Kilimanjaro Region Research Articles

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.

Dietary Practices, Nutrient Adequacy, and Nutrition Status among Adolescents in Boarding High Schools in the Kilimanjaro Region, Tanzania.

A cross-sectional study was conducted to assess dietary practices, nutrient adequacy, and nutrition status among 164 adolescents aged between 16 and 19 years in boarding secondary schools in the Kilimanjaro region. In-depth interviews and a survey guided by a semistructured and structured questionnaire, including 24-hour recall and food frequency questionnaire techniques, were used to collect information. Nutrition status was assessed using anthropometric measurements and hemoglobin levels. WHO AnthroPlus software and NutriSurvey software were used to analyze anthropometry and dietary data, respectively. Diet in boarding schools was monotonous comprising mainly of cereal-legume meal with low intake of animal sources, fruits, and vegetables. Mean intake of energy, vitamin C, iron, calcium, and zinc was 1392 kcal, 24.8 mg, 9.2 mg, 134.5 mg, and 4.3 mg, respectively, which were below the Recommended Daily Allowance. The average carbohydrate, fat, and protein intake of 471.9 g, 73.7 g, and 80.7 g, respectively, were slightly higher than the Recommended Daily Allowance in both sexes. Male had a significantly higher intake of protein and carbohydrates (P < 0.001). Female had a significantly (P < 0.001) high intake of fat compared to male adolescents. Overall, 23.1% of the adolescents were anaemic, 25% were overweight, and 6.1% were obese. Boarding secondary schools' diet is monotonous and are inadequate in key micronutrients, iron, zinc, calcium, and vitamin C. There is a coexistence of undernutrition and overnutrition among adolescents in boarding schools. Therefore, monitoring adolescents' dietary intake and nutrition status is a key in preventing adolescents' malnutrition in the short term and diet-related diseases in the long term.

Pregnant Women Level of Satisfaction on Quality of Care in Reproductive and Child Health clinic at Huruma Designated District Hospital in Rombo District, Kilimanjaro Region, Tanzania.

Background:The clients' level of satisfaction is an important measure in assessing the quality of health care services provided in health facilities, and is important in enhancing the utilisation of health care services.Objectives:This study aimed to determine pregnant women's level of satisfaction on the quality of care in the Reproductive and Child Health (RCH) clinic at Huruma Designated District Hospital, Rombo Kilimanjaro.Methodology:A cross-sectional study was conducted from May to June 2018 using the Donabediean model. Using systematic sampling, 270 pregnant women were selected to participate in the study. Data was collected using a pre-tested Service Quality(SERVQUAL) questionnaire. Descriptive statistics were performed using univariate and bivariate analysis, and one sample t-test to compare mean gap scores. The principal component analysis was employed to identify key items that measure the quality of care. A p-value of <.05 was considered statistically significant.Results:Overall, pregnant women's level of satisfaction on the quality of care in the Reproductive and Child Health clinic at Huruma DDH was 48.5%. The overall mean gap score (±SD) for the level of satisfaction was -0.53 (±1.69) signifying dissatisfaction with the quality of care. The overall level of satisfaction was associated with level of education (p<.001), occupation (p=.003), residence (p=.035). The levels of dissatisfaction in the 5 service dimensions were: empathy (-0.05), responsiveness (-0.09), assurance (-0.10), tangible (-0.13), and reliability (-0.17).Conclusion:Overall, pregnant women were dissatisfied with the quality of care provided. Pregnant women who are educated, being employed, and residing in Rombo were more likely to report dissatisfied with the quality of care. To improve the quality of care, lack of adequate staff and inadequate knowledge of the staff at RCH, and improvement in staff-clients interactions, and keeping scheduled appointments need to be improved.

Negotiating social norms, the legacy of vertical health initiatives and contradicting health policies: a qualitative study of health professionals’ perceptions and attitudes of providing adolescent sexual and reproductive health care in Arusha and Kilimanjaro region, Tanzania

ABSTRACT Background Adolescents in Tanzania are at risk of many health problems attributed to limited access to quality sexual and reproductive health services. Health professionals are a crucial part of service delivery, and their perspective on providing care is important in understanding the barriers that hamper access to sexual and reproductive health services for adolescents. Better understanding these barriers will support the development of more effective interventions. This paper explores these perspectives in view of the health-policy context that surrounds them. Objective This study has aimed to explore and understand health professionals’ perceptions and attitudes regarding the provision of adolescent sexual and reproductive health care in a selected national sexual and reproductive health programme in the Arusha region and Kilimanjaro region, Tanzania. Methods A qualitative cross-sectional interview design was applied. Sixteen in-depth interviews were conducted with health professionals and community health workers. Data was analysed following inductive thematic analysis. Results Four main themes are identified in the data: concern about the stigma directed towards adolescents; over-medicalisation of services; difficulty involving adolescent males; and ambiguous policies and contradictory messages. The findings suggest that health professionals providing care in the current adolescent sexual and reproductive health programme must navigate the legacy of vertical health programmes as well as contradicting views and messages that are influenced by social norms, by uncertainties about current laws and by statements from political leaders. Conclusions The findings suggest that future research, policies and health programmes should consider the perspectives of health professionals and their challenges in delivering care for adolescents to help improve the understanding of how to effectively and sensitively implement sexual and reproductive health programmes for adolescents.

"If You Have No Money, You Might Die": A Qualitative Study of Sociocultural and Health System Barriers to Care for Decedent Febrile Inpatients in Northern Tanzania.

Infectious diseases are a leading cause of mortality in low- and middle-income countries (LMICs) despite effective treatments. To study the sociocultural and health system barriers to care, we conducted a qualitative social autopsy study of patients who died from febrile illness in northern Tanzania. From December 2016 through July 2017, we conducted in-depth interviews in Arusha and Kilimanjaro regions with a purposive sample of 20 family members of patients who had died at two regional referral hospitals. Of the deceased patients included in this study, 14 (70%) were adults and 10 (50%) were female. Patients identified their religion as Catholic (12, 60%), Lutheran (six, 30%), and Muslim (two, 10%), and their ethnicity as Chagga (14, 70%) and Sambaa (two, 10%), among others. Family members reported both barriers to and facilitators of receiving health care. Barriers included a perceived lack of capacity of local health facilities, transportation barriers, and a lack of formal referrals to higher levels of care. Family members also reported the cost of health care as a barrier. However, one facilitator of care was access to financial resources via families' social networks-a phenomenon we refer to as social capital. Another facilitator of care was families' proactive engagement with the health system. Our results suggest that further investment in lower level health facilities may improve care-seeking and referral patterns and that future research into the role of social capital is needed to fully understand the effect of socioeconomic factors on healthcare utilization in LMICs.

Predictors of perinatal death in the presence of missing data: A birth registry-based study in northern Tanzania.

More than five million perinatal deaths occur each year globally. Despite efforts put forward during the millennium development goals era, perinatal deaths continue to increase relative to under-five deaths, especially in low- and middle-income countries. This study aimed to determine predictors of perinatal death in the presence of missing data using birth registry data from Kilimanjaro Christian Medical Center (KCMC), between 2000-2015. This was a retrospective cohort study from the medical birth registry at KCMC referral hospital located in Moshi Municipality, Kilimanjaro region, northern Tanzania. Data were analyzed using Stata version 15.1. Multiple imputation by fully conditional specification (FCS) was used to impute missing values. Generalized estimating equations (GEE) were used to determine the marginal effects of covariates on perinatal death using a log link mean model with robust standard errors. An exchangeable correlation structure was used to account for the dependence of observations within mothers. Among 50,487 deliveries recorded in the KCMC medical birth registry between 2000-2015, 4.2% (95%CI 4.0%, 4.3%) ended in perinatal death (equivalent to a perinatal mortality rate (PMR) of 41.6 (95%CI 39.9, 43.3) deaths per 1,000 births). After the imputation of missing values, the proportion of perinatal death remained relatively the same. The risk of perinatal death was significantly higher among deliveries from mothers who resided in rural compared to urban areas (RR = 1.241, 95%CI 1.137, 1.355), with primary education level (RR = 1.201, 95%CI 1.083, 1.332) compared to higher education level, with <4 compared to ≥4 antenatal care (ANC) visits (RR = 1.250, 95%CI 1.146, 1.365), with postpartum hemorrhage (PPH) (RR = 2.638, 95%CI 1.997, 3.486), abruption placenta (RR = 4.218, 95%CI 3.438, 5.175), delivered a low birth weight baby (LBW) (RR = 4.210, 95%CI 3.788, 4.679), male child (RR = 1.090, 95%CI 1.007, 1.181), and were referred for delivery (RR = 2.108, 95%CI 1.919, 2.317). On the other hand, deliveries from mothers who experienced premature rupture of the membranes (PROM) (RR = 0.411, 95%CI 0.283, 0.598) and delivered through cesarean section (CS) (RR = 0.662, 95%CI 0.604, 0.724) had a lower risk of perinatal death. Perinatal mortality in this cohort is higher than the national estimate. Higher risk of perinatal death was associated with low maternal education level, rural residence, <4 ANC visits, PPH, abruption placenta, LBW delivery, child's sex, and being referred for delivery. Ignoring missing values in the analysis of adverse pregnancy outcomes produces biased covariate coefficients and standard errors. Close clinical follow-up of women at high risk of experiencing perinatal death, particularly during ANC visits and delivery, is of high importance to increase perinatal survival.

Micronutrients Potential of Underutilized Vegetables and Their Role in Fighting Hidden Hunger.

Background Innumerable underutilized vegetable (UV) species have been utilized as food and as folklore medicine since time immemorial. Such vegetables have been part and parcel of the food dishes, especially to the ancient rural and periurban dwellers. However, researchers and agricultural scientists have given little or no attention to such vegetables, as to what constitutes their potentials in curbing hidden hunger. To achieve the global Sustainable Development Goals, Tanzania needs to address the issue of food insecurity through the use of not only grains, fruits, and edible insects but also through embracing the UVs. The overall objective of this study was to screen the indigenous vegetables with nutritional and health claims from communities in Kilimanjaro and Morogoro regions. Methods Quantitative data were obtained by conducting laboratory nutrient and antinutrients composition analyses as per standard Association of Official Analytical Chemists (AOAC) methods. This was carried out to determine the moisture content, micronutrient, and antinutrients composition of the selected UVs. Results The nutritional and medicinal claims of the selected UVs mentioned during interviews were validated by data obtained from laboratory nutrient and antinutrients composition analyses. Chemical analyses revealed that vitamin A, B1, B2, B3, and C contents ranged from 2.50-6.67, 18.94-182.95, 0.18-0.76, 0.09-0.43, and 46.52-198.08 mg/100 g, respectively. Minerals, on the other hand, Ca, Fe, Mg, and Zn contents ranged from 60.28-421.03, 4.28-21.05, 191.12-1151.91, and 4.28-21.10 mg/100, respectively. Moisture content, oxalates, and phytates contents ranged from 78.59-95.49%, 1.28-3.15, and 1.64-6.18 mg/100 g, respectively. Conclusion The findings from the study added credence to the selected UVs that they are rich sources of micronutrients and crucial in daily human diet to curb hidden hunger.

Colorectal Cancer in Northern Tanzania: Increasing Trends and Late Presentation Present Major Challenges.

PURPOSEA trend of increasing incidence of colorectal cancer (CRC) has been observed in northern Tanzania. Studies have shown a six-fold increase in CRC in the past decade, with 90% of patients presenting in late stages, with resultant high morbidity and mortality rates. In this study, we aimed to document the burden of CRC in the northern zone of Tanzania from 1998 to 2018, focusing on patient presentation, clinical features, and treatment at a tertiary hospital.METHODSPathological and clinical records for all patients from 1998 to 2018 were identified and reviewed. Records of patients whose CRC was diagnosed histologically were retrospectively reviewed.RESULTSApproximately 313 CRC cases were documented. The majority age group (29.1%) was between 50 and 64 years (mean [standard deviation], 54.28 [16.75] years). However, together, the age groups of patients younger than 50 years was 41.5% (n = 130). Of 174 patients with complete records, most (29.3%) were between 35 and 49 years of age. The median age was 52 (interquartile range, 40-67) years. Men accounted for 62.1% of patients and were mostly from the Kilimanjaro region. More than half (54.7%) presented > 3 months after symptom debut; 62.6% first sought care at lower-level health facilities. Most (64.9%) presented as emergencies, necessitating colostomy for fecal diversion as the initial surgical procedure in 60.3% of patients. Colonoscopy was performed for 38.6% of the study participants. Most tumors (72.7%) originated from the sigmoid and rectum. Adenocarcinoma was the most prevalent histologic type.CONCLUSIONHigh proportions of young individuals with CRC pose great concern and a need for further appraisal. Furthermore, late emergency presentation and low colonoscopy rates highlights underlying system challenges and need for education campaigns.

Inadequate pollination services limit watermelon yields in northern Tanzania

Insect pollination plays a vital role for the yield of many crops, such as apples, strawberries and coffee, which are economically significant commodities on the global market. Yet, knowledge about the role of insect pollination is lacking for many cash crops that support the livelihoods of small-scale farmers in developing countries.To assess if yields of watermelon are pollen limited, we conducted a supplemental hand-pollinated experiment (using a pollen mixture of cross and self-pollen) in 13 small-scale farms in an agricultural landscape in the Kilimanjaro and Arusha regions in northern Tanzania. We assessed fruit set, fruit abortion and weight of the mature fruits stemming from hand pollinated and control flowers. To check if differences in yield responses between hand-pollinated and control treatments depended on resource availability, we also accounted for local soil conditions.We found that hand pollination (i) increased the probability of fruit initiation by 30%, (ii) reduced the probability of fruit abortion by 13%, (iii) increased the probability of flowers developing into mature fruits by 42% and (iv) increased average fruit weight by 1.3 kg (±0.15 SE). Our results indicate that our system is pollen limited, due to insufficient visitor frequency and/or inefficient pollinator species.Fruit initiation and fruit weight were positively related to soil carbon, irrespective of treatment. The influence of soil moisture was not consistent across the measured responses, and differed between hand-pollinated and the control treatments.We suggest that farmers in our focal area should focus on improving the quality of the landscape to sustain and enhance healthy pollinator communities ultimately improving yields. We also suggest that farmers should continue current practices with respect to fertilization. The role of soil moisture on fruit initiation and maturation should be investigated to ensure that the positive effects of pollen is not hindered by soil moisture conditions.

Nursing Student’s Perceptions on Formative Assessment Procedures and its Effects on Midwifery Module Performance: A Cross-Sectional Study among Diploma Nursing Students in Tanzania

Background: The issue of low performance among student nurses is still a challenge in theoretical and clinical practice, insufficient use of formative assessment is among the contribution factors. Objective: Assessment of nursing students’ perceptions on formative assessment procedures and its effect on midwifery subject performance. Method: A Cross-sectional study of 430, third year Diploma Nursing Students’ from seven nursing schools was conducted in Kilimanjaro, Dodoma, and Morogoro regions. The approach was quantitative and a sample size was calculated and obtained using simple random sampling technique. Students’ perception was measured by 18 questions from the tool adopted and modified from Vaessen(1), performance of students was reviewed and recorded using NACTE form No. 3. Descriptive and Principal Component Analysis used to analyze data of this study. Results: Out of 430 respondents of this study, 221 (51.4%) had positive perception on formative assessment procedures. Also out of 430 respondents, 226(53%) had high performance in midwifery II module with the mean score of 69.85%. Moreover, the association between students perception and performance on midwifery module was not statistically significant(X2 = 0.027, p= 0.870) Conclusion: Majority of students’ reported positive perception on formative assessment; however, there were no association between perception and actual midwifery module performance, yet, students with positive perception performed high than those with negative perception.

Understanding the Rural–Rural Migration of Health Workers in Two Selected Districts of Tanzania

Globally, rural–urban migration has been the focus in addressing the question of availability of health workers in rural areas. Often, the rural–rural migration of health workers, another important dimension is neglected. This study aimed to analyze the magnitude and the underlying factors for rural–rural migration of health workers in two rural districts of Tanzania. An exploratory comparative cross-sectional study adopting both quantitative and qualitative approaches was carried out in two districts of Kilwa in Lindi region, southern Tanzania, and Rombo in Kilimanjaro region, northern Tanzania. In a quantitative approach, 174 health workers (both clinicians and nonclinicians) filled in a self-administered questionnaire between August 2015 and September 2016. For the qualitative sub-study, 14 key informants that included health facilities in-charges and district health managers from the two districts were interviewed. In addition, three focus group discussions were conducted with members of the health facilities committee, in the two districts. Over 40% of health workers migrated from one workstation to another between 2011 and 2015. Close to 70% of the migrated health workers, migrated within the same districts. The proportion of health workers migrated was higher in Kilwa compared to Rombo. However, the difference was not statistically significant. The major underlying factors for migration in both districts were: Caring for the family and Unfavorable working and living conditions. In Kilwa, unlike Rombo, rejection by the community, superstitious beliefs, and lack of social services, were the other major factors underlying migration of the health workers. While addressing rural–urban migration, attention should be paid also to the rural–rural migration of health workers. Lastly, addressing the migration of health workers is a multi-dimensional issue that needs the engagement of all stakeholders within and beyond the health sector.

Atmospheric moisture pathways of East Africa and implications for water recycling at Mount Kilimanjaro

AbstractThe Mt. Kilimanjaro ecosystem depends on atmospheric moisture transport and recycling of water, yet limited knowledge on the relation between advective moisture pathways and local water recycling is available. This study uses a regional atmospheric model to analyse moisture source and sink processes as well as precipitation recycling at Mt. Kilimanjaro. The results indicate that locally produced precipitation is deposited mainly in June and July while trans‐regional effects are weak. Results also revealed the importance of tropical storm systems for local convection in the Kilimanjaro region and the effect of the Indian Ocean Zonal Mode phases on East African moisture pathways. The analysis further revealed connections between the Madagascar tip jet and the Turkana jet with implications for regional moisture pathways that have not been described before.

Knowledge gaps among smallholder farmers hinder adoption of conservation biological control

ABSTRACTConservation biological control uses habitat management to enhance the survival and impact of arthropod natural enemies for pest control. Its advantages are that it relies on native or established invertebrate populations that are adapted to local agricultural ecosystems and conditions. We surveyed 300 farmers in three agro-ecological zones of Kilimanjaro Region, Tanzania to assess farmers’ knowledge of natural enemies, insect pests and pesticide use and ways of accessing agricultural information to identify hurdles to the adoption of conservation biological control measures. Data were collected through face to face interviews using questionnaires and pictures and by using a novel voice-response mobile phone survey. The farmers surveyed regarded almost all insects as pests, with data analyses revealing that 98.7% of farmers were completely unaware of natural enemies. After completing a short training course, however, awareness was transformed, with 80% of farmers recognising beneficial insects and expressing an intention to change farming practices to enhance their survival within the crop. Access to information about synthetic pesticide alternatives was a limiting factor to uptake of biological control measures with 8.7% of farmers reporting no access to agricultural information, while others were mostly dependent on agricultural officers. These findings identified a severe lack of knowledge among smallholder farmers about beneficial insects which will impact adoption of conservation biological control. We recommend improved access to information and knowledge among the technical officers and the smallholder farmers with direct training on agro-ecological intensification for wider adoption of conservation biological control.

Community engagement in COVID-19 prevention: experiences from Kilimanjaro region, Northern Tanzania

Prevention of exposure to the COVID-19 virus in the general population is an essential strategy to slow community transmission. This paper shares the experiences and challenges of community engagement in COVID-19 prevention in the Kilimanjaro region, Northern Tanzania implemented by our team from the Institute of Public Health (IPH), Kilimanjaro Christian Medical University College (KCMUCo) in collaboration with the COVID-19 response team in the Moshi Municipality. We conducted an education session with the COVID-19 response team and together brainstormed transmission hotspots and which interventions would be most feasible in their settings. The first hotspot identified was crowded local market spaces. Suggested interventions included targeted and mass public health education through the engagement of market opinion leaders, public announcements, and radio shows. We conducted participatory rural appraisal techniques to enable market vendors and clients to visualize two-meter distances and provided a prototype hand-washing facility that was foot operated. We found mass public health educational campaigns essential to inform and update the public about COVID-19 pandemic and to address rumors and misinformation, which hampers compliance with public health interventions. Coordinated efforts among stakeholders in the country are necessary to develop context-specific prevention and case management strategies following the national and international guidelines. Local ownership of recommended interventions is necessary to ensure compliance.

Plant-parasitic nematodes associated with sugarcane in Kilimanjaro, Tanzania.

Morphological and molecular analyses of plant-parasitic nematodes (PPN) from 12 sugarcane plantation sites of Tanganyika Planting Company (TPC) Limited in Kilimanjaro region of Tanzania revealed the presence of six PPN genera, i.e. Helicotylenchus, Hemicycliophora, Pratylenchus, Rotylenchulus, Scutellonema, and Tylenchorhynchus. The genera with the highest densities and present in virtually all samples were Pratylenchus and Rotylenchulus, and the most important species appeared to be R. parvus, P. zeae, T. crassicaudatus, and T. ventrosignatus. A total sequences of 11 partial ITS, 15 D2-D3 of 28S, and 6 partial 18S of rRNA gene, and 7 partial COI gene of mtDNA of these species were obtained in this study. Morphology and molecular data comparisons between the Tanzanian R. parvus and the South African R. parvus indicated that R. parvus is a cryptic species complex. Based on the results of morphological and molecular analyses of T. crassicaudatus and T. agri from China, Haiti, Indonesia, Iran, Niger and the USA, T. agri syn. n. is proposed as a junior synonym of T. crassicaudatus.

Prevalence of hearing impairment among primary school children in the Kilimanjaro region within Tanzania

IntroductionHearing impairment is becoming a public health concern and a widespread problem. The World Health Organization estimates that globally there are about 466 million people with hearing impairment, of which 34 million represent children. We examined the prevalence and etiology of hearing impairment among primary school children in the Kilimanjaro region within Tanzania. MethodA cross-sectional study of primary school children aged 6–17 was conducted to determine the prevalence of hearing impairment. Tanzanian primary school children were screened for hearing loss and an otoscopy was performed on those who failed the screening. ResultsThere were 403 children screened from three schools in rural areas of Tanzania. The prevalence of hearing loss was found to be 7.1%, 10.8% and 16.7% in the different schools. Cerumen was proven to be the most common possible cause of hearing impairment. Other possible causes of hearing impairment were found to be (in descending order) otitis (all types), no abnormalities, and perforation of the tympanic membrane. ConclusionsThese results show a need for better identification of hearing impairment in school-going children and implementation of prevention and treatment options in Tanzania and other developing countries. This can further improve children's potential for language development, communication and academic achievement.

Risk factors of low back pain and the relationship with sagittal vertebral alignment in Tanzania

BackgroundLBP is a common and serious problem affecting vast populations of the world. However, only few studies on LBP in sub-Saharan Africa have been conducted. Studies report that LBP and pelvic angle are interrelated, and African residents have a high pelvic tilt. The strategy to prevent LBP should focus on activities that promote holistic health. For that purpose, it is important to grasp the state of LBP and how it affects people’s lifestyle in Tanzania to clarify the direction of implementation of physiotherapy treatment and reduce the incidences of LBP among adults. This study aimed to investigate the prevalence and presentation of low back pain (LBP) and the relationship between anthropometric measurements and LBP among people in Moshi city, Kilimanjaro region Tanzania.MethodsFollowing signing consent forms, participants were given questionnaires regarding LBP and then grouped accordingly into either asymptomatic or symptomatic cohorts. Anthropometric measurements of participants’ height, weight, curvature of the spine, and pelvic angle were obtained.ResultsA Mann-Whitney U test analysis showed a significant difference in pelvic angle, body mass index (BMI), and thoracic kyphosis angle between the asymptomatic group and the symptomatic group. No significant differences in lumbar lordosis angle or abdominal muscle strength were found between the two groups.ConclusionsA person with symptomatic LBP in Tanzania has a large anteversion of the pelvic tilt and a thoracic kyphotic posture. This study shows a relationship between sagittal spinal alignment and LBP in Tanzania, which could allow for prospective identification of subjects prone to developing LBP in the future.

Distance Education as a Strategy towards Employee Skills Development: A Case Study of Kilimanjaro Region

Education is a vital element in the process of innovation and development of: organizations, governments and societies. The need for the employee to develop: skills, knowledge, experiences and competence necessitates that they become innovative towards learning. Distance education is a flexible strategy through which the employee could use to learn in order to meet the changing demands of the workplace. Research questions: what factors influence the uptake of distance education as an innovative learning strategy among employees? To what extent is distance education implemented to develop employees? What is the perception of employees towards distance education as an innovative strategy towards skills development? Research hypotheses: there is a significant difference in the mean perception of workers on the skills development of workers in distance education by gender. The study used a quantitative research approach and the design was correlational survey. The study covered two universities in Kilimanjaro. Data collection was done using: questionnaires and interview schedules. The findings were analysed through frequencies, percentages, means and T-test for the hypotheses. The study found out that: employees had equal opportunity to pursue their career development through distance education and distance education increases competency, improves employee skills and work experience. Also, most employees were involved in distance education however many employees did not receive support for their education from employers. Therefore, the study concluded that distance education has influence on employee development.

Evaluation of Prescriptions Dispensed in the Outpatient Pharmacies of a University Teaching Hospital in Moshi, Kilimanjaro Region, Tanzania: A Cross-Sectional Study

Background: Prescriptions written in daily medical practice are associated with increasing numbers of prescription writing errors. Both omission and commission errors are encountered and caused by prescribers of different cadres. Prescribing errors are associated with adverse drug events (ADEs), which are harmful to patients. This study aimed to determine the common prescription errors, the categories of prescribers who commit prescription errors, and the most prescribed drugs in the outpatient pharmacies in general practice at Kilimanjaro Christian Medical Centre (KCMC). Methods: A prospective cross-sectional descriptive study was conducted at KCMC, a referral and teaching university hospital. All prescription dispensed on 2 June 2017 from the hospital's 2 outpatient pharmacies were reviewed, and our analysis determined the different types of prescription errors. A form designed by the authors was used to collect data from the prescription forms. Results: A total of 242 prescriptions were studied, and the most common omission errors were missing patients' weight (n=231, 95.5%), missing patients' address (n=213, 88.0%), missing drug dosage (n=159, 67.1%), and commission errors were due to wrong drug strength (n=10, 2.0%). Intern doctors were leading in writing prescriptions with errors (n=352, 25.6%), followed by residents (n=199, 14.5%), registrar doctors (n=167, 12.1%), and specialists (n=45, 3.3%). The most commonly prescribed drugs were antibiotics (n=120, 17.3%), antihypertensives (n=81, 11.7%), and analgesics (n=86, 12.4%). Conclusion: There were significant prescription errors at the study site, hence an intervention is needed to improve skills of prescribers. Educational interventions can substantially contribute to minimising such errors. Initaiting programmes and short courses on prescription writing before medical internship at the health facility might also be helpful.