Months In Tanzania Research Articles

Cross-sectional analysis of risk factors associated with the coexistence of three undernutrition indicators among children aged 0–23 months in Tanzania

BackgroundUndernutrition in children under two years is a persistent challenge in Tanzania. This study investigates demographic, maternal, and child-related factors associated with stunting, wasting, and underweight coexistence.MethodsSecondary data from 2,158 children aged 0–23 months in the 2022 Tanzania Demographic and Health Survey (TDHS) were analyzed. Risk factors assessed included child age, birth weight, size at birth, birth order, and maternal education. Multinomial regression analysis was conducted to determine associations.ResultsThe risk of coexisting undernutrition was significantly higher among children aged 12–17 months (RRR = 8.297, 95% CI = 1.768–38.931, p = 0.007) and 18–23 months (RRR = 12.860, 95% CI = 2.661–62.152, p = 0.001). Protective factors included birth weight < 2,501 g (RRR = 0.211, 95% CI = 0.056–0.783, p = 0.02), average size at birth (RRR = 0.262, 95% CI = 0.076–0.908, p = 0.035), and higher birth order (2nd–4th: RRR = 0.372, p = 0.023; 5th: RRR = 0.340, p = 0.048). Maternal education emerged as a significant risk factor (RRR = 1.327, 95% CI = 1.128–6.841, p = 0.02).ConclusionThis study highlights critical risk factors, including maternal education, child age, and birth characteristics, for the coexistence of stunting, wasting, and underweight. Interventions should target the 12–23-month age group and address maternal education to eradicate child malnutrition in Tanzania.

Prevalence and Factors Associated With Severity of Undernutrition Among Children Aged 6-59 Months in Tanzania.

Undernutrition has been identified as a significant public health challenge in developing nations like Tanzania. Severe childhood undernutrition is a life-threatening problem that can result in impaired growth, weakened immune systems, and even death. The primary aim of this study was to identify the prevalence of multiple forms of severe undernutrition and factors associated with the severity of childhood undernutrition in children aged 6-59 months in Tanzania. This was a secondary data analysis conducted on a cross-sectional survey obtained from the 2022 Tanzania Demographic and Health Survey Malaria Indicator Survey (TDHS-MIS). This analysis comprised 4224 children with complete information. The study employed the proportional odds model of ordinal logistic regression to identify factors associated with severity of stunting, wasting, and anemia. Out of the 4224 included children, 8.6% were severely stunted, 0.8% were severely wasted, and 1.7% were severely anemic. The prevalence of multiple forms of severe undernutrition was 10.4%. Significant associations were observed between socioeconomic factors-including the gender and age of the household head, household wealth status, possession of health insurance, and availability of mosquito nets with severe undernutrition. Maternal factors such as nutrition status, current age, age at first birth, education, marriage, and occupation were related to the severity of undernutrition. Approximately one children out of every 10 suffers from some form of severe undernutrition in Tanzania. Several factors including maternal and socioeconomic were identified as potentially influencing severe undernutrition. Multifaceted efforts are required to lessen the severity of undernutrition.

Routine Immunization Status and Factors Associated with Immunization Coverage among Children Aged 12-23 Months in Tanzania.

Immunization has saved millions of lives globally from vaccine-preventable diseases. Childhood immunization is an effective public health strategy for decreasing morbidity and mortality among children in developing countries. Tanzania has one of the highest rates of coverage of routine child immunization among sub-Saharan African countries. However, obstacles to universal immunization still exist, particularly in rural areas of the country. Assessing routine immunization coverage is essential to inform vaccine policies and program implementation. This study aimed to assess routine immunization status and factors associated with its coverage among children aged 12-23 months. We conducted a cross-sectional, quantitative household survey in 31 regions with caretakers of children in Tanzania, where a total of 4,560 households were visited. Nationally, 85.5% of children aged 12-23 months had completed the full recommended course of vaccines. Overall, 14.5% of children aged 12-23 months did not complete routine immunization schedules in 2019. We found that factors associated with immunization coverage included having one to six family members, higher household wealth, the family's head engaging in subsistence farming, caretakers' age, children's age, educational level, children with clinic cards, and children receiving the diphtheria, pertussis, tetanus-3 vaccine. The country is about to reach the vaccination coverage target set by the WHO and the United Nations Children Fund. Improving existing vaccination coverage and optimizing the use of recommended interventions are required. We strongly advise using the periodic micro-planning tool and satellite image technology, particularly in areas where immunization coverage is less than 80%.

Factors associated with zero vegetable and fruit consumption among Tanzanian children

BackgroundProper nutrition during early childhood is essential for healthy growth and development, yet many children, particularly in low and middle-income countries, fail to meet recommended intake levels of fruits and vegetables. This study aims to assess the factors associated with zero vegetable and fruit (ZVF) consumption among children aged 6–23 months in Tanzania, using data from the 2022 Tanzania Demographic and Health Survey (DHS).MethodsA weighted sample of 4582 children aged between 6 and 23 months were included in the study. Data cleaning, coding, and analysis were performed using STATA version 17 software. To address the hierarchical nature of the DHS data and the binary outcome variable, a multilevel mixed-effect binary logistic regression model was used. The deviance value served as a guide for determining the best-fitting model. In the subsequent multivariable multilevel binary logistic regression analysis, adjusted odds ratios were computed alongside their respective 95% confidence intervals to evaluate the strength of association, with statistical significance set at a p-value below 0.05.ResultThe overall proportion of ZVF consumption among children aged 6–23 months in Tanzania was 48.34% (95% CI: 46.87, 49.81). Current breastfeeding status, maternal educational status, household wealth index, sex of the household head, and community poverty level were associated with higher odds of ZVF consumption. Meanwhile, child age, maternal employment status, father’s educational status, and media exposure were associated with lower odds of ZVF consumption.ConclusionChild age, current breastfeeding status, maternal educational status, maternal employment status, father’s educational status, household wealth index, sex of household, media exposure, and community poverty level were significantly associated with ZVF consumption. Efforts should focus on educating mothers about the early introduction of fruits and vegetables in children’s diets, alongside supporting breastfeeding. Tailored economic empowerment initiatives are needed in impoverished communities to improve access to nutritious foods.

Vitamin A supplementation status and associated factors among children aged 6-59 months in Tanzania: a multi-level analysis.

Vitamin A supplementation every 4-6 months is an economical, rapid, and effective strategy to enhance vitamin A status and minimize child morbidity and mortality due to vitamin A deficiency in the long run. Therefore, this study was aimed at investigating the level as well as the factors influencing VAS status among children aged 6-59 months in Tanzania. This analysis relied on data from the 2022 Tanzania Demographic and Health Survey (TDHS). The study used a weighted sample of 9,382 children aged 6-59 months. Given the effect of clustering and the binary character of the outcome variable, we employed a multilevel binary logistic regression model. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to determine statistical significance, considering the model with the lowest deviation that best fits the data. In this study, vitamin A supplementation among children aged 6-59 months was found to be 53.18% [95% CI: 52.17, 54.19]. Mother's/caregiver's working status; Working [AOR = 1.59, 95% CI: 1.34, 1.89], ANC follow-up [AOR = 1.71, 95%CI: 1.34, 2.2], and health facility delivery [AOR = 1.55, 95%CI: 1.25, 1.91] were individual-level factors associated with vitamin A supplementation. Whereas administrative zones of Western [AOR = 2.02, 95% CI: 1.16, 3.52], Southern highlands [AOR = 3.83, 95% CI: 2.02, 7.24], Southern administrative zone [AOR = 2.69, 95% CI: 1.37, 5.3], and South West highlands [AOR = 0.56, 95% CI: 0.33, 0.95] were community-level factors associated with vitamin A supplementation. The proportion of VAS among children in Tanzania is low compared to UNICEF's target of 80. Mother's/caregiver's working status, antenatal care, place of delivery, community-level media exposure, and administrative zones were significantly associated factors with vitamin A supplementation. Therefore, interventions should be designed to improve the uptake of VAS. Provision and promotion of ANC and institutional delivery and strengthening of routine supplementation are recommended to increase coverage of childhood vitamin A supplementation. Moreover, special focus should be given to regions in the south-western highlands.

Effect of Deworming on Health Outcomes among Children Aged 12-59 Months in Tanzania: A Multilevel Mixed Effects Analysis.

Mass deworming of preschool children is a strategy suggested to prevent soil-transmitted helminth infections in most developing countries. Nonetheless, there is a scarcity of data showing the contribution of mass deworming to a child's nutritional status. The purpose of this study was to assess the effect of deworming on nutritional health outcomes (stunting, underweight, and anemia) in children aged 12 to 59 months. A secondary analysis of data extracted from the Tanzania Demographic and Health Survey (TDHS) 2015-16 data was carried out. A total of 7,962 children were included in this study. A multilevel logistic regression was used at a 5% level of significance to determine the individual- and community-level determinants of deworming on health outcomes among children. The prevalence of underweight (62.6%), stunting (61.0%), and anemia (61.8%) was higher in children who were not dewormed than those who were dewormed. Female children were more likely to suffer from poor health outcomes (OR = 1.01 and 95% CI = 0.95-1.07) than male children. Children aged 24-35 months and 36-47 months were significantly less likely to suffer from poor health outcomes (OR = 0.89; 95% CI = 0.82-0.97 and OR = 0.88; 96% CI = 0.81-0.96, respectively; p < 0.01). Children from households with unimproved toilets (OR = 1.38 and 95% CI = 1.25-1.52), unimproved water sources (OR = 1.08 and 95% CI = 1.01-1.16), and living in rural areas (OR = 1.02 and 95% CI = 0.91-1.14) had higher odds for poor health outcomes. Deworming may be an effective technique for preventing poor health outcomes in children and the risks associated with them, such as poor growth and development.

Sensory properties, preference mapping and shelf life stability of linear programmed quelea meat based instant complementary food for children aged 6–23 months in Tanzania

Linear programming has been reported to be a good technique that can be used to develop and optimize complementary foods to curb children's malnutrition. Despite some studies using it to develop and assess the nutritional quality of linear programmed instant complementary foods based on high proteinous red-billed quelea bird meat, information on the sensory and shelf life stability of these foods is limited in the country. The objective of this study was to develop and assess the sensory properties, preference mapping and shelf life of the developed and optimized quale birds meat-based complementary flour and porridge. Four formulations; control containing birds meat only, banana mixed with meat (Banana_meat), potatoes mixed with meat (potatoes_meat) and rice mixed with meat (rice_meat) were developed by mixing with other ingredients and extruded separately using a barrel extrude to get flour. The extruded flours were assessed for shelf life and also used to develop porridge samples for sensory properties, consumer acceptance and preference mapping analyses using standard methods. There were significant (p < 0.05) differences in mean intensity scores between the formulation with potatoes mixed with meat samples having higher colour (7.5 ± 1.5), aroma (7.3 ± 1.6), viscosity (5.3 ± 3.0) and smoothness (7.65.3 ± 2.5) values than other samples with respective lower values of 4.4 ± 2.1–6.5 ± 1.5.2.6 ± 0.6–6.4 ± 2.4), 4.8 ± 0.2–5.2 ± 1.8 and 2.7 ± 0.6–6.3 ± 2.3. Rice mixed with meat sample had significantly highest whiteness (4.5 ± 1.5) and sweetness (7.5 ± 1.9) intensities scores while the control meat only samples had significantly highest oiliness intensity scores (5.0 ± 1.4) compared to other samples. Moreover, the potatoes mixed with meat sample was the most acceptable formulation (7.7 ± 0.3) compared to other samples with aroma, smoothness sweetness, colour and viscosity attributes being the main drivers for consumer liking of complementary porridge samples. The shelf life study revealed that the overall acceptability scores of complementary flour samples decreased progressively with storage days with the longest predicted shelf life of 140 days observed in rice mixed with meat sample followed by potatoes mixed with meat with 48 days and the shortest shelf life of 23.7 days in control samples. This suggests that quelea bird meat could be combined with cereal, tubers, and other minor ingredients like vegetables, optimized using the linear programming technique and extruded into complementary instant flour and porridge for children between the ages of 6 and 23 months with long shelf lives, appealing sensory properties, and consumer acceptance, respectively. Hence, it is advised to use the method and consume the developed formulations. • Linear programming resulted in complementary foods with appealing sensory properties and consumer acceptability. • The mean intensity score of sensory attributes differed significantly (p < 0.05) between the linear programmed complementary porridge samples. • Control (meat only) and potatoes_meat samples were the least and most acceptable formulations respectively. • Aroma, sweetness, smoothness, and colour were the main attributes driving consumers' acceptance of the porridge samples. • Rice_ meat and control samples had the longest and shortest shelf lives of 140 and 23.7 days respectively.

Predictors of iron deficiency anaemia among children aged 6-59 months in Tanzania: Evidence from the 2015-16 TDHS-MIS cross-sectional household survey.

Iron deficiency anaemia remains a public health problem, particularly in children aged 6-59 months. This study assessed factors associated with iron deficiency anaemia among children aged 6-23 months, 24-59 months and 6-59 months in Tanzania. Data for this cross-sectional study were extracted from the 2015-16 Tanzania Demographic and Health Survey and Malaria Indicator Survey (2015-16 TDHS-MIS). The study covered 8014 children aged 6-59 months and their mothers. Iron deficiency anaemia was defined (haemoglobin < 11g/dL). Univariable and multivariable logistic regression analyses that adjust for clustering and sampling weights were conducted to describe the associations between anaemia and potential confounding variables. The prevalence of iron deficiency anaemia among children aged 6-23 months, 24-59 months and 6-59 months were 76%, 49% and 59%, respectively. Factors associated with increased odds of iron deficiency anaemia among children aged 6-23 months included a mother being employed, being a male child, child perceived to small size at birth by mothers, a mother being anaemic and children belonging to the poorest socio-economic quintile. In addition, being a mother with no schooling, children not being dewormed, a mother being anaemic, delivering a baby at home, child fever and stunting, were factors associated with increased odds of iron deficiency anaemia among children aged 24-59 months. Factors associated with increased odds of iron deficiency anaemia among children aged 6-59 months were: a mother being employed, being a mother with no schooling, being a male child, belonging to the 6-59 months age bracket, a mother having a BMI of between 19 and 25 kg/m2, a mother being anaemic, having a baby at home, children belonging to bigger households, child fever and stunting. Interventions to minimise the burden of iron deficiency anaemia in children should target employed and/or anaemic mothers, poor and rich households, as well as male children.

A Retrospective Study to Examine Nutrition Based Risk and Protective Factors in Relation to Diarrhoea Incidence in Children Aged Less Than Two Years in Tanzania

Background: Diarrhea disorders account for a significant portion of the morbidity and mortality burden among children in resource-constrained settings, and they are economically significant to both families and health systems. In real sense, any intervention that has shown the potential to reduce diarrhea-related mortality and morbidity is valuable in terms of the global child health agenda.&#x0D; Objective: To explore the role of nutrition based risk and protective factors on diarrhea morbidity among children aged less than two years in Tanzania.&#x0D; Methods: We analyzed household-based data on risks and preventive interventions including exclusive breastfeeding, complementary feeding, water, sanitation hygiene, and vitamin A supplementation. Data from the Tanzania Demographic Health Survey (TDHS) of 2015/2016 were used to describe odds of diarrhoea morbidity in children aged 0-5 months and 6-23 months. Multivariate logic regression models were developed to identify risk factors.&#x0D; Results: Children aged less than 5 months, who were exclusively breastfed experienced a reduction in the odds of having diarrhoea by 72% (P-value &lt;0.001), compared to those who were not exclusively breastfed. Children aged between 6 months and less than 23 months, from families with detergent at hand washing facility, experienced a reduction in the odds of having diarrhoea by 37% (P-value &lt;0.01), compared to their peers in the other group. Diarrhoea odds were predicted to be higher in higher wealth quintile as compared to lowest group by 1.39 (P-value =0.028), 1.53 (P-value &lt;0.01), 1.74 (P-value &lt;0.01) and 1.78 (P-value =0.01) for second, middle, fourth to highest groups respectively.&#x0D; Conclusions: The data has demonstrated the important role of exclusive breastfeeding and sanitation on diarrhoea occurrence amongst children aged less than 23 months in Tanzania. Yet there are areas for which it remains inconclusive and requires further work to improve insights and strength of available evidence so far.

Determinants of underweight among children aged 0-23 months in Tanzania.

Underweight is the most dependable growth indicator for overall child growth. Tanzania has the highest rate of underweight children in East Africa, with 1.27 million children under the age of five suffering from the condition. This study aimed to determine factors that influence underweight in Tanzanian children aged 0–23 months. We used data from the Tanzania Demographic and Health Survey (TDHS) 2015–2016 to conduct secondary analysis on a sample of 4,327 children aged 0–23 months. Descriptive and inferential statistics such as frequency, chi‐square, binary, and multivariate logistic regression were performed using the Statistical Package of Social Science (SPSS version 25). Statistical significance was defined as a p‐value of less than 0.05. Multivariate analysis found risk factors for underweight children were as follows: child's gender, age, birth weight, mothers' BMI, level of education, and type of toilet facility used by the households. Females had a significantly lower risk of being underweight (AOR = 0.62, 95% CI = 0.48–0.81, p < .05) compared with male children. The odds of being underweight increase with low birth weight (AOR = 2.92, 95% CI = 1.92–4.43, p < .05), low mother's BMI (AOR = 2.48, 95% CI = 1.34–4.58, p < .05), and low educational level (AOR = 1.78, 95% CI = 1.23–2.58, p < .05). Nutrition interventions such as growth monitoring, nutrition counseling, and nutrition education for parents/caregivers are critical to ensuring proper weight gain for all children under 2 years of age.

Causes of death after biannual azithromycin treatment: A community-level randomized clinical trial.

The MORDOR study, a masked, community-level randomized clinical trial conducted in Niger, Malawi and Tanzania (2015 to 2017), showed that biannual administration of single-dose azithromycin to preschool children reduced all-cause mortality. We sought to evaluate its impact on causes of death in children aged 1–59 months in Tanzania. A random sampling of 614 communities was conducted in Kilosa District, Tanzania, with simple random assignment of communities to receive either azithromycin or placebo. In these communities, a census was carried out every 6 months and children aged 1–59 months received biannual (every 6 months), single-dose azithromycin (~20mg/kg) or placebo depending on community assignment, over a 2-year period. Mortality was determined at the time of the biannual census. For child deaths, a verbal autopsy was performed to ascertain the cause using a standardized diagnostic classification. A total of 190- (0.58 /100 person-years) and 200 deaths (0.59/100 person-years) were reported in the azithromycin and placebo arms, respectively. Malaria, pneumonia and diarrhea, accounted for 71% and 68% of deaths in the respective arms. Overall, the mortality was not different by treatment arm, nor were the distribution of causes of death after adjusting for community clustering. The cause-specific mortality for diarrhea/pneumonia was no different over time. In children aged 1–5 months, 32 deaths occurred in the placebo arm and 25 deaths occurred in the azithromycin arm; 20 (62.5%) deaths in the placebo- and 10 (40%) in the azithromycin arm were attributed to diarrhea or pneumonia. Neither differences in the number of deaths nor the diarrhea/pneumonia attribution was statistically significant after adjusting for community clustering. In conclusion, azithromycin was not associated with a significant decline in deaths by specific causes compared to placebo. The non-significant lower rates of diarrhea or pneumonia in children <6 months who received azithromycin merit further investigation in high-mortality settings.Trial registration:NCT02048007.

Factors affecting non-coverage of measles-rubella vaccination among children aged 9–59 months in Tanzania

Globally, measles remains a major cause of child mortality, and rubella is the leading cause of birth defects among all infectious diseases. In 2012, the World Health Assembly endorsed the Global Vaccine Action Plan that set a target to eliminate Measles-Rubella (MR) in five of the six World Health Organization (WHO) regions by 2020. This was cross-sectional study employed both quantitative and qualitative research methods. The sample size was calculated to provide overall, age- and sex-specific coverage estimates for MR vaccine among children aged between 9 and 59 months at the national level. Using desired precision of ±5% with an expected coverage of 95%, a total of 15,235 households were required. The age of children, a child who had received the MR vaccine before the campaign, household wealth quintile, the age of caregivers, and their marital status were associated with non-coverage of MR vaccination among children aged 9–59 months in Tanzania. Nationally, an estimated 88.2% (95% CI: 87.3–89%) of children aged 9–59 months received the MR campaign dose, as assessed by caregivers’ recall. These estimates revealed slightly higher coverage in Zanzibar 89.6% (95% CI: 84.7–93%) compared to Mainland Tanzania 88.1% (95% CI 87.2–88.9%). These associated factors revealed causes of unvaccinated children and may be some of the reasons for Tanzania’s failure to meet the MR campaign target of 95 percent vaccination coverage. Thus, vaccine development must increase programmatic oversight in order to improve immunization activities and communication strategies in Tanzanian areas with low MR coverage.

The influence of dietary diversity on the nutritional status of children between 6 and 23\u2009months of age in Tanzania

BackgroundUndernutrition poses a serious health challenge in developing countries and Tanzania has the highest undernutrition burden of Eastern and Southern Africa. Poor infant and young child feeding practices have been identified as the main causes for undernutrition. As dietary diversity is a major requirement if children are to get all essential nutrients, it can thus be used as one of the core indicators when assessing feeding practices and nutrition of children. Therefore, adequate information on the association between dietary diversity and undernutrition to identify potential strategies for the prevention of undernutrition is critical. Here we examined to what extent dietary diversity is associated with undernutrition among children of 6 to 23 months in Tanzania.MethodsUsing existing data from the Tanzania Demographic and Health Survey of 2015–2016, we carried out secondary data analysis. Stunting, Wasting and Underweight of the surveyed children were calculated from Z-scores of Height-for-age (HAZ), Weight-for-height (WHZ) and Weight-for-age (WAZ) based on 2006 WHO standards. A composite dietary diversity score was created by summing the number of food groups eaten the previous day as reported for each child by the mother ranging from 0 to 7. Then, minimum dietary diversity (MDD) of 4 food groups out of seven was used to assess the diversity of the diet given to children. Bivariate and multivariate logistic regression techniques were used to assess the crude and adjusted odds ratios of stunting, wasting and being underweight.ResultsA total of 2960 children were enrolled in this study. The prevalence of stunting was 31%, wasting 6% and underweight 14%. Among all children, 51% were female and 49% male. The majority (74%) of children did not reach the MDD. The most commonly consumed types of foods were grains, roots and tubers (91%), and Vitamin A containing fruits and vegetables (65%). The remaining food groups were reported to be consumed by a much lower proportion of children, including eggs (7%), meat and fish (36%), milk and dairy products (22%), as well as legumes and nuts (35%), and other vegetables (21%). Consumption of a diverse diet was significantly associated with a reduction of stunting, wasting and being underweight in children. The likelihood of being stunted, wasted and underweight was found to decrease as the number of food groups consumed increased. Children who did not receive the MDD had a significantly higher likelihood of being stunted (AOR = 1.37, 95% CI; 1.13–1.65) and underweight (AOR = 1.49, 95% CI; 1.15–1.92), but this was not the case for wasting. Consumption of animal-source foods has been found to be associated with reduced stunting among children.ConclusionConsumption of a diverse diet is associated with a reduction in undernutrition among children of 6 to 23 months in Tanzania. Measures to improve the type of complementary foods in order to meet the energy and nutritional demands of children should be considered in Tanzania.

Maternal Employment Status and Minimum Meal Frequency in Children 6-23 Months in Tanzania.

As women in developing world settings gain access to formal work sectors, it is important to understand how such changes might influence child nutrition. The purpose of this paper is to examine the relationship between maternal employment status and minimum meal frequency (MMF) among children in Tanzania. Interviews were conducted with 5000 mothers of children ages 0–23 months. The questionnaire used in these interviews was developed by adopting questions from Tanzania’s latest Demographic and Health Survey (2015–2016) where possible and creating additional questions needed for programmatic baseline measurements. MMF was used as proxy for child nutrition. Logistic regression analyses were used to identify associations between employment status and parenting practices of Tanzanian mothers and MMF of their children. After adjusting for confounders, informal maternal employment [OR = 0.58], lack of financial autonomy [OR = 0.57] and bringing the child with them when working away from home [OR = 0.59] were negatively associated with meeting MMF. Payment in cash [OR = 1.89], carrying food for the child [OR = 1.34] and leaving food at home for the child [OR = 2.52] were positively associated with meeting MMF. Informal maternal employment was found to be negatively associated with meeting MMF among Tanzanian children. However, behaviors such as bringing or leaving prepared food, fiscal autonomy and payment in cash showed significant positive associations. These findings could help direct future programs to reduce child stunting.

The economic costs of malaria in children in three sub-Saharan countries: Ghana, Tanzania and Kenya.

BackgroundMalaria causes significant mortality and morbidity in sub-Saharan Africa (SSA), especially among children less than five years of age (U5 children). Although the economic burden of malaria in this region has been assessed previously, the extent and variation of this burden remains unclear. This study aimed to estimate the economic costs of malaria in U5 children in three countries (Ghana, Tanzania and Kenya).MethodsHealth system and household costs previously estimated were integrated with costs associated with co-morbidities, complications and productivity losses due to death. Several models were developed to estimate the expected treatment cost per episode per child, across different age groups, by level of severity and with or without controlling for treatment-seeking behaviour. Total annual costs (2009) were calculated by multiplying the treatment cost per episode according to severity by the number of episodes. Annual health system prevention costs were added to this estimate.ResultsHousehold and health system costs per malaria episode ranged from approximately US$ 5 for non-complicated malaria in Tanzania to US$ 288 for cerebral malaria with neurological sequelae in Kenya. On average, up to 55% of these costs in Ghana and Tanzania and 70% in Kenya were assumed by the household, and of these costs 46% in Ghana and 85% in Tanzania and Kenya were indirect costs. Expected values of potential future earnings (in thousands) lost due to premature death of children aged 0–1 and 1–4 years were US$ 11.8 and US$ 13.8 in Ghana, US$ 6.9 and US$ 8.1 in Tanzania, and US$ 7.6 and US$ 8.9 in Kenya, respectively. The expected treatment costs per episode per child ranged from a minimum of US$ 1.29 for children aged 2–11 months in Tanzania to a maximum of US$ 22.9 for children aged 0–24 months in Kenya. The total annual costs (in millions) were estimated at US$ 37.8, US$ 131.9 and US$ 109.0 nationwide in Ghana, Tanzania and Kenya and included average treatment costs per case of US$ 11.99, US$ 6.79 and US$ 20.54, respectively.ConclusionThis study provides important insight into the economic burden of malaria in SSA that may assist policy makers when designing future malaria control interventions.

Factors associated with inappropriate complementary feeding practices among children aged 6–23 months in Tanzania

Inappropriate complementary feeding is one of the major causes of undernutrition among young children in Tanzania. Prevalence of newly developed World Health Organization complementary feeding indicators and their associated factors were determined among 2402 children aged 6-23 months in Tanzania using data from the 2010 Tanzania Demographic and Health Survey. The survey used a multistage cluster sample of 10 300 households from the eight geographical zones in the country. The prevalence of the introduction of soft, semi-solid or solid foods among infants aged 6-8 months was 92.3%. Of all the children aged 6-23 months, the prevalence of minimum dietary diversity, meal frequency and acceptable diet were 38.2%, 38.6% and 15.9%, respectively. Results from multivariate analyses indicated that the main risk factors for inappropriate complementary feeding practices in Tanzania include young child's age (6-11 months), lower level of paternal/maternal education, limited access to mass media, lack of post-natal check-ups, and poor economic status. Overall, complementary feeding practices in Tanzania, as measured by dietary diversity, meal frequency and acceptable diet, are not adequately met, and there is a need for interventions to improve the nutritional status of young children in Tanzania.

Tribute to: Prof. Sam WP Mhlongo

Professor Sam Mhlongo was born on 31st July 1940 in South Africa. He left the country in 1963 when many activists were being re-arrested under the 90-day Law. After spending some few months in Tanzania, he went to Britain where he studied medicine as a United Nations fellow first at university of Cambridge (pre-clinical) and Charing Cross Hospital Medical School, University of London (clinical). After graduating in medicine in the early 70s, he did various jobs in London and in the United States of America. Between 1975 and 1977, he was a cardiology resident at University of Pennsylvania and Mount Sinai Hospital, New York respectively. In 1978, he returned to the United Kingdom.

Infant feeding practices in western Tanzania and Uganda: implications for infant feeding recommendations for HIV-infected mothers.

Current infant feeding guidelines of UNICEF/UNAIDS/WHO for HIV-infected women recommend the avoidance of breastfeeding or to breastfeed exclusively. In the context of a prevention of HIV mother-to-child transmission programme we assessed the feeding practices in peripheral areas of Tanzania and Uganda. A total of 237 mothers in south-western Tanzania and 424 mothers in western Uganda attending urban and rural antenatal care services as well as village women were interviewed with regard to duration of breastfeeding, time of introduction of additional nutrients and type of solid and liquid nutrients. The average reported duration of breastfeeding was 24 months in Tanzania but 18 months in Uganda (P < 0.001). Solid nutrients were added on average at month 6 in both areas while liquids were given significantly earlier in Tanzania (month 4) than in Uganda (month 5; P < 0.001). A total of 19% and 48% of the study participants, respectively, stated to breastfeed their infants exclusively at the age of 4 months in Tanzania and Uganda. Age between 26 and 35 years, urban residence and ethnic group were the risk factors for earlier introduction of nutrients in Uganda. In Tanzania, solid maize porridge was the most frequent (94%) and often single nutrient given during breastfeeding, while in Uganda combinations of nutrients such as bananas, millet and beans were used. Milk was the most frequently added fluid in Uganda whereas in Tanzania various liquids such as liquid maize porridge, milk, juice or water were used. Feeding practices differed considerably in the two countries. According to the interviewees, exclusive breastfeeding was rarely practiced in Tanzania. Our findings underline the necessity to promote exclusive breastfeeding if infant feeding recommendations are to be realized and emphasize the need to assess the local situation in order to ensure that locally appropriate information and recommendations are given to the target groups.