Adolescents In Tanzania Research Articles

Hope for the Future and Its Associated Factors Among Adolescents in Tanzania: A Cross-Sectional Study.

Introduction Hope is a universal, multidimensional psychological construct related to an individual's expectation that they will achieve desirable outcomes by setting realistic objectives. The study aims to investigate the factors associated with hope among adolescents in Tanzania. Methods Baseline characteristics were collected from 2,058 adolescent girls and 1,770 adolescent boys at 41 primary and 13 secondary schools in Korogwe District, Tanzania. The level of hope was measured using the Herth Hope Index. The associated hope factors were analyzed using multiple linear regression models based on sex. Results The results of multiple regression analyses indicated that secondary school students demonstrated significantly higher levels of hope for the future than primary school students among both adolescent girls and boys [95% CI]: 2.34 [1.53 to 3.15], 1.69 (0.98 to 2.41). Both Christian adolescent girls and boys had significantly higher levels of hope than their Muslim counterparts. Adolescent girls who intended to enrol in secondary school or obtain employment exhibited significantly higher levels of hope than those who were uncertain about their post-school plans. Conclusions This study showed common and distinct factors associated with hope for the future ofadolescent girls and boys in Tanzania. This suggests that there are potential avenues for identifying target subpopulations of adolescent girls and boys and developing sex-specific interventions to enhance their hope for the future. Future research must focus on elucidating the methods for assessing and measuring hope in various populations in order to understand the essence of this concept based on strengths within particular cultural contexts.

School health and nutrition services for children and adolescents in Tanzania: A review of policies and programmes.

School health and nutrition programmes are effective strategies to address the health problems among school-going children and adolescents. We examined the policy environments, successesand bottlenecks associated with school health and nutrition programmes in Tanzania. We used the 'policy triangle framework' to examine 22 national and regional school health and nutrition policies and programmes in Tanzania. We also interviewed 16 key informants to gain further insights into school health and nutrition programmes. Several school health and nutrition policies in Tanzania outline the basic elements of school-based health and nutrition services. Yet, these documents neither recognise vulnerable groups, recommend age-appropriate strategies to address children's and adolescents' varied and transient needs, nor provide a framework for implementing and tracking recommended activities. In these documents, underweight and infectious diseases, including humanimmunodeficiency virus/acquired immunodeficiency syndrome, are frequently identified as major concerns of young people, with little or no consideration of social determinants. Diverse strategies including school feeding, water and sanitation services, health and nutrition educationand promotion of healthy behaviours are identified. In doing so, these documents adequately define the roles and responsibilities of all government actors, but young people and their guardians are not actively engaged in design and implementation. Additionally, there are several challenges to implementing these policies including budgetary constraints, limited resources, a lack of inter-sectoral coordinationand insufficient capacity within targeted schools. To improve the health and nutritional status of school-going children and adolescents in Tanzania, adequate budgets, strengthened coordination and implementation efforts, the development of school-based stakeholders' capacity, as well as the involvement of all other stakeholders, including adolescents, are imperative.

A hybrid digital parenting programme to prevent abuse of adolescents in Tanzania: statistical analysis plan for a pragmatic cluster randomised controlled trial

BackgroundGlobally, violence against children poses substantial health and economic challenges, with estimated costs nearing USD 7 trillion. This prompts the urgent call for effective evidence-based interventions in preventing and mitigating violence against children. ParentApp is a mobile, open-source application designed to offer a remote version of the Parenting for Lifelong Health (PLH) programme. ParentApp is the first digital parenting intervention for caregivers of adolescents aged 10–17 years to be tested in low- and middle-income settings.MethodsThis study is a pragmatic, two-arm, cluster-randomised trial in Mwanza, Tanzania’s urban and peri-urban areas. Assessments are set for baseline, 1 month post-intervention, and 12 months post-intervention. We randomised 80 clusters, each with about 30 caregiver-adolescent dyads, with a 1:1 ratio stratified by urban or peri-urban location. Both arms receive an entry-level smartphone preloaded with Kiswahili apps—ParentApp for intervention and WashApp control.The primary method of analysis will be generalised linear mixed-effects models with adjustment for person-level characteristics and multiple imputation. In three-level models, measurement waves are nested within a person, nested within a sub-ward. Regressions will constrain groups to be equal at baseline and include covariates for stratification, percentage of male caregivers, and individual-level characteristics.DiscussionsPreparations for the trial began in December 2022, including community mobilisation and sensitisation. Rolling recruitment, baseline data collection, and implementation onboarding took place between April and September 2023. One-month post-test data collection began in August 2023 and thus far achieved 97% and 94% retention rates for caregivers and adolescents respectively. Final post-test data collection will begin in September 2024, anticipated to run until April 2025. This SAP was submitted to the journal before the interim analysis to preserve scientific integrity under a superiority hypothesis testing framework.Trial registrationThe trial was registered on the Open Science Framework on 14 March 2023: https://doi.org/10.17605/OSF.IO/T9FXZ.The trial protocol was published in Trials 25, 119 (2024): Baerecke, L., Ornellas, A., Wamoyi, J. et al. A hybrid digital parenting programme to prevent abuse of adolescents in Tanzania: study protocol for a pragmatic cluster-randomised controlled trial. Trials 25, 119 (2024). https://doi.org/10.1186/s13063-023-07893-x.

Use of contraceptives and associated factors among male adolescents in rural secondary schools, Coast Region, Tanzania: a school-based cross-sectional study

BackgroundTeenage pregnancy is still one of the reproductive health concerns facing adolescents in Tanzania. The problem has been associated with physiological, psychological, and social changes and increases the risk of unsafe abortion and adverse maternal, fetal, and neonatal outcomes among adolescents. Low utilization of contraceptive methods among adolescents is one of the key causes. The strategy of involving male adolescents in sexual and reproductive health programs can increase the rate of contraceptive use among adolescents, thereby preventing teenage pregnancy.ObjectiveTo examine factors associated with the uptake of contraceptives among male secondary school adolescent students.MethodsThis was a cross-sectional study conducted in rural secondary schools in Kisarawe District, Coast Region, Tanzania. Multi-stage sampling methods were used to recruit participants. Descriptive and multiple regression analyses were conducted to assess the prevalence and factors associated with contraceptive use. 95% confidence interval and p-value < 0.05 were considered statistical significance. Univariate and multivariate logistic regression were tested for the Crude Odds Ratio (COR) and Adjusted Odds Ratio (AOR) respectively.ResultsThe study involved 422 male students with the majority of them 58.1% aged 17–19 years, 50.2% were Muslim, 76.3% were studying in government schools, 62.3% were from households size of 4–6 members, 87.4% were not in a relationship, and 64.2% were living with both parents. Less than half (38.9%) of male students reported ever having sex in their lifetime, and among them, very few (29.8%) used any method of contraceptive. The reported lowest age for the first sex was 10 years. The male condom was the most method used (69.4%) and Pharmacy/Chemist Shops were the common source of contraceptive services (55.1%). Students who had adequate knowledge of contraceptives were more likely to report the use of contraceptive methods compared to those who had inadequate knowledge (AOR = 2.704, 95% CI: 1.220–5.995, p = 0.014). Participants in Private schools were 4.3 times more likely to report the use of contraceptives than those in government schools (AOR = 4.347, 95% CI: 1.758–10.762, p = 0.01). Students in a relationship were 3.5 times more likely than those not in a relationship to report the use of a contraceptive method (AOR = 3.51, 95% CI: 1.421–8.670, p = 0.006).ConclusionThe study found the low use of contraceptives among male adolescents who ever had sex in their lifetime. Thus, it’s suggested that age-tailored comprehensive sexual and reproductive health education should start to be taught from a very young age as adolescents initiate sex at an early age. Also, Teenage pregnancy prevention programs should involve males as the key players during the development and implementation of the program as most of the decisions among partners are from men.

A hybrid digital parenting programme to prevent abuse of adolescents in Tanzania: study protocol for a pragmatic cluster-randomised controlled trial

BackgroundEvidence-based parenting programmes have strong evidence in preventing and mitigating violence, but in-person programmes are challenging to deliver at scale. ParentApp is an open-source, offline-first app-based adaptation of the Parenting for Lifelong Health for Parents and Teens programme to promote playful and positive parenting, reduce risks for sexual violence victimisation, and prevent violence against adolescents. This study aims to evaluate the effectiveness and cost-effectiveness of ParentApp compared to an attention-control group.MethodsThis study is a two-arm pragmatic cluster-randomised controlled trial to test whether ParentApp reduces adolescent physical abuse, emotional abuse, and sexual violence risks and victimisation at 1 month and 12 months post-intervention. Caregivers of adolescents aged 10–17 years and their adolescent children (N = 2400 caregiver-adolescent dyads) will be recruited in urban and peri-urban communities in the Mwanza region of Tanzania. A total of 80 study clusters will be stratified and randomised (1:1) to the intervention group, who will receive ParentApp with support through a WhatsApp group, or to an attention-control group, who will receive a water, sanitation, and hygiene app. Quantitative data will be collected through outcomes questionnaires with caregivers and adolescents, administered at baseline, 4 months post-baseline, and 16 months post-baseline, as well as through routine implementation data and ParentApp engagement data. Qualitative data will be collected through individual interviews and focus groups with caregivers, adolescents, and implementing partner staff.DiscussionApp-based interventions have the potential to expand access to evidence-based parenting support, but currently lack rigorous evidence in low- and middle-income countries. This is the first known randomised control trial of a hybrid digital parenting programme to prevent the abuse of adolescents in low- and middle-income settings.Trial registrationThe trial was registered on the Open Science Framework on 14 March 2023, registration: OSF.IO/T9FXZ.

Parent-adolescent communication about sexual and reproductive health and its determinants among adolescents: Baseline findings from a Randomized Controlled Trial in Tanzania

Regardless of the importance of youth in socio-economic development around the globe, adolescents aged between 10 and 19 years face problems ranging from their basic to Sexual and Reproductive Health economic needs (SRH). This study determined baseline parent-adolescent communication about SRH from a randomized controlled trial of integrated reproductive health materials in a Problem-Based Pedagogy (PBP) for shaping safe sexual behavior among adolescents in Tanzania. The study employed a baseline cross-section survey from a randomized controlled trial of integrated reproductive health materials in a problem-based learning pedagogy for shaping safe sexual behavior among 647 randomly selected adolescents in Tanzanian ordinary-level secondary schools. The response rate of the study was 100% of which 57.5% were females. Totalities of 73.3% of adolescents reported having never communicated with their parents about SRH. Parent-adolescent communication about SRH matters was found to be low and thus, recommends collaborative parent-adolescent interventions to address it accordingly.

Attitude and prevalence of early sexual debut and associated risk sexual behavior among adolescents in Tanzania; Evidence from baseline data in a Randomized Controlled Trial

BackgroundUnsafe sexual behaviours and associated sexual ideas among adolescents may contribute to adverse health consequences for sexual health in adulthood. The patterns of sexual ideology and sociodemographic factors profiles on adolescents' sexual behaviours have not been the subject of a definite consensus in research. The purpose of this study was to investigate the attitude and prevalence of early sexual debut and associated risk sexual behavior among adolescents in Tanzania as the evidence from baseline data in a Randomized Controlled Trial.MethodsThe study included 647 randomly chosen in-school adolescents from Tanzania and used an analytical cross-section survey in a quantitative research approach. Sexual-risk Behaviour Beliefs and Self-esteem Scale from previous studies were the main data collection tool. According to the Statistical Analysis Software (SAS), computer software version 9.4 descriptive analysis established respondents' socio-demographic profiles, attitudes, prevalence, and determinants linked to teenagers' early sexual debut. The link between the variables was established via multivariate logistic regression at a 5% significance level and a 95% confidence interval.ResultsThe mean age was 15 ± 1.869 years while 57.5% of adolescents were females. 69.7% of adolescents were sexually active whereas 44.8% of them practised sexual behaviours willingly against 24.9% who practised coerced sexual behaviours. The majority (44.4%) and 16.2% of them initiated sexual behaviours during the early and middle adolescence stages respectively. Most adolescents had the ideology that sex was okay to them even before the age of 18 years. Their odds of practicing sexual behaviours were significantly high with the ideology that sex was okay to them even before 18 years of age (AOR = 1.293; p < 0.05; 95%CI: 0.689, 2.989), exposure to drug abuse (AOR = 1.210; p < 0.05; 95%CI: 0.803, 2.130), using media (AOR = 1.006; p < 0.05; 95%CI: 0.748, 2.667) and/or exposure to social groups [Jogging, Gym, health clubs, betting, Games] (AOR = 1.032; p < 0.05; 95%CI: 0.889, 2.044).ConclusionFindings suggest that holding a positive attitude towards early sexual debut is a precursor to early sexual activity among adolescents. Unsafe sex, coercive sex, and other risky sexual behaviors are not uncommon among adolescents starting sex before the age of 18 years. Exposure to drug abuse, online sexual content, and/or social groups significantly influenced early sexual debut irrespective of other known factors. Age-appropriate school-based sexuality education programs should be promoted and implemented to address the most prevalent positive attitude towards early sexual debut and associated risk sexual behaviour among adolescents in Tanzania and other similar settings.

Online sexual exploitation of adolescents in Tanzania: Explaining help-seeking intention using the theory of planned behaviour

BackgroundThe online sexual exploitation (OSE) of children and adolescents is an emerging global concern, particularly following the increase in Internet and social media utilisation among schoolchildren during the COVID-19 pandemic. Numerous empirical studies have investigated the factors affecting children’s and adolescents’ seeking help for this problem in Tanzania. However, whether their explanations can be applied to understand similar cases in the cyberspace remain uncertain. ObjectivesDriven by the theory of planned behaviour (TPB), we conducted this study in Tanzania in 2022 to understand adolescents’ help-seeking intention for OSE. Two primary research objectives included (a) examining four TPB variables (i.e., attitude towards seeking help, perceived social support, generalised self-efficacy, and perceived social stigmas) as determinants of adolescents’ help-seeking intention for OSE and (b) assessing the moderating effects of two types of social stigma on the relationship between the TPB factors and adolescents’ help-seeking intention for OSE. MethodsUsing a cross-sectional survey design, we collected data from a stratified random sample of 1,014 secondary school adolescents recruited from two regions (i.e., Dar es Salaam and Ruvuma) in Tanzania. The data were analysed using hierarchical multiple regression. ConclusionsThe results indicate that adolescents’ attitude towards seeking help, perceived social support, and generalised self-efficacy were significantly associated with adolescents’ help-seeking intention for OSE in general. Through moderation analyses, we found that social stigma for sexual exploitation moderated the effect of generalised self-efficacy on explaining adolescents’ intention to seek help from family members while social stigma for receiving help moderated generalised self-efficacy on explaining their intention to seek help from friends.

Optimising engagement in a digital parenting intervention to prevent violence against adolescents in Tanzania: protocol for a cluster randomised factorial trial

BackgroundViolence against adolescents is a universal reality, with severe individual and societal costs. There is a critical need for scalable and effective violence prevention strategies such as parenting programmes, particularly in low- and middle-income countries where rates of maltreatment are highest. Digital interventions may be a scalable and cost-effective alternative to in-person delivery, yet maximising caregiver engagement is a substantial challenge. This trial employs a cluster randomised factorial experiment and a novel mixed-methods analytic approach to assess the effectiveness, cost-effectiveness, and feasibility of intervention components designed to optimise engagement in an open-source parenting app, ParentApp for Teens. The app is based on the evidence-based Parenting for Lifelong Health for Teens programme, developed collaboratively by academic institutions in the Global South and North, the WHO, and UNICEF.Methods/designSixteen neighbourhoods, i.e., clusters, will be randomised to one of eight experimental conditions which consist of any combination of three components (Support: self-guided/moderated WhatsApp groups; App Design: sequential workshops/non-sequential modules; Digital Literacy Training: on/off). The study will be conducted in low-income communities in Tanzania, targeting socioeconomically vulnerable caregivers of adolescents aged 10 to 17 years (16 clusters, 8 conditions, 640 caregivers, 80 per condition). The primary objective of this trial is to estimate the main effects of the three components on engagement. Secondary objectives are to explore the interactions between components, the effects of the components on caregiver behavioural outcomes, moderators and mediators of programme engagement and impact, and the cost-effectiveness of components. The study will also assess enablers and barriers to engagement qualitatively via interviews with a subset of low, medium, and high engaging participants. We will combine quantitative and qualitative data to develop an optimised ParentApp for Teens delivery package.DiscussionThis is the first known cluster randomised factorial trial for the optimisation of engagement in a digital parenting intervention in a low- and middle-income country. Findings will be used to inform the evaluation of the optimised app in a subsequent randomised controlled trial.Trial registrationPan African Clinical Trial Registry, PACTR202210657553944. Registered 11 October 2022, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=24051.

Psychometric validation of the collective asset Utu: associations with coping strategies and resilience during adolescence

BackgroundUtu is a Kiswahili term with a long history of cultural significance in Tanzania. It conveys a value system of shared, collective humanity. While variants of Utu have been studied in other contexts, a measure of Utu that captures this important collective asset has not been developed in Tanzania. The aims of this study were to (1) examine dimensional constructs that represent Utu, (2) validate a measurement scale of Utu for use with adolescents, (3) examine differences between orphan and non-orphan adolescents in self-reported Utu and, (4) examine structural paths between adverse life experiences, coping strategies, Utu, and resilience. MethodsThis study collected survey data from adolescents from three districts in peri-urban Tanzania in two samples: 189 orphan adolescents ages 10–17 in May 2020 and 333 non-orphan adolescents ages 10–14 in August 2020. Confirmatory factor analysis was used to validate the hypothesized factor structure of the developed Utu measure. Structural equation models were used to examine path associations with adverse life experiences, coping and resilience.ResultsThe five dimensional constructs comprising the Utu measure included Resource Sharing, Group Solidarity, Respect and Dignity, Collectivity, and Compassion. Confirmatory factor analysis of the Utu measure demonstrated excellent fit (CFI = 0.98; TLI = 0.97; SRMR = 0.024; RMSEA = 0.046) and internal consistency (α = 0.94) among adolescents in this study. Positive, significant associations were found between Utu and coping (β = 0.29, p < 0.001) and Utu and intra/interpersonal and collective resilience (β = 0.13, p < 0.014). Utu was not significantly associated with adverse life experiences, age or gender.ConclusionsA five-dimensional measurement scale for Utu was validated in a sample of orphan and non-orphan adolescents in Tanzania. Utu is a collective asset associated with higher levels of reported resilience in both orphan and non-orphan adolescent populations in Tanzania. Promoting Utu may be an effective universal public health prevention approach. Implications for adolescent programming are discussed.

Associated factors for multidimensional attitudes and behaviors of reproductive health toward pregnancy among early and late adolescents in Tanzania: a cross-sectional study

BackgroundAdolescent pregnancy is a serious reproductive health problem in Tanzania. However, the risk factors for multidimensional attitudes and behaviors of reproductive health toward pregnancy in Tanzanian adolescents remain unexplored.MethodsWe collected baseline characteristics and information on attitudes and behaviors of reproductive health from 4161 Tanzanian adolescents in all 54 primary and secondary schools in the Korogwe district. We applied mixed effect multiple regression analyses stratified by sex to find the factors related to reproductive health attitudes and behaviors toward pregnancy.ResultsIn female students, regarding the attitudes of reproductive health, higher age, hope for marriage in the future, a talk with a parent about sex or pregnancy, and a higher hope score were significantly associated with a lower score. For the behaviors of reproductive health, higher age, a talk with a parent about sex or pregnancy, time to talk with a parent about daily life, and a higher hope score were significantly associated with a lower score. In male students, regarding the attitudes of reproductive health, a higher hope score was significantly associated with a lower score. For the behaviors of reproductive health, higher age, time to talk with a parent about daily life, and a higher hope score was significantly associated with a lower score.ConclusionsThe heterogeneous factor-outcomes association between female and male students suggested that sex-specialized interventions may be required to change their risky attitudes or behaviors of reproductive health. Although we cannot conclude as points of intervention, our study suggested that it may be practical to improve parent-adolescents communication about sex or reproductive health and change adolescents’ views of pregnancy or marriage for gaining financial or social status.

A Decision Aid for Postpartum Adolescent Family Planning: A Quasi-Experimental Study in Tanzania.

We evaluated the effects of our postpartum Green Star family planning decision aid on the decisional conflict, knowledge, satisfaction, and uptake of long-acting reversible contraception among pregnant adolescents in Tanzania. We used a facility-based pre-post quasi-experimental design. The intervention arm received routine family planning counseling and the decision aid. The control received only routine family planning counseling. The primary outcome was the change in decisional conflict measured using the validated decision conflict scale (DCS). The secondary outcomes were knowledge, satisfaction, and contraception uptake. We recruited 66 pregnant adolescents, and 62 completed this study. The intervention group had a lower mean score difference in the DCS than in the control (intervention: -24.7 vs. control: -11.6, p < 0.001). The mean score difference in knowledge was significantly higher in the intervention than in the control (intervention: 4.53 vs. control: 2.0, p < 0.001). The mean score of satisfaction was significantly higher in the intervention than in the control (intervention: 100 vs. control: 55.8, p < 0.001). Contraceptive uptake was significantly higher in the intervention [29 (45.3%)] than in the control [13 (20.3%)] (p < 0.001). The decision aid demonstrated positive applicability and affordability for pregnant adolescents in Tanzania.

Exploring a faith-based approach to puberty education in Tanzania.

Many adolescents in Tanzania do not receive timely and comprehensive puberty education. This study explored faith-based organizations a site for puberty education. Two puberty books, each developed through participatory research with Tanzanian adolescents and stakeholders, were promoted to 177 Christian denomination churches in Dar es Salaam, Tanzania to understand the factors that faith leaders considered in their decision to purchase puberty books, or share information about the intervention to their peers and congregants. Data collection included routine monitoring via weekly reports and ethnographic observation. Data were analyzed using the Ecological Framework for Health Promotion to capture how individual, interpersonal, and institutional factors influenced leaders' decisions to purchase or promote puberty books. At the individual level, leaders cited their personal experiences in their support for the intervention, but leaders' time and confidence in their ability to effectively promote books to others were barriers to participation. Interpersonally, the diffusion of information between church leaders, particularly when information came from well-known or respected leaders, emerged as an important factor in leaders' willingness to promote books. At the institutional level, leaders' decisions were impacted by resources, institutional culture, and institutional hierarchy. Importantly, twelve churches in the sample purchased books. Limited financial resources and the need to receive approval from denominational leaders were discussed by leaders as barriers to purchasing books. Despite research showing high religiosity in Tanzania, the role of religious institutions in providing puberty education has remained unexplored. Our results inform future research and practice by providing an articulation of the socioecological factors that played a role in faith leaders' decisions related to puberty education interventions in Tanzania.

Vicarious Experience as a Predictor of Self-efficacy in Condom Use among Adolescents in Tanzania: Reflections from Media, Peers and Adults

Vicarious Experience as a Predictor of Self-efficacy in Condom Use among Adolescents in Tanzania: Reflections from Media, Peers and Adults

The Relationship between Vicarious Experiences and Self-Efficacy in Condom use among Adolescents in Tanzania

Inadequate condom use among adolescents is a health and behavioural concern across countries. Adolescents are largely vulnerable to sexually transmitted diseases and early pregnancies. However, little attention has been paid to studying the factors that are associated with self-efficacy in condom use among adolescents. The study presents results on the relationship between vicarious experiences and self-efficacy in condom use among adolescents in Tanzania. The study applied a quantitative approach using a sample of 552 respondents from two districts of Mpanda and Njombe in Tanzania. The data were collected with questionnaires, and the analysis used independent t-test and Spearman's rank-order correlation coefficient. The results revealed a positive and statistically significant relationship between vicarious experiences and self-efficacy in condom use among adolescents (r=.462, p value=.001). It was also revealed that girls had higher condom use self-efficacy than boys (M=6.75, SD= 2.88), t=3.691, df=550, p value =.001). It is, thus, recommended that health behavioural change programmes such as condom use, targeting adolescents, should encourage the use of vicarious experiences such as peer educator programmes and TV/radio ads. That could help strengthening the use of condom, and it is practically effective in preventing HIV/AIDS and early pregnancies. It is further recommended that such programmes be packaged differently for boys and girls.

Development of a Psychological Intervention to Improve Depressive Symptoms and Enhance Adherence to Antiretroviral Therapy among Adolescents and Young People Living with HIV in Dar es Salaam Tanzania.

Background: Interventions that simultaneously target depression and antiretroviral therapy (ART) medication adherence are recommended for improving HIV treatment outcomes and quality of life for adolescents living with HIV. However, evidence is scarce on culturally feasible and acceptable interventions that can be implemented for HIV-positive adolescents in Tanzania. We, therefore, developed a manualized brief psychological intervention that utilizes evidence-based strategies to address depression and ART adherence in adolescents living with HIV in Tanzania. Methods: We used the Theory of Change Enhanced Medical Research Council framework (TOCMRC) for developing complex interventions in health care to develop the intervention in five phases. First, the literature was reviewed to identify potential intervention components. Second, we conducted a situational analysis using qualitative interviews with adolescents living with HIV, health care providers, and caregivers. Third, we conducted a mental health expert workshop; and fourth, theory of change workshops with representatives from the Ministry of Health, mental health professionals, HIV implementing partners, adolescents, and healthcare providers. Lastly, we synthesized results to finalize the intervention and a theory of change map showing the causal pathway for how we expect the developed intervention to achieve its impact. Results: Adolescents living with HIV in Tanzania experience several unmet mental health needs ranging from overwhelming depressive symptoms to not feeling understood by healthcare providers who lack mental health knowledge. Participants perceived psychological intervention that utilizes a task-shifting approach to be acceptable and beneficial to addressing those problems. The novel components of the NITUE intervention included incorporating evidence-based intervention components, namely, cognitive-behavioral therapy, motivational interviewing, and problem solving. In addition, caregiver inclusion in the treatment was essential to ensure access to care, compliance, and improved outcomes. Conclusions: A culturally appropriate brief psychological intervention that utilizes a task-shifting approach to address depression and medication adherence for adolescents living with HIV in Dar es Salaam, Tanzania, was developed. The intervention will be piloted for appropriateness, feasibility, and acceptability and will provide material for a future trial to determine its effectiveness.

Qualitative inquiry into adolescents\u2019 experience of ethical challenges during enrollment and adherence to antiretroviral therapy (ART) in Temeke Regional Referral Hospital, Tanzania

BackgroundAdolescents living with human immunodeficiency virus (HIV) experience challenges, including lack of involvement in their care as well nondisclosure of HIV status, which leads to poor adherence to antiretroviral therapy (ART). Parents have authority over their children, but during adolescence there is an increasing desire for independence. The aim of the study was to explore adolescents’ experience of challenges identified by adolescents ages 10–19 years attending HIV care and treatment at Temeke Regional Referral Hospital in Tanzania.MethodsAn exploratory descriptive qualitative design was employed in the HIV Care and Treatment Centre (CTC) in the Out-Patient Department at the Temeke Regional Referral Hospital in Tanzania with adolescents living with HIV who were 10–19 years of age. A total of 22 adolescents participated in semi-structured face-to-face interviews after parental consent and adolescent assent were obtained. Participants were interviewed about their participation in decisions to be tested for HIV and enrolled in the CTC, concerns surrounding disclosure of their HIV status to the adolescent or to others, stigma and discrimination, and the effect of these challenges on their adherence to medication. All interviews were audio-taped, transcribed verbatim in Swahili, and back-translated to English. Data analysis included both inductive and deductive thematic analysis.ResultsQualitative themes identified included lack of participation in decisions about HIV testing, challenges to enrollment in care and treatment; issues around disclosure of HIV status, such as delays in disclosure to the adolescent and disclosure to other persons and benefits and harms of such disclosures; and factors supporting and interfering with adherence to ART, such as parental support, organizational (clinic) support and problems, and self-stigmatization and shame.ConclusionLack of adolescents’ involvement in their care decision making and delayed disclosure of HIV status to the adolescent were identified concerns, leading to poor adherence to ART among adolescents. Disclosure to others, especially teachers, helped adolescents at school to take their medication properly. Disclosure to others led to stigma and discrimination for some adolescents. More research is needed to better understand the role of disclosure and its benefits and challenges for HIV-positive adolescents in Tanzania.

The effect of educational intervention on shaping safe sexual behavior based on problem-based pedagogy in the field of sex education and reproductive health: clinical trial among adolescents in Tanzania

ABSTRACT Background The majority of adolescents are currently becoming sexually active before their 18th birthday having to battle with unsafe sexual behaviors, teenage pregnancies, sexually transmitted infections, and school dropouts. The study designed and tested the effect of integrated reproductive health lesson materials in a Problem-Based pedagogy (PBP) to enhance safe sexual behaviors among adolescents in Tanzania. Methods Clustered Randomized Controlled Trial was adopted among 660 adolescents in Tanzania. The study consisted of three research arms including pure PBP, Hybrid PBP, and Lecture-Based Pedagogy (LBP). Sexual-risk Behavior Beliefs and Self-esteem Scale adopted from previous studies measured adolescents' sexual behaviors. A Statistical Analysis Software (SAS) version 9.4 was used to analyze data. Descriptive analysis established adolescents' socio-demographic profiles. Generalized Estimating Equation (GEE) determined the effect of interventions on adolescents' intentions to practice safe sexual behaviors at a 95% confidence interval and a significance level of 5%. Results Adolescents' mean age was 15 ± 1.869 years. Sums of 57.5% (n = 380) were females. 39.5% of adolescents were sexually active whereas 44.8% of them initiated sexual intercourse by the age between 10 and 12 years. The end-line findings showed that 54.9% of adolescents in the LBP group demonstrated a significant intention to unsafe sexual behaviors against 26.3% and 30.9% of adolescents in the pure PBP and Hybrid PBP groups respectively. The Difference-In-Difference odds ratio for unsafe sexual behavior among adolescents in the Hybrid PBP and pure PBP was less (AOR = 0.30; p < 0.0001; 95%CI: 0.1398, 0.5559) and (AOR = 0.30, p < 0.0002; 95%CI: 0.1386, 0.5487) contrary to a control group respectively. Conclusion The integrated RH lesson materials in a PBP can change a spectrum of sexual behavior among adolescents in Tanzania. This study suggests school teachers and health workers work together to facilitate RH lessons using PBP to enhance safe sexual behaviors among adolescents for their healthy adulthood and future investment. Trial registration: Pan African Clinical Trial Registry identifier: PACTR202009656160779..

Adherence, Effectiveness and Safety of Dolutegravir Based Antiretroviral Regimens among HIV Infected Children and Adolescents in Tanzania.

Objectives:This study aimed at assessing adherence, effectiveness, and safety of DTG-based HAART regimens among HIV-infected children and adolescents in Tanzania. Methods: This was a single-center prospective cohort study, conducted at the pediatric HIV Clinic in Mbeya, Tanzania. A binary logistic regression model was used to determine predictors of undetectable viral load at week 24. The results were significant when P-value was <0.05. Results: A total of 200 patients were enrolled with the majority (85.5%) being treatment experienced. High adherence levels (71%) were observed using the pharmacy refill method. At week 24, the overall proportion of patients with undetectable viral load was 70.2%. The predictors of undetectable viral load were age, World Health Organization (WHO) clinical stage, baseline VL and adherence to pharmacy refill. Conclusion: The majority of patients attained undetectable viral load 6 months after using DTG based regimen. DTG-based regimens were generally safe with few ADEs reported.

Rural-urban disparities in the nutritional status of younger adolescents in Tanzania.

Research on geographic differences in health focuses largely on children less than five years; little is known about adolescents-and even less regarding younger adolescents-a vulnerable group at a critical stage of the life course. Africa's rapid population growth and urbanization rates, coupled with stagnant rates of undernutrition, further indicate the need for country-specific data on rural-urban health disparities to inform development policies. This study examined rural-urban disparities in body mass index-for-age-and-sex (BAZ) and height-for-age-and-sex z-scores (HAZ) among younger adolescents in Tanzania. Participants were randomly selected adolescents aged 10-14 years (N = 1,125) residing in Kilosa (rural) and Moshi (urban) districts of Tanzania. Individual and household-level data were collected using surveys and anthropometric data was collected on all adolescents. Age, sex, household living conditions, and assets were self-reported. BAZ and HAZ were calculated using the WHO reference guide. The prevalence of undernutrition was 10.9% among rural and 5.1% among urban adolescents (p<0.001). Similarly, stunting prevalence was greater in rural (64.5%) than urban (3.1%) adolescents (p<0.001). After adjusting for covariates, rural residence was significantly and inversely associated with BAZ (B = -0.29, 95% CI: -0.52, -0.70, p = 0.01), as well as with HAZ (B = -1.79, 95% CI: -2.03, -1.54, p<0.001). Self-identified males had lower BAZ (B = -0.23, 95% CI: -0.34, -0.11, p<0.001) and HAZ (B = -0.22, 95% CI: -0.35, -0.09, p = 0.001) than self-identified female adolescents. Rural-urban disparities in nutritional status were significant and gendered. Findings confirm place of residence as a key determinant of BAZ and HAZ among younger adolescents in Tanzania. Targeted gender-sensitive interventions are needed to limit growth faltering and improve health outcomes in rural settings.