (WHO) Anatomical Therapeutic Chemical (ATC) Classification System and the DDD methodology endorsed by the WHO Collaborating Centre for Drug Statistics Methodology. Results Between 2019 and 2023, there was a pronounced increase in the importation of approximately 587 consignments of PDE5Is. Employing the Holt model (R-square = 0.843), a substantial increase from 0.220910 DID in 2019 to 0.534272 DID by 2025 was observed and anticipated. The period witnessed sildenafil dominating 75.5% of the total use, with Erecto being the most consumed brand (37.6% of total DID). Notably, 2022 had the highest surge (27.2% of the total), albeit a slight decline was observed in 2023 (20.5%). This trend was supported by a linear regression model (R-square = 0.889). Conclusion We found increasing annual trends of PDE5Is of utilization. This requires critical oversight and effective policies to ensure appropriate use and risk minimization.

Barriers to viral load suppression among adolescents living with HIV on anti-retroviral therapy: a retrospective study in Tanga, Tanzania.

BACKGROUND: Despite the decreased incidence of the human immunodeficiency virus (HIV) in Tanzania, the number of adolescents living with HIV is increasing. This study aimed to describe factors independently associated with viral load non-suppression among adolescents living with HIV (ALHIV) on ART in the Tanga region. METHODS: We conducted a retrospective study of routinely collected data from ALHIV on ART from October 2018 to April 2022. We extracted data from the Care and Treatment Clinics form number 2 (CTC2) database that included age, sex, BMI, World Health Organization HIV clinical disease stage, marital status, ART duration, viral load suppression, facility level, and Dolutegravir (DTG)-based regimen. We did descriptive analysis using frequencies to describe the study participants' socio-demographic and clinical characteristics. The Cox proportional hazard regression model was used to identify factors associated with viral load non-suppression (VLS). Viral load non-suppression was defined as viral load ≥ 1000 copies/ml. A total of 4735 ALHIV on ART were extracted from CTC2, then 2485 were excluded (2186 missed viral load results, 246 were lost to follow-up, and 53 deaths). RESULTS: 2250 ALHIV on ART were tested for viral load, of whom 2216 (98.62%) adolescents were on first-line ART, and 2024 (89.96%) participants were virally suppressed, while 226 (10.04%) were virally non-suppressed. In addition, 2131 (94.71%) of participants were using a DTG-based regimen; of them, 1969 (92.40%) were virally suppressed. Not using a DTG-based regimen (HR: 9.36, 95% CI 3.41-15.31) and dispensary facility level (HR: 3.61, 95% CI 1.44-7.03) were independently associated with increased hazard for viral load non-suppression. In addition, adolescents aged between 15 and 19 years are less likely to be virally suppressed (HR: 0.55, 95% CI 0.30-0.99). CONCLUSIONS: The dispensary facility level and not using a DTG-based regimen were significantly associated with viral load non-suppression. HIV intervention strategies should ensure a DTG-based regimen utilization in all adolescents living with HIV, and techniques used by higher-level health facilities should be disseminated to lower-level facilities.

Dietary diversity and associated factors among women attending antenatal clinics in the coast region of Tanzania.

BACKGROUND: Antenatal care (ANC) is crucial for reducing maternal morbidity and mortality, especially in low-resource settings. During antenatal care, women are provided with resources for enhancing their dietary diversity, like nutrition education and counseling. Improved nutrition knowledge influences positive nutritional behavior change, like women's improved dietary diversity, which may increase the likelihood of a healthier pregnancy and delivery experience. OBJECTIVE: This study aim was to assess dietary diversity and associated factors among pregnant women attending antenatal care in the Coast region of Tanzania. METHODS: The descriptive cross-sectional study design was used to assess dietary diversity and associated factors among 338 pregnant women. A semi-structured questionnaire collected information from pregnant women on social demographic characteristics, nutrition knowledge and dietary diversity. Women were classified as having a varied diet if they had consumed at least five of the ten food groups over the previous twenty-four hours. Multivariable logistic regression analyses were used to identify predictors of dietary diversity in pregnant women. RESULTS: Only 28% (95% CI: 23.5-33.1) (n = 95) of pregnant women met the minimum dietary diversity, and 18% (95% CI: 13.8-21.9) (n = 59) were considered to have a high level of nutrition knowledge. Living near a health facility (AOR = 1.77, CI 1.02, 3.06), having high nutrition knowledge (AOR = 2.58, 95% CI: 1.36, 4.89), and being pregnant for the first time (AOR = 2.44, 95% CI: 1.09, 5.44) were associated with adequate dietary diversity. CONCLUSION: Pregnant women in the study were found to have low knowledge about nutrition and inadequate dietary diversity intake. The findings underscore the need to improve nutrition knowledge provision in antenatal clinics by emphasizing the importance of a diversified and high-quality diet. Healthcare providers in antenatal care clinics should consistently provide nutrition education and counseling to pregnant women and promote their diversified food consumption. Such knowledge may eventually promote healthier pregnancy and child development by curbing the nutritional deficiencies experienced during pregnancy.

Women's Expectations of and Satisfaction with Antenatal Care Services in a Semi-Urban Setting in Tanzania and Associated Factors: A Cross-Sectional Survey.

Women's satisfaction has been found to be a good indicator of quality of care and is associated with the utilization of healthcare services. Women's needs and satisfaction could be improved through the provision of high-quality antenatal care services. This study assessed women's expectations of and satisfaction with antenatal care and their associated factors in a semiurban setting in Tanzania. A cross-sectional survey using the Expectations and Satisfaction with the Prenatal Care Questionnaire (PESPC) was used to measure pregnant women's expectations of and satisfaction with antenatal care in the two districts of Kibaha and Bagamoyo, involving 338 pregnant women. The data were analyzed using SPSS version 26. In the expectation subscale, women had high expectations for personalized care (78.4%), other services (from a social worker and nutritionist) (68.8%), and complete care (being taken care of on time, receiving excellent care, and receiving information without prompting) (60.9%), while expectations for continuity of care were the lowest (38.9%). In the satisfaction subscale, women were highly satisfied with providers' care (being cared for with respect, healthcare provision, the way they were made to feel, and the ability to ask questions) (88.9%), while the least satisfying aspect was system characteristics (e.g., waiting times, scheduling, parking, tests and examinations, and facilities) (63.4%). Distance from a health facility was a significant predictor of both women's expectations of and satisfaction with antenatal care services, while age and number of pregnancies were also significant predictors of antenatal care expectations. To meet expectations for quality antenatal care services and improve satisfaction with antenatal care, policymakers should improve system characteristics, including the availability of human resources and medical supplies, increased consultation time, flexible schedules, and reduced waiting time. Additionally, ensuring the accessibility of evidence-based health information is important for increasing health literacy among pregnant women.

Exploring approaches to weighting estimates of facility readiness to provide health services used for estimating input-adjusted effective coverage: a case study using data from Tanzania.

The ideal approach for calculating effective coverage of health services using ecological linking requires accounting for variability in facility readiness to provide health services and patient volume by incorporating adjustments for facility type into estimates of facility readiness and weighting facility readiness estimates by service-specific caseload. The aim of this study is to compare the ideal caseload-weighted facility readiness approach to two alternative approaches: (1) facility-weighted readiness and (2) observation-weighted readiness to assess the suitability of each as a proxy for caseload-weighted facility readiness. We utilised the 2014-2015 Tanzania Service Provision Assessment along with routine health information system data to calculate facility readiness estimates using the three approaches. We then conducted equivalence testing, using the caseload-weighted estimates as the ideal approach and comparing with the facility-weighted estimates and observation-weighted estimates to test for equivalence. Comparing the facility-weighted readiness estimates to the caseload-weighted readiness estimates, we found that 58% of the estimates met the requirements for equivalence. In addition, the facility-weighted readiness estimates consistently underestimated, by a small percentage, facility readiness as compared to the caseload-weighted readiness estimates. Comparing the observation-weighted readiness estimates to the caseload-weighted readiness estimates, we found that 64% of the estimates met the requirements for equivalence. We found that, in this setting, both facility-weighted readiness and observation-weighted readiness may be reasonable proxies for caseload-weighted readiness. However, in a setting with more variability in facility readiness or larger differences in facility readiness between low caseload and high caseload facilities, the observation-weighted approach would be a better option than the facility-weighted approach. While the methods compared showed equivalence, our results suggest that selecting the best method for weighting readiness estimates will require assessing data availability alongside knowledge of the country context.

Predictors of the observed high prevalence of loss to follow-up in ART-experienced adult PLHIV: a retrospective longitudinal cohort study in the Tanga Region, Tanzania.

BACKGROUND: Antiretroviral therapy (ART) programs have expanded rapidly, and they are now accessible free of charge, yet "loss to follow-up, LTFU" is still a national public health issue. LTFU may result in treatment failure, hospitalization, increased risk of opportunistic infections and drug-resistant strains, and shortening the quality of life. This study described the rates and predictors of LTFU among adults living with human immunodeficiency virus (PLHIV) on ART in the Tanga region, Tanzania. METHODS: A retrospective longitudinal cohort study was conducted between October 2018 and December 2020 in Tanga's care and treatment health services facilities. The participants were HIV adult PLHIV aged 15 years and above on ART and attended the clinic at least once after ART initiation. LTFU was defined as not taking ART refills for 3 months or beyond from the last attendance of a refill and not yet classified as dead or transferred out. Cox proportional hazard regression models were employed to identify risk factors for LTFU. P values were two-sided, and we considered a p < 0.05 statistically significant. RESULTS: 57,173 adult PLHIV were on ART of them, 15,111 (26.43%) were LTFU, of whom 10,394 (68.78%) were females, and 4717 (31.22%) were males. Factors independently associated with LTFU involved age between 15 and 19 years (HR: 1.85, 95% CI 1.66-2.07), male sex (HR: 2.00 95% CI 1.51-2.62), divorce (HR: 1.35, 95% CI 1.24-1.48), second-line drug type (HR: 1.13, 95% CI 1.09-1.18), poor drug adherence (HR: 1.50, 95% CI 1.23-1.75), unsuppressed viral load (HR: 2.15, 95% CI 2.02-2.29), not on DTG-related drug (HR: 7.51, 95% CI 5.88-10.79), advanced HIV disease WHO stage III and IV (HR: 2.51, 95% CI 2.32-2.72). In contrast to cohabiting, ART duration < 1 year, and being pregnant showed a reduced likelihood of LTFU. CONCLUSION: A high prevalence of LTFU was observed in this study. Young age, not using DTG-based regimen, WHO clinical stage IV, poor drug adherence, male sex, unsuppressed viral load, divorcee, and second-line regime were independently associated with LTFU. To reduce LTFU, evidence-based interventions targeting the identified risk factors should be employed.

Knowledge of danger signs during pregnancy and subsequent healthcare seeking actions among women in Urban Tanzania: a cross-sectional study.

BACKGROUND: Tanzania is among the countries with a high maternal mortality ratio. However, it remains unclear how information and education on danger signs of pregnancy translate into appropriate actions when a woman recognizes danger signs. This study aimed to determine women's knowledge of obstetric danger signs during pregnancy and their subsequent healthcare seeking actions. METHODS: The study design was a health facility-based cross-sectional study. Quantitative data were collected through interviewer-administered questionnaires. Descriptive and inferential statistics were used to analyze the data. The study enrolled 384 women from two health centers in Kinondoni Municipality, Dar es Salaam, Tanzania. A woman who had not mentioned any danger sign was categorized as having no knowledge, mentioned one to three danger signs as having low knowledge, and mentioned four or more danger signs as having sufficient knowledge. RESULTS: Among the 384 participants, 67 (17.4%) had experienced danger signs during their pregnancy and reported their healthcare seeking actions after recognizing the danger signs. Among those who recognized danger signs, 61 (91%) visited a healthcare facility. Among the 384 participants, five (1.3%) had no education, 175 (45.6%) had primary education, 172 (44.8%) had secondary education, and 32 (8.3%) had post-secondary education as their highest educational levels. When asked to spontaneously mention the danger signs, more than half of the participants (n = 222, 57.8%) were able to mention only one to three danger signs. Only 104 (31%) had correct knowledge of at least four danger signs and nine (2.7%) were not able to mention any item. The most commonly known pregnancy danger signs were vaginal bleeding (81%); swelling of the fingers, face, and legs (46%); and severe headache (44%). Older women were 1.6 times more likely to have knowledge of danger signs than young women (OR 1.61; 95% CI 1.05-2.46)". CONCLUSION: Women took appropriate healthcare seeking action after recognizing danger signs during pregnancy. However, the majority had low knowledge of pregnancy danger signs. Additional studies are warranted to address the knowledge gap and to plan interventions for improving health education under limited resource settings.

Explaining progress towards Millennium Development Goal 4 for child survival in Tanzania.

BACKGROUND: During the Millennium Development Goal (MDG) era (1990-2015) the government in Mainland Tanzania and partners launched numerous initiatives to advance child survival including the comprehensive One Plan for Maternal Newborn and Child Health in 2008-2015 and a "sharpened" One Plan strategy in early 2014. Moving into the Sustainable Development Goal era, the government needs to learn from successes and challenges of striving towards MDG 4. METHODS: We expand previous work by presenting data for the full MDG period and sub-national results. We used data from six nationally-representative household surveys conducted between 1999 and 2015 to examine trends in coverage of 22 lifesaving maternal, newborn, child health and nutrition (MNCH&N) interventions, nutritional status (stunting; wasting) and breastfeeding practice across Mainland Tanzania and sub-nationally in seven standardized geographic zones. We used the Lives Saved Tool (LiST) to model the relative contribution of included interventions which saved under 5 lives during the period from 2000-2015 compared to 1999 on a national level and within the seven zones. FINDINGS: Child survival and nutritional status improved across Mainland Tanzania and in each of the seven zones across the 15-year period. MNCH&N intervention coverage varied widely and across zones with several key interventions declining across Mainland Tanzania or in specific geographical zones during all or part the period. According to our national LiST model, scale-up of 22 MNCH&N interventions - together with improvements in breastfeeding practice, stunting and wasting - saved 838 460 child lives nationally between 2000 and 2015. CONCLUSIONS: Mainland Tanzania has made significant progress in child survival and nutritional outcomes but progress cannot be completely explained by changes in intervention coverage alone. Further examination of the implementation and contextual factors shaping these trends is important to accelerate progress in the SDG era.

The psychosocial problems of families caring for relatives with mental illnesses and their coping strategies: a qualitative urban based study in Dar es Salaam, Tanzania.

BACKGROUND: Mental illness may cause a variety of psychosocial problems such as decreased quality of life of the patient's family members as well as increased social distance for the patient and the family caring for the patient. Psychosocial challenges are enhanced by the stigma attached to mental illness, which is a problem affecting not only the patient but also the family as a whole. Coping mechanisms for dealing with mentally ill patients differ from one family to another for a variety of reasons. The aim of the study was to determine the psychosocial problems of mental illness on the family including the coping strategies utilized by family members caring for a person with mental illness. METHOD: A qualitative study was conducted, involving four focus group discussions and 2 in-depth interviews of family members who were caring for patient with mental illness at Temeke Municipality, Dar es Salaam. Purposive sampling procedure was used to select participants for the study. Audio-recorded interviews in Swahili were conducted with all study participants. The recorded interview was transcribed and qualitative content thematic analysis was used to analyse the data. RESULTS: Financial constraints, lack of social support, disruption of family functioning, stigma, discrimination, and patients' disruptive behaviour emerged as the main themes in this study. Acceptance and religious practice emerged as the major coping strategies used by family members. CONCLUSION: Familial care for a person with mental illness has its advantages, yet it has multiple social and psychological challenges. Coping strategies and skills are important for the well-being of the caregiver and the patient. Addressing these psychosocial challenges requires a collaborative approach between the health care providers and government so that the needs of the family caregivers and those of the patients can be addressed accordingly.

Risk and protective factors for relapse among individuals with schizophrenia: a qualitative study in Dar es Salaam, Tanzania.

BACKGROUND: Relapse in people with schizophrenia is a major challenge for mental health service providers in Tanzania and other countries. Approximately 10% of people with schizophrenia are re-admitted due to relapse at Muhimbili National Hospital (MNH) Psychiatric Unit each month. Relapse brings about negative effects and it results in a huge burden to patients, their families, the mental health sector and the country's economy. So far no study has been done to address relapse in Tanzania. The purpose of the study was to explore perspectives on risk and protective factors influencing relapse of people with schizophrenia and their caregivers attending Muhimbili National Hospital Psychiatric Out-patient Department, Dar es Salaam, Tanzania. METHODS: A qualitative study was conducted, involving in-depth interviews of seven people with schizophrenia who are out-patients and their seven family caregivers at MNH. Purposive sampling procedure was used to select participants for the study. Audio recorded in-depth interviews in Swahili language were conducted with all study participants. The recorded information was transcribed and analyzed using NVivo 9 computer assisted qualitative data analysis software. RESULTS: Personal risk and protective factors for relapse, environmental risk and protective factors for relapse and suggestions to reduce relapse were the main themes that emerged from this study. People with schizophrenia and their caregivers (all of whom were relatives) perceived non adherence to antipsychotic medication as a leading risk factor of relapse; other risks included poor family support, stressful life events and substance use. Family support, adherence to antipsychotic medication, employment and religion were viewed as protective factors. Participants suggested strengthening mental health psycho-education sessions and community home visits conducted by mental health nurses to help reduce relapse. Other suggestions included strengthening the nurse-patient therapeutic relationship in provision of mental health care. CONCLUSIONS: This study calls for improvement in mental health care service delivery to individuals with schizophrenia. Establishing a curricular in mental health nursing that aims to produce competent mental health nurse force would improve nursing practice in mental health care service delivery.

HIV-1, HSV-2 and syphilis among pregnant women in a rural area of Tanzania: prevalence and risk factors.

BACKGROUND: Evidence suggests that a substantial proportion of new HIV infections in African countries are associated with herpes simplex virus type 2 (HSV-2). Thus, the magnitude of HSV-2 infection in an area may suggest the expected course of the HIV epidemic. We determined prevalence of genital herpes, syphilis and associated factors among pregnant women from a remote rural Tanzanian community that has a low but increasing HIV prevalence. METHODS: We analysed 1296 sera and responses to a standard structured questionnaire collected from pregnant women aged between 15-49 years, attending six different antenatal clinics within rural Manyara and Singida regions in Tanzania. Linked anonymous testing (with informed consent) of the serum for specific antibodies against HSV-2 was done using a non-commercial peptide- 55 ELISA. Antibodies against syphilis were screened by using rapid plasma reagin (RPR) and reactive samples confirmed by Treponema pallidum haemagglutination assay (TPHA). RESULTS: Previous analysis of the collected sera had shown the prevalence of HIV antibodies to be 2%. In the present study the prevalence of genital herpes and syphilis was 20.7% (95% CI: 18.53-23.00) and 1.6% (95% CI: 1.03-2.51), respectively. The presence of HSV-2 antibodies was associated with polygamy (OR 2.2, 95% CI: 1.62 - 3.01) and the use of contraceptives other than condoms (OR 1.7, 95% CI: 1.21 - 2.41). Syphilis was associated with reporting more than one lifetime sexual partner (OR 5.4, 95% CI: 1.88 - 15.76) and previous spontaneous abortion (OR 4.3, 95% CI: 1.52-12.02). CONCLUSION: The low prevalence of HIV infection offers a unique opportunity for strengthening HIV prevention in a cost-effective manner. The identification and control of other prevalent curable STIs other than syphilis and specific intervention of HSV-2 in specific populations like pregnant women would be one among approaches towards preventing incident HIV infections.

High potential of escalating HIV transmission in a low prevalence setting in rural Tanzania.

BACKGROUND: Previous surveillance among antenatal clinic (ANC) attendees within the remote rural Manyara and Singida regions in Tanzania identified an imminent but still, relatively low HIV epidemic. We conducted a population-based HIV study to identify risk factors and validate the representativeness of ANC-based estimates. METHODS: Using a two-stage cluster sampling approach, we enrolled and then interviewed and collected saliva samples from 1,698 adults aged 15-49 years between December 2003 and May 2004. We anonymously tested saliva samples for IgG antibodies against HIV using Bionor HIV-1&2 assays (R). Risk factors for HIV infection were analysed by multivariate logistic regression using the rural population of the two regions as a standard. RESULTS: The prevalence of HIV in the general population was 1.8% (95% CI: 1.1-2.4), closely matching the ANC-based estimate (2.0%, 95% CI: 1.3-3.0). The female to male prevalence ratio was 0.8 (95% CI 0.4-1.7). HIV was associated with being a resident in a fishing community, and having recently moved into the area. Multiple sexual partners increased likelihood of HIV infection by 4.2 times (95% CI; 1.2-15.4) for men. In women, use of contraceptives other than condoms was associated with HIV infection (OR 6.5, 95% CI; 1.7-25.5), while most of the population (78%) have never used condoms. CONCLUSION: The HIV prevalence from the general population was comparable to that of pregnant women attending antenatal clinics. The revealed patterns of sexual risk behaviours, for example, close to 50% of men having multiple partners and 78% of the population have never used a condom; it is likely that HIV infection will rapidly escalate. Immediate and effective preventive efforts that consider the socio-cultural contexts are necessary to reduce the spread of the infection.

The silent HIV epidemic among pregnant women within rural Northern Tanzania.

BACKGROUND: Many national antenatal clinics (ANC) based HIV surveillance systems in sub-Saharan Africa have limited coverage of remote rural sites, a weakness that compromises adequate estimation, monitoring and development of effective preventive and care programmes. To address this void in rural Manyara and Singida within Northern Tanzania, we conducted antenatal clinic-based sentinel surveillance. METHODS: We consecutively enrolled 1377 counselled and consenting pregnant women attending ANC clinics for the first time during the current pregnancy. The study was conducted in six antenatal clinics, within three divisions of rural Manyara and Singida regions in 2003/2004. Interviews were conducted and blood samples for routine purposes were collected and tested for anti-HIV IgG antibody anonymously, using Bionor HIV-1 & 2 assay. RESULTS: Among enrollees, 94% (1296/1377) participated fully. The overall prevalence of HIV was 2.0% (95%CI: 1.34-2.97). The highest HIV prevalence was among women aged between 15-19 years in both rural and remote rural populations. The odds of HIV infection was 4.3 (95%CI: 1.42-12.77) times among women reporting more than one lifetime sexual partners compared with those with one partner. HIV infection was associated with history of genital sores or foul smelling discharge, OR 6.8 (95%CI: 2.78-16.66) and age at first pregnancy (2.5 times higher likelihood of infection if before the age of 18 years versus at a later age). CONCLUSION: Including rural remote sites, as part of the national ANC routine surveillance, is crucial in order to discover imminent silent epidemics such as the one described in this paper. Scaling up HIV prevention efforts is mandatory to prevent the imminent escalation of the HIV epidemic highly associated with a history of sexually transmitted infections (STIs), multiple sexual partners and pregnancies at a younger age. Ignorance of relevant knowledge and low utilisation of condoms underscores the urgency for large-scale preventive efforts. Research to capture a wider representation of the risk factors in the general population should be a priority to enable further customised HIV prevention efforts.