Kilimanjaro Region Research Articles

Risk factors for spotted fever group rickettsioses in Kilimanjaro Region, Tanzania

Abstract Background Knowledge gaps exist on risk factors for spotted fever group rickettsioses (SFGR) in sub-Saharan Africa. We sought to identify SFGR risk factors in Kilimanjaro Region, Tanzania. Methods We recruited febrile patients presenting at two hospitals in Moshi from February 2012 through May 2014. Standardised clinical and risk factor questionnaires were administered. SFGR exposure was defined as a Rickettsia africae immunofluorescence antibody reciprocal titer ≥64, and acute SFGR as a ≥four-fold rise between paired sera. Logistitic regression was used to identify associations. Results Of 1,190 participants providing ≥1 serum sample, median (range) age was 21.8 (0.3, 100.2) years, 545 (54.3%) were female, and 650 (54.6%) had SFGR exposure. Of 731 participants with paired sera, 67 (9.2%) had acute SFGR. On multivariable analysis, odds of acute SFGR were higher in age group 0-2 years (adjusted odds ratios [aOR] for older age groups <0.36, p<0.011), rural residence (aOR 4.1, p=0.007), and areas with maximum daily temperature <26°C (aORs for higher temperature groups <0.42, p-values<0.035). Odds of SFGR exposure were higher in those working in the garden (aOR 1.8, p=0.010), and seeing a dog (aOR 1.5, p=0.010). Odds of SFGR exposure were lower in age group 0-2 years (aORs for older age groups >1.5, p<0.026), female sex (aOR 0.62, p<0.001), and being from Chaga tribe (aOR 0.68, p=0.003). Conclusion Those aged <2 years, rural residents, and persons residing in areas with cooler temperatures had increased odds of SFGR. Our results identify groups for further research on tick exposure and for targeted prevention interventions.

Predictors of neonatal hypothermia within six hours of birth and exploring preventive practices among post-natal mothers in Kilimanjaro region: Explanatory sequential mixed method protocol.

Neonatal hypothermia is a worldwide problem that can lead to a high impact on neonatal health outcomes if appropriate thermal care measures are not implemented. Tackling neonatal hypothermia from the time of delivery with appropriate thermal care measures will increase neonatal survival and decrease complications related to hypothermia. The study aims to determine the predictors of neonatal hypothermia within six hours of birth and explore its preventive practices among postnatal mothers. This is a mixed-method sequential explanatory study. The first phase will be a quantitative study with a hospital-based analytical cross-sectional design. 325 neonates and their mothers will be randomly selected through a 4-stage sampling technique. The data will be collected using a structured questionnaire, checklist and documentary review. Descriptive and inferential statistics will be used to analyse the data. The second phase will be a descriptive qualitative study involving postnatal mothers who participated in a quantitative study. The data will be collected via in-depth interviews, and thematic analysis will be used to analyse the data. The findings of quantitative and qualitative studies will be triangulated in the discussion. This study will provide a wide understanding of neonatal hypothermia in the region which will help healthcare providers who are caring for neonates to be informed about the current situation, evaluate the care they provide, and find the best way to adhere to thermal care measures. Moreover, the practices of postnatal mothers will be known, which will help to develop tailored interactions to address this problem.

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.

Knowledge, attitude, and food safety practices among university students in Kilimanjaro region, northern Tanzania

Food safety is a public health concern worldwide due to an increased morbidity and mortality risk associated with the outbreak of food-borne diseases. This study aimed to assess knowledge, attitude, and food safety practices (KAP) among university students in northern Tanzania. This is interesting because it allows data to be collected for creating awareness on safety, sanitation, and quality of food available within and outside the university environments.We conducted a cross-sectional study among 407 university students in Kilimanjaro region and all authors participated equally. Participants completed an online, self-administered questionnaire. Data was analyzed using SPSS version 25 and summarized using descriptive statistics. The Chi-squared test compared the proportion of KAP by participant characteristics and the multiple logistic regression model used to determine the associated factors. Participants had a mean age (standard deviation) of 23.2 (2.6) years, 51.4% were males, and 83% were < 25 years. The overall proportion of good knowledge, attitude, and food safety practices were 82.6, 78.4, and 31.9%, respectively. Higher odds of knowledge and attitude on food safety were students from KCMUCo (OR = 2.36; 95% CI 1.33–4.17) and (OR = 4.80; 95% CI 2.67–8.63). Also higher odds of food safety practice were students with good knowledge (OR = 1.80; 95% CI 1.03–3.13).Good food safety knowledge but not attitudes was associated with good food safety practices. This shows the need to introduce practical food safety within college environments to help students improve food hygiene and safety practices.

Psychological wellbeing among carers of children and adolescents with physical disabilities in North-Eastern Tanzania-a cross-sectional survey study.

Caring for physically disabled children, particularly in contexts where resources are often insufficient or absent, exposes primary carers to significant psychological strain. The lack of structured mechanisms to address this psychological burden poses a considerable threat to the wellbeing of both carers and the children with disabilities under their care. However, research on the psychological wellbeing of carers in Tanzania is scarce. This study aimed to evaluate the psychological wellbeing and symptoms of anxiety and depression, along with associated factors, of carers of children, and adolescents with physical disabilities in the Kilimanjaro region. A cross-sectional survey was conducted from November 2020 to June 2021 in the Kilimanjaro region, involving 212 carers. The Swahili versions of the WHO-5 Wellbeing Index and Hopkins Symptoms Check List-25 were used to assess psychological wellbeing and symptoms of anxiety and depression. Data were analysed using IBM SPSS Statistics V.28. Multivariable linear and binary logistic regression were used to assess the associations. More than four fifths (81%) of the carers were parents, and most of these parents were mothers (92%). Of the 212 carers, more than half (51%) exhibited poor psychological wellbeing, 42% had symptoms of anxiety, and 38% symptoms of depression. Notably, poor psychological wellbeing was significantly associated with symptoms of anxiety and depression. Results of a multivariable regression analysis indicated that extended family support was associated with better psychological wellbeing and lower odds of symptoms of anxiety and depression. A higher estimated monthly income was associated with better psychological wellbeing, and lower odds of symptoms of depression. Access to rehabilitation for the child was associated with improved psychological wellbeing and decreased likelihood of symptoms of anxiety. Many carers of children, and adolescents with physical disabilities in Tanzania are at high risk of having poor psychological wellbeing, and symptoms of anxiety and depression. Support from extended-family networks is crucial in promoting good psychological wellbeing. The government in Tanzania should improve rehabilitation services, especially in disadvantaged rural areas, and integrate mental-health screening for carers in both rehabilitation programmes and primary healthcare.

PDOC-12 PEDIATRIC BRAIN TUMOR INCIDENCE, AND TREATMENT MODALITY AT KILIMANJARO CHRISTIAN MEDICAL CENTER

Abstract INTRODUCTION Pediatric brain tumors (PBT) a significant health concern, they are the primary cause of cancer-related deaths among children. PBTs in Low- and Middle-Income Countries are diagnosed late due to insufficient resources. This abstract describes Pediatric Brain tumor incidence and treatment modalities at Kilimanjaro Christian Medical Center (KCMC) Cancer Care Center (CCC), Moshi, Tanzania from December 2016 to March 2024. METHOD Data on pediatric patients treated at the CCC between Dec. 2016 and March 2024, were analyzed. Inclusion criteria were a primary brain tumor and patients aged 0-19 at the time of diagnosis. All patients were previously diagnosed by computer tomography/ magnetic resonance imaging. Variables retrospectively collected from patient’s medical records were: demographic characteristics (age, gender, Place of residence, and insurance status), previous history of malignant diseases, incidence date, and treatment modality. RESULTS Total of 748 cases of pedeatric cancer were diagnosed at CCC. Of all the pediatric cancers diagnosed, brain cancer accounted for 22(2.9%). Out of these cases of brain cancer, 63.6% were males and 36.4% were females.Majority of them came within the Kilimanjaro region. 41% were palliated while 59% had a curative intent at the time of diagnosis, 22.7% died between December 2016 to March 2024.Embryonal tumors were (40.9%) with a breakdown that includes 6 Medulloblastoma and 3 cases of Craniopharyngioma (teratoid/rhabdoid), gliomas (36.4%) with sub-types such as Ependymoma, Anaplastic Astrocytoma, Pilocytic Astrocytoma, Pineocytoma, Stem glioma, and Tectal glioma, unspecified cases (13.6%), and Pineoblastoma were (9.1%). Surgery was used in 40.9% of cases, radiotherapy in 31.8%, and chemotherapy in 72.7%. Chemoradiotherapy was used in 31.8% of cases. 13.6% of cases utilized a combined approach, including chemotherapy, radiotherapy, and surgery. CONCLUSION PBT incidence at KCMC is 2.9%, improving access to screening, accurate diagnosis and treatment modalities are essential in identifying and managing PBT in our setting.

Clients’ and providers’ perspectives in informing a digital health intervention to improve linkage to care after Index HIV self-testing in Hai and Moshi Districts, Tanzania

BackgroundDigital health interventions have the potential to improve linkage to care after HIV self-testing (HIVST). This study aimed to understand clients’ and providers’ perceptions of benefits, and barriers of a digital health intervention designed to improve linkage to care after HIV self-testing in Tanzania.MethodsThis exploratory qualitative research study was conducted in Hai and Moshi, districts in Kilimanjaro region, Tanzania. Four health facilities were selected based on their involvement in an HIVST pilot program implemented by Elizabeth Glassier Pediatric AIDS Foundation (EGPAF) Tanzania through the USAID funded program. The study included female index clients and their partners, and healthcare providers at the healthcare facilities. We used a semi-structured interview guide with open-ended questions for data collection. Data collection was conducted from 16th January 2023 to 3rd February 2023. Thematic analysis of the qualitative data was conducted, guided by the Health Belief Model (HBM), and results were developed in collaboration with the community partners.ResultsA total of 42 participants were included in the study, comprising 9 male clients, 17 female index clients, and 16 health care workers (HCWs) (4 male and 12 female) who were involved in delivering HIVST services. The study’s findings revealed mixed feelings about the use of a digital health intervention. Majority of participants perceived digital health as a valuable intervention for enhancing linkage to care, improved health outcomes, improved communication with healthcare workers, and increased privacy. Therefore, they supported scale-up of a digital health intervention. Participants also expressed that the potential benefits of a digital health intervention include the convenience of accessing healthcare services from the comfort of their homes or any location. However, a few participants expressed concerns about potential risks associated with sending health-related text messages. They feared that recipients might not be in a safe space, leading to stigma and avoidance of engagement. A few female participants expressed concerns about confidentiality breaches, particularly regarding shared phones with family or friends. Fear of being judged or misunderstood by others could deter them from reading or acting upon these messages. Most participants recommended tailored strategies that prioritize confidentiality and trust. Recognizing these psychological aspects is vital for customizing digital health interventions to effectively address participants’ concerns.ConclusionsDigital health interventions may improve the linkage of HIV self-testers to care. Recommendations include personalized and culturally relevant communication and technical accessibility to make interventions effective and inclusive. This study provides valuable insights for designing patient-centered interventions for HIV care and treatment.

Risk Factors for Salmonella Infection in Children under Five Years: A Hospital-Based Study in Kilimanjaro Region, Tanzania.

Salmonella is among the causative agents for diarrhea worldwide, but its risk factors in Tanzanian children are poorly understood. A hospital-based cross-sectional study was conducted in Moshi, Kilimanjaro region, from July 2020 to November 2022 among children under five admitted with diarrhea. A questionnaire was administered to all parents/caretakers of the enrolled children. Logistic regression was utilized to analyze the risk factors, with significance at p < 0.05. A total of 306 children were enrolled in the study. The median age was 13.8 months (IQR 8.4-21.8). The majority (58.5%) were males, and 59.5% were from rural areas. Salmonella was identified in eight (2.6%) stool samples, with a higher prevalence in urban than rural areas (4.8% vs. 1.1%; p-value = 0.044). The significant risk factors associated with Salmonella infection among the children included consuming raw milk (adjusted OR = 30.19; 95% CI: 3.94-231.46), using infant formula (adjusted OR = 15.78; 95% CI: 2.98-83.56), undisclosed household income (adjusted OR = 9.98; 95% CI: 2.46-40.12), purchasing eggs direct from the farms (adjusted OR = 7.58; 95%CI: 1.31-43.96), and contact with chickens (adjusted OR = 6.49; 95%CI: 1.25-33.59). These findings highlight the need for targeted interventions to improve food safety, hygiene practices, and socioeconomic conditions.

Effects of Computerized Accounting Procedures on the Quality of Financial Reporting of Crop Boards in Kilimanjaro

In today's technological world, the use of computerized accounting procedures has become increasingly prevalent across various organizations. Computerized accounting procedures have been employed by organizations for financial record keeping and reporting. Financial reports are an essential source of information needed for different decision makers and other stakeholders. Therefore, this study aimed to establish the effects of computerised accounting procedures on the quality of financial reporting of crop boards in Kilimanjaro region, Tanzania. The study was grounded by Resource-Based View (RBV) developed by Barney in the 1990s. The study applied a descriptive research design under quantitative research approach. Eight (8) crop boards in Moshi Municipality were targeted comprising of Forty (40) staff dealing with accounting and finance. Sample size was obtained through Sample Size Calculation for Finite Population. Data was collected through questionnaires. Face and content validity was used to ensure the validity of the research instruments, and then the instruments were piloted Three (3) accounts and finance employees at Tanzania Coffee board to clarify any ambiguities and checked for consistency of the data to be collected. Reliability was ensured through Cronbach’s alpha test which was run through Statistical Package for Social Sciences (SPSS) and obtained a coefficient of 0.81 which is reliable. Data was analysed through the aid of SPSS and then presented in form of tables, frequencies, percentages and means. Ethical considerations and ethics ethical values were adhered throughout the research process. The study found that computerized accounting procedures had effects on the quality of financial reports of Crop boards in Kilimanjaro region, Tanzania. Basing on the findings it was concluded that the computerized accounting procedures have a positive effect on the quality of financial reporting of Crop Boards in Kilimanjaro. Further, it was concluded that computerized accounting procedures were effective in facilitating decision making and improving the overall quality of financial reporting. This study recommended that Crop Boards in Kilimanjaro should continue using computerized accounting procedures and enhance the system for improved efficiency, accuracy, and accessibility of financial data. Further, it is recommended that Crop Boards should provide training and skill development programs to their accountants. Also, this study provides area for further studies, recommending that further studies could be conducted on the influence of Computerized accounting systems on the Financial Decision Making.

COVID-19 vaccine confidence and its effect on vaccine uptake among people with hypertension or diabetes mellitus in Kilimanjaro region, Tanzania

ABSTRACT COVID-19 vaccination effectively reduces disease severity, hospitalization, and mortality, particularly among individuals with chronic conditions who bear a disproportionate burden of disease complications. Vaccine confidence – belief in its safety, effectiveness, and importance – boosts uptake. However, limited data on vaccine confidence in this population hinders the development of targeted interventions. This study examined COVID-19 vaccine confidence and its impact on uptake among individuals with hypertension or diabetes mellitus in the Kilimanjaro region, Tanzania. A community-based cross-sectional study was conducted in March 2023 among 646 randomly selected adults aged ≥18 years with hypertension or diabetes mellitus in three districts of Kilimanjaro region, northern Tanzania. An interviewer-administered electronic questionnaire assessed confidence and uptake of COVID-19 vaccines in addition to related knowledge and demographic characteristics. Data analysis was done for 646 individuals who consented to participate. Multivariable logistic regression models determined the factors associated with COVID-19 vaccine confidence and its effect on vaccine uptake. The proportion of COVID-19 vaccine confidence among all 646 participants was 70% and was highest for perceived vaccine importance (80%), followed by perceived vaccine effectiveness (77%) and perceived vaccine safety (74%). Good knowledge of COVID-19 vaccines and living in the Mwanga municipal council (MC), a semi-urban district, was independently associated with confidence in the vaccines’ importance, safety, effectiveness, and overall COVID-19 vaccine confidence. Confidence in COVID-19 vaccines increased the odds of vaccine uptake. Targeted interventions to boost vaccine confidence are therefore essential to enhance vaccine uptake in this high-risk population.

Effectiveness of Face-to-Face Meetings Heads of School Leadership Strategy on Teachers’ Levels of Commitment in Community-Cased Secondary Schools, in Selected District Councils in Kilimanjaro Region, Tanzania

Effectiveness of Face-to-Face Meetings Heads of School Leadership Strategy on Teachers’ Levels of Commitment in Community-Cased Secondary Schools, in Selected District Councils in Kilimanjaro Region, Tanzania

Evaluating the Utilization of Human Resources for Health Information Systems at the Local Government Level: Findings from the Kilimanjaro Region

Introduction: Human resources for health (HRH) are critical to healthcare delivery. Global HRH shortages hinder health service provision. This study explored how data from HRHIS is utilized to optimize HRH planning, management, and development. Methods: The study used a utility-focused evaluation approach, employing multiple case study designs. Data were collected from seven (7) of the Ministry of Health and President's Office—Regional Administrative and Local Government through in-depth interviews and an observation checklist, whereas ten (10) participants were interviewed. Interpretative phenomenological analysis was used to describe individual experiences, practices of HRH management, and data use from HRHIS. Results: The study found that staffing levels, DHIS2, Work Indicators, Staff Needs and Prioritization, and Optimization Analysis are key data sources for HRH planning, allocation, and deployment decisions. However, relying on multiple systems for employee data management proved challenging due to inconsistencies and errors. While essential, HRHIS lacks integration with other systems, hindering data utilization. Manual data entry further exacerbates data quality issues, emphasizing the need for a more robust and integrated HRH information system. Conclusion: HRHIS is a valuable tool for HRH data management, but its potential is underutilized in Kilimanjaro. Despite implementation, challenges persist in using HRHIS data for planning, management, and development. Significant efforts are needed to promote data utilization and improve HRHIS's contribution to Tanzania's healthcare workforce. The study recommends accelerating the integration of HRHIS with other systems, such as the District Health Information System, the Human Capital Management Information System, Professional Councils databases, Regulatory bodies – Tanzania Commission for University, NACVET, Health Facility Registry, and TrainSmart. This integration will enhance data accessibility and improve HRH planning and management.

Analysis of Health Workers’ Use of Libraries and Digital Platforms in Accessing and Sharing Health Information in Tanzania

Background Health information comprises valuable data and knowledge that supports healthcare delivery. Although libraries and digital platforms are valuable for providing health information, there is a lack of documentation regarding their use by health workers in Tanzania. This study sought to analyze health workers’ use of libraries and digital platforms to access and share health information. Method A cross-sectional study using a mixed research approach was conducted from August to September 2022 at primary, secondary, and tertiary health facilities in Kilimanjaro and Mbeya regions. Semi-structured questionnaires and interviews were used to collect data from 500 health workers from all selected health facilities in all regions. IBM SPSS version 21 was used to analyze quantitative data, while thematic analysis was used to analyze qualitative data. Results Very few health workers (32.6%) used libraries while lack of physical libraries, limited time, and use of mobile phones hindered health workers from using libraries to access and share health information. Most of the health workers (56%) used digital platforms to access and share health information. Insufficient skills, lack of internet connectivity, and high cost of internet bundles limited health workers from utilizing digital platforms for accessing and sharing health information. Conclusion Many health workers do not use libraries and digital platforms to access and share health information. As a result, efforts should be made to increase the use of libraries and digital platforms among health workers to increase access to reliable and relevant health information to improve the quality of healthcare services.

Acceptability of a Digital Adherence Tool Among Patients With Tuberculosis and Tuberculosis Care Providers in Kilimanjaro Region, Tanzania: Mixed Methods Study.

The World Health Organization has recommended digital adherence tools (DATs) as a promising intervention to improve antituberculosis drug adherence. However, the acceptability of DATs in resource-limited settings is not adequately studied. We investigated the acceptability of a DAT among patients with tuberculosis (TB) and TB care providers in Kilimanjaro, Tanzania. We conducted a convergent parallel mixed methods study among patients with TB and TB care providers participating in our 2-arm cluster randomized trial (REMIND-TB). The trial aimed to investigate whether the evriMED pillbox with reminder cues and adherence feedback effectively improves adherence to anti-TB treatment among patients with TB in Kilimanjaro, Tanzania. We conducted exit and in-depth interviews among patients as well as in-depth interviews among TB care providers in the intervention arm. We conducted a descriptive analysis of the quantitative data from exit interviews. Translated transcripts and memos were organized using NVivo software. We employed inductive and deductive thematic framework analysis, guided by Sekhon's theoretical framework of acceptability. Out of the 245 patients who completed treatment, 100 (40.8%) were interviewed during exit interviews, and 18 patients and 15 TB care providers were interviewed in-depth. Our findings showed that the DAT was highly accepted: 83% (83/100) expressed satisfaction, 98% (98/100) reported positive experiences with DAT use, 78% (78/100) understood how the intervention works, and 92% (92/100) successfully used the pillbox. Good perceived effectiveness was reported by 84% (84/100) of the participants who noticed improved adherence, and many preferred continuing receiving reminders through SMS text messages, indicating high levels of self-efficacy. Ethical concerns were minimal, as 85 (85%) participants did not worry about remote monitoring. However, some participants felt burdened using DATs; 9 (9%) faced difficulties keeping the device at home, 12 (12%) were not pleased with receiving daily reminder SMS text messages, and 30 (30%) reported challenges related to mobile network connectivity issues. TB care providers accepted the intervention due to its perceived impact on treatment outcomes and behavior change in adherence counseling, and they demonstrated high level of intervention coherence. DATs are highly acceptable in Tanzania. However, some barriers such as TB-related stigma and mobile network connectivity issues may limit acceptance. RR2-10.1186/s13063-019-3483-4.

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.

"Alcohol will never run out": Socio-ecological drivers of adolescent boys' alcohol use in Kilimanjaro Region, Tanzania.

Heavy alcohol use amongst adolescent boys is a major public health concern in many countries. It is associated with a range of negative physical and mental health outcomes and predicts alcohol-related problems in adulthood. In Kilimanjaro Region, adolescent boys' alcohol use is widespread, and higher than other regions in Tanzania. An understanding of causal and contextual factors that influence the use of alcohol is needed to inform the development and implementation of effective alcohol prevention interventions. This study aimed to explore these socio-ecological factors in-depth amongst adolescent boys, young men and key stakeholders in Kilimanjaro Region, Tanzania. Between August 2022 and June 2023, multi-method, participatory, qualitative methods including: ethnographic observations (8 weeks), 37 in-depth interviews, 14 focus group discussions and participatory adolescent activities were used to elicit perceptions on factors driving adolescent boys' alcohol use in two (rural/urban) settings. Data were triangulated and deductively analysed, guided by Bronfenbrenner's socio-ecological framework. This study found many dynamic and inter-related factors linked to alcohol use within adolescents' social, cultural, economic, regulatory, and physical environments. In a context of widespread availability of alcohol, low enforcement of alcohol regulation and (mis)conceptions around the benefits of alcohol use (e.g. curative and/or nutritional properties), parental and cultural influences largely determined the initiation of use in childhood and younger adolescence; employment status, peers, lack of alternative recreational activity and social norms around independence appeared to drive continued and increased use in older adolescence. Factors and their impact varied between rural and urban settings. In conclusion, a wide range of determinants and drivers of alcohol use among ABYM work at multiple socio-ecological levels especially parental, cultural and socioeconomic factors. This suggests that effective prevention requires a systems approach intervening across these levels. For example, incorporating education/awareness raising, increased law enforcement, parent-child communication and problem-solving, and income generation activities.

Adaptive adjustment to the needs of families caring for children and adolescents with physical disabilities in north-eastern Tanzania: a grounded-theory study

ABSTRACT Background Family interactions, which are always multi-faceted, are complicated further by family members with disabilities. In resource-poor settings, policies and programmes that address the needs of and challenges faced by families are often inaccessible or unavailable. Approximately 13% of the families in Tanzania have at least one member with a disability, yet family-centred research on caring for disabled children and adolescents is scarce in this context. Objective The aim is to explore the needs and challenges faced by families that care for children and adolescents with physical disabilities in the Kilimanjaro Region of north-eastern Tanzania. Methods This qualitative study had a constructivist grounded-theory design. In-depth interviews, using a semi-structured interview guide based on the social-capital framework, were conducted with 12 female participants aged between 24 and 80. A conceptual model of family needs, inspired by Maslow’s hierarchy of needs, informed the analysis. Results Challenging needs were grouped into five categories, which were linked to Maslow’s hierarchy of needs and related to the central concept of ‘adaptive adjustment’: (1) ‘barely surviving’; (2) ‘safety needs in jeopardy’; (3) ‘sociocultural protection’; (4) ‘self-esteem far beyond reach’, and (5) ‘dreaming of self-actualisation’. Conclusion Families caring for children and adolescents with physical disabilities in north-eastern Tanzania have needs that extend beyond the available and accessible resources. Families can adjust and adapt by avoiding certain situations, accepting the reality of their circumstances and exploring alternative ways of coping. A sustainable support system, including social networks, is essential for meeting basic needs and ensuring safety.

Forgetting to Take Medication, Treatment Adherence and Their Relationship with Viral Load Suppression Among People Living with HIV in the Kilimanjaro Region, Tanzania.

Antiretroviral therapy (ART) adherence is crucial for virological suppression and positive treatment outcomes among people living with HIV (PLHIV), but remains a challenge in ensuring patients achieve and sustain viral load suppression. Despite the recommended use of digital tools medications uptake reminders, the contribution of forgetting to take medication is unknown. This study investigated the contribution of forgetting to take medication on the total missed medication and its effects on detectable viral load (VL). This mixed-method research was conducted among children, adolescents, pregnant, and breastfeeding women living with HIV on ART in northern Tanzania. Forgetting to take medication constituted reporting to have missed medication due to forgetfulness. A multivariable logistic regression model was used to estimate the adjusted odds ratio (AOR) with a 95% confidence interval (CI) to determine the contribution of forgetting medication intakes on total missed medication and other factors associated with having a detectable VL. Of 427 respondents, 33.3% were children, 33.4% adolescents, and 33.3% pregnant and breastfeeding women, whose median age (interquartile range) was 9 (7-12), 18 (16-18), and 31 (27-36) years, respectively. Ninety-two (22.3%) reported missing medication over the past month, of which 72 (17.9%) was due to forgetting. Forgetting to take medication (AOR: 1.75 95% CI: 1.01-3.06) and being on second-line regimen (AOR: 2.89 95% CI: 1.50-5.55) increased the chances of a detectable VL, while females had lower chances of detectable VL (AOR: 0.62 95% CI: 0.41-0.98). The themes on the reasons for forgetting to take medication from qualitative results included being busy with work and the importance of reminders. Forgetting to take medication is common among PLHIV and an important predictor of a detectable VL. This calls for the use of automated short message services (SMS) reminders or Digital Adherence Tools with reminders to improve and promote good ART adherence among PLHIV.

Mobile Phone-Based Confidential Social Network Referrals for HIV Testing (CONSORT): Protocol for a Randomized Controlled Trial.

Critical to efforts to end the HIV epidemic is the identification of persons living with HIV who have yet to be diagnosed and engaged in care. Expanded HIV testing outreach efforts need to be both efficient and ambitious, targeting the social networks of persons living with HIV and those at above-average risk of undiagnosed HIV infection. The ubiquity of mobile phones across many high HIV prevalence settings has created opportunities to leverage mobile health (mHealth) technologies to engage social networks for HIV testing outreach, prevention, and treatment. The purpose of this study is to evaluate the acceptability and efficacy of a novel mHealth intervention, "Confidential Social Network Referrals for HIV Testing (CONSORT)," to nudge at-risk individuals to test for HIV using SMS text messages. We will conduct the CONSORT study in Moshi, Tanzania, the commercial center and administrative capital of the Kilimanjaro Region in northern Tanzania. After qualitative formative work and pilot testing, we will enroll 400 clients presenting for HIV counseling and testing and 200 persons living with HIV and receiving care at HIV care and treatment centers as "inviters" into a randomized controlled trial. Eligible participants will be aged 18 years or older and live, work, or regularly receive care in Moshi. We will randomize inviters into 1 of 2 study arms. All inviters will be asked to complete a survey of their HIV testing and risk behaviors and to think of social network contacts who would benefit from HIV testing. They will then be asked to whom they would prefer to extend an HIV testing invitation in the form of a physical invitation card. Arm 1 participants will also be given the opportunity to extend CONSORT invitations in the form of automated confidential SMS text messages to any of their social network contacts or "invitees." Arm 2 participants will be offered physical invitation cards alone. The primary outcome will be counselor-documented uptake of HIV testing by invitees within 30 days of inviter enrollment. Secondary outcomes will include the acceptability of CONSORT among inviters, the number of new HIV diagnoses, and the HIV risk of invitees who present for testing. Enrollment in the randomized controlled trial is expected to start in September 2024. The findings will be disseminated to stakeholders and published in peer-reviewed journals. If CONSORT is acceptable and effective for increasing the uptake of HIV testing, given the minimal costs of SMS text reminders and the potential for exponential but targeted growth using chain referrals, it may shift current practices for HIV testing programs in the area. ClincalTrials.gov NCT05967208; https://clinicaltrials.gov/study/NCT05967208. PRR1-10.2196/55068.

Positional Effects of Bottle-Baited Traps in Reducing Infestation Level of Coffee Berry Borer Hypothenemus Hampei Ferrari in Kilimanjaro Region, Tanzania

Coffee berry borer (CBB) is among the key insect pests of coffee worldwide. The use of bottle-baited traps has been in practice in several coffee-growing areas including Tanzania. However, there is limited information about the influence of height and spacing of commonly used bottle-baited traps in managing CBB in coffee-growing areas in the country. Therefore, the objective of this research was to evaluate the effect of height where traps were placed (0.6, 1.2, and 1.6 m) on the reduction of infestation level of coffee berry borers at different developmental stages of coffee fruit (green and red fruit) under field conditions. The experiment followed a completely randomized block design with a factorial arrangement and four replications, three (lower, middle, and upper) levels of height and spacing were placed for 7 months. The number of captured CBB and damaged berries percentage was evaluated. The data were analyzed by R Software (2021) through an analysis of variance and means were separated by Turkey&amp;rsquo;s (0.05). A significant minimum berries damage (0.26%) as an implication of the lowest CBB infestation level was shown at the height of 0.6 m (for all stages of berries). On the other hand, at the red berries stage, the lowest damage (11.12%) was observed at the height of 1.6 m. Generally, this study deduced that the lower the height from which the traps are placed, the lower the infestation level of CBB hence reducing crop damage by the pest.