The impact of community based continuous training project on improving couples' knowledge on birth preparedness and complication readiness in rural setting Tanzania; A controlled quasi-experimental study.

BACKGROUND: It is widely accepted that community-based interventions are vital strategies towards reduction of maternal and neonatal mortalities in developing counties. This study aimed at finding the impact a Community Based Continuous Training (CBCT) project in improving couples' knowledge on birth preparedness and complication readiness in rural Tanzania. METHOD: The quasi-experimental study design with control was adopted to determine the impact of CBCT in improving knowledge on birth preparedness and complication readiness. The study was conducted from June 2017 until March 2018. A multi-stage sampling technique was employed to obtain 561couples. Pre-test and post-training intervention information were collected using semi-structured questionnaires. The impact of CBCT was determined using both independent t-test and paired t-test. Linear regression analysis was used to establish the association between the project and the change in knowledge mean scores. The effect size was calculated using Cohen's d. RESULTS: At post-test assessment, knowledge mean scores were significantly higher in the intervention group among both pregnant women (m = 14.47±5.49) and their male partners (m = 14.1±5.76) as compared to control group among both pregnant women (m = 9.09±6.44) and their male partners (m = 9.98±6.65) with large effect size of 0.9 among pregnant women and medium effect size of 0.66 among male respondents. When the mean scores were compared within groups among both pregnant women and male partners in the intervention group, there were a significant increase in knowledge mean scores at post-test assessment as compared to pre-test assessment with large effect size of Cohen's d = 1.4 among pregnant women and 1.5 among male partners. After adjusting for the confounders, the predictors of change in knowledge among pregnant women were the CBCT project (ß = 0.346, p<0.000) and ethnic group [Mambwe (ß = -0.524, p = 0.001)] and the predictors of change in knowledge among male partners were the CBCT project (ß = 1.058, p<0.001) and walking distance [more than five kilometers (ß = -0.55, p< 0.05)]. CONCLUSION: This interventional study which focused on knowledge empowerment and behavior change among expecting couples was both feasible and effective on improving knowledge about birth preparedness and complication readiness in rural settings of Tanzania.

Exploring factors influencing pregnant Women's attitudes, perceived subjective norms and perceived behavior control towards male involvement in maternal services utilization: a baseline findings from a community based interventional study from Rukwa, rural Tanzania.

BACKGROUND: Although male involvement enhances obstetric care-seeking behavior, the practice of male involvement in developing countries remains unacceptably low. Male involvement in maternal services utilization can be influenced by the attitude, subjective norm, and perceived behavior control of their female partners. Little is known about factors influencing pregnant women's attitudes, perceived subjective norms, and perceived behavior control towards male involvement in maternal services utilization. METHODS: A baseline community-based cross-sectional study whose target was pregnant women were performed from 1st June until 30th October 2017. A three-stage probability sampling technique was employed to obtain a sample of 546 pregnant women. A structured questionnaire that hinged the Theory of Planned Behavior was used. The questionnaire explored three main determinants of male involvement, which were: attitudes towards male involvement, perceived subjective norms towards male involvement, and perceived behavior control towards male involvement. RESULTS: After adjusting for the confounders, factors influencing positive attitude towards male involvement were age at marriage [19 to 24 yrs.,(AOR = 1.568 at 95% CI =1.044-2.353), more than 24 yrs. (AOR = 2.15 at 95% CI = 1.150-1.159)]; education status [primary school (AOR = 1.713 at 95% CI = 1.137-2.58)] and economic status [earning more than one dollar per day (AOR = 1.547 at 95% CI = 1.026-2.332)]. Factors influencing perceived subjective norms was only age at marriage [19 to 24 yrs., (AOR = 1.447 at 95% CI = 0.970-2.159), more than 24 years, (AOR = 2.331 at 95% CI = 1.261-4.308)]; factors influencing perceived behavior control were age at marriage [more than 24 years (AOR = 2.331 at 95%CI = 1.261-4.308)], and the intention to be accompanied by their male partners (AOR = 1.827 at 95%CI = 1.171-2.849). CONCLUSION: The study revealed that women who were married at an older age were more likely to have a positive attitude, subjective norms, and perceived behavior control towards male involvement in maternal services utilization than those who were married at a young age. Pregnant women who had primary education and earn more than a dollar per day were more likely to have positive attitudes towards male involvement than poor and uneducated pregnant women. The study recommends an interventional study to evaluate the influence attitude, subjective norms, and perceived behavior control on male involvement in maternal services utilization.

Using the theory of planned behavior to explain birth in health facility intention among expecting couples in a rural setting Rukwa Tanzania: a cross-sectional survey.

BACKGROUND: According to the theory of planned behavior, an intention to carry out a certain behavior facilitates action. In the context of birth in health facility, the intention to use health facilities for childbirth may better ensure better maternal and neonatal survival. Little is known on the influence of the domains of theory of planned behavior on birth in health facility intention. The study aimed to determine the influence of the domains of theory of planned behavior on birth in health facility intention among expecting couples in the rural Southern Highlands of Tanzania. METHODS: A community based cross-sectional study targeting pregnant women and their partners was performed from June until October 2017. A three-stage probability sampling technique was employed to obtain a sample of 546 couples (making a total of 1092 study participants). A structured questionnaire based upon the Theory of Planned Behavior was used. The questionnaire explored three main domains of birth in health facility intentions. These three domains included; 1) attitudes towards maternal services utilization, 2) perceived subjective norms towards maternal services utilization and 3) perceived behavior control towards maternal services utilization. RESULTS: The vast majority of study participants had birth in health facility intention. This included 499(91.2%) of pregnant women and 488(89.7%%) of their male partners partner. Only perceived subjective norms showed a significant higher mean score among pregnant women (M = 30.21, SD = 3.928) compared to their male partners (M = 29.72, SD = 4.349) t (1090) = - 1.965 at 95% CI = -0.985 to - 0.002; p < 0.049. After adjusting for the confounders, no intention to use health facility for childbirth decreased as the attitude [pregnant women (B = - 0.091; p = 0.453); male partners (B = - 0.084; p = 0.489)] and perceived behavior control [pregnant women (B = - 0.138; p = 0.244); male partners (B = - 0.155; p = 0.205)] scores increase among both pregnant women and their male partners. CONCLUSION: Despite the fact that majority of study respondents had birth in health facility intention, the likelihood of this intention resulting into practice is weak because none of the domains of theory of planned behavior showed a significant influence. Innovative interventional strategies geared towards improving domains of intention is highly recommended in order to elicit strong intention to use health facilities for childbirth.

Using the Theory of Planned Behaviour to Describe Male Involvement Intention During Childbirth Among Expecting Couples in a Rural Setting: A Cross-Sectional Study From Rukwa Region, Southern Tanzania.

BACKGROUND: Male involvement during childbirth can increase utilisation of maternal services and reduce maternal and neonatal mortality. An individual's intention towards such male involvement can be understood through the theory of planned behaviour, which postulates that such intention is influenced by 3 domains: 1) attitudes, 2) perceptions of social approval (subjective norms) and 3) feelings about control over the intended behaviour. In sub-Saharan Africa, rates of male involvement in childbirth birth are low, and little is known about the predictors of intention for such involvement among expecting couples in rural Africa. This study aimed to determine the influence of the 3 domains of intention on male involvement intention during childbirth among expecting couples in Rukwa Region, Tanzania. METHODS: We conducted a community-based, cross-sectional study of pregnant women and their partners from June until October 2017. In total, 546 couples (n=1,092 participants) were identified through 3-stage probability sampling. A structured questionnaire based on the theory of planned behaviour was used to elicit information on the 3 domains of intention. RESULTS: Most pregnant women (71.6%) and their male partners (77.3%) intended to have male involvement during childbirth. Among women, only positive attitude (odds ratio [OR] 0.2, 95% CI, 0.1 to 0.7; P=.012) was significantly associated with intention, though in an unexpected direction. In adjusted analysis, men's positive attitude (adjusted odds ratio [AOR] 9.0, 95% CI, 1.9 to 40.9; P=.004) and positive subjective norms (AOR 4.4, 95% CI, 1.1 to 18.6; P=.041) were significantly associated with an increased likelihood of intention to accompany their partners during childbirth. CONCLUSION: More male partners had the intention to accompany their spouses during childbirth compared to their female partners. Male attitudes and subjective norms may be influential in determining male involvement during childbirth in rural African settings.

Knowledge on birth preparedness and complication readiness among expecting couples in rural Tanzania: Differences by sex cross-sectional study.

BACKGROUND: Inadequate knowledge of birth preparedness and complication readiness (BPCR) among expecting couples delays timely access to maternal emergency services. The aim of this study was to assess knowledge on birth preparedness and complication readiness and how men and women differ" among expecting couples in a rural setting of Rukwa Region, Tanzania. METHODS: A community-based cross-sectional study targeting pregnant women and their partners was performed from June 2017 to October 2017. A total of 546 couples were sampled using three-stage probability sampling techniques and then interviewed using a structured questionnaire. The mean score difference was sought using independent t-test. Multiple linear regressions were performed to determine the predictors of knowledge. RESULTS: There was a significant difference in mean knowledge scores between pregnant women (M = 5.58, SD = 4.591) and male partners (M = 4.37, SD = 4.285); t (1085) = -4.525; p<0.001. Among women, BPCR levels were positively influenced by age (ß = 0.236; p<0.01), having ever heard about birth preparedness (ß = 0.176;p<0.001), being of Mambwe ethnicity (ß = 0.187; p<0.001), living near a health center rather than a dispensary (ß = 0.101;p<0.05) and having had a prior preterm delivery (ß = 0.086;p<0.05). Access to media through radio ownership negatively influenced BPCR levels among both women (ß-.119; p<0.01) and men (ß = -0.168; p<0.0001). Among men, the BPCR knowledge was only positively influenced by having ever heard about birth preparedness (ß = 0.169;p<0.001), age at marriage (ß = -0.103; p<0.05), and having completed either primary (ß = 0.157;p<0.001) or secondary education (ß = 0.131;p<0.01). CONCLUSION: Some important predictors of knowledge were revealed among women and men, but overall knowledge about birth preparedness and complication readiness was low. This study demonstrates inadequate knowledge and understanding at the community level about key elements of birth preparedness and complication readiness. In order to improve access to life-saving care for women and neonates, there is a pressing need for innovative community strategies to increase knowledge about birth preparedness and complication readiness. Such strategies are essential in order to reduce maternal and neonatal mortality in rural Tanzania.

The Effectiveness of Community-Based Continuous Training on Promoting Positive Behaviors towards Birth Preparedness, Male Involvement, and Maternal Services Utilization among Expecting Couples in Rukwa, Tanzania: A Theory of Planned Behavior Quasi-Experimental Study.

Background: Rukwa Region has the highest maternal mortality ratio, 860 deaths per 100,000 live births in Tanzania. The region has neonatal mortality rate of 38 deaths per 1,000 live births. Previous interventions to promote maternal and neonatal health targeted access to maternal services by removing financial barriers and increasing the number of health facilities. However, maternal service utilization remains very low, especially facility delivery. The proposed intervention was sought to address deep-rooted behavioral beliefs, normative beliefs, control beliefs, and knowledge empowerment to determine their effect on improving birth preparedness, male involvement, and maternal services utilization. The study tested the effectiveness of a Community-Based Continuous Training (CBCT) intervention that was based upon the theory of planned behavior and was sought to promote positive behaviors. Methods: The study used a quasi-experimental design. The design consisted of pre- and postintervention assessments of two nonequivalent groups. Two districts were selected conveniently using criteria of high home birth. A district to hold intervention was picked randomly. Study participants were expecting couples at gestation age of 24 weeks and below. After obtaining informed consents, participants were subjected to baseline assessment. Expecting couples in the intervention group had two training sessions and two encounter discussions. The three primary outcomes of the study were changes in the level of knowledge about birth preparedness, male involvement, and use of maternal services. Data were collected at preintervention, midintervention, and postintervention. Policy Implications of the Results: The aim of this paper was to describe the study protocol of a quasi-experimental study design to test the effectiveness of an interventional program on promoting positive behaviors on birth preparedness, male involvement, and maternal services utilization among expecting couples. This study has a potential to address the challenge of low birth preparedness, male involvement, and use of maternal health services in Rukwa Region.

Position of the mandibular foramen in adult male Tanzania mandibles.

Failure of the inferior alveolar nerve block anesthesia is common in various dental operations. Anatomical variations of the location of the inferior alveolar nerve as it enters the mandibular foramen have been implicated as a main cause of these anesthesia failures. The aim of this work was to determine the location of the mandibular foramen in relation to the occlusal plane at the level of mandibular first molar and second premolar--often used as landmarks during the blocking procedure--and to different landmarks on the ramus of the mandible. The study was performed using mandibles from adult black male Tanzanians aged 30-45 years. Measurements were accomplished using two-digit electronic Vernier calipers. The distances were determined from the center of the mandibular foramen to the different reference points. The mandibular foramen was above the occlusal plane at the M1 and PM2 reference points in all the mandibles studied. It was also located about 20 mm and 12 mm from the anterior and posterior borders of the ramus respectively. There was no significant difference between the left and right side in any of the measurements. These results indicate that during anesthetic or other clinical procedures, the clinician can precisely determine the position of neurovascular bundle of the inferior alveolar nerve above the occlusal plane.

Risk factors for signs and symptoms of TMD in a rural adult southeast Tanzanian population.

The aim of this study was to determine some risk factors for signs and symptoms of temporomandibular disorders (TMD) in a rural adult population of Southeast Tanzania. Two hundred and eighteen adults aged 40+ years participated in the study. Joint clicking was significantly higher (p < 0.024) in the adults aged 60+ years than in the younger age group. Limited jaw opening was higher in females than males (chi2 = 46.4 on 2 df; p < 0.001), and there was a significant association between the type of toothbrush and limitation in jaw opening (chi2 = 156.6 on 4 df; p < 0.001). The results suggest that the use of miswaki (chewing sticks) and advanced age are risk factors for the high prevalence of signs and symptoms of TMD in this rural population. Further studies are recommended to control for other confounding factors such as socio-economic status.

Double superior vena cava presenting with anomalous jugular and azygous venous systems.

OBJECTIVE: To report on the double superior vena cava occurring with anomalous azygous vein and abnormal termination of the cardiac veins, which has not been reported before in one individual. RESULTS: Examination of the heart revealed the presence of both the right and left superior vena cava. The right superior vena cava terminated into the right atrium and received the right root of the azygous vein, and the left superior vena cava received the left root of the azygous vein before entering the dilated coronary sinus. The azygous vein ascended in the right chest, and at the level of the third thoracic vertebra, it divided into the right and left roots, which joined the respective superior vena cava. Observation of the left lung revealed the presence of both the oblique and horizontal fissures that demarcated the upper, middle, and lower lobes. Dissection of the neck revealed abnormal connection of the superficial veins. The left external and anterior jugular veins opened at the confluence of veins that was drained by the venous arch that passed to the right side of the neck to open into the right external jugular vein. CONCLUSION: The coexistence of double superior vena cava with azygous and superficial jugular venous anomalies is considered to be incidental finding. However, continued documentation of such anomalies is clinically important, and it remains to be important in medical science.

Position, shape and direction of opening of the mental foramen in dry mandibles of Tanzanian adult black males.

This study was aimed at documenting the location, shape, and direction of the opening of the mental foramen in dry mandibles of adult black Tanzanian population. A hundred mandibles were available for studying. In 45% the mental foramen was located below the apex of the second premolar, 35% between the second premolar and the first molar, 12% between the first premolar and second premolar and 8% below the first molar. The mental foramen was asymmetrically located between the right and left sides in 78% of the mandibles. The shape of the mental foramen was oval in 54% and rounded in 46% of the mandibles observed. The direction of opening was superiorly in 44%, posterosuperiorly in 40%, labially in 10%, mesially (anteriorly) in 3%, and posteriorly in 3%. Unilateral double mental foramen was observed in 3% of the mandibles. In conclusion these results showed that the mental foramen in the dry mandibles of adult black male Tanzanians was located mostly below the apices of the second premolar or more posteriorly (80%) while only a small percentage was located between the first andsecond premolars. This is different from previous reports. In more than half the shape was oval and it was rounded in less than half of the mandibles. The opening was mainly superiorly and posterosuperiorly, with a small percentage opening labially, mesially (anteriorly) and posteriorly.

Awareness of HIV/AIDS and its oral manifestations among people living with HIV in Dar es Salaam, Tanzania.

The aim of this study was to investigate the awareness of the oral manifestations of HIV/AIDS and general issues about HIV and AIDS among people living with HIV (PLHIV) in Dar es Salaam, Tanzania. A structured questionnaire was used to collect information from 187 participants chosen by convenience sampling from NGOs supporting PLHIV. A total of 13.4% of the participants were completely unaware of the oral manifestations of HIV/AIDS whereas all participants were fully aware of general symptoms of AIDS. There were no significant associations between awareness of oral manifestations and general awareness of HIV/AIDS, or level of education. Participants were relatively well aware of the different types of oral manifestations (e.g. oral ulcers 87%, oral candidiasis 84%) while their knowledge of the management of specific oral manifestations and the problems associated with oral manifestations was more limited. It is recommended that health authorities in Tanzania establish population-oriented health education for improving knowledge about oral disease in HIV/AIDS and that oral health professionals provide sound information to PLHIV in community-outreach oral healthcare programmes.

Anomalous jugular veins system in an adult male cadaver.

This is an observation of anomaly of the jugular veins system bilaterally. Both right and left external jugular veins drained into the subclavian veins. The right anterior jugular vein drained into the confluence of internal jugular and the subclavian veins as they join to form the right brachiocephalic vein. The left anterior jugular vein drained into the internal jugular vein just before it joins the subclavian vein to form the left brachiocephalic vein. Both the external and anterior jugular veins were smaller than normal on the right, moreover, the right external jugular vein was smaller than the right anterior jugular vein. The right internal jugular vein was almost twice the size of the left internal jugular vein. The right subclavian vein was larger that its left counterpart. The current observations are being reported for the first time. The anomalies reported in this observation involve most veins of the jugular system and therefore suggests that anomalies of a particular vein may affect the size and symmetry of veins that drain into it, or communicate with it.

Observation of the position of the lingula in relation to the mandibular foramen and the mylohyoid groove.

There are contradicting data and reports regarding the position of the mandibular lingula in relation to the mandibular foramen and the mylohyoid groove. The current observation attempts to describe the location of the lingula in relation to the mandibular foramen, and the location of the mylohyoid groove in relation to the lingula and mandibular foramen. Fifty adult black Tanzanian mandibles were used in this study. The lingula was observed to belong into 5 major groups based on shape and size as large nodular, small nodular, large triangular, small triangular, and small bony spicule type located anterior or posterior to the mandibular foramen. In 64% (32) of the mandibles the mylohyoid groove originated from the medial wall of the mandibular foramen, at the posterior border of the lingula, in 24% (12) the mylohyoid groove started on medial wall of the mandibular foramen, non-related to the lingula and in 12% (6) at the posterior border of the mandibular foramen. We conclude that in more than half of the adult mandibles the lingula contributes into formation of the anterior half to two third of the medial wall of the mandibular foramen and the mylohyoid groove starts at the posterior border of the lingula. In less than half of the adult mandibles the mylohyoid groove is not related to the lingula starting at the posterior one third of the medial wall or at the posterior border of the mandibular foramen. This implies that the attachment for the sphenomandibular ligament is either on the lingula or on the medial wall of the mandibular foramen or on both leading into variation in the location of the mylohyoid groove.