Kilimanjaro Region Research Articles

HIV viral suppression and risk of viral rebound in patients on antiretroviral therapy: a two- year retrospective cohort study in Northern Tanzania

BackgroundThe world is moving towards the third target of the Joint United Nations Programme on HIV/AIDS to ensure most people receiving antiretroviral therapy (ART) are virologically suppressed. Little is known about viral suppression at an undetectable level and the risk of viral rebound phenomenon in sub-Saharan Africa which covers 67% of the global HIV burden.This study aimed to investigate the proportion of viral suppression at an undetectable level and the risk of viral rebound among people living with HIV receiving ART in northern Tanzania.MethodologyA hospital based-retrospective study recruited people living with HIV who were on ART for at least two years at Kibong’oto Infectious Disease Hospital and Mawenzi Regional Referral Hospital in Kilimanjaro Region, Tanzania. Participants’ two-year plasma HIV were captured at months 6, 12, and 24 of ART. Undetectable viral load was defined by plasma HIV of viral load (VL) less than 20copies/ml and viral rebound (VR) was considered to anyone having VL of more than 50 copies/ml after having history of undetectable level of the VL less than 20copies/ml. A multivariable log-binomial generalized linear model was used to determine factors for undetectable VL and viral VR.ResultsAmong 416 PLHIV recruited, 226 (54.3%) were female. The mean (standard deviation) age was 43.7 (13.3) years. The overall proportion of undetectable VL was 68% (95% CI: 63.3–72.3) and 40.0% had viral rebound (95% CI: 34.7–45.6). Participants who had at least 3 clinic visits were 1.3 times more likely to have undetectable VL compared to those who had 1 to 2 clinic visits in a year (p = 0.029). Similarly, participants with many clinical visits ( > = 3 visits) per year were less likely to have VR compared to those with fewer visits ( = 2 visits) [adjusted relative risk (aRR) = 0.64; 95% CI: 0.44–0.93].ConclusionParticipants who had fewer clinic visits per year(ART refills) were less likely to achieve viral suppression and more likely to experience viral rebound. Enhanced health education and close follow-up of PLHIV on antiretroviral therapy are crucial to reinforce adherence and maintain an undetectable viral load.

A simple, collaborative prioritization process for wildlife-associated zoonotic diseases in northern Tanzania

Background and Aim: Zoonotic diseases are naturally transmissible infections between animals and humans. To address these cross-sectoral health issues holistic, transdisciplinary health approaches are required. The legalization of the game meat trade in Tanzania in 2020 has created a new value chain from wild habitats to registered game meat selling facilities in human settlements, thus creating new human–animal interfaces associated with potential risks of zoonotic disease transmission among wildlife, livestock, and human populations. This study aimed to apply a simple, collaborative prioritization process to identify important zoonotic pathogens associated with wild animal taxa harvested and traded for game meat consumption in northern Tanzania. Materials and Methods: A prioritization process was conducted to identify and rank zoonotic diseases associated with wildlife in the Arusha, Kilimanjaro, and Manyara regions of northern Tanzania to help determine the zoonotic disease risks associated with the game meat value chain. Two districts from each region were selected for this study. The prioritization process was conducted through an expert workshop that involved 41 participants, including a District Veterinary Officer, Public Health Officer, and District Game Officer from each district, as well as national One Health focal persons, zonal Veterinary and Laboratory Officers, scientific researchers, and a representative from the national Game Meat Selling Advisory Committee. Results: Experts identified 11 common zoonotic diseases reported in these regions, of which anthrax, rabies, brucellosis, Rift Valley fever, and bovine tuberculosis were considered the most important. This finding is broadly consistent with the national priority list for zoonotic diseases. Conclusion: This approach was time-efficient and cost-effective. In Tanzania, multi-sectoral planning, communication, and cooperation among human health, domestic animal health, wildlife health, and environmental protection have been strengthened. In the future, we recommend regular exercises using such an approach to update the information on important diseases and promote information sharing for epidemic and pandemic preparedness associated with the wild animal trade. Keywords: epidemic and pandemic, expert opinion, game meat, one health, wildlife, zoonoses.

Growth and Fruit morphometric characteristics of local avocado germplasm (Persea americana Mill.) grown in northern Tanzania

Tanzania has a diverse agroecological area suitable for growing tropical fruits, including avocados. In Northern Tanzania, avocados have been growing under variable soil and altitudinal characteristics for over 100 years, allowing the naturalisation of this crop in this region. However, the region's avocado germplasm is uncharacterised, thus impeding the selection of elite genotypes for increased value and breeding programmes. This study examined the growth and fruit morphometric characteristics of avocado populations grown under variable soil pH and altitude in six districts in the Tanga, Kilimanjaro and Arusha regions. Variations in growth and fruit morphometric characteristics were compared using a one-way analysis of variance (ANOVA). Pearson product-moment correlations (r) were used to evaluate the relationship between studied growth and fruit morphometric traits. A linear mixed-effects model (LMM) was used to assess the influence of the soil pH, altitude, tree height, canopy diameter, and trunk diameter on fruit length, fruit diameter, pulp thickness, and seed diameter. Principal Component Analysis (PCA) was used to depict the extent of the racial admixtures in the avocado germplasm in the Northern regions of Tanzania. The results revealed a significant variation in growth and fruit morphometric characteristics (p < 0.05). The Korogwe population had the highest tree height, while the Karatu had the lowest. Tree height was positively correlated with the trunk diameter (r = 0.63, p < 0.001. There was a positive correlation between fruit length and pulp thickness (r = 0.51, p < 0.001), fruit diameter and pulp thickness (r = 0.47, p < 0.001), and fruit length and fruit diameter (r = 0.36, p < 0.001). The fruit diameter was positively correlated with the seed diameter (r = 0.61, p < 0.001). There was a significant but weak association between fruit length and trunk diameter (−0.01), fruit length and canopy diameter (0.15), and between seed diameter and tree height (2.95e-2). These findings highlight the influence of individual tree genetic makeup on the variation in growth and fruit morphometric characteristics. The morphometric trait correlations may prove valuable in field measurements, especially when resources are limited. The study further indicates the presence of all avocado races within the local germplasm, highlighting its high diversity. Remarkably, the observed admixture of variant races implies gene flow among studied avocado populations, possibly facilitated by sharing seedlings among farmers or seed disposal through avocado fruit trading. Further study is needed, particularly in quantifying the above-ground biomass of local avocados in northern Tanzania, potentially contributing to carbon credit initiatives for fruit crops..

HIV-related Shame among Women Giving Birth in Tanzania: A Mixed Methods Study.

Women living with HIV (WLHIV) commonly experience HIV-related shame which can interfere with HIV care-seeking behavior and lead to poor clinical outcomes. HIV-related shame may be particularly heightened during the pregnancy and postpartum periods. This study aimed to describe HIV-related shame among WLHIV giving birth, identify associated factors, and qualitatively examine the impacts of HIV-related shame on the childbirth experience. Postpartum WLHIV (n = 103) were enrolled in the study between March and July 2022 at six clinics in the Kilimanjaro Region, Tanzania. Participants completed a survey within 48h after birth, prior to being discharged. The survey included a 13-item measure of HIV-related shame, which assessed levels of HIV-related shame(Range: 0-52). Univariable and multivariable regression models examined factors associated with HIV-related shame. Qualitative in-depth interviews were conducted with pregnant WLHIV (n = 12) and postpartum WLHIV (n = 12). Thematic analysis, including memo writing, coding, and synthesis, was employed to analyze the qualitative data. The survey sample had a mean age of 29.1 (SD = 5.7), and 52% were diagnosed with HIV during the current pregnancy. Nearly all participants (98%) endorsed at least one item reflecting HIV-related shame, with an average endorsement of 9 items (IQR = 6). In the final multivariable model, HIV-related shame was significantly associated with being Muslim vs. Christian (ß = 6.80; 95%CI: 1.51, 12.09), attending less than four antenatal care appointments (ß = 5.30; 95%CI: 0.04, 10.55), and reporting experiences of HIV stigma in the health system (ß = 0.69; 95%CI: 0.27, 1.12). Qualitative discussions revealed three key themes regarding the impact of HIV-related shame on the childbirth experience: reluctance to disclose HIV status, suboptimal adherence to care, and the influence on social support networks. WLHIV giving birth experience high rates of HIV-related shame, and social determinants may contribute to feelings of shame. HIV-related shame impacts the childbirth experience for WLHIV, making the labor and delivery setting an important site for intervention and support.The study is funded by the National Institutes of Health (R21 TW012001) and is registered on clinicaltrials.gov (NCT05271903).

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.

Factors Hindering Primary School Pupils to Report Incidences of Physical and Sexual Violence in Tanzania

The issue of pupils' reluctance to report incidences of physical and sexual violence poses a significant difficulty in Tanzania, resulting in adverse consequences such as bodily harm, psychological distress, behavioural problems, and academic progress for the victims. Despite these challenges, primary school pupils are reluctant to report incidences of physical and sexual violence. This study, therefore, explores factors that hinder primary school pupils to report incidences of physical and sexual violence, a case of Moshi district, in Kilimanjaro region, Tanzania. This study employed a mixed approach whereby interviews and questionnaires were used as data collection tools. Random sampling technique was utilized to select 92 students from three primary schools as the study's sample unit, while a purposeful sampling technique was employed to select 12 key informants (6 teachers and 6 parents) from the total population. The findings have revealed that pupils failed to report physical and sexual incidences due to fear of perpetrators, lack of awareness on reporting channels and support services, and societal and cultural norms. The study suggests that efforts should be made to ensure the safety and protection of victims who decide to report violence, including providing legal support and confidentiality. In addition, schools and community at large should create a safe environment that will encourage students to feel comfortable reporting incidences of physical and sexual violence.

Challenges and opportunities for improving mental health care and preventing suicide among people living with HIV: Perspectives of mental health professionals in Tanzania.

People living with HIV (PLWH) experience unique stressors that contribute to emotional distress, and PLWH are more than twice as likely to die by suicide when compared to the general population. In countries like Tanzania, there is a relatively high burden of HIV but few resources to support mental health needs. To gain a better understanding of mental health challenges experienced by PLWH in northern Tanzania and identify opportunities for intervention, we interviewed 12 mental health professionals working in the Kilimanjaro region. Thematic analysis was used to explore drivers and impacts of emotional distress, community influences on mental health, and gaps and barriers to existing mental health care. Perspectives from mental health workers highlight the compounding effects of stress related to HIV status, family conflict, finances, and other social challenges, which can lead to poor HIV treatment outcomes and suicidal ideation. Cultural beliefs and stigma surrounding both mental health and HIV limit care-seeking behavior for mental health issues. Those who do seek care often encounter barriers related to poor mental health infrastructure, including a lack of providers, limited financial resources, and little integration into other health services. There is a clear need for investment in the mental health care system, as well as interventions to improve knowledge and perceptions of mental health and comprehensively address stressors. We describe feedback on a proposed telehealth counseling intervention integrated into routine HIV services, which shows strong potential to mitigate barriers to mental health treatment, reduce suicidal ideation, and support the wellbeing of PLWH.

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&amp;lt;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.

Dairy input agri-entrepreneurs’ practices and their effect on inputs market participation by smallholder farmers in Tanzania

Dairy productivity per cow remains lower than the production ability amid increasing population. Among major reasons for this is the lower uptake of improved dairy inputs by smallholder dairy farmers. We characterized dairy input providers' business practices using Latent class analysis (LCA) and determined the effect of these business practices on the uptake of inputs by smallholder dairy farmers in Tanga and Kilimanjaro regions using OLS. From LCA, Bayesian Information Criteria (BIC) revealed a 3-class model as the most parsimonious and best fit (2153.071). The latent class (LC) membership of the input/service entrepreneurs for classes I, II, and III was 37.6% (35), 9.7% (9), and 52.7% (49), respectively. Using item response probabilities, we classified class I, II and III as ‘High business activities and business promotional practices’, ‘Low business activities, medium business promotional activities’, and ‘Medium business activities, Low business promotional activities’. Extension services provision was significant across all the classes with probability values greater than 0.5. The OLS model revealed that LC I and II were significant at 1% while LC III was significant at 5%. Education level and Moshi Rural District were negatively significant. Technical training of input entrepreneurs and capacity building on bundling relevant information alongside inputs is necessary for knowledge sharing with farmers. Networking, collaborations, and alliances among input/service entrepreneurs and between entrepreneurs and dairy farmers should be fostered for adequacy in technical information sharing and connecting farmers to other input suppliers. There is need for entrepreneurs to invest in rural areas and improve information and input access by the farmers. The study explored private dairy entrepreneurs as alternative extension services providers as a business strategy to enhance uptake of improved inputs by smallholder farmers. This study is relevant in making workable decisions towards implementing programmes geared towards increasing the improved input uptake in developing countries.

High diversity of Salmonella spp. from children with diarrhea, food, and environmental sources in Kilimanjaro - Tanzania: one health approach.

Salmonella is one of the most frequent causes of diarrhea globally. This study used a One Health approach to identify Salmonella species in children admitted with diarrhea and tested samples from the cases' household environment to investigate their genetic similarity using whole genome sequencing. Surveillance of hospitalized diarrhea cases among children under 5 years was conducted in rural and urban Moshi Districts in the Kilimanjaro Region of Tanzania from July 2020 through November 2022. Household visits were conducted for every child case whose parent/caregiver provided consent. Stool samples, water, domestic animal feces, meat, and milk were collected and tested for Salmonella. Isolates were sequenced on the Illumina NextSeq platform. Multilocus Sequence Typing and phylogenetic analyses were performed to map the genetic relatedness of the isolates. Salmonella was isolated from 72 (6.0%) of 1,191 samples. The prevalence of Salmonella in children with diarrhea, domestic animal feces, food, and water was 2.6% (n = 8/306), 4.6% (n = 8/174), 4.2% (n = 16/382), and 17.3% (n = 39/225), respectively. Four (1.3%) of the 306 enrolled children had a Salmonella positive sample taken from their household. The common sequence types (STs) were ST1208, ST309, ST166, and ST473. Salmonella Newport was shared by a case and a raw milk sample taken from the same household. The study revealed a high diversity of Salmonella spp., however, we detected a Salmonella clone of ST1208 isolated at least from all types of samples. These findings contribute to understanding the epidemiology of Salmonella in the region and provide insight into potential control of foodborne diseases through a One Health approach.

Financial toxicity and acute injury in the Kilimanjaro region: An application of the Three Delays Model.

Trauma and injury present a significant global burden-one that is exacerbated in low- and middle-income settings like Tanzania. Our study aimed to describe the landscape of acute injury care and financial toxicity in the Kilimanjaro region by leveraging the Three Delays Model. This cross-sectional study used an ongoing injury registry and financial questionnaires collected at Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania from December 2022 until March 2023. Financial toxicity measures included catastrophic expenditure and impoverishment, in accordance with World Health Organization standards. Descriptive analysis was also performed. Most acute injury patients that presented to the KCMC Emergency Department experienced financial toxicity due to their out-of-pocket (OOP) hospital expenses (catastrophic health expenditure, CHE: 62.8%; impoverishment, IMP: 85.9%). Households within our same which experienced financial toxicity had more dependents (CHE: 18.4%; IMP: 17.9% with ≥6 dependents) and lower median monthly adult-equivalent incomes (CHE: 2.53 times smaller than non-CHE; IMP: 4.27 times smaller than non-IMP). Individuals experiencing financial toxicity also underwent more facility transfers with a higher surgical burden. Delay 1 (decision to seek care) and Delay 2 (reaching appropriate care facility) could be significant factors for those who will experience financial toxicity. In the Tanzanian healthcare system where national health insurance is present, systematic expansions are indicated to target those who are at higher risk for financial toxicity including those who live in rural areas, experience unemployment, and have many dependents.

Factors Associated with the Uptake of Human Papilloma Virus Vaccine Among Adolescent Girls Aged 14 Old in Hai District of Kilimanjaro Region in Northern Tanzania.

Human Papilloma Virus (HPV) vaccination is a key primary prevention method against cervical cancer which is given to young girls before onset of sexual activity. In Tanzania, cervical cancer is the most frequent occurring cancer among women and is the leading cause of cancer mortality. The HPV Vaccination programme was rolled-out in Tanzania in 2018 for adolescent girls aged 9-14 years to receive two doses at a six-months interval, with an annual vaccine uptake of 46.1%. In 2019, the uptake of the HPV vaccine was only 64%, whereas the national coverage target is 75%. This study aimed at assessing the determinants of HPV vaccination among adolescent girls in Hai district, Kilimanjaro region, northern Tanzania. A cross-sectional study was conducted from July 2020 to August 2020 among 14-year-old adolescent girls in four selected secondary schools, including two government-owned and two private-owned, within Hai district. Close-ended questionnaire interviews were conducted with the adolescent girls in the study and data analysis was done using IBM SPSS Statistics for Windows version 20.0 (IBM Corp, Armonk, NY, USA). Odds ratio was used to assess the association between several factors and HPV vaccination. A total of 301 adolescent girls aged 14 years consented to the study. HPV vaccination uptake was 65%. More than three-fifths (n=119, 60.7%) reported having received the two required doses. Knowledge of HPV (OR 5.68; 95% CI, 0.72 to 44.96; P=.01) and HPV vaccine (OR 20.11; 95% CI, 10.88 to 37.99); P =.01) contributed significantly to HPV vaccine uptake among the adolescent girls in the study. More than one-third (n=105, 34.9%,) of the participants, were not vaccinated, the main reasons adduced for not being vaccinated include lack of proper information about the HPV vaccine (60.0%), fear of side effects (14%) and parental refusal (11%). HPV vaccination uptake was 65%. Lack of proper information to both the children and parents about the safety of the vaccine hinders its uptake. More effort should be made for clear and comprehensible dissemination of information especially to the community stakeholders mainly parents, community and religious leaders, about cervical cancer and HPV vaccine in order to considerably increase vaccination coverage among adolescent girls. Likewise, involvement of healthcare workers and policymakers in educating people about cervical cancer prevention measures can ensure successful implementation of HPV vaccination. There is need to conduct an indepth qualitative study to explore further people's perceptions and attitudes towards HPV.

Estimating the prevalence and predictors of musculoskeletal disorders in Tanzania: a cross-sectional pilot study.

musculoskeletal (MSK) disorders account for approximately 20% of all years lived with disability worldwide however studies of MSK disorders in Africa are scarce. This pilot study aimed to estimate the community-based prevalence of MSK disorders, identify predictors, and assess the associated disability in a Tanzanian population. a cross-sectional study was conducted in one village in the Kilimanjaro region from March to June 2019. The Gait, Arms, Legs, Spine (GALS) or paediatric GALS (pGALS) examinations were used during household and school visits. Individuals positive in GALS/pGALS screening were assessed by the regional examination of the musculoskeletal system (REMS) and Modified Health Assessment Questionnaire (MHAQ). among the 1,172 individuals enrolled in households, 95 (8.1%, 95% CI: 6.6 - 9.8) showed signs of MSK disorders using the GALS/pGALS examination and 37 (3.2%, 95% CI: 2.2 - 4.3) using the REMS. Among 682 schools enrolled children, seven showed signs of MSK disorders using the GALS/pGALS examination (1.0%, 95% CI: 0.4 - 2.1) and three using the REMS (0.4%, 95% CI: 0.0 - 1.3). In the household-enrolled adult population, female gender and increasing age were associated with GALS and REMS-positive findings. Among GALS-positive adults, increasing age was associated with REMS-positive status and increasing MHAQ score. this Tanzanian study demonstrates a prevalence of MSK disorders and identifies predictors of MSK disorders comparable to those seen globally. These findings can inform the development of rheumatology services and interventions in Tanzania and the design of future investigations of the determinants of MSK disorders, and their impacts on health, livelihoods, and well-being.

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.

Effects of Organizational Values on Employee Job Performance at NSSF Kilimanjaro Region, Tanzania

Effects of Organizational Values on Employee Job Performance at NSSF Kilimanjaro Region, Tanzania

The Usage of social media in Creating Land Degradation Awareness in Rombo District, Kilimanjaro Region - Tanzania

The environment is the fundamental for all living things, and land conservation is of greater apprehension for the sustainable economic development. To attain higher level of land conservation there should be greater effort in creating awareness to people on land degradation conservation. The study aimed to find out the usage of social media in creating land degradation awareness. Specifically, the study intended to: find out the causes of land degradation, identify the status on the usage of social media for land degradation awareness, likely determine the type of social media frequently used for land degradation awareness. The field work covered Rombo district in the Kilimanjaro region Tanzania, where five administrative wards were scrutinized, to mention: Tarakea, Motamburu, Olele, Mahida, and Ngoyoni. Data was collected employing household survey and interview and analysed using descriptive and thematic analysis techniques. The results show that the usage of social media that can be used in creating land degradation awareness includes providing education through media for peoples to understand relationship between human activities and land quality, providing user-friendly tools for knowledge sharing, enabling users to create, edit and add online contents, engaging discussions through social media on environmental issues as well as reporting on land degradation. Further, social media can be used to create land degradation awareness to peoples in Rombo district by 59%. It was concluded that, public campaign program to enhance awareness on land degradation should be strengthened through the usage of social media for sustainable land usage.

Availability of English Textbooks on Influencing Teachers' Effectiveness in Community Secondary Schools in Rombo District, Tanzania

The study investigated the availability and influence of English textbooks on teaching and learning effectiveness in community secondary schools in Rombo District in Kilimanjaro region. The study was guided by the System Resource Theory on Organizational Effectiveness developed by Yutchman and Seashore (1967). A convergent parallel design involves a collection of both quantitative and qualitative data from 150 respondents, including 10 heads of schools, 20 English subject teachers, and 120 students, obtained through purposive and stratified random sampling techniques. Data were collected through questionnaires, interview schedules, and documentary reviews whose validity and reliability were established. Descriptive and inferential statistics were used to analyze quantitative data, which were summarized into frequency and percentage. The study found that the policy of student – English textbook policy ratio is implemented by different means, including encouraging teachers to use the available English textbooks, providing English textbooks in schools, giving homework to students, and improving the learning process in various ways, such as testing students after reading a passage, giving assignment, instruction and activities to students. The study concluded that, despite the shortage of English textbooks in community secondary schools, their existence brings effective learning and teaching in English language subjects. The study recommended that the government should provide enough English textbooks to the community secondary schools to ensure a good student-English textbooks ratio policy is achieved. Also, heads of schools should provide clinical supervision to teachers to exhaust English textbooks during the teaching process since some schools have textbooks that are not utilized effectively in teaching and learning activities.

Implementation bottlenecks of real time medication monitoring (evriMED) for improving adherence to anti-TB drugs among people with tuberculosis in Kilimanjaro, Tanzania

IntroductionDigital Adherence Tools (DATs), which include real-time medication monitoring and Short Message Service (SMS) reminders, have been reported to improve medication adherence among people with Tuberculosis (TB). Recently, in limited resource settings, DATs have been described as a promising tool to monitor patients’ medication behaviour. We aimed to determine implementation bottlenecks of real-time medication monitoring using the evriMED device. MethodWe conducted a research study using a mixed-methods approach, involving both people with TB s and directly observed treatment (DOT) providers who participated in the REMIND-TB trial and utilized the evriMED devices. EvriMED is a medication dispenser with internet connectivity that can send real-time SMS reminders. To gather data, we extracted reports from the Wisepill dashboard, specifically the client status report. This report documented the activity status of all devices, including communication and battery status. Additionally, we conducted in-depth interviews with people with TB and TB care providers who were involved in implementing the Remind TB trial in the Kilimanjaro region. These interviews were guided by the MIDI (Measurement Instrument for Determinants of Innovation), which helps identify the factors influencing the implementation of innovations such as evriMED. ResultsOut of the initial 281 participants who were given devices, 245 completed the 6-month follow-up period. The findings indicate that at month 6, most of the devices (49%) reported battery-related challenges. Additionally, forty devices (14%) had reported more than one incidence of losing communication. Through interviews with participants, we observed that evriMED was perceived as user-friendly, and the people with TB reported high satisfaction as the device facilitated improved medication intake. TB care providers also said that evriMED was a relevant tool to be used by the people with TB. However, during the in-depth interview certain implementation bottlenecks were identified, including network issues, limited training, and low technology knowledge among TB care providers, who found the procedure of using the evriMED to be time-consuming. ConclusionImplementation of evriMED was perceived as user-friendly and highly satisfactory by people with TB. Certain implementation bottlenecks were identified as potential barriers to the use of devices. These bottlenecks include network issues, limited training, battery-related challenges and low technological knowledge among TB care providers, which may have contributed to communication loss. Further research may be needed to address these limitations and develop effective strategies to facilitate the successful implementation of evriMED as a tool for improving medication intake among people with TB.

Bullying Behavior among Secondary School Students in Hai District, Kilimanjaro Region,Tanzania

The study assessed the extent to which bullying behavior exists among secondary school students in Hai District, Moshi Region-Tanzania. Mixed approaches, and convergent parallel design were applied in this study. Data were collected using questionnaires, interviews. The study collected data from the sample of one hundred and seventy-one (171) persons selected from 13,945 target population. The SPSS software package was used to examine quantitative data while qualitative data was analyzed using thematic analysis. The findings of the study show that, bullying behaviour exists in Secondary schools at Hai district. The study concludes that, the rate of bullying acts such as hitting, beating, stealing, senior students oppressing junior students, gossiping and spread rumours about others, use of insulting words, bad name-calling and excessive punishment were practiced by students in schools. It has impact to students‟ academic achievement and the whole life in general. The study recommended that policy makers should encourage the practice of effective control of bullying in schools by formulating anti-bullying policies to guide effectiveness in bullying management.