The typology of female sex workers in Dar-es-Salaam: implications to HIV and AIDS interventions targeting female sex workers in Tanzania.

OBJECTIVE: To establish the categories of female sex workers in Dar es Salaam. METHODS: We conducted in depth-interviews with 32 female sex workers (FSWs) in five geographic areas of Dar-es-Salaam known to be the primary residential and working places, three local government leaders in three of the five areas known to have brothels and two NGO representatives working with this population. RESULTS: There are about 14 categories of FSWs with fluid perceived 'boundaries', which could change given factors like the availability of clients, active prostitution control mechanisms, the weather, the female sex worker's need for money and the type of sexual services demanded. CONCLUSIONS: different categories provided by the study participants are only useful in the Dar-es-Salaam context but generalization to other places in Tanzania might not be quite possible. However, using these classifications provides an understanding of how they construct their real world with regard to sex work, experiences, (health) needs and shared characteristics that are important when planning for all aspects of research designs and the implementation of interventions targeting them. The Ministry of Health and Social Welfare (MoHSW), through the National AIDS Control Program (NACP), stakeholders and development partners should conduct more research in this area to generate more information that would facilitate lobbying and advocating for repealing colonial-rooted anti-prostitution laws and replacing them with policies aiming at assisting them.

Perceived causes of obstetric fistulae from rural southern Tanzania.

BACKGROUND: Although the magnitude of obstetric fistulae (OF) is reported to have decreased in industrialized countries, it is still a major problem in developing countries. While the main cause of OF is prolonged obstructed labour without prompt medical attention, misconceptions about OF exist. OBJECTIVE: To determine awareness and perceived causes of OF in rural areas of southern Tanzania. METHODS: A cross-sectional survey was conducted among women of reproductive age, men, health personnel, birth attendants, community leaders and OF cases using qualitative and quantitative approaches. RESULTS: More than 60% of interviewees reported to be aware of OF with a connotation of urine in the names. Perceived causes of OF include sorcery, prolonged labour, delivering by operation where doctors/nurses make mistakes perforate the urinary bladder, physique of the expecting mother, poor skills of doctors/nurses to conduct caesarean section, young or old age of an expecting mother and having sex before recovering from the operation. CONCLUSION: Although OF is not reported to exist, most of the interviewees were aware of them. However, were few respondents are able to mention the main cause of OF. Maternal health education is important as a strategy to minimize the spread of misconceptions about causes of OF.

Health seeking behavior among cancer patients attending Ocean Road Cancer Institute; Tanzania

Objectives: To characterize cancer patients and to determine the associated health seeking behaviours. Methods: Between September 2005 and February 2006; we collected data using structured and semi-structured interviews among new cancer patients attending the ORCI. Findings are summarized using univarite and bivariate analyses. Results: There were 330 cancer patients during the study period. The mean age was 48 (SD = 13.5) years ranging between 21 and 84 years. The majority; 205 (62.1); were females. More than two thirds of all patients; that is 225 (68.2); presented at the ORCI at advanced stages of disease. Many patients reported to have neither heard; 193 (58.5); nor to know cancer symptoms; 203 (61.5). Only 185 (56.1) of all patients reported their willingness to disclose and a freedom to talk about the disease. Risk factors for cancer staging were sex; patient's education status; awareness and knowledge of disease symptoms. Conclusions: Interventions targeted to improve health care seeking behaviour among cancer patients need to include health education and sensitization specifically of cancer disease; establish a strong referral mechanisms at primary health level and to start a population cancer registry for monitoring and evaluation purposes

Estimates of maternal mortality by the sisterhood method in rural nothern Tanzania: a household sample and an antenatal clinic sample.

OBJECTIVE: To estimate maternal mortality in two samples of a population in northern Tanzania. SETTING: Rural communities and antenatal clinics, Mbulu and Hanang districts, Arusha region, Tanzania. POPULATION: From a household survey 2,043 men and women aged 15-60, and from an antenatal clinic survey 4,172 women aged 15-59. METHOD: The indirect sisterhood method. MAIN OUTCOME MEASURES: The risk of maternal deaths per 100,000 live births (maternal mortality ratio), and the lifetime risk of a maternal death. RESULTS: The risk of a maternal death per 100,000 live births was 362 (95% CI 269-456) and 444 (95% CI 371-517) for the household and antenatal clinic surveys, respectively. The lifetime risk of maternal death was 1 in 38 and 1 in 31, respectively, for the two surveys. A significantly lower risk of maternal death was observed for the respondents attending antenatal clinics closer to the hospital than for those attending clinics further away: 325 (95% CI 237-413) compared with 561 (95% CI 446-677) per 100,000 live births. Lifetime risk of maternal death was 1 in 42 and 1 in 25, respectively. CONCLUSIONS: The risk of maternal death per 100,000 live births in this area were comparatively high, but in our survey substantially lower than in previous surveys in Tanzania. Increasing distance from the antenatal clinics to the hospital was associated with higher maternal mortality. There was no significant difference between results based on household and antenatal clinic data, suggesting that accessible health facility data using the sisterhood method may provide a basis for local assessment of maternal mortality in developing countries.