Kilimanjaro Region Of Tanzania Research Articles

Components in Lesson Planning for Secondary School Teachers in Tanzania: Implications for Supervision and Teachers’ Training

Purpose. The purpose of the study was to identify specific components of a lesson plan that teachers struggle to design. Methodology. The study used a qualitative research approach and an exploratory case study design. The criterion-purposeful sampling technique was employed to select eighteen (18) participants from six public secondary schools in the Kilimanjaro region of Tanzania. The study participants comprised six heads of secondary schools, six internal school quality assurance officers, and six teachers. Through semi-structured interviews and document reviews, data on specific components of the lesson plan that teachers find challenging to design was collected. The reviewed documents included school performance evaluation reports (SPERs) and lesson plans. The researchers employed thematic analysis methods. The study also followed all necessary principles of research ethics, including obtaining participants’ consent and employing pseudonyms. Results. The study found that teachers were struggling in formulating a coherent statement of specific lesson objectives, teaching and learning materials, and teaching and learning activities. The study also demonstrated that teachers faced difficulties in selecting effective teaching and learning approach, establishing assessment criteria, and conducting proper lesson evaluation. Conclusion. We conclude that inadequate design of one component of the lesson plan negatively affects the overall quality of the lesson plan, the delivery of lessons in the classroom, and the quality of education. Therefore, instructional supervisors and teacher trainers must take immediate action to assist teachers in developing lesson planning skills. This endeavour will not only result in improved lesson planning and delivery by teachers, but it will also contribute to an overall improvement in student learning and educational quality.

Transformational Leadership and Employees’ Commitment: Evidence from Selected SACCOs in Kilimanjaro Region, Tanzania

It has long been demonstrated that followers of transformative leaders perform better than average, but it is unknown why this happens. However, the reasoning behind why this process occurs is unclear. The main aim of this study was to establish the influence transformational leadership on employee commitment among selected SACCOS in Kilimanjaro region. Specifically, the study pursued the following objectives; establish the influence of idealized influence, inspirational motivation, individualized consideration and intellectual stimulation on employee commitment among selected SACCOS in Kilimanjaro region in Tanzania. The study adopted explanatory research design using both qualitative and qualitative research technique. Both primary and secondary data were collected whereas questionnaire was used to collect primary data from employees of the four selected SACCOS in Kilimanjaro region. Study population comprised of all employees in function level team and SACCOS board members. Purposive sampling was used to sample 102 employees whereas the collected data were analyzed both descriptively and inferentially. The results found that, there is a positive significant relationship between transformational leadership and employee commitment of selected SACCOS in Kilimanjaro region. Moreover, the results concluded that, compared with other variables, idealized influence had a significant positive relationship on employee commitment in the selected SACCOS. Further, the study rejected all null hypotheses and concludes that all transformational leadership variables had a statistical significant relationship with employee commitment. Based on the above conclusion, the study recommends that, SACCOS management should embrace every facet of transformational leadership across all domains of work as a fundamental style that will be crucial to the success of their business. This research contributes to the area of literature of transformational leadership and their influence on employee job commitment.

Outcomes of the MAMA Training: A Simulation and Experiential Learning Intervention for Labor and Delivery Providers to Improve Respectful Maternity Care for Women Living with HIV in Tanzania.

Respectful maternity care (RMC) for women living with HIV (WLHIV) improves birth outcomes and may influence women's long-term commitment to HIV care. In this study, we evaluated the MAMA training, a team-based simulation training for labor and delivery (L&D) providers to improve RMC and reduce stigma in caring for WLHIV. The study was conducted in six clinical sites in the Kilimanjaro Region of Tanzania. 60 L&D providers participated in the MAMA training, which included a two-and-a-half-day workshop followed by a half-day on-site refresher. We assessed the impact of the MAMA training using a pre-post quasi-experimental design. To assess provider impacts, participants completed assessments at baseline and post-intervention periods, measuring RMC practices, HIV stigma, and self-efficacy to provide care. To evaluate patient impacts, we enrolled birthing women at the study facilities in the pre- (n = 229) and post- (n = 214) intervention periods and assessed self-reported RMC and perceptions of provider HIV stigma. We also collected facility-level data on the proportion of patients who gave birth by cesarean section, disaggregated by HIV status. The intervention had a positive impact on all provider outcomes; providers reported using more RMC practices, lower levels of HIV stigma, and greater self-efficacy to provide care for WLHIV. We did not observe differences in self-reported patient outcomes. In facility-level data, we observed a trend in reduction in cesarean section rates for WLHIV (33.0% vs. 24.1%, p = 0.14). The findings suggest that the MAMA training may improve providers' attitudes and practices in caring for WLHIV giving birth and should be considered for scale-up.

2012 The long-term clinical outcomes of older adults with frailty following acute hospital admission in Tanzania

Abstract Background Non-communicable disease, multimorbidity and frailty are posing considerable challenges as global populations age. Healthcare systems in Low- and Middle-Income Countries are having to rapidly adapt services to meet the needs of older people. Objective This study, the first of its kind in sub-Saharan Africa, aimed to establish whether screening older people for frailty on admission to hospital could be used to identify those at greatest risk of adverse outcomes. Methods At baseline assessment, 308 participants aged ≥60 years, admitted to medical wards at four hospitals in the Kilimanjaro Region of Tanzania, were screened for frailty using the Clinical Frailty Scale (CFS). After 10-12 months, participants, and their informants, were contacted by telephone to establish clinical outcomes. The primary outcome was all-cause mortality. Cox regression was used to estimate hazard ratios ( 95% confidence interval) for mortality, with dichotomised CFS frailty status (frail if ≥5) as the independent variable. Results Primary outcome data were obtained for 194 (63.0%) of the original participants after a mean follow-up period of 10.8 ( 0.9) months. Mean age was 75.1 years and 99 (51%) of respondents were female. A total of 100 (51.5%) respondents were deceased and hazard ratios for all-cause mortality demonstrate that those with frailty were at significantly greater risk of mortality (HR 2.27 [CI 1.39 – 3.69], p<0.01), an effect that persisted even after adjustment for age, baseline Barthel Index, education and number of chronic conditions. Conclusion For older people living in Tanzania, unplanned admission to hospital is associated with high mortality and frailty is a strong independent predicator. In accurately identifying which older people are at the greatest risk, frailty screening using the CFS could provide a starting point for the development of targeted care pathways and interventions.

2014 The experience of frailty in the Tanzanian hospital system: A qualitative exploration service user and provider perspectives

Abstract Background Frailty is becoming increasingly prevalent in Low- and Middle-Income Countries (LMICs). However, little is known about the lived experience of older people with frailty in their interactions with the healthcare systems in LMICs. This study aimed to explore the experiences, attitudes and needs of hospitalised older people with frailty in a low-income setting, from the perspective of service users and providers. Methods A purposive sample of older people with frailty recently admitted to hospital, their carers and healthcare providers, were recruited from four hospitals in the Kilimanjaro Region of Tanzania. One-to-one and dyad interviews were conducted in Swahili, based around a structured topic guide. Recordings were transcribed and translated into English in an iterative process aimed at preserving the original meaning through “transliteration”. Transcripts were analysed using a reflexive thematic paradigm. Results Interviews with 43 service users and 15 service providers highlighted the cultural norm of respect and value placed on older people; as such it is considered the role of everyone in society to provide care. However, many working age adults struggle with the competing responsibilities of supporting their parents and their children. Maintaining strong relationships with family and financial preparation were therefore considered critical to healthy ageing. The complex health problems and significant care needs of older people with frailty pose a considerable challenge during hospital admission. On the ward, family often take responsibility for personal care and feeding to reduce the work of healthcare providers. Economic worries and resource scarcity impact every part of the patient journey from struggles in accessing hospital services, to quality of care during admission and after discharge. Conclusion Frailty is understood as a communitywide issue in Tanzania, and family are expected to take a much larger role in care during acute hospital admission, partly mitigating the impact of resource scarcity.

The role of clinical breast examination and fine needle aspiration cytology in early detection of breast cancer: A cross-sectional study nested in a cohort in a low-resource setting.

Breast cancer is prevalent worldwide, with disparities in screening, diagnosis, treatment outcomes, and survival. In Africa, the majority of women are diagnosed at advanced stages, affecting treatment outcomes. Screening is one of the best strategies to reduce mortality rates caused by this cancer. Yet in a resource-constrained setting, there is limited access to screening and early detection services, which are available only at a few referral hospitals. We aimed to evaluate the prevalence and screening results of breast cancer using clinical breast examination coupled with fine needle aspiration cytology in a resource-constraint setting. A combined cross-sectional and cohort study. Women at risk of developing breast cancer in the Kilimanjaro region of Tanzania were invited, through public announcements, to their primary healthcare facilities. A questionnaire was used to assess the participants' characteristics. The women received a clinical breast examination, and detectable lesions were subjected to a confirmatory fine needle aspiration cytology or an excisional biopsy. Preliminary data from this ongoing breast cancer control program were extracted and analyzed for this study. A total of 3577 women were screened for breast cancer; their mean age was 47 ± 7.53 years. About a third of them (1145, 32%) were practicing self-breast examination at least once a month. Of 200 (5.6%) with abnormal clinical breast examination, 18 (9%) were confirmed to be breast cancer, making the prevalence to be 0.5%. The vast majority of participants with breast cancer (13, 72.2%) had early disease stages, and infiltrating ductal carcinoma, no special type, was the most common (15, 83.3%) histopathology subtype. Hormonal receptor status determination results indicated that 11 (61.1%), 7 (38.9%), and 5 (27.8%) of the tumors overexpressed estrogen receptor, progesterone receptor, and human epidermal receptor-2, respectively. Our study demonstrates 5.6% of Tanzanian women have abnormal clinical breast examination findings, with 9% having breast cancer. Nearly three-quarters (72.2%) of breast cancer screened for early disease were detected in the early disease stages. This finding suggests that organized screening with clinical breast examination coupled with fine needle aspiration cytology, which is a simple and cost-effective screening method, has the potential to improve early detection and outcomes for breast cancer patients in a resource-constraint setting.

Understanding male involvement in antenatal care in the Kilimanjaro region of Tanzania: Barriers, facilitators, and opportunities for engagement

BackgroundMale engagement in antenatal care (ANC) has been recommended by the World Health Organization to improve maternal and newborn health outcomes, but implementation challenges remain. This study explored barriers, facilitators, and opportunities to improve male attendance and engagement in ANC. MethodsIn-depth interviews were conducted individually with pregnant women and male partners attending a first ANC visit at two public health facilities in Moshi, Tanzania. Interviews examined factors influencing male ANC attendance and male experiences during the clinic visit. Interviews were recorded, transcribed verbatim, and translated from Swahili into English. Transcripts were coded thematically in NVivo. Main findingsConstructions of masculinity both positively and negatively influenced male involvement in ANC. Individual-level barriers included a fear of HIV testing, perceptions of pregnancy as the woman’s responsibility, and discomfort with ANC as a predominantly female space. Structural barriers included inability to take time off from work and long clinic wait times. The primary facilitator to male involvement was the preferential care given in the ANC clinic to women who present with a male partner. Additionally, some men desired to learn about their family’s health status and felt that attending ANC was a sign of respect and love for their partner. ConclusionsOpportunities exist to improve male involvement in ANC, namely training providers to engage men beyond HIV testing and counseling. Peer programs that promote men’s engagement in pregnancy could prove useful to reduce apprehension around HIV testing and dispel conceptions of ANC as only a women’s healthcare space.

Pre-service Teachers’ Preparedness to Teach during Teaching Practice in Tanzania

Teachers are vital to the success of any education system. However, concern continues to be raised about the quality of teachers’ preparation in the teachers’ colleges and about the quality of teachers in schools in Tanzania (Global Partnership for Educational Support in Tanzania Mainland, 2013; Mgaiwa, 2018; Makoro, 2020). In line with such concerns, this study explored Tanzania’s pre-service teachers’ demonstration of knowledge and skills of teaching during teaching practice. The study was conducted in three secondary schools located in Moshi rural District in Kilimanjaro region in Tanzania. It involved five pre-service teachers from one of the Diploma Teachers Colleges, five supervisors from the same Teachers’ College and mentor teachers from the three home schools where pre-service teachers were placed for teaching practice. The study is descriptive, employing qualitative methods of data collection. Interviews, focus group discussions and observations were used to collect data. Drawing on Shulman’s (1986) categories of knowledge, data were analyzed thematically. The findings revealed that the pre-service teachers had limited skill in lesson preparation and classroom management, which negatively impacted their learning during teaching practice. Based on these findings, the study recommends that teacher education colleges should take steps to better prepare pre-service teachers to effectively handle lesson planning, teaching, and classroom management.

Protocol for a feasibility randomized controlled trial to evaluate the efficacy, safety and tolerability of N-acetylcysteine in reducing adverse drug reactions among adults treated for multidrug-resistant tuberculosis in Tanzania

BackgroundAdverse drug reactions (ADRs) frequently occur in patients using second-line anti-tuberculosis medicine for treatment of multidrug resistant tuberculosis (MDR-TB). ADRs contribute to treatment interruptions which can compromise treatment response and risk acquired drug resistance to critical newer drugs such as bedaquiline, while severe ADRs carry considerable morbidity and mortality. N-acetylcysteine (NAC) has shown promise in reducing ADRs for medications related to TB in case series or randomized controlled trials in other medical conditions, yet evidence is lacking in MDR-TB patients. TB endemic settings have limited capacity to conduct clinical trials. We designed a proof-of-concept clinical trial primarily to explore the preliminary evidence on the protective effect of NAC among people treated for MDR-TB with second-line anti-TB medications.MethodsThis is a proof-of-concept randomized open label clinical trial with 3 treatment arms including a control arm, an interventional arm of NAC 900 mg daily, and an interventional arm of NAC 900 mg twice-daily administered during the intensive phase of MDR-TB treatment. Patients initiating MDR-TB treatment will be enrolled at Kibong’oto National Center of Excellence for MDR-TB in the Kilimanjaro region of Tanzania. The minimum anticipated sample size is 66; with 22 participants in each arm. ADR monitoring will be performed at baseline and daily follow-up over 24 weeks including blood and urine specimen collection for hepatic and renal function and electrolyte abnormalities, and electrocardiogram. Sputum will be collected at baseline and monthly thereafter and cultured for mycobacteria as well as assayed for other molecular targets of Mycobacterium tuberculosis. Adverse drug events will be analysed over time using mixed effect models. Mean differences between arms in change of the ADRs from baseline (with 95% confidence intervals) will be derived from the fitted model.DiscussionGiven that NAC promotes synthesis of glutathione, an intracellular antioxidant that combats the impact of oxidative stress, it may protect against medication induced oxidative damage in organs such as liver, pancreas, kidney, and cells of the immune system. This randomized controlled trial will determine if NAC leads to fewer ADRs, and if this protection is dose dependent. Fewer ADRs among patients treated with MDR-TB may significantly improve treatment outcomes for multidrug regimens that necessitate prolonged treatment durations. Conduct of this trial will set the needed infrastructure for clinical trials.Trial registrationPACTR202007736854169 Registered 03 July 2020

A simulation and experiential learning intervention for labor and delivery providers to address HIV stigma during childbirth in Tanzania: study protocol for the evaluation of the MAMA intervention

BackgroundThe experience of HIV stigma during intrapartum care can impact women’s trust in the health care system and undermine their long-term commitment to HIV care engagement. Delivery of respectful maternity care (RMC) to women living with HIV (WLHIV) can improve quality of life and clinical outcomes. The goal of this study is to conduct an evaluation of MAMA (Mradi wa Afya ya Mama Mzazi, Project to Support the Health of Women Giving Birth), a simulation team-training curriculum for labor and delivery providers that addresses providers’ instrumental and attitudinal stigma toward WLHIV and promotes the delivery of evidence-based RMC for WLHIV.MethodsThe MAMA intervention will be evaluated among healthcare providers across six clinics in the Kilimanjaro Region of Tanzania. To evaluate the impact of MAMA, we will enroll WLHIV who give birth in the facilities before (n = 103 WLHIV) and after (n = 103 WLHIV) the intervention. We will examine differences in the primary outcome (perceptions of RMC) and secondary outcomes (postpartum HIV care engagement; perceptions of HIV stigma in the facility; internal HIV stigma; clinical outcomes and evidence-based practices) between women enrolled in the two time periods. Will also assess participating providers (n = 60) at baseline, immediate post, 1-month post training, and 2-month post training. We will examine longitudinal changes in the primary outcome (practices of RMC) and secondary outcomes (stigma toward WLHIV; self-efficacy in delivery intrapartum care). Quality assurance data will be collected to assess intervention feasibility and acceptability.DiscussionThe implementation findings will be used to finalize the intervention for a train-the-trainer model that is scalable, and the outcomes data will be used to power a multi-site study to detect significant differences in HIV care engagement.Trial RegistrationThe trial is registered at clinicaltrials.gov, NCT05271903.

A systematic review and cross-sectional survey of rehabilitation resources for injury patients in the Kilimanjaro Region of Tanzania

Purpose An estimated 10 million people across Tanzania have a condition that would benefit from rehabilitative care. However, access to rehabilitation remains inadequate to meet the needs of Tanzania’s population. The goal of this study was to identify and characterize rehabilitation resources available to injury patients in the Kilimanjaro region of Tanzania. Methods We used two approaches to identify and characterize rehabilitation services. First, we conducted a systematic review of peer-reviewed and gray literature. Second, we administered a questionnaire to rehabilitation clinics identified through the systematic review as well as through staff at Kilimanjaro Christian Medical Centre. Results Our systematic review identified eleven organizations offering rehabilitation services. Eight of these organizations responded to our questionnaire. Seven of the surveyed organizations provide care to patients with spinal cord injuries, short term disability, or permanent movement disorders. Six offer diagnostic and treatment procedures to injured and disabled patients. Six offer homecare support. Two require no payment. Only three accept health insurance. None offer financial support. Conclusions There is a sizable portfolio of health clinics offering rehabilitation services to injury patients in the Kilimanjaro region. However, there remains an ongoing need to connect more patients in the region to long-term rehabilitative care. IMPLICATIONS FOR REHABILITATION Injury is a leading cause of death and disability worldwide and disproportionately affects populations in low- and middle-income countries (LMICs). Rehabilitation is an essential component of injury care, yet an estimated 50% of patients in LMICs who need rehabilitation do not receive it. This study offers insight into the availability and use of rehabilitative services in an LMIC with a substantial injury burden.

Patient priority setting in HIV ageing research: exploring the feasibility of community engagement and involvement in Tanzania

ObjectiveThe chronic complications of ageing with HIV are not well studied in sub-Saharan Africa (SSA) where general healthcare resources are limited. We aimed to collaborate with individuals living with HIV aged ≥ 50 years, and community elders (aged ≥ 60 years) living with non-communicable diseases in the Kilimanjaro region of Tanzania in a health research priority-setting exercise.MethodsWe conducted structured workshops based on broad questions to aid discussion and group-based patient priority setting, alongside discussion of the feasibility of future community research engagement. Participant priorities were tallied and ranked to arrive at core priorities from consensus discussion.ResultsThirty older people living with HIV and 30 community elders attended separate priority setting workshops. Both groups reported motivation to participate in, conduct, and oversee future studies. In this resource-limited setting, basic needs such as healthcare access were prioritised much higher than specific HIV-complications or chronic disease. Stigma and social isolation were highly prioritised in those living with HIV.ConclusionsCommunity engagement and involvement in HIV and ageing research appears feasible in Tanzania. Ageing and non-communicable disease research should consider the wider context, and lack of basic needs in low-income settings. A greater impact may be achieved with community involvement.

Consumer Perceptions, Preferences and Awareness Towards Potential Geographical Indication of Products in Tanzania

This paper assesses consumer awareness, preference and perception of high-quality products from information provided in the market, and on the labels for coffee and rice products in Mbeya and Kilimanjaro regions of Tanzania. This paper is a part of a study that was established to understand the potential of geographical indication protection in Tanzania, which looked at producers, sellers, and consumers. The study collected data from a sample of 130 consumers: 58 and 72 rice and coffee consumers, respectively. A mixed method approach was used to analyse data; specifically a logit model was used to understand the determinants of consumers awareness; and providing a clear description of the different factors that determine consumers’ preferences and perceptions. The results showed that 62% of the consumers had awareness of the different qualities they seek in a product. Price and label/brand information were found to be the main factors influencing and signalling the preferences and perceptions of consumers to high-quality products.
 JEL Classification Q18, D18, L15,

Spatio-temporal Analysis of Changes in Land Use-Land Cover for Conservation Efficacy of Urban Forest Reserve: The Case of Rau Forest Reserve, Tanzania

Changes in land use and land cover in different places around the globe have a significant impact on ecological structure and functions as well. Analysis of the changes in land use and land cover is useful in management activities, especially forest reserves as it reflects the interaction between adjacent communities and natural resources. Due to the rapid sprawl in urbanisation, there has been a rapid change in the human-land relationship. Rau Forest is situated in Moshi Municipality of Kilimanjaro Region in Tanzania. There have been several claims of a decrease in vegetation cover in this important forest reserve, although there is no documentation on such claims. It is on the basis of this background this study was conducted to explore the changes in land use and land cover in the Rau Forest reserve to show the management status of this ecosystem which is also located in an urban area where management activities have been a challenge. The land use and cover (LULC) Spatio-temporal changes in the Rau Forest were classified as Densely Vegetation, Slightly Vegetation, Grassland, Bare land, Built-up, and Waterbodies to evaluate qualitative and quantitative changes in this reserve through the use of GIS techniques and tools over time (1990, 2000 and 2019). Forest encroachment has driven changes in land use and land cover and transformed parts of the Rau Forest reserve into the urban settlement, and grazing lands which has ultimately led to gradual forest degradation. Landsat imageries for the year were used to identify the Spatio-temporal changes in vegetation in the area. This study shows the downward trend for the densely vegetated part of the reserve at the expense of expansion in the built-up area. The results demonstrate the urgent need for strong and more severe regulations concerning the protection of Rau Forest and other urban situated forest reserves against land use and land cover changes for the benefit of the present and future generations.

Facility-based disease surveillance and Bayesian hierarchical modeling to estimate endemic typhoid fever incidence, Kilimanjaro Region, Tanzania, 2007-2018.

Growing evidence suggests considerable variation in endemic typhoid fever incidence at some locations over time, yet few settings have multi-year incidence estimates to inform typhoid control measures. We sought to describe a decade of typhoid fever incidence in the Kilimanjaro Region of Tanzania. Cases of blood culture confirmed typhoid were identified among febrile patients at two sentinel hospitals during three study periods: 2007–08, 2011–14, and 2016–18. To account for under-ascertainment at sentinel facilities, we derived adjustment multipliers from healthcare utilization surveys done in the hospital catchment area. Incidence estimates and credible intervals (CrI) were derived using a Bayesian hierarchical incidence model that incorporated uncertainty of our observed typhoid fever prevalence, of healthcare seeking adjustment multipliers, and of blood culture diagnostic sensitivity. Among 3,556 total participants, 50 typhoid fever cases were identified. Of typhoid cases, 26 (52%) were male and the median (range) age was 22 (<1–60) years; 4 (8%) were aged <5 years and 10 (20%) were aged 5 to 14 years. Annual typhoid fever incidence was estimated as 61.5 (95% CrI 14.9–181.9), 6.5 (95% CrI 1.4–20.4), and 4.0 (95% CrI 0.6–13.9) per 100,000 persons in 2007–08, 2011–14, and 2016–18, respectively. There were no deaths among typhoid cases. We estimated moderate typhoid incidence (≥10 per 100 000) in 2007–08 and low (<10 per 100 000) incidence during later surveillance periods, but with overlapping credible intervals across study periods. Although consistent with falling typhoid incidence, we interpret this as showing substantial variation over the study periods. Given potential variation, multi-year surveillance may be warranted in locations making decisions about typhoid conjugate vaccine introduction and other control measures.

Concurrent Infection With Dengue and Chikungunya Viruses in Humans and Mosquitoes: A Field Survey in Lower Moshi, Tanzania

Introduction: Dengue and Chikungunya have re-emerged as important diseases of global concern. Co-infections with Dengue virus (DENV) and Chikungunya virus (CHIKV) could have serious outcomes if not diagnosed and managed optimally. However, the key focal points for the maintenance of CHIKV and DENV infections and the extent of their co-infection remain poorly understood in many geo-ecologically distinct parts of Tanzania. Objective: We aimed to comparatively examine the prevalence and factors for seropositivity to DENV and CHIKV and their infection rates in humans and mosquitoes Methods: A cross-sectional study was performed in the Lower Moshi area of the Kilimanjaro region from April to July 2020. DENV and CHIKV exposure was determined by detecting IgM to the viruses using enzyme linked immunosorbent assay whereas infection was determined by real time quantitative polymerase chain reaction (RT-qPCR) assay. Results: Insecticide Treated Bed Net (ITN) use (χ2=3.504; p&lt; 0.05), being ≥7 individuals living in the same household (χ2=4.655; p&lt;0.05) and a recent travel to an urban destination (χ2=3.39; p&lt; 0.05) were the only factors associated with CHIKV seropositivity. ITN use was the only factor associated with CHIKV infection (χ2=5.204; p&lt;0.05). A recent travel to an urban destination (χ2=4.401; p&lt; 0.05) was the only factor associated with DENV seropositivity. Five (1.5%) Ae. aegypti pools were positive for CHIKV whereas 1 (0.3%) was positive for DENV. Two Cx. pipiens, pools (1.9%) were positive for CHIKV. None of the Cx. pipiens mosquitoes was positive for DENV. No associations between DENV and CHIKV seropositivity was observed in humans but DENV infection was strongly associated with CHIKV infection (χ2 = 238.45; p&lt;0.01). CHIKV infection was observed to be consistently higher in both, humans and mosquitoes. Conclusion: Detection of DENV and CHIKV in both humans and vector mosquitoes confirms that both viruses are actively circulating in the Lower Moshi area of Kilimanjaro region in Tanzania. Our findings point out the Lower Moshi area as a potential focal point for the maintenance of the two viruses and possibly other vector borne viruses. We call upon sustained active surveillance of arboviruses and other re-emerging infections to be better prepared for possible outbreaks by the viruses.

Is the southern patas monkey Erythrocebus baumstarki Africa's next primate extinction? Reassessing taxonomy, distribution, abundance, and conservation.

The "Critically Endangered" southern patas monkey Erythrocebus baumstarki, thought to be endemic to Tanzania, has been resurrected to species level based on its geographic isolation, and on the coloration and pattern of its pelage. This study presents the first evidence for E. baumstarki in Kenya and reviews its historic and current geographic distributions based on the literature, museum specimens, online platforms, responses to requests for site records, and our own fieldwork. The distribution of E. baumstarki in the early 20th century was roughly 66,000 km2 . This has declined about 85% to around 9700 km2 at present (post-2009). The current "Extent of Occurrence" is only about 2150 km2 . This species was extirpated from Kenya in about 2015 and from the Kilimanjaro Region in Tanzania in about 2011. At present, E. baumstarki appears to be restricted to the protected areas of the western Serengeti, with the western Serengeti National Park being the stronghold. The number of individuals remaining is probably between 100 and 200, including between 50 and 100 mature individuals. The ultimate threat to E. baumstarki is the very rapidly increasing human population, while the main proximate threats are the degradation, loss, and fragmentation of natural habitats, and the related competition with people and livestock for habitat and water, particularly during droughts. Other problems are hunting by poachers and domestic dogs, and probably loss of genetic variation and climate change. This article provides recommendations for reducing the threats and promoting the recovery of E. baumstarki. We hope this article heightens awareness of the dire conservation status of E. baumstarki and encourages an increase in research and conservation action for this monkey.

Symptoms and predictors of depression among university students in the Kilimanjaro region of Tanzania: a cross-sectional study

Background Depression is the second leading cause of death among young people worldwide, and severity and suicidality are useful predictors of an adverse outcome. Aim This study aimed at examining factors associated with depression among university students in Tanzania. Methods A cross-sectional study was conducted between March 2018 and July 2019 of undergraduate students across four universities. They completed a self-reported questionnaire collecting socio-demographic, together with a Patient Health Questionnaire (PHQ-9) to screen for depression. A multivariate logistic regression model was used to determine independent predictors of depression. Results A total of 1047 students completed the study. Their mean (±SD) age was 24.2 (±7) years. 219 students (21.3%) screened positive for probable depression (survey-1 34% vs survey-2 13%). A total of 228 (21.9%) students reported having thoughts of serious self-harm. Factors independently influencing depression included year of study, substance abuse, unhappy interpersonal relationships and chronic mental or physical illness. The presence of an eating disorder was a predictor of depression and was recorded in 7.4% of all students. Conclusion Significant probable depression is present in one fifth of undergraduate students in this study. These results demonstrate a worrying degree of self- reported features of depression among North Tanzanian university students.

Good death: An exploratory study on perceptions and attitudes of patients, relatives, and healthcare providers, in northern Tanzania.

ImportanceIn the Kilimanjaro region of Tanzania, there are no advance care planning (ACP) protocols being used to document patient preferences for end-of-life (EoL) care. There is a general avoidance of the topic and contemplating ACP in healthcare-limited regions can be an ethically complex subject. Nonetheless, evidence from similar settings indicate that an appropriate quality of life is valued, even as one is dying. What differs amongst cultures is the definition of a ‘good death’.ObjectiveEvaluate perceptions of quality of death and advance EoL preparation in Moshi, Tanzania.Design13 focus group discussions (FGDs) were conducted in Swahili using a semi-structured guide. These discussions were audio-recorded, transcribed, translated, and coded using an inductive approach.SettingKilimanjaro Christian Medical Centre (KCMC), referral hospital for northern Tanzania.ParticipantsA total of 122 participants, including patients with life-threatening illnesses (34), their relatives/friends (29), healthcare professionals (29; HCPs; doctors and nurses), and allied HCPs (30; community health workers, religious leaders, and social workers) from KCMC, or nearby within Moshi, participated in this study.FindingsIn characterizing Good Death, 7 first-order themes emerged, and, of these themes, Religious & Spiritual Wellness, Family & Interpersonal Wellness, Grief Coping & Emotional Wellness, and Optimal Timing comprised the second-order theme, EoL Preparation and Life Completion. The other first-order themes for Good Death were Minimal Suffering & Burden, Quality of Care by Formal Caregivers, and Quality of Care by Informal Caregivers.InterpretationThe results of this study provide a robust thematic description of Good Death in northern Tanzania and they lay the groundwork for future clinical and research endeavors to improve the quality of EoL care at KCMC.

Mother's Knowledge on HIV, Syphilis, Rubella, and Associated Factors in Northern Tanzania: Implications for MTCT Elimination Strategies.

Background Infections transmitted from mother to child (MTCT) during pregnancy, childbirth, and breastfeeding contribute significantly to the high infant and childhood morbidity and mortality in sub-Saharan African countries. The most significant and preventable of these include HIV, syphilis, and rubella. To achieve elimination, mothers need to be aware of and to understand effective preventive measures against these infections. Lack of comprehensive knowledge on transmission and prevention of MTCT infections is one of the factors hindering achievement of the elimination goals for these infections. The aim of this study was to assess the knowledge of HIV, syphilis, rubella, and associated factors among mothers in the Kilimanjaro region of Tanzania. Methods We conducted a community-based cross-sectional study in three districts of the Kilimanjaro region from September to October 2016. The study involved mothers with children up to five years of age. Data collection involved the use of a questionnaire, administered by face-to-face interviews. Logistic regression analysis was used to assess predictors of mothers' knowledge on MTCT infections. Results A total of 618 mothers were recruited, with a mean age of 29.6 (SD 7.6) years. The overall knowledge on MTCT infections was low. The highest level of knowledge on MTCT infections was regarding HIV (89.2%). Fewer mothers had knowledge of syphilis (27.8%). Rubella was the least known; only 12% of mothers were aware of rubella infection. District of residence and having knowledge of syphilis were predictors for rubella knowledge, while for syphilis knowledge, significant predictors were age group, occupation, and those having knowledge on HIV and rubella. Predictors for HIV knowledge were residential district, having a mobile phone, and those having knowledge of syphilis and rubella. Conclusions This study confirmed that mothers have low overall knowledge on MTCT infections. To achieve the MTCT elimination goals, targeted interventions to improve knowledge among women of childbearing age are recommended.