The status of occupational safety among health service providers in hospitals in Tanzania.

Occupational hazards exist wherever health care is practised. However, there is dearth of information on the status of occupational safety among hospital workers in Tanzania. This study was therefore carried to assess the current status of occupational health and safety (OHS) in Tanzanian hospitals and identify key areas for intervention. Data was collected using a self-administered questionnaire randomly distributed to the health service providers (HSPs) working in 14 district, regional and referral hospitals in Tanzania. A total of 430 HSPs (mean age = 42+/-8.8 years) were involved in the study. Female workers accounted for the majority (71%) of the respondents. None of the 430 respondents had received training on OHS as a profession. Most of the supervisors were holders of certificates (54.4%). Only 42.9% (6/14) of the hospitals, had at least a supervisor with post-graduate degree. Needlestick injuries accounted for the largest part of the most common accidents (52.9%); followed by splash of blood from patients (21.7%); burn injury from chemicals (10.6%); and slippery floors (5.9%). There was lack of qualified personnel for OHS in all hospitals. Most of the hazardous activities were carried out by nurses and attendants. Chemicals used in hospitals were mainly antiseptics and disinfectants, which causes skin burns during handling and use. Seminars and workshops were the major source (N = 429; 33%) of information on OHS. The seven major hazardous activities were injection, cleaning, patient care, bedding, dressing of wounds, medication and surgical operation. The largest proportion of HSPs involved in hazardous activities was found at referral hospitals. The mostly available antiseptics were 70-90% alcohol, 3% aqueous iodine, chlorhexidine gluconate and cetrimide. In conclusion, the OHS was observed to be inadequate in most workplaces in Tanzanian hospitals. Special efforts including training, exposure to information and creation of awareness, are recommended for improving occupational health and safety in hospitals in Tanzania.

Cost-sharing strategies combining targeted public subsidies with private-sector delivery achieve high bednet coverage and reduced malaria transmission in Kilombero Valley, southern Tanzania.

BACKGROUND: Cost-sharing schemes incorporating modest targeted subsidies have promoted insecticide-treated nets (ITNs) for malaria prevention in the Kilombero Valley, southern Tanzania, since 1996. Here we evaluate resulting changes in bednet coverage and malaria transmission. METHODS: Bednets were sold through local agents at fixed prices representing a 34% subsidy relative to full delivery cost. A further targeted subsidy of 15% was provided to vulnerable groups through discount vouchers delivered through antenatal clinics and regular immunizations. Continuous entomological surveys (2,376 trap nights) were conducted from October 2001 to September 2003 in 25 randomly-selected population clusters of a demographic surveillance system which monitored net coverage. RESULTS: Mean net usage of 75% (11,982/16,086) across all age groups was achieved but now-obsolete technologies available at the time resulted in low insecticide treatment rates. Malaria transmission remained intense but was substantially reduced: Compared with an exceptionally high historical mean EIR of 1481, even non-users of nets were protected (EIR [fold reduction] = 349 infectious bites per person per year [x4]), while the average resident (244 [x6]), users of typical nets (210 [x7]) and users of insecticidal nets (105 [x14]) enjoyed increasing benefits. CONCLUSION: Despite low net treatment levels, community-level protection was equivalent to the personal protection of an ITN. Greater gains for net users and non-users are predicted if more expensive long-lasting ITN technologies can be similarly promoted with correspondingly augmented subsidies. Cost sharing strategies represent an important option for national programmes lacking adequate financing to fully subsidize comprehensive ITN coverage.