Dodoma Region In Tanzania Research Articles

Effectiveness of EHR systems on decision support in primary healthcare: a technology acceptance model 3 perspective.

This study aims to evaluate healthcare practitioners' perceptions of electronic health record (EHR) systems and their effectiveness in supporting clinical decision-making in Tanzanian Primary Healthcare (PHC) facilities. A mixed-methods approach was employed, combining quantitative data from structured questionnaires and qualitative insights from open-ended responses. The study was conducted in the Dodoma region of Tanzania, focusing on a diverse representation of PHC facilities, including district hospitals, health centres and dispensaries. Data were analysed using multiple linear regression for quantitative data, and thematic analysis was applied to qualitative responses. The results revealed that while EHR systems are widely used in Tanzanian PHC facilities, their impact on clinical decision-making remains limited. Only a moderate portion of practitioners perceived EHR systems as effective in decision support, and frequent system use was negatively correlated with user satisfaction. Challenges such as inadequate training and support, system crashes, slow performance and poor usability and integration into clinical workflows were significant barriers to effectively utilising EHR systems. This study contributes to the limited literature on EHR system implementation in low-resource settings, specifically Tanzania, by focusing on decision-support features within EHR systems. The findings offer valuable insights for healthcare policymakers, system designers and practitioners to optimise EHR implementation and improve healthcare outcomes in resource-constrained environments.

The Factors Enabling Adoption of E-learning Post Covid-19 Pandemic for Teaching and Learning in Selected Secondary Schools in Tanzania

This study assessed the factors enabling adoption of e-learning post Covid-19 pandemic in selected secondary schools in the Dodoma region of Tanzania. Specifically, the study wanted to determine the use of e-learning post, Covid-19 pandemic from the perspective of students, teachers, and ICT support staff in selected Secondary schools in Dodoma, Tanzania; to identify strategies used by teachers to teach e-learning all through the post-covid-19 pandemic in selected Secondary schools in Dodoma, Tanzania; and to identify factors enabling students to use e-learning during the post-covid-19 pandemic in selected Secondary schools in Dodoma, Tanzania. The study was guided by the Technology acceptance (TAM) as advocated by Davis in 1989 in creating variables and constructs used in the study. The study employed a mixed research approach in which both quantitative and qualitative techniques were used. The study used a sample size of 492 obtained by simple random sampling. The findings showed that e-learning is associated with various perceptions of teachers and students which were identified as follows; 47.8% are of the view that e-learning lacks a proper implementation mechanism in secondary schools. The factors for the adoption of e-learning were such as perceived ease of use, attitude towards use and perceived usefulness which revealed that e-learning is good system used in teaching students in secondary schools. This study recommends on the selection of the right e-learning software solution compatible with contemporary secondary school. This study also recommends for the creation of the multi – format contents to the user, such as reading e-books, viewing videos, and listening to audiobooks, learners may learn concepts and gain information via e-learning solutions. The study also recommends to stakeholders to ensure overcoming of the implementation challenges of e-learning.

Investigating secondary school mathematics teachers’ knowledge, preparation and use of assessment rubrics in teaching and learning 3D-geometry in Tanzania

This study investigated mathematics teachers’ knowledge, preparation, and use of assessment rubrics for teaching and learning 3D-geometry at selected secondary schools in the Dodoma region of Tanzania. The study was motivated by teachers' limited understanding of classroom assessment. The study was based on the premise that the existing assessment practices used by teachers in assessment of teaching and learning of mathematics are inadequate. A mixed research method was applied in this investigation. There were 51 mathematics teachers who participated and were purposively selected from 20 secondary schools. The data were collected through documentary reviews, classroom observations, questionnaires, and interviews. Qualitative data were analyzed thematically, while quantitative data were analyzed by using descriptive statistics such as mean, standard deviation, frequencies, and percentages. The study revealed that teachers have limited knowledge of assessment rubrics; hence, most do not prepare or use rubrics for assessing students. The use of rubrics could assist teachers to spot-out the specific point at which a particular learner has encountered learning obstacle, this could assist in making quick and pertinent teaching and learning adjustments to increase the effectiveness of teaching and learning. Through teachers’ professional development, the study recommends improving mathematics teachers' knowledge of planning and using assessment rubrics to improve 3D-geometry teaching and learning.

Emergency contraceptive use of Metronidazole among University female students in Dodoma region of Tanzania: a descriptive cross-sectional study

BackgroundMetronidazole is known for its therapeutic effect as antibacterial and anti-parasitic. However, its toxicity on the reproductive system remains unclear. Metronidazole use in rodents is associates with toxic effects on the reproductive system, including hormonal alterations, reduced number of fertile cells and reduced sites for implantation, size of the placental disc area, constituent elements of the labyrinth, and spongiotrophoblast layers. Its use at a therapeutic dose among humans has been associated with an increased risk of spontaneous abortion. The effects on the reproductive system in humans may result in misconceptions about contraceptive effects hence sexually active individuals like students who, for any reason, fail to access safe contraceptive services use any possible methods to protect them from conception. This study aims to investigate the unofficial (un-prescribed) use of Metronidazole as an emergency contraceptive and some of its associated factors.MethodsThis quantitative cross-sectional study involved 470 participants where stratified random sampling technique was used to obtain the sample from three educational institutions in the Dodoma Municipal, Dodoma region. Collected data were analyzed using SPSS version 25, descriptive statistical analysis was done to determine frequencies, percentages, and association, p < 0.05 was used to determine statistical significance. Further analysis using Multivariate binary logistic regression was done to determine the nature of the association between the study variables.ResultsThe finding shows that 169(62.4%) use Metronidazole as an emergency contraceptive. Notably, 345(73.4%) stated that they had ever heard someone use Metronidazole for contraception, especially their peers. Furthermore, an increase in the year of study was significantly associated with reduced use of Metronidazole as an emergency contraceptive (B = [-0.45], p = [0.02]). Furthermore, an increase in age, studying in non-medical college/university, the experience of using contraceptive methods, and hearing someone ever used Metronidazole was found to be positively associated with its use as an emergency contraceptive, although not statistically significant.ConclusionMetronidazole was found to be used as an emergency contraceptive in high doses, different factors associated with its use, and reasons influencing its use. Further research may be done to explore the toxicological effect of high doses of Metronidazole as a contraception and compare the efficiency of Metronidazole over other emergency contraceptives.

Geochemistry and sources of fluoride and nitrate contamination of groundwater in six districts of the Dodoma region in Tanzania.

Fluoride (F−) and nitrate (NO3−) are common groundwater contaminants. In high concentrations, F− and NO3− cause skeletal fluorosis and methemoglobinemia in children respectively. Therefore protection of public health necessitates the evaluation of groundwater for F− and NO3− contamination. The goal of this study was to assess the geochemistry and spatial distribution of F− and NO3− in six districts in the Dodoma region. Results show that greater than 98% of samples were found to contain F− below 1.50 mgl−1 (WHO 2017). F− Levels exist in the gradient and concentrated to the north of the region. The highest and lowest levels of F− were found in Chemba district, and Mpwapwa district. In the Chemba district, values for F− are (max= 7.30 mgl−1, min = 0.11 mgl−1, mean and SD = 0.87±1.67). In the Mpwapwa district, values for F− are (max= 0.80 mgl−1, min = 0.06 mgl−1, mean and SD= 0.36±0.23). Positive correlation between F− and HCO3− / Ca2+ +Mg+2 and negative correlation between F− and TH, F− and Ca2++Mg2+, and F− and Ca2++Mg2+/Na++K+ suggests HCO3− promote dissolution of F containing rocks while Ca2++Mg2+ removes F− through precipitation reactions. Elevated levels of NO3− were found throughout the districts. The order of districts with NO3− levels above 45.0 mgl−1 was found to be Kongwa (94.74%) > Chemba (69.23%) > Dodoma urban (34.80%) > Chamwino (28.57%) > Mpwapwa (6.60%) and Kondoa (0.00%). Kongwa and Kondoa districts are located south and north of the region. The values in Kongwa are; (max= 196.8 mgl−1, min = 12.5 mgl−1, mean and SD= 137.02±48.47). Values in Kondoa are; (max= 28.00 mgl−1, min = 12.00 mgl−1, mean and SD= 19.97±4.61). Conclusions; groundwater in the Dodoma region safe for drinking with respect to F− and unsafe for drinking with respect to NO3− without remediation.

Predictors of Birth Asphyxia among neonates in Dodoma Region Tanzania: A matched case-control study

INTRODUCTION &#x0D; There has been an increase in the morbidity and mortality rates among neonates born with Birth Asphyxia (BA) in Africa including Tanzania. Despite the efforts made by the stakeholders the problem of BA is still persistently increasing. The study aimed at determining the predictors of BA among neonates in the Dodoma region of Tanzania. &#x0D; MATERIALS AND METHODS &#x0D; This study employed a matched case-control study design and was conducted between May-August 2021. A total of 317 neonates were recruited in the study. Data were collected by using questionnaires whereby information related to maternal and neonatal characteristics was collected. The association between variables was determined using the Chi-square test and logistic regression. &#x0D; RESULTS &#x0D; Among the cases, the majority were females (68.36%) and 31.64% in the controls. Odds of developing BA were 3 times among neonates with meconium stains (AOR=3.731, C I [1.764,7.937]. p=0.0006), and 2 times among neonates with a birth weight of 2500-3999 (AOR =2.127, [1.110,4.078], p=0.0230) while not having complications during pregnancy was a protective factor (AOR= 0.326[0.171,0.624], p=0.0007). &#x0D; CONCLUSION &#x0D; Membrane rupture and birth weight were positively associated with BA and having no complications was negatively associated with BA.

Entrepreneurial Competence and Small and medium enterprises’ Profitability: A Case of sunflower oil processing enterprises in Tanzania

Determine the influence of entrepreneurial competence on SMEs’ profitability focusing on personal, interpersonal and business competencies on SMEs’ profitability. A cross-sectional research design whereby data were collected at once from 102 randomly selected sunflower oil processing firms in Dodoma region in Tanzania. Structured questionnaires were used to collect data. The study’s findings reveal that personal, interpersonal and business competencies had a positive significant influence on the profitability of SMEs (p<0.05). Integration of personal, interpersonal, and business competence influences profitability of sunflower processing firms. Involvements of personal, interpersonal, and business competencies influence the profitability of SMEs (sunflower processing firms).

Impact of Humanitarian Supply Chain Management on Disaster Response in Tanzania

Humanitarian Supply Chain is an emerging concept in Disaster Management and academic and practitioner interest in it is beginning to expand. Limited or no consensus is currently available among decision-makers, academicians, and practitioners as to the exact effect and extent of influence of Humanitarian Supply Chain Management on Disaster response. Therefore, this study tries to examine the relationship between Humanitarian Supply Chain Management and Disaster Response. The study formulated a hypothesis based on the identified study concepts. Stratified random sampling was used to sample 258 respondents from Dodoma Region in Tanzania. Semi-structured questionnaires were administered to collect primary data from the study population. Data were confirmed by using validity and reliability tests, normality tests, and linearity tests. Data analysis was conducted through descriptive analysis, regression analysis, multiple regression analysis, and Pearson correlation analysis. In this study, it was revealed that Humanitarian Supply Chain Management is significant to Disaster Response. Further findings in the study also revealed that there is a positive correlation between Humanitarian Supply Chain Management and Disaster Response. It is therefore recommended that the practitioners, decision-makers, and academicians should move away from the basic understanding of Humanitarian Supply Chain Management which might pave the way for rapid assistance to disaster victims in salvaging restoration of human dignity during and after a disaster.

Evaluation of hydrogeochemical characteristics, spatial distribution of major ions, and water quality for drinking and irrigation in six districts of the Dodoma region in Tanzania.

The present study was carried out to evaluate the hydrogeochemical characteristics, spatial distribution of major ions, and quality of water for drinking and irrigation purposes in six districts of the Dodoma region. The results show that mineralization levels exist along the gradient and are concentrated in the southern part of the region. The order of Electrical Conductivity (EC) was found to be Kongwa > Mpwapwa > Chamwino > Dodoma Urban > Kondoa > Chemba. The percentage of samples in Kongwa district that exceeded the WHO guideline was discovered to be 68.42% for EC (<2500 μS/cm), 85.90% for Ca2+ (75 mg/l),89.50% for Mg2+ (50 mg/l),89.50% for K+ (12 mg/l), 52.63% for Na+ (200 mg/l),46.67% for SO42− (250 mg/l), 94.74% for Cl− (300 mg/l) and 84.21% for HCO3−(250 mg/l). The mean value for some of the parameters in Kongwa district are; 3045.58 ± 1107.64 μS/cm for Electrical Conductivity (EC), 225.91 ± 160.52 mg/l for Ca2+, 116.09 ± 54.64 mg/l for Mg2+,11.85 ± 3.17 mg/l for K+,264.33 ± 144.04 mg/l for Na+, 278.07 ± 335.39 mg/l for SO42−, 608.93 ± 296.17 mg/l for Cl−0.295.86 ± 100.59 mg/l for HCO3−. The order of the cations and anions was found to be Na+>Ca2+>Mg2+>K+ and Cl− > HCO3− > SO4−2. The dominant hydrochemical facies was found to be a mixed Ca–Mg–Cl–SO4 type in all Dodoma districts. Wilcox diagram, Sodium Adsorption Ratio (SAR), Kellys Ratio (KR), %Na, Magnesium Absorption Ratio (MAR) indicate that most of the water in Dodoma is suitable for irrigation purposes.

Knowledge, attitude, and perceived practice of sanitary workers on healthcare waste management: A descriptive cross-sectional study in Dodoma region,Tanzania.

Healthcare facilities produce a variety of trash that, if handled improperly, could endanger the environment, the health of patients and clients, healthcare personnel, and the general public. Health staff have been given training on infection control and healthcare waste management. It is not apparent whether similar initiatives are taken for sanitary personnel, though. By evaluating sanitary workers' knowledge, attitudes, and practices about healthcare waste treatment in the Dodoma region of Tanzania, this study sought to clarify the situation. From March to August 2022 in Dodoma, Tanzania, a descriptive cross-sectional study using a quantitative methodology was conducted on 156 randomly chosen sanitary workers. The primary data collection instruments were structured questionnaires that were conducted by interviewers and a trash checklist that the research team created. Statistical Package for Social Sciences computer software was used to conduct a descriptive analysis of the data with a 95% confidence level and a 5% level of significance. The average age was 28 ± 6.2 years, and there were 74.4% females. Of all of the health institutions under study, 78.4% of the generated medical waste was non-infectious, whereas 21.6% of it was infectious. The share of non-infectious and infectious healthcare waste created by regional referral hospitals was 43.5% and 13.2%, respectively. While 67.8% of sanitary workers believed that handling healthcare waste was not their problem and 63.6% of sanitary workers actually displayed subpar practices of handling healthcare waste, 74.4% of sanitary workers had low understanding about handling healthcare waste. Their procedures for handling medical waste were substantially influenced by the kind of healthcare facility, sex, education, job experience, knowledge, and attitude (p < 0.05). Sanitary staff members had limited understanding and thought they were less concerned with gathering, moving, and storing medical waste. To provide the highest level of health safety, national health policy and facility-based interventions must support and fund participatory waste management training that is tailored to the sociodemographic profiles of sanitary employees.

Reprint of: Influence of trees on landscape temperature in semi-arid agro-ecosystems of East Africa

In the Dodoma region of Tanzania, overexploitation of natural resources has led to a severe land degradation and, consequently, to the need to restore local ecosystems. Within the possible strategies, the farmer managed natural regeneration agroforestry is strongly being promoted in the area. To validate the utilisation of this practise, this research aims (i) to assess the benefits of trees on microclimate studying the relationship between land surface temperature (LST) and tree canopy cover (TCC) in farmlands and (ii) to propose an operative tree density threshold to be set as objective by restoration activities in the area. Data collected with an unmanned aerial vehicle were integrated with Landsat 8 and Sentinel 2 satellite imagery. LST was retrieved through the practical single channel algorithm and TCC was calculated with a supervised classification. Pixel-based analyses at a resolution of 30 m and 10 m were performed, and the resulting data statistically analysed through the coefficient of determination, the Kruskal–Wallis test, and the Dunn test. Results showed that the TCC of the surveyed areas was 5.1%, and a significant decrease in LST of 1.32 °C (p < 0.01) was found in the areas with the highest TCC, during the late dry season. From these preliminary analyses, a threshold of 10% TCC is suggested for farmlands in this agroecological zone to bring beneficial microclimate changes in terms of temperature. Considering the average plant phenotype characteristic of the area, it corresponds to a tree density of 50 trees ha−1.

Community Participation in the Constituency Development Catalyst Fund: A case of Bahi District, Tanzania

This study examined the community participation in constituency development catalyst fund in Bahi District Council, Dodoma Region of Tanzania. The area was chosen because of low participation nature in community development programs among community members. The study used a descriptive design and employed the quantitative approach. A sample of 76 community stakeholders was selected out of the 94 study population through the simple random sampling technique. A structured questionnaire was used to collect information from respondents and the following mean scores interpretation scale was used: 3.50-4.00= very high participation, 2.50-3.49 = high participation, 1.50-2.49= low participation and 1.00-1.49 = very low participation. After analysis, the study concluded that the community highly participated in the Constituency Development Catalyst Fund (CDCF) programs. Due to such desirable results, it is recommended that the government should encourage community participation to continue for effective results to be maintained. Furthermore, the parliament should take all necessary steps to make sure that the Constituency Development Catalyst Fund’s (CDCF) Act of 2009 is amended by including provisions which show clearly how the community should participate in CDCF projects in various aspects as initiation, implementation and control. This will further enhance the community development.

Influence of trees on landscape temperature in semi-arid agro-ecosystems of East Africa

In the Dodoma region of Tanzania, overexploitation of natural resources has led to a severe land degradation and, consequently, to the need to restore local ecosystems. Within the possible strategies, the farmer managed natural regeneration agroforestry is strongly being promoted in the area. To validate the utilisation of this practise, this research aims (i) to assess the benefits of trees on microclimate studying the relationship between land surface temperature (LST) and tree canopy cover (TCC) in farmlands and (ii) to propose an operative tree density threshold to be set as objective by restoration activities in the area. Data collected with an unmanned aerial vehicle were integrated with Landsat 8 and Sentinel 2 satellite imagery. LST was retrieved through the practical single channel algorithm and TCC was calculated with a supervised classification. Pixel-based analyses at a resolution of 30 m and 10 m were performed, and the resulting data statistically analysed through the coefficient of determination, the Kruskal–Wallis test, and the Dunn test. Results showed that the TCC of the surveyed areas was 5.1%, and a significant decrease in LST of 1.32 °C (p < 0.01) was found in the areas with the highest TCC, during the late dry season. From these preliminary analyses, a threshold of 10% TCC is suggested for farmlands in this agroecological zone to bring beneficial microclimate changes in terms of temperature. Considering the average plant phenotype characteristic of the area, it corresponds to a tree density of 50 trees ha −1 . • LST decrease of 1.32 °C found in areas with high TCC in the late dry season. • 10% TCC threshold, or 50 trees ha −1 should be reached using restoration. • Integration of Landsat 8 with Sentinel 2 data gave improved analysis.

Drivers of Millet Consumption Among School Aged Children in Central Tanzania

Background: Iron and zinc deficiency are common public health problems in low-income countries largely due to poor consumption of iron and zinc rich foods. It has previously been observed that 57% of school aged children (SAC) in Tanzania suffer from anemia. In addition, estimates indicate that over 25% of the population have inadequate zinc intake. Pearl millet is an example of a nutrient dense, resilient cereal crop, that can be promoted to diversify diets and combat iron and zinc deficiency. This study overall aim was to increase pearl millet consumption among school aged (5 – 12 years) children. As part of the study, we investigated, the drivers of food choice relating to pearl millet consumption.Methods: The study was a cross-sectional study of randomly selected households in Kongwa district, Dodoma region of Tanzania. In total, 128 women of reproductive age (20 – 49 years) were randomly selected for the study. A study questionnaire consisting of 66 items, was developed and validated. The constructs in the questionnaire were categorized in two groups: internal and external factors. Respondents were asked to indicate their level of agreement or disagreement with statements read to them by interviewers. The scores on intention and behavior constructs were based on the number of times caregivers intended to, or had fed their school going children with pearl millet in the referent month. Intention was considered high if it was higher than the median intention score of the group, and low if it was equal to or lower than the median scores. Correlations and multiple linear regressions were performed to measure association between constructs and to identify predictive constructs. The Mann-Whitney U test was used for score comparison.Results: There was a significant difference between intention and behavior among those who did not consume pearl millet (P = 0.003), and those who consumed pearl millet two or more times a week, in the same month (P = 0.01). Knowledge was significantly correlated with behavior identity (ρ = 0.58, P = 0.001), while health behavior identity was significantly correlated with intention (ρ = 0.31, P = 0.001). Intention of caregivers was significantly and positively correlated (ρ = 0.44, P = 0.001) with and predicted consumption of pearl millet (ρ = 0.87, P = 0.067).Conclusion: Increasing knowledge or awareness on nutritional benefits of pearl millet among caregivers may increase consumption of pearl millet by children of school going age.

Adherence to standard treatment guidelines among prescribers in primary healthcare facilities in the Dodoma region of Tanzania

BackgroundTanzania’s primary healthcare system suffers from a scarcity of financial and human resources that impedes its effectiveness to deliver dependable and uniform quality healthcare. Adherence to standard treatment guidelines (STG) can help provide more consistent and correct diagnoses and treatments and limit the irrational use of medicines and the negative health consequences that can occur as a result. The purpose of this study was to investigate prescribers’ adherence of their diagnoses and respective treatments to national STG and to identify potential areas for planning interventions.MethodsA cross-sectional study on prescribers’ adherence to diagnosis and treatment, according to national STG, was conducted in 2012 in public primary healthcare facilities (HCF) in the Dodoma region of Tanzania. Information on 2886 patients was collected, prospectively and retrospectively, from 120 HCF across the Dodoma region using a structured questionnaire. Twenty-five broadly defined main illness groups were recorded and the nine most prevalent and relevant conditions were statistically analysed in detail.ResultsDiagnoses and related treatments were recorded and analysed in 2872 cases. The nine most prevalent conditions were upper respiratory tract infections (25%), malaria (18%), diarrhoea (9.9%), pneumonia (6.1%), skin problems (5.8%), gastrointestinal diagnoses (5%), urinary tract infections (4%), worm infestations (3.6%) and eye problems (2.1%). Only 1.8% of all diagnoses were non-communicable diseases. The proportion of prescribers’ primary diagnoses that completely adhered to national STG was 599 (29.9%), those that partially adhered totalled 775 (38.7%), wrong medication was given in 621 cases (30.9%) and no diagnosis or medication was given in nine cases (0.5%). Sixty-one percent of all patients received an antibiotic regardless of the diagnoses. Complete adherence was highest when worms were diagnosed and lowest for diarrhoea. The proportion of cases that did not adhere to STG was highest with patients with skin problems and lowest for malaria.ConclusionPrescribers’ general adherence to national STG in primary HCF in the public sector in Dodoma region is sub-optimal. The reasons are multifaceted and focused attention, directed at improving prescribing and pharmacotherapy, is required with a view of improving patient care and health outcomes.

Chicken production, flock size, management systems, and challenges in the Dodoma region in Tanzania

Dodoma's population is growing rapidly creating a high demand for food security like chicken products. However, the distribution of chickens’ management systems, breed of chicken kept, and challenges facing chicken production in Dodoma are less documented. This study focused on finding out the productivity of chicken in terms of flock size and how it is affected by the management system, types/breed of chicken keeping, and evaluating the challenges facing chicken production in Dodoma. A cross-sectional survey using a semi-structured questionnaire was used to generate data from the two randomly selected districts namely, Kongwa and Dodoma Municipal. The results showed that the average flock size was significantly (P < 0.0001) higher in Dodoma municipal (mean = 124.56 ± 35.08, n = 200) than in Kongwa district (mean = 42.55 ± 5.54, n = 200). Broiler and layers keeping under the intensive system were dominant in Dodoma municipal while local breed chicken under the free-range system was dominant in Kongwa district (P < 0.001). Diseases were the main challenge facing chicken production. It was eminent that, diseases and other challenges such as theft, predation, lack of experts, unavailable space and huts for keeping chicken, and insufficient feed staffs for chicken significantly lowered the chicken production in Dodoma (P < 0.05). It is conclusive that, the demand for chicken products in Dodoma is higher and will continue to increase. There is a need for chicken keepers to increase production to overcome the current deficit. The increases in production should go hand in hand with solving the challenges which face chicken production in Dodoma.

Factors influencing variation in implementation outcomes of the redesigned community health fund in the Dodoma region of Tanzania: a mixed-methods study

IntroductionMicro-health insurance (MHI) has been identified as a possible interim solution to foster progress towards Universal Health Coverage (UHC) in low- and middle- income countries (LMICs). Still, MHI schemes suffer from chronically low penetration rates, especially in sub-Saharan Africa. Initiatives to promote and sustain enrolment have yielded limited effect, yet little effort has been channelled towards understanding how such initiatives are implemented. We aimed to fill this gap in knowledge by examining heterogeneity in implementation outcomes and their moderating factors within the context of the Redesigned Community Health Fund in the Dodoma region in Tanzania.MethodsWe adopted a mixed-methods design to examine implementation outcomes, defined as adoption and fidelity of implementation (FOI) as well as their moderating factors. A survey questionnaire collected individual level data and a document review checklist and in-depth interview guide collected district level data. We relied on descriptive statistics, a chi square test and thematic analysis to analyse our data.ResultsA review of district level data revealed high adoption (78%) and FOI (77%) supported also by qualitative interviews. In contrast, survey participants reported relatively low adoption (55%) and FOI (58%). Heterogeneity in adoption and FOI was observed across the districts and was attributed to organisational weakness or strengths, communication and facilitation strategies, resource availability (fiscal capacity, human resources and materials), reward systems, the number of stakeholders, leadership engagement, and implementer’s skills.At an individual level, heterogeneity in adoption and FOI of scheme components was explained by the survey participant’s level of education, occupation, years of stay in the district and duration of working in the scheme. For example, the adoption of job description was statistically associated with occupation (p = 0.001) and wworking in the scheme for more than 20 months had marginal significant association with FOI (p = 0.04).ConclusionThe study demonstrates that assessing the implementation processes helps to detect implementation weaknesses and therefore address such weaknesses as the interventions are implemented or rolled out to other settings. Attention to contextual and individual implementer elements should be paid in advance to adjust implementation strategies and ensure greater adoption and fidelity of implementation.

Species Selection and Management Under Farmer Managed Natural Regeneration in Dodoma, Tanzania

Farmer managed natural regeneration (FMNR) is promoted as a cost-effective technique to restore degraded arable drylands. Evidence comes mainly from the West-African Sahel, where it is a traditional practice, and it is now being promoted across the African continent. In this study, we evaluated the role of the farmer affecting natural regeneration under farmer managed natural regeneration in the highly degraded Dodoma region in Tanzania. We systematically assessed the linkages between species selection, perceived benefits and management practices as reported by 57 farmers in 13 villages involved in FMNR. On average, farmers list 2.8 species to be promoted on their farms as part of the practice of FMNR. In total, a list of 69 species was promoted by the practice, of which most (51) were only mentioned by one or two farmers, indicating that FMNR may contribute substantially to on-farm regional diversity. Most species selected were associated with a range of benefits and the diversity of benefits, not any single benefit, explained species selection under FMNR. Management of FMNR species goes beyond pruning, a practice promoted within FMNR, and is characterized by 10 different practices that are differentially applied to the selected species and individuals. We conclude that species selection and management under FMNR is driven by farmers autonomous decisions, making FMNR both diverse and complex and complicates predicting the extent to which FMNR may successfully contribute to achieving specific restoration outcomes. Monitoring farms over extended periods may increase outcome prediction capacity.

Inadequate management of complementary foods contributes to the risk of aflatoxin exposure and low nutrition status among children

Early exposure to aflatoxins through complementary food is linked to impaired growth in childhood. The current study assessed the household’s practices on management of complementary foods in relation to the risk of aflatoxin exposure and poor nutritional status among infant and young children in Tanzania. A cross-sectional study of complementary feeding practices, aflatoxin exposure and nutritional status was conducted to 101 infants and young children aged between 6-23 months in Dodoma region of Tanzania. The intake of complementary food was estimated by using repeated 24 h dietary recall. Flour used as complementary food was sampled from each of the 101 families and aflatoxins were analysed using high-performance liquid chromatography. A deterministic approach was used to estimate dietary exposure of aflatoxins in the complementary foods. Anthropometric measurements were taken and rates of stunting, underweight and wasting estimated according to the WHO standard procedures. Multivariate logistic regression analysis was used to assess the association between feeding practices and aflatoxin exposure or the growth performance among subjects. The average consumption of complementary flour was 118 g per child per day and 52% of the flours contained groundnuts. AFB1 was detected in 42.5% of the flour and levels ranged from 0.3 to 2,128.0 μg/kg (mean 228.11±49.84 μg/kg). Dietary exposures of aflatoxin B1 ranged from 0.1 to 23,172.81 ng/kg body weight per day (mean 1,337±392.5 ng/kg). Of the subjects, 40.4% (95% CI; 29.8; 50.9) were stunted and significant association was found between stunted growth and dietary exposure of AFB1 (adjusted odd ratio (AOR)=5.9; 95% CI: 0.019-0.028). Early introduction of cereal-and groundnut-based complementary foods in Tanzania is associated with high risk of aflatoxin exposure and impaired growth in children. There is need to integrate aflatoxin management measures in the guidelines for Infant and Young Children Feeding of Tanzania.

The impact of anthelmintic drugs on weight gain of smallholder goats in subtropical regions

Helminth infections are recognised as a major impediment to the productivity of goats in smallholder production systems. We used a multilevel framework to estimate the impact that administration of locally available anthelminthic drugs can have on the weight gains of goats in smallholder settings in India and Tanzania.We recruited 234 goats from 92 households from Odisha state in India and 253 goats from 15 households from Dodoma region in Tanzania. The goats were non-pregnant adult females, and from each household a minimum of two goats were recruited wherever possible. Each goat was randomly assigned to treatment with a locally available anthelminthic drug, or non-treatment. Each animal was tagged, weighed and had its body condition score (BCS) assessed. Animals were followed up after 28 and 56 days and re-weighed. To account for the local variations in exposure to helminths and for variations between households and herds, the data were analysed in a multilevel mixed model with herd in village as nested random effects.Over the 56 days of study, the non-treated goats in India had gained a mean of 30.64 g per day (a daily gain of 0.23% baseline body weight) and in Tanzania 66.01 g per day (0.33% baseline body weight). From the mixed model, the treated goats in India gained a mean of 25.22 g per day more than non-treated goats, this is significantly greater than the weight gain in non-treated goats (p < 0.001). In Tanzania treated goats gained a mean of 9.878 g per day more than non-treated goats, which is also significantly greater than non-treated goats (p = 0.007). Furthermore, in India and Tanzania, goats with a lighter weight at the baseline survey gained greater amounts of weight. In both studies the BCS of the treated goats improved by a greater amount than the non-treated goats.In this study we have demonstrated that in certain settings, the administration of anthelminthic drugs has a clear beneficial impact on goat weight.