High Seropositivity of Brucella melitensis Antibodies among Pregnant Women Attending Health Care Facilities in Mwanza, Tanzania: A Cross-Sectional Study.

Background: Brucellosis is one of the most prevalent zoonotic neglected tropical diseases across the globe. Brucella melitensis (B. melitensis), the most pathogenic species is responsible for several pregnancy adverse outcomes in both humans and animals. Here, we present the data on the magnitude of B. melitensis antibodies among pregnant women in Mwanza, Tanzania, the information that might be useful in understanding the epidemiology of the disease and devising appropriate control interventions in this region. Methodology. A hospital-based cross-sectional study involving pregnant women was conducted at two antenatal clinics in Mwanza between May and July 2019. The pretested structured questionnaire was used for data collection. Blood samples were collected aseptically from all consenting women followed by the detection of B. melitensis antibodies using slide agglutination test. Descriptive data analysis was done using STATA version 17. Results: A total of 635 pregnant women were enrolled with the median age of 25 (interquartile range (IQR): 16-48) years and median gestation age of 21 (IQR: 3-39) weeks. Seropositivity of B. melitensis antibodies was 103 (16.2 (95% CI:13.3-19.1)). On the multivariate logistic regression analysis, as the gestation age increases, the odds of being seropositive decreases (aOR:0.972 (95% CI: 0.945-0.999), P = 0.045). Furthermore, being a housewife (aOR:3.902 (95% CI:1.589-9.577), P = 0.003), being employed (aOR:3.405 (95% CI:1.412-8.208), P = 0.006), and having history of miscarriage (aOR:1.940 (95% CI:1.043-3.606), P = 0.036) independently predicted B. melitensis seropositivity among pregnant women in Mwanza. Conclusion: High seropositivity of B. melitensis was observed among employed and housewife pregnant women in Mwanza. This calls for the need of more studies in endemic areas that might lead to evidence-based control interventions.

Implications of power imbalance in antenatal care seeking among pregnant adolescents in rural Tanzania: A qualitative study.

BACKGROUND: Adolescent girls (10-19 years) are at increased risk of morbidity and mortality from pregnancy and childbirth complications, compared with older mothers. Low and middle-income countries, including Tanzania, bear the largest proportion of adolescent perinatal deaths. Few adolescent girls in Tanzania access antenatal care at health facilities, the reasons for which are poorly understood. METHODS: We conducted a qualitative thematic analysis study of the experiences of pregnant adolescents with accessing antenatal care in Misungwi district, Tanzania. We recruited 22 pregnant or parenting adolescent girls using purposive sampling, and conducted in-depth interviews (IDIs) about antenatal care experiences. IDI data were triangulated with data from eight focus group discussions (FGDs) involving young fathers and elder men/women, and nine key informant interviews (KIIs) conducted with local health care providers. FGDs, KIIs and IDIs were transcribed verbatim in Swahili. Transcripts were then translated to English and analysed using emergent thematic analysis. RESULTS: Four main themes emerged: 1) Lack of maternal personal autonomy, 2) Stigma and judgment, 3) Vulnerability to violence and abuse, and 4) Knowledge about antenatal care, and highlighted the complex power imbalance that underlies barriers and facilitators to care access at the individual, family/interpersonal, community, and health-systems levels, faced by pregnant adolescents in rural Tanzania. CONCLUSION: Adolescent antenatal care-seeking is compromised by a complex power imbalance that involves financial dependence, lack of choice, lack of personal autonomy in decision making, experiences of social stigma, judgement, violence and abuse. Multi-level interventions are needed to empower adolescent girls, and to address policies and social constructs that may act as barriers, thereby, potentially reducing maternal morbidity and mortality in Tanzania.

Prevalence of bacterial vaginosis and associated factors among pregnant women attending at Bugando Medical Centre, Mwanza, Tanzania.

Bacterial vaginosis (BV) is an extremely common reproductive tract condition worldwide with reported high prevalence among African population. Factors associated with this condition include preterm labour, premature rupture of membranes, preterm delivery and possibly spontaneous abortion. Nevertheless, antenatal screening and treatment is not routinenly available in most poor-resource countries including Tanzania. A cross-sectional descriptive study was conducted among delivering women at Bugando Medical Centre (BMC), Mwanza, Tanzania to determine the magnitude of the BV using the Nugent's criteria and to document factors associated with the condition. A total of 284 women who presented for delivery at BMC labour ward from February to March 2011 were recruited into the study. For each consented women, a vaginal swab was taken, samples collected tested and a Nugent's score of at least seven indicated bacterial vaginosis. Overall, bacterial vaginosis was diagnosed in 28.5% (n=81) of all participants. Gardnerella was the commonest morphotypes found in approximately 66.2% (n=188) of all participants while 11.6% (33 participants) had Mobilincus. There were no evidence for the association between bacterial vaginosis having formal education, (OR, 1.42[95%CI, 0.29-6.97; p=0.6671). Urban residence (OR, 1.29 [95% CI, 0.76-2.19; p=0.352]), ever delivered before (OR 0.66[95%CI, 0.39-1.12; p=0.126]), vaginal practice to enhance dry sex (OR, 1. 16[95%CI, 0.43-3.17; p=0.768]) or wet sex (OR 1.31[95%CI, 0.46-3.7; p=0.613]), gestation age less than 37 weeks (OR 0.82[95%CI, 0.45-1.51; p=0.534]) and HIV infection (OR 0.90[95%CI, 0.28-2.92; p=0.863]) were not associated with bacterial vaginosis. Bacterial vaginosis is common among women delivering at Bugando Medical Centre and more studies to include antenatal clinic attendees initiating care are required to reliably document the magnitude the condition.