Factors associated with anemia among school-going adolescents aged 10-17 years in Zanzibar, Tanzania: a cross sectional study.

BACKGROUND: Anemia among adolescents (ages 10-19 years) is a leading cause of morbidity and mortality in low- and middle-income countries and carries long-term health and economic consequences. To address the issue, policymakers and programmers require evidence of the burden of anemia among adolescents in specific contexts, as well as an understanding of the factors associated with anemia in this population. METHODS: We conducted a cross-sectional survey as a baseline assessment to determine the prevalence and factors associated with anemia in secondary school students, as part of a cluster-randomized effectiveness trial testing different micronutrient supplementation strategies in addressing anemia among adolescents in Zanzibar. Between March 7th to 25th, 2022 the survey was conducted on 2,479 school-going adolescents aged 10-17 years from 42 schools on the island of Zanzibar, Tanzania. Hemoglobin concentration was measured along with the collection of socio-demographics, health, food frequency, and water, sanitation and hygiene data. RESULTS: Based on the World Health Organization cutoffs for anemia, 53.3% of the sample had anemia (mild, moderate, or severe). Using chi-square tests and logistic regressions, we determined that females had higher odds of anemia than males (Adjusted OR = 1.47; 95% CI: 1.24, 1.74), those in the highest wealth quintile had lower odds of anemia than those in the lowest wealth quintile (Adjusted OR = 0.7; CI: 0.54, 0.91), stunted adolescents had higher odds of anemia than non-stunted students (Adjusted OR = 1.38; 95% CI: 1.06,1.81), and those who used shared toilets had higher odds of moderate or severe anemia than those with private toilet access (Adjusted OR = 1.68; CI: 1.07, 2.64). CONCLUSIONS: The high prevalence of anemia in this sample indicates an urgent need to address anemia among adolescents in Zanzibar, and the factors associated with anemia point to the importance of water, sanitation, and hygiene interventions in addition to dietary and nutritional support. TRIAL REGISTRATION: NCT05104554, registered 03/11/2021.

Scaling-up high-impact micronutrient supplementation interventions to improve adolescents' nutrition and health in Burkina Faso and Tanzania: protocol for a cluster-randomised controlled trial.

INTRODUCTION: Adolescence is a critical time for growth and development, but this age group is often neglected in research and development of nutrition interventions. Despite recommendations from the WHO to provide nutrient supplements to adolescents, evidence remains scarce on the most effective supplementation strategy. This study aims to compare weekly iron and folic acid (IFA) supplementation with daily multiple micronutrient supplements (MMSs) in prevention of anaemia and improvement of school outcomes among adolescents in Burkina Faso and Tanzania. METHODS AND ANALYSIS: A three-arm cluster-randomised, school-based supplementation trial will be conducted among 84 schools (42 schools per site) and roughly 4500 students aged 10-17. Schools will be matched on three characteristics: number of students, school ranking profile, distance to main road (Tanzania) or distance to city council (Burkina Faso). Each school will be randomised to receive either weekly IFA, daily MMSs or serve as a control. Supplements will be delivered to students by teachers, who will provide monitoring data to the study team. Baseline and endline surveys will be conducted prior to and after each supplementation cycle (12 weeks in Burkina Faso; 1 year in Tanzania) to assess haemoglobin, anthropometry and sociodemographic variables. The primary outcome of haemoglobin will be analysed continuously using linear regression, and anaemia status will be analysed using logistic or multinomial regression, depending on categorisation level of the outcome. Secondary analyses of school performance indicators will also be conducted with either logistic or linear regression. ETHICS AND DISSEMINATION: This protocol has been approved by the Institutional Review Board of the Harvard TH Chan School of Public Health (IRB20-1108) and the Research Ethics Committees for the Ministries of Health in Tanzania (Zanzibar) and Burkina Faso. Results will be disseminated during meetings with the Ministries of Health and the participating communities as well as through peer-reviewed publications. TRIAL REGISTRATION NUMBER: NCT04657640; NCT05104554.

Micronutrient Supplementation for Pregnant and Lactating Women to Improve Maternal and Infant Nutritional Status in Low- and Middle-Income Countries: Protocol for a Systematic Review and Meta-analysis.

BACKGROUND: Two billion people in low- and middle-income countries (LMICs) are deficient in key nutrients. Nutritional deficiencies worsen during pregnancy, causing adverse outcomes for the mother and the fetus, with consequences after pregnancy. These effects may be mitigated by providing micronutrient supplementation to women during pregnancy and lactation. However, the effects of micronutrient supplementation on the nutritional status of pregnant and lactating women and that of their infants remain largely unclear in LMICs. OBJECTIVE: The purpose of this systematic review and meta-analysis is to determine the effects of single, double, or multiple micronutrient supplements during pregnancy or lactation on maternal and infant nutritional status in LMICs. METHODS: Randomized controlled trials of single, double, or combinations of micronutrients assessing effects on the maternal (serum, plasma, and breastmilk) and infant (serum and plasma) nutritional status will be included. MEDLINE (through PubMed), EMBASE, CENTRAL (through Cochrane Library), and the World Health Organization (WHO) library database will be used to identify relevant published studies, starting from the inception of each database until February 28, 2022. The Cochrane Risk of Bias Tool will be used to assess the risk of bias in the included studies. The selection of studies, data extraction, and risk of bias assessment will be carried out independently by 2 reviewers. A narrative summary will be provided of all the included studies. Meta-analyses will be performed whenever possible, and the heterogeneity of effects will be evaluated using I2, subgroup analyses, and metaregression. The certainty of the evidence for each outcome will be assessed using the GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) approach. RESULTS: We will conduct meta-analyses using Stata software (version 16, StataCorp) and present both a narrative and systematic summary of all studies included in this review in text and table form. For continuous outcomes, effect estimates will be expressed as mean differences and standardized mean differences, while for binary outcomes, they will be expressed as risk ratios, rate ratios, hazards ratios, or odds ratios, all with 95% CIs and comparing the intervention group with the control group. When studies for an outcome are adequately consistent with respect to intervention, comparator, and definition of the outcome, a random-effects, inverse variance-weighted meta-analysis will be conducted. We will provide a narrative synthesis for outcomes with insufficient data or extreme heterogeneity. CONCLUSIONS: This review will provide evidence upon which to base policy and programming for women in LMICs to supplement micronutrients in pregnancy and lactation. Detailed results disaggregated by variables such as maternal age, sex of infant, duration, and dose of intervention may also help policy makers, researchers, practitioners, and government agencies to adopt more effective maternal and child health policies and programs in LMICs. The review will also identify any gaps in the existing evidence. TRIAL REGISTRATION: PROSPERO CRD42022308715; https://tinyurl.com/y33cxekr. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/40134.

Are home gardening programs a sustainable way to improve nutrition? Lessons from a cluster-randomized controlled trial in Rufiji, Tanzania.

Homestead food production (HFP) programs may improve diet and nutrition outcomes by increasing availability of nutrient dense foods such as vegetables and supporting livelihoods. We conducted a pair-matched cluster-randomized controlled trial to investigate whether vegetable home gardens could improve women's dietary diversity, household food security, maternal and child iron status, and the probability of women consuming nutrient-rich food groups. We enrolled 1,006 women of reproductive age (18-49 years) in ten villages in Pwani Region, Eastern Tanzania, matched the villages into pairs according to village characteristics, and randomly allocated villages to intervention or control. Households in the intervention villages received agricultural training, inputs to promote home production of nutritious crops, and nutrition and health education. Data were collected in 2016, 2017, and 2019 and analyzed using linear regression models with propensity score weighting adjusting for individual-level confounders, differential loss to follow-up, and fixed effects for village pairs to accommodate the pair-matched design. Results after one year of the intervention (previously published) found significant improvements in dietary diversity. However, three years after the start of the intervention the difference in dietary diversity disappeared, even though the number of women who grew at least one crop was significantly higher (75 percentage points, 95% CI: 72, 81) in treatment households compared to controls. Barriers to maintaining a home garden, including lack of irrigation opportunities and fencing materials, and social disruption may have precluded sustained impacts from home gardening in this context. Future home garden programs should carefully consider mechanisms and investments needed for sustained impact over time.

Initiation of postpartum modern contraceptive methods: Evidence from Tanzania demographic and health survey.

BACKGROUND: Postpartum contraceptive use is vital to improve maternal and child survival. It helps to have optimal child spacing, prevent unplanned pregnancies and associated adverse birth outcomes. However, postpartum contraceptive use in Tanzania remains low. Short median interval for resumption to sex after birth among African women has been associated with adverse maternal and child health wellbeing. This study aimed to assess optimal time to contraceptive use and predictors of time to contraceptive use after birth among women of reproductive age in Tanzania. METHODS: A cross section study using the TDHS 2015-16 data was used. A total of 3775 postpartum women were analyzed. Information on pregnancy, births and contraceptive use were recorded over the previous 5 years with the focus on most recent birth from the contraceptive calendar. Data analysis was performed using Stata 14.0. Analysis accounted for complex survey design. Time to modern contraceptive use after birth was computed using Kaplan Meier estimate. Adjusted time ratios with 95% CI were estimated using Weibull accelerated failure time models. RESULTS: A total weighted sample of 3775 women was analyzed. The median time to contraceptive use after birth was 7(IQR: 4-13) months, while for resumption to sex afterbirth was 2(IQR: 1-5) months. Factors such as never been married (TR: 1.63; 95%CI: 1.26-2.11) and breastfeeding (TR: 5.50; 95%CI: 4.12-7.35) were associated with longer time to postpartum contraceptive use. Belonging to richest wealth quintile (TR: 0.73; 95%CI: 0.54-0.99) and adopting long acting methods (TR: 0.70; 95%CI: 0.60-0.82) increased women's likelihood of having shorter time to postpartum contraceptive use. CONCLUSION: There was a time lag of five months from resumption of sex and initiation of postpartum contraception use. The interceptive measures to facilitate timely availing methods of women's choice and promotion of utilization of maternal health care services may reduce delays in postpartum contraceptive use.

Association between male involvement during antenatal care and use of maternal health services in Mwanza City, Northwestern Tanzania: a cross-sectional study.

BACKGROUND: Male involvement in antenatal care (ANC) is among interventions to improve maternal health. Globally male involvement in ANC is low and varies in low-income and middle-income countries including Tanzania where most maternal deaths occur. In Sub-Sahara, men are chief decision makers and highly influence maternal health. In Tanzania information is limited regarding influence of male involvement during ANC on utilisation of maternal health services. OBJECTIVES: To determine the effect of male involvement during ANC on use of maternal health services in Mwanza, Tanzania. DESIGN: A cross-sectional study conducted from June to July 2019. SETTING: This study was conducted at seven randomly selected health facilities providing reproductive, maternal and child health (RCH) services in Mwanza City. PARTICIPANTS: Included 430 postpartum women who delivered 1 year prior to the study and attending for RCH services (growth monitoring, vaccination, postpartum care). OUTCOME MEASURES: 4 or more ANC visits, skilled birth attendant (SBA) use during childbirth and postnatal care (PNC) utilisation 48 hours after delivery. METHODS: Interviews and observation of the women's ANC card were used to collect data. Data was entered, cleaned and analysed by SPSS. RESULTS: The mean age of participants was 25.7 years. Of 430 women, 54.4% reported their partners attended ANC at least once, 69.7% reported they attended for four or more ANC visits during last pregnancy, 95% used SBAs during childbirth and 9.2% attended PNC within 48 hours after delivery. Male involvement during ANC was significantly associated with four or more ANC visits (Crude Odds Ratio (COR): 1.90; 95% CI: 1.08-3.35) but not with SBA use or PNC utilisation. CONCLUSION: Male involvement in ANC is still low in Mwanza, as 46% of the partners had not attended with partners at ANC. Alternative strategies are needed to improve participation. Studies among men are required to explore the barriers of participation in overall RCH services.

Trends and predictors of changes in modern contraceptive use among women aged 15-49 years in Tanzania from 2004-2016: Evidence from Tanzania Demographic and Health Surveys.

INTRODUCTION: Modern contraceptive use provides opportunities for women and couples to achieve optimal child spacing, achieve desired family size and reduce unsafe abortions. Despite these facts, modern contraceptive prevalence rate (mCPR) in Tanzania remains as low as 32%. This study aimed to determine trends and factors associated with changes in modern contraceptive use among women of reproductive age in Tanzania from 2004-2016. METHODOLOGY: This was a cross-sectional study utilizing data from Tanzania Demographic and Health Surveys of 2004-2005, 2010 and 2015-2016. Data analysis was performed using Stata version 14. Analysis considered the complex survey design through application of weights, clustering and strata. Multivariable Poisson decomposition analysis was used to assess factors associated with changes in modern contraceptive use. Results were presented in the form of decomposition coefficients and percentages. RESULTS: Modern contraceptive use increased from 23.0% in 2004 to 34.3% in 2016. Differences in women's characteristics contributed 12.5% of the increase in mCPR. These characteristics include partner's education levels, recent sexual activity and being visited by a family planning worker. The difference in coefficients contributed 87.5% increase in mCPR. The most increase in modern contraceptive use was attributed to rural population (44.1%) and women who experienced a termination of pregnancy (7.1%). CONCLUSION: Modern contraceptive use has steadily increased in Tanzania. Health policies and interventions need to target sexually active women, rural residents as well as less educated women and men to maintain and further accelerate the trends in mCPR. Interventions focusing on women who experienced a termination of pregnancy may also serve as an entry point to promote use of modern contraceptive methods.