Children In Tanzania Research Articles

Routine Immunization Status and Factors Associated with Immunization Coverage among Children Aged 12-23 Months in Tanzania.

Immunization has saved millions of lives globally from vaccine-preventable diseases. Childhood immunization is an effective public health strategy for decreasing morbidity and mortality among children in developing countries. Tanzania has one of the highest rates of coverage of routine child immunization among sub-Saharan African countries. However, obstacles to universal immunization still exist, particularly in rural areas of the country. Assessing routine immunization coverage is essential to inform vaccine policies and program implementation. This study aimed to assess routine immunization status and factors associated with its coverage among children aged 12-23 months. We conducted a cross-sectional, quantitative household survey in 31 regions with caretakers of children in Tanzania, where a total of 4,560 households were visited. Nationally, 85.5% of children aged 12-23 months had completed the full recommended course of vaccines. Overall, 14.5% of children aged 12-23 months did not complete routine immunization schedules in 2019. We found that factors associated with immunization coverage included having one to six family members, higher household wealth, the family's head engaging in subsistence farming, caretakers' age, children's age, educational level, children with clinic cards, and children receiving the diphtheria, pertussis, tetanus-3 vaccine. The country is about to reach the vaccination coverage target set by the WHO and the United Nations Children Fund. Improving existing vaccination coverage and optimizing the use of recommended interventions are required. We strongly advise using the periodic micro-planning tool and satellite image technology, particularly in areas where immunization coverage is less than 80%.

52477 Evaluation of Dermatologic Diagnoses Among School-Aged Children in Tanzania

52477 Evaluation of Dermatologic Diagnoses Among School-Aged Children in Tanzania

Vitamin A supplementation status and associated factors among children aged 6-59 months in Tanzania: a multi-level analysis.

Vitamin A supplementation every 4-6 months is an economical, rapid, and effective strategy to enhance vitamin A status and minimize child morbidity and mortality due to vitamin A deficiency in the long run. Therefore, this study was aimed at investigating the level as well as the factors influencing VAS status among children aged 6-59 months in Tanzania. This analysis relied on data from the 2022 Tanzania Demographic and Health Survey (TDHS). The study used a weighted sample of 9,382 children aged 6-59 months. Given the effect of clustering and the binary character of the outcome variable, we employed a multilevel binary logistic regression model. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to determine statistical significance, considering the model with the lowest deviation that best fits the data. In this study, vitamin A supplementation among children aged 6-59 months was found to be 53.18% [95% CI: 52.17, 54.19]. Mother's/caregiver's working status; Working [AOR = 1.59, 95% CI: 1.34, 1.89], ANC follow-up [AOR = 1.71, 95%CI: 1.34, 2.2], and health facility delivery [AOR = 1.55, 95%CI: 1.25, 1.91] were individual-level factors associated with vitamin A supplementation. Whereas administrative zones of Western [AOR = 2.02, 95% CI: 1.16, 3.52], Southern highlands [AOR = 3.83, 95% CI: 2.02, 7.24], Southern administrative zone [AOR = 2.69, 95% CI: 1.37, 5.3], and South West highlands [AOR = 0.56, 95% CI: 0.33, 0.95] were community-level factors associated with vitamin A supplementation. The proportion of VAS among children in Tanzania is low compared to UNICEF's target of 80. Mother's/caregiver's working status, antenatal care, place of delivery, community-level media exposure, and administrative zones were significantly associated factors with vitamin A supplementation. Therefore, interventions should be designed to improve the uptake of VAS. Provision and promotion of ANC and institutional delivery and strengthening of routine supplementation are recommended to increase coverage of childhood vitamin A supplementation. Moreover, special focus should be given to regions in the south-western highlands.

Parents’ perspectives on homework practices in pre-primary school children in Tanzania: a phenomenological analysis

This study investigated parents’ practices in helping pre-primary school children with homework in Dodoma City, Tanzania. The study was guided by two specific objectives: to investigate the learning opportunities perceived by parents and the perceived challenges. The study involved 23 respondents from 15 families in Dodoma City, Tanzania. A convenience sampling technique was used to obtain families and parents. A phenomenology design was used, and semi-structured interviews were conducted to obtain data from the respondents. Thematic analysis was employed to analyse the collected data. The study revealed several learning opportunities among children, such as fostering child-parent relationships, knowing and monitoring children’s academic progress, and reinforcing learning and discipline among children. Also, several challenges were revealed from the study findings, including time-consuming, stressful and tedious activities for parents and children. The study concludes that parents’ involvement in children’s homework is vital for improving child-parent relationships and monitoring children’s academic progress. Therefore, the study recommends that teachers provide clear guidance to parents on assisting children with homework. Further, school administrators should encourage parents to participate in their children's education to improve their learning.

Exploring the Factors Influencing Undernutrition Among Children Under Five in Tanzania

Undernutrition is common, especially in low-income countries. Tanzania has the highest number of stunted and wasted children. This present study aims to analyze the determinants of undernutrition among children under the age of five in the country. The Tanzania Demographic and Health Survey Data (TDHS) for 2015/16 was utilized in this research, which employed a cross-sectional survey technique. Research employed a binary logit model to analyze the determinants of undernutrition among under five years in Tanzania. Study outcomes shed light on key determinants of undernutrition among under-five children in the nation. Results illustrate that child age, gender, parental maternal education, marital status, access to clean water, and food security emerge as significant factors influencing the prevalence of stunting. Variables including secondary education, university education, parent education, marital status, food security, and access to clean water were associated with child wasting. Results at the same time indicate that child gender (4.15, with a p-value of 0.000), secondary education (Odds Ratio: 4.06, p-value: 0.019), university education of parents (Odds Ratio=4.53, p-value=0.021), and marital status (2.52, with a p-value of 0.039) are significantly associated with child underweight. These findings highlight the nature of undernutrition, necessitating comprehensive and targeted interventions. Addressing these determinants, which promote educational initiatives, enhance water accessibility, and foster food security, is vital to establishing effective tactics for curbing undernutrition among the vulnerable demographic of under-five children in Tanzania.

Child Health and Infection with Low Density (CHILD) malaria: a protocol for a randomised controlled trial to assess the long-term health and socioeconomic impacts of testing and treating low-density malaria infection among children in Tanzania

IntroductionAs malaria declines, low-density malaria infections (LMIs) represent an increasing proportion of infections and may have negative impacts on child health and cognition, necessitating development of targeted and effective solutions....

Prosocial Behaviour Development among Preschool Children: Effect of Peer Socialisation

This study applied a systematic literature review to explore the influence of peer socialisation on prosocial behaviour among preschool children. Using Manual content analysis, 57 studies were identified; variables covered peer socialisation and prosocial behaviour. The study revealed that the majority of research focused on the role of parental and siblings' socialisation in the home context and teachers' socialisation in the school context and their influence on prosocial behaviours among young children. However, few studies focused on the influence of peer socialisation on children's prosocial behaviour in preschools. The main analyses were revealed to be regression and multilevel. Few studies linked attachment theory with socialisation and prosocial behaviour. This is the first study to explore the influence of peer socialisation on prosocial behaviour among preschool children in Tanzania. Since prosocial behaviour is a foundation of positive emotional development and individual well-being, this study recommends that preschool curriculum should consider peer socialisation as an important aspect in promoting prosocial behaviour. Teachers in preschools should be advised to design frameworks that can guide peer socialisation among children in a bid to enhance sustainable and prospective prosocial behaviour, which has a great influence on positive emotional development, positive social interaction, and cognitive development among young children in preschool contexts

Risk factors for moderate acute malnutrition among children with acute diarrhoea in India and Tanzania: a secondary analysis of data from a randomized trial

BackgroundModerate acute malnutrition (MAM) affects over 30 million children aged < 5 years worldwide. MAM may confer a greater risk of developing severe malnutrition and even mortality in children. Assessing risk factors for MAM may allow for earlier recognition of children at risk of deleterious health outcomes.ObjectiveTo determine risk factors associated with the prevalence and development of MAM among children aged 6 to 59 months with acute diarrhoea who received treatment with oral rehydration solution and zinc supplementation.MethodsWe conducted a secondary analysis of data from a randomized, dose-finding trial of zinc among children with acute diarrhoea in India and Tanzania. We used regression models to assess risk factors for prevalent MAM at the start of diarrhoea treatment and to identify risk factors associated with the development of MAM at 60 days. MAM was defined as weight for length (or height) Z score ≤—2 and > -3 or mid-upper arm circumference < 12.5 and ≥ 11.5 cm.ResultsA total of 4,500 children were enrolled; 593 (13.2%) had MAM at the baseline. MAM at baseline was significantly less common among children in Tanzania than in India (adjusted risk ratio [aRR] 0.37, 95% confidence interval [CI]: 0.30, 0.44, P < 0.001), in children aged 24- < 60 months versus 6- < 12 months (aRR 0.46, 95% CI: 0.38, 0.56, P < 0.001), and in families with household wealth index higher than the median (aRR 0.79, 95% CI: 0.68, 0.92, P = 0.002). Sixty days after outpatient treatment and follow-up, 87 (2.5%) children developed MAM. When compared to children aged 6- < 12 months, children aged 24- < 60 months had a 52% lower risk of developing MAM. Every one unit increase in weight for length (or height) Z score at enrolment was associated with a 93% lower risk of developing MAM during follow-up.ConclusionsAmong children with diarrhoea, younger children and those from households with lower wealth were at greater risk of MAM. These children may benefit from targeted interventions focusing on feeding (targeted nutrition support for at-risk households) and follow up in order to reduce the occurrence of MAM and its consequences.

Analysis of Correlated Outcomes of Anthropometric Measurements for Under-Five Children in Tanzania.

The study aimed at applying Multivariate Generalized Linear Mixed Models to examine factors associated with correlation outcomes, in particular, anthropometric measurements among under-five children in Tanzania. Three anthropometric measurements: weight-for-age (WAZ), height-for-age (HAZ), and weight-for-height (WHZ) among under-five children in Tanzania were jointly modeled to identify common factors associated with childhood malnutrition. A total of 9052 children with valid measures of height and weight were processed and analyzed. The results indicate that WAZ was correlated with HAZ (P-value < 2e-16) and WHZ (P-value < 2e-16). The Multivariate Ordered Logit Model has lower AIC = 53213.92 and BIC = 52727.95, indicating better model fit than the Multivariate Ordered Probit Model. In Tanzania, the age of the child, birth order, mother education level, child gender, mother working status, wealth index, marital status, and mother body mass index are important determinants of malnutrition among children under the age of five. Moreover, the common factors were child's age, Birth order, Mother's education attainment, child's sex, Mother working status, wealth index, Marital status, and Mother's Body Mass Index. As a result, emphasis should be placed on analyzing correlated health outcomes in order to draw conclusions about the factors that may have a mutual effect on anthropometric measurements.

Challenges and Stakeholders' Views on Achievements of Multi-Sectoral Governance in Improving Child Nutrition in Buhigwe District, Tanzania.

In recent years, Tanzania has made good progress in addressing the problem of chronic malnutrition in children, but the levels are still unsatisfactory, at almost three in ten of its children are stunted. The government of Tanzania has taken significant measures to establish and strengthen multi-sectoral governance as part of national efforts to reduce the unacceptably high level of malnutrition. However, few studies have qualitatively documented stakeholder's perspectives at sub-national and community level with regards to performance of multi-sectoral governance in improving nutrition status of children in Tanzania. This study aimed to explore the achievements, facilitating factors and challenges of multi-sectoral governance in improving child nutrition in Buhigwe District Council. This was cross-sectional study, which employed qualitative method of data collection whereby semi-structured interviews were used to conduct in-depth interviews with members of the multisectoral steering committee for nutrition in Buhigwe Council and parents/caregivers of under-five children. There is significant improvement in allocating funds for multisectoral governance interventions targeting under five children across sectors, improved inter-sectoral coordination and increased knowledge on feeding practices among parents/caregivers. Strong leadership and political commitment, inter-sectoral linkage and Presence of Non-Governmental Organizations (NGOs) supporting nutrition were identified as factors for improving child nutrition in the context of multisectoral governance. The issue of insufficient funding, inadequate spending of allocated funds, inadequate capacity, lack of cross-sectional financial mechanism and tools to collect nutrition information were raised by stakeholders as factors hindering the implementation of multi-sectoral governance in improving child nutrition. Smooth implementation of multi-sectoral interventions targeting under-five children requires strong multi-sectoral governance, which is supported by adequate spending of the allocated funds, strong leadership and political commitment, presence of NGOs supporting nutrition and inter-sectoral linkage among line sectors. However, key stakeholders including central and local government authorities should address the challenge of insufficient funds, inadequate capacity, lack of cross-sectoral co-financing mechanism and tools to collect nutrition information, which were reported as barriers to the implementation of multi-sectoral governance in improving child nutrition.

Bayesian multilevel modelling of the association between socio-economic status and stunting among under-five-year children in Tanzania

BackgroundStunting is associated with socioeconomic status (SES) which is multidimensional. This study aimed to compare different SES indices in predicting stunting.MethodsThis was the secondary data analysis using Tanzania Demographics and Health Surveys (TDHS). The study used 7492, 6668, and 8790 under-five-year children from TDHS 2004/5, 2010, and 2015/16, respectively. The Household Wealth Index (HWI); Water and Sanitation, Assets, Maternal education and Income (WAMI); Wealth Assets, Education, and Occupation (WEO); and the Multidimensional Poverty Index (MPI) indices were compared. The summated scores, principal component analysis (PCA), and random forest (RF) approaches were used to construct indices. The Bayesian and maximum likelihood multilevel generalized linear mixed models (MGLMM) were constructed to determine the association between each SES index and stunting.ResultsThe study revealed that 42.3%, 38.4%, and 32.4% of the studied under-five-year children were stunted in 2004/5, 2010, and 2015/16, respectively. Compared to other indicators of SES, the MPI had a better prediction of stunting for the TDHS 2004/5 and 2015/16, while the WAMI had a better prediction in 2010. For each score increase in WAMI, the odds of stunting were 64% [BPOR = 0.36; 95% CCI 0.3, 0.4] lower in 2010, while for each score increase in MPI there was 1 [BPOR = 1.1; 95% CCI 1.1, 1.2] times higher odds of stunting in 2015/16.ConclusionThe MPI and WAMI under PCA were the best measures of SES that predict stunting. Because MPI was the best predictor of stunting for two surveys (TDHS 2004/5 and 2015/16), studies dealing with stunting should use MPI as a proxy measure of SES. Use of BE-MGLMM in modelling stunting is encouraged. Strengthened availability of items forming MPI is inevitable for child growth potentials. Further studies should investigate the determinants of stunting using Bayesian spatial models to take into account spatial heterogeneity.

Wilms tumor treatment protocol compliance and the influence on outcomes for children in Tanzania.

Standardized Wilms tumor treatment protocols exist for low- and middle-income countries, but outcomes equivalent to high-income countries are not achieved outside of clinical trials. As Wilms tumor treatment protocols in Africa shift with increasing resource capacity, it is not known how treatment compliance to each stage of therapy affects outcomes and where the critical breakpoints are for protocol adherence in clinical practice. We describe both treatment outcomes and treatment protocol adherence in a retrospective single-center cohort study of pediatric Wilms tumor patients at a zonal cancer referral hospital in Tanzania from 2016 to 2019, treated per the International Society of Paediatric Oncology standard (2016-2017) or Tanzania adapted (2018-2019) therapy protocols. A total of 69 patients were evaluated. The two-year overall survival and event-free survival rates were 40% and 29%, respectively. Only 29% of patients completed recommended chemotherapy per protocol, and completion of preoperative and postoperative chemotherapy was predictive of two-year overall survival (odds ratio [OR] 14.4, p<.001). There were delays at almost every stage of treatment, especially time from preoperative chemotherapy to surgery (56days), from surgery to pathology report (30days), and from surgery to initiation of postoperative chemotherapy (38days). Nonadherence with recommended Wilms tumor treatment guidelines due to key health system delays correlated to reduced overall survival rates, with chemotherapy nonadherence due to abandonment, lack of surgery, and deaths on therapy as the strongest contributors. Future interventions targeting health system delays and reducing deaths during therapy are critical to improving protocol compliance and increasing overall survival for pediatric Wilms tumor patients in low-resource settings.

COVID-19 Pandemic in Pre-Primary Children in Tanzania: Strategies and Challenges

This study aimed at exploring challenges faced by pre-primary children during COVID-19 pandemic and the strategies adapted to help them to cope with the pandemic in a Tanzanian context. Fifteen parents whose children were in pre-primary schools were interviewed through mobile phones on the challenges faced children and the strategies used to help their children cope with COVID 19 pandemic. The main challenges reported were loneliness and inactiveness. Majority of the parents could not device strategies that would help their children cope with the pandemic but reported to connect their children with the media such as educative cartoons. Based on the findings, it is recommended that necessary measures should be taken to empower parents to stimulate, play, communicate, and support their children’s learning at home. Guidance should be provided to parents on how to engage their children in age-appropriate ways in order to develop literacy and numeracy skills at home.

Sub-clinical rheumatic heart disease (RHD) detected by hand-held echocardiogram in children participating in a school-based RHD prevention program in Tanzania

BackgroundRheumatic Heart Disease (RHD) continues to cause suffering and premature deaths in many sub-Saharan Africa (SSA) countries, where the disease is still endemic. RHD is largely preventable and determining its community burden is an important critical step in any RHD prevention program.MethodsWe conducted a cross-sectional study of 5–16 years old pupils from 11 primary schools participating in an RHD prevention program in 4 districts in Tanzania, between 2018 and 2019. At the school, all children were invited to participate after receiving consent from their parents/guardians. Participating children filled a questionnaire and were auscultated for cardiac murmurs. Echocardiographic screening was done by two experienced cardiologists, using a hand-held machine (V-Scan, GE®). All positive screening tests were stored for further examination by the same two cardiologists to reach to a consensus of definite, borderline or no RHD, using a modified World Heart Federation (WHF) criterion.ResultsOf the 6895 children invited, 4738 (68.7%) were screened and 4436 (64.3%) had complete data. The mean (SD) age was 10.04 (2.43) years, and 2422 (54.6%) were girls. Fifty three (1.2%) children were found to have a murmur. The proportion of children with trace or mild valvular regurgitation, sub-valvular/chordal thickening and valvular thickening/deformity were 8.3%, 1.3%, and 1.0%, respectively. Sub-clinical RHD was found in 95 children (59 definite and 36 borderline), giving a prevalence of 2.1%, [95% CI 1.7% – 2.6%]. Sub-clinical RHD was independently associated with female sex (aOR 1.83, 95% CI 1.18–2.85, p = 0.007), older age groups (aOR 1.73, 95% CI 1.10–2.72, p = 0.018 for age group 11–14 years; and aOR 3.02 95% CI 1.01–9.05, p = 0.048 for age group 15–16 years), as well as presence of a cardiac murmur, aOR 5.63 95% CI 2.31–13.69, p < 0.0001. None of the studied socio- or economic factors was associated with the presence of sub-clinical RHD in this study.ConclusionThe prevalence of sub-clinical RHD among primary school children in Tanzania is 2.1%, similar to previous reports in SSA. Efforts to prevent and control RHD in our communities are highly warranted.

Sleep and physical activity patterns among Tanzanian, South African, and Côte d’Ivoire primary schoolchildren. Findings from the KaziAfya study

Introduction Sleep and physical activity habits during childhood are influenced by developmental, cultural and environmental factors. Poor sleep is associated with lower immune function, physical activity levels, and psychological functioning, thus contributing to a vicious cycle of increased vulnerability during this developmental period. Regular physical activity, in turn, is associated with better sleep, improved immune function, and higher psychological well-being. There is, however, a lack of research on sleep and physical activity patterns in Sub-Saharan Africa, especially among children from marginalized areas. Therefore, the present study has two objectives: First, it aims to fill a gap in the literature by reporting sleep and physical activity patterns among primary schoolchildren aged 6-12 years from Tanzania (Ifakara: N = 845), South Africa (Gqeberha: N = 1,287), and Côte d’Ivoire (Taabo: N = 1,027). Second, to investigate the relationship between habitual physical activity (7-day actigraphy) and sleep (parental and self-reported). Methods Thousand three-hundred and twenty children aged 5-12 years from each country were recruited. Sleep. Parents were asked to complete a few sleep-related questions regarding their child`s bed- and rise times. To assess sleep quality, children completed questions from the Pittsburgh Sleep Quality Index (Buysse et al., 1989). To screen for sleep disturbances, children also answered three items of the Insomnia Severity Index (Morin et al., 2011), addressing difficulty falling asleep, staying asleep and waking up too early in the morning. Physical Activity. Objective physical activity was assessed with an accelerometry (Actigraph wGT3x-BT, Shalimar, FL, USA) worn around the hip. The device was worn for 7 consecutive days to assess a full weekly period, with a sampling epoch of 15 sec (Rowlands, 2007). Time per day spent in MPA (&gt;3 MET [metabolic equivalents of task]) and VPA (&gt;6 MET) is determined based on the raw accelerometry counts and the ActiLife computer software, with cut-off values derived from Freedson et al. (1998). The ActiGraph accelerometrys have been validated with children (Crouter et al., 2013; Hänggi et al., 2013). Results Children assessed in Côte d’Ivoire and Tanzania showed higher levels of daily physical activity (MVPA) than those assessed in South Africa. Yet, mean group levels still exceeded the recommended amount of 60 min MVPA/day. Across all three countries, boys generally had higher MVPA levels than their female peers, and children from the poorest wealth quintile were also more active than their peers from the least poor quintile. Composite sleep health was significantly different between countries, with the highest scores reported in Tanzania, followed by Côte d’Ivoire and South Africa. After controlling for sex, it was found that MVPA significantly predicted composite sleep health among children in Tanzania (ß = 5.83, p = .002) and Côte d’Ivoire (ß = 3.41, p = .072), but not in South Africa (ß = 0.67, p &gt; .05). Discussion/Conclusion Adequate sleep and physical activity is crucial for children’s physical and mental development. Most of our understanding of the relationship between daily physical activity and sleep patterns is based on research conducted in Western high income countries. Currently, little is known about this association in children from Sub-Saharan African, specifically primary schoolchildren living in marginalized areas in Tanzania, South Africa, and Côte d’Ivoire. Results will reveal whether research from high-income countries is generalizable to low- or middle-income countries, and inform health policy makers on points for prevention and intervention in school-based settings.

Challenges of Implementing World Health Organisation Measures on Covid-19 for People with Disabilities in Tanzania

Tanzania like other countries was also affected by the COVID-19 pandemic. Following the coronavirus outbreak, Tanzania decided to adopt health control measures from World Health Organisation. Even though the measures were taken, it was more challenging to disabled people. This study intended to examine the challenges that affected disabled people in implementing WHO health measures during the COVID-19 outbreak. The study used a desk review study whereby full-length articles published in academic journals between 2019 to date were reviewed. Data were generated from WHO reports, health reports from Tanzania, online coronavirus news via Google scholar using keywords such as "disabled people," "COVID-19", and "government responses." 48 articles were generated and analyzed using content analysis. The findings revealed that people with disabilities faced challenges in implementing WHO measures even though Tanzania has several laws and regulations to protect people with disabilities. The Ministry of Health, Community Development, Gender, Elderly, and Children in Tanzania needs to use an acceptable form of communication that is user-friendly to disabled people when announcing coronavirus news. Maintaining social distancing is challenging for disabled people. Most of them depend significantly on others, but investing in building health centers specifically for them would help them to socially distance themselves from the mainstream population. Although wearing of face mask is crucial, but transparent face mask is the way to go as this would help those with hearing issues to interpret the lips movement. Health workers need to be trained on how to communicate with disabled people properly. Special lines need to be introduced in every public hospital to assist them in handling emergencies for disabled persons.

Implementation research of a cluster randomized trial evaluating the implementation and effectiveness of intermittent preventive treatment for malaria using dihydroartemisinin-piperaquine on reducing malaria burden in school-aged children in Tanzania: methodology, challenges, and mitigation

BackgroundIt has been more than 20 years since the malaria epidemiologic shift to school-aged children was noted. In the meantime, school-aged children (5–15 years) have become increasingly more vulnerable with asymptomatic malaria prevalence reaching up to 70%, making them reservoirs for subsequent transmission of malaria in the endemic communities. Intermittent Preventive Treatment of malaria in schoolchildren (IPTsc) has proven to be an effective tool to shrink this reservoir. As of 3rd June 2022, the World Health Organization recommends IPTsc in moderate and high endemic areas. Even so, for decision-makers, the adoption of scientific research recommendations has been stifled by real-world implementation challenges. This study presents methodology, challenges faced, and mitigations used in the evaluation of the implementation of IPTsc using dihydroartemisinin-piperaquine (DP) in three councils (Handeni District Council (DC), Handeni Town Council (TC) and Kilindi DC) of Tanga Region, Tanzania so as to understand the operational feasibility and effectiveness of IPTsc on malaria parasitaemia and clinical malaria incidence.MethodsThe study deployed an effectiveness-implementation hybrid design to assess feasibility and effectiveness of IPTsc using DP, the interventional drug, against standard of care (control). Wards in the three study councils were the randomization unit (clusters). Each ward was randomized to implement IPTsc or not (control). In all wards in the IPTsc arm, DP was given to schoolchildren three times a year in four-month intervals. In each council, 24 randomly selected wards (12 per study arm, one school per ward) were chosen as representatives for intervention impact evaluation. Mixed design methods were used to assess the feasibility and acceptability of implementing IPTsc as part of a more comprehensive health package for schoolchildren. The study reimagined an existing school health programme for Neglected Tropical Diseases (NTD) control include IPTsc implementation.ResultsThe study shows IPTsc can feasibly be implemented by integrating it into existing school health and education systems, paving the way for sustainable programme adoption in a cost-effective manner.ConclusionsThrough this article other interested countries may realise a feasible plan for IPTsc implementation. Mitigation to any challenge can be customized based on local circumstances without jeopardising the gains expected from an IPTsc programme.Trial registration clinicaltrials.gov, NCT04245033. Registered 28 January 2020, https://clinicaltrials.gov/ct2/show/NCT04245033

Predictors and outcome of time to presentation among critically ill paediatric patients at Emergency Department of Muhimbili National Hospital, Dar es Salaam, Tanzania

BackgroundMortality among under-five children in Tanzania remains high. While early presentation for treatment increases likelihood of survival, delays to care are common and factors causing delay to presentation among critically ill children are unknown. In this study delay was defined as presentation to the emergency department of tertially hospital i.e. Muhimbili National Hospital, more than 48 h from the onset of the index illness.MethodologyThis was a prospective cohort study of critically ill children aged 28 days to 14 years attending emergency department at Muhimbili National Hospital in Tanzania from September 2019 to January 2020. We documented demographics, time to ED presentation, ED interventions and 30-day outcome. The primary outcome was the association of delay with mortality and secondary outcomes were predictors of delay among critically ill paediatric patients.Logistic regression and relative risk were calculated to measure the strength of the predictor and the relationship between delay and mortality respectively.ResultsWe enrolled 440 (59.1%) critically ill children, their median age was 12 [IQR = 9–60] months and 63.9% were males. The median time to Emergency Department arrival was 3 days [IQR = 1–5] and more than half (56.6%) of critically ill children presented to Emergency Department in > 48 h whereby being an infant, self-referral and belonging to poor family were independent predictors of delay. Infants and those referred from other facilities had 2.4(95% CI 1.4–4.0) and 1.8(95% CI 1.1–2.8) times increased odds of presenting late to the Emergency Department respectively. The overall 30-day in-hospital mortality was 26.5% in which those who presented late were 1.3 more likely to die than those who presented early (RR = 1.3, CI: 0.9–1.9). Majority died > 24 h of Emergency Department arrival (P-value = 0.021).ConclusionThe risk of in-hospital mortality among children who presented to the ED later than 48 h after onset of illness was 1.3 times higher than for children who presented earlier than 48 h. It could be anywhere from 10% lower to 90% higher than the point estimate. However, the effect size was statistically not significant since the confidence interval included the null value Qualitative and time-motion studies are needed to evaluate the care pathway of critically ill pediatric patients to identify preventable delays in care.

Educational Expectations of School-Age Street Children in Tanzania

Abstract This research investigated the expectations of school-age street children who operate in the margins and whose prospects tend to be in limbo despite the country’s commitment to egalitarianism and universalisation of its basic education. The study generated data using interviews, observations, and documentary reviews. The findings suggest that school-age children on the streets were mainly drop-out cases with some not having any formal education. Despite being on the streets, the study found that these school-age children still nurse educational dreams and understand the link between education and employment. Hence, the onus is on stakeholders to adopt mechanisms that unreservedly guarantee universal access to, and participation in education for all Tanzanian children operating in the margins.

Household Air Pollution from Cooking Fuels Increases the Risk of Under-Fives Acute Respiratory Infection: Evidence from Population-Based Cross-Sectional Surveys in Tanzania.

Background and Aims:Increased risk of acute respiratory infection (ARI) in children has been linked with exposure to household air pollution (HAP) from solid biomass fuels. However, information is limited on the trend use of biomass fuels and their association with ARI among children in Tanzania. The current study analysed nationally representative data from the Tanzania Demographic Health Surveys of the years 2004, 2010, and 2015–16 to explore the prevalence of the trend of cooking fuels and ARI as well as ascertain their association among under-fives.Methods:A total sample of 20,323 under-fives were included in the current analysis. A mixed-effects multilevel logistic regression was fitted to assess the association between unclean fuels (solid biomass fuels and kerosene) and ARI among under-fives.Results:The use of solid biomass fuels has remained persistent high (98.6%) while ARI among under-fives has declined from 16% in 2004 to 9% in 2016; p < 0.001. Furthermore, under-fives exposed to unclean fuel combustion had a significantly higher incidence of ARI (AOR = 3.47; 95% CI, 1.31–9.21).Conclusion:Efforts should be made to switch to alternative sources of clean energy such as natural gas and biogas in Tanzania and other countries with similar settings.