Rural Kilimanjaro Research Articles

Maternal and infant predictors of proinflammatory milk immune activity in Kilimanjaro, Tanzania.

The immune system of milk (ISOM) creates a mother-infant immune axis that plays an important role in protecting infants against infectious disease (ID). Tradeoffs in the immune system suggest the potential for both protection and harm, so we conceive of two dimensions via which the ISOM impacts infants: promotion of protective activity and control of activity directed at benign targets. High variability in ISOM activity across mother-infant dyads suggests investment the ISOM may have evolved to be sensitive to maternal and/or infant characteristics. We assessed predictors of appropriate and misdirected proinflammatory ISOM activity in an environment of high ID risk, testing predictions drawn from life history theory and other evolutionary perspectives. We characterized milk in vitro interleukin-6 (IL-6) responses to Salmonella enterica (a target of protective immune activity; N = 96) and Escherichia coli (a benign target; N = 85) among mother-infant dyads in rural Kilimanjaro, Tanzania. We used ordered logistic regression and mixture models to evaluate maternal and infant characteristics as predictors of IL-6 responses. In all models, IL-6 responses to S. enterica increased with maternal age and decreased with gravidity. In mixture models, IL-6 responses to E. coli declined with maternal age and increased with gravidity. No other considered variables were consistently associated with IL-6 responses. The ISOM's capacities for appropriate proinflammatory activity and control of misdirected proinflammatory activity increases with maternal age and decreases with gravidity. These findings are consistent with the hypothesis that the mother-infant immune axis has evolved to respond to maternal life history characteristics.

Acceptability and feasibility of self‐sampling and follow‐up attendance after text message delivery of human papillomavirus results: A cross‐sectional study nested in a cohort in rural Tanzania

The objective was to determine if self-collection of vaginal samples for human papillomavirus (HPV) testing was acceptable and feasible in rural Tanzania and to assess the extent of attendance at a follow-up appointment among women who tested HPV-positive after delivery of HPV results via text messages. A combined cross-sectional and cohort study was conducted among women aged 25-60years from rural Kilimanjaro, Tanzania. Women were offered HPV self-sampling or traditional visual inspection of the cervix with acetic acid. If HPV self-sampling was preferred, participants received instructions on self-collection with an Evalyn Brush. A questionnaire was used to assess the acceptability and feasibility of the self-sampling procedure for the participants and delivery of HPV results via text messages. A mobile text message platform was used to send private text messages with the screening results to the participants. A total of 1108 women were enrolled and self-collected an HPV sample; 11.8% tested positive for high-risk HPV. The majority (98.9%) agreed that they had no trouble in understanding the instructions on how to perform the self-collection and that they would recommend it to a friend (94.5%) or as a standard screening method in Tanzania (95.5%). A minority of women experienced bleeding (2.4%) or pain (6%) while collecting the sample, while some were worried that they would get hurt (12.7%) or felt embarrassed (3.5%). The majority (98.4%) of women would like to receive the screening test results via text messages. Eighty-two percent of those who tested positive for high-risk HPV attended the follow-up appointment after receiving a text message reminder and an additional 16% attended after receiving both a text message and a phone call reminder whereas 2% did not attend follow up at all. Attendance was not influenced by age, marital status, education level, parity, or HIV status. Human papillomavirus self-sampling and text-message feedback delivery are generally well-perceived and accepted among rural Tanzanian women, and the majority of HPV-positive women attended a follow-up appointment after receiving their HPV results and follow-up appointment via text messages. This screening method may have potential to be transferrable to other low-income countries with a high incidence of cervical cancer and so improve cervical cancer screening attendances.

Prevalence estimates of dementia in older adults in rural Kilimanjaro 2009-2010 and 2018-2019: is there evidence of changing prevalence?

Although limited, existing epidemiological data on dementia in sub-Saharan Africa indicate that prevalence may be increasing; contrasting with recent decreases observed in high-income countries. We have previously reported the age-adjusted prevalence of dementia in rural Tanzania in 2009-2010 as 6.4% (95% confidence interval [CI] 4.9-7.9) in individuals aged ≥70 years. We aimed to repeat a community-based dementia prevalence study in the same setting to assess whether prevalence has changed. This was a two-phase door-to-door community-based cross-sectional survey in Kilimanjaro, Tanzania. In Phase I, trained primary health workers screened all consenting individuals aged ≥60 years from 12 villages using previously validated, locally developed, tools (IDEA cognitive screen and IDEA-Instrumental Activities of Daily Living questionnaire). Screening was conducted using a mobile digital application (app) on a hand-held tablet. In Phase II, a stratified sample of those identified in Phase I were clinically assessed using the DSM-5 criteria and diagnoses subsequently confirmed by consensus panel. Of 3011 people who consented, 424 screened positive for probable dementia and 227 for possible dementia. During clinical assessment in Phase II, 105 individuals met DSM-5 dementia criteria. The age-adjusted prevalence of dementia was 4.6% (95% CI 2.9-6.4) in those aged ≥60 years and 8.9% (95% CI 6.1-11.8) in those aged ≥70 years. Prevalence rates increased significantly with age. The prevalence of dementia in this rural Tanzanian population appears to have increased since 2010, although not significantly. Dementia is likely to become a significant health burden in this population as demographic transition continues.

Quality of life of persons with traumatic spinal cord injury in rural Kilimanjaro, Tanzania: a community survey

Aim To describe the quality of life of persons with traumatic spinal cord injury (TSCI) in a rural area of a low-income country. Methods This was a cross-sectional descriptive study in which snowballing was used to identify persons with TSCI in their homes. A Kiswahili version of the short version of the World Health Organization quality of life questionnaire was used for data collection. Data were analyzed descriptively and independent samples t-tests were used to calculate the difference in the mean scores between groups. Results Eighty persons with TSCI with a mean age of 42.29 ± 11.4 years were identified, 68.8% of whom were males. The highest scoring domains were psychological (12.76 ± 2.55) and social relationships (12.62 ± 2.95). The lowest scores were for physical (11.48 ± 2.74) and environment (9.59 ± 2.68) domains. Significantly higher scores were associated with younger age in: physical (0.05), social relationships (0.01), and environment (0.02) domains (p value < 0.05). Conclusions Persons with TSCI in the Kilimanjaro rural area registered a relatively low quality of life in which the most affected domains are physical health and environment. Implications for rehabilitation Quality of life is the ultimate goal in the rehabilitation of persons with any irreversible disability such as spinal cord injury. It is important for rehabilitation professionals to know which domains of quality of life are most affected among persons with spinal cord injury. Rehabilitation professionals ought to understand and address physical health and environmental issues that affect persons with traumatic spinal cord injury in rural resource-constrained areas. Addressing physical health and environmental challenges for persons with spinal cord injury in resource-constrained rural areas require involvement of the family, rehabilitation personnel, policy makers, and the community.

Urinary incontinence and its relation to delivery circumstances: A population-based study from rural Kilimanjaro, Tanzania.

ObjectivesTo investigate the prevalence and risk factors of urinary incontinence (UI), the different UI subtypes and the association between UI and delivery circumstances.DesignCross-sectional population-based study conducted in Kilimanjaro Region, Tanzania.Participants and settings1048 women aged 18–90 women living in rural Kilimanjaro. Simple random sampling was done to select villages, households and participants. Community health workers helped in identifying eligible women and trained nurses/midwives conducted face-to-face interviews. Data were analysed using descriptive statistics and Univariate and Multivariate logistic regression modelling.ResultsThe overall prevalence rate of UI was 42%. When focusing on the different types of UI, 17% of the women had stress UI, 9% had urge UI and 16% had mixed UI. Only one woman (0.1%) with vesico-vaginal fistula was identified. UI was found to be significantly associated with increasing parity (OR = 2.41 (1.55–3.74). In addition, women who in relation to their first delivery had delivered at home or had been in labour for more than 24 hours, had increased adjusted ORs of 1.70(1.08–2.68) and 2.10(1.08–4.10), respectively, for having UI.ConclusionUI is common in rural Tanzania and of the subtypes of UI, Stress Urinary Incontinence (SUI) is the commonest followed by Mixed Urinary Incontinence (MUI). Home delivery, prolonged labour and increasing parity especially having 5 or more deliveries are associated with increased risk for developing UI.

Vaginal pessaries in the management of symptomatic pelvic organ prolapse in rural Kilimanjaro, Tanzania: a pre-post interventional study.

The objective of this study was to evaluate the outcomes of vaginal pessaries in managing symptomatic pelvic organ prolapse (POP) in a low-income setting. A pre-post interventional study was conducted in the Kilimanjaro region, Tanzania. Seventy-one women with symptoms and a POP stage II or more on the POP quantification test were fitted with a vaginal pessary. Pelvic examination, POP Distress Inventory (POPDI-6) and POP Impact Questionnaire (POPIQ-7) were completed at baseline, after 3months and after 12-18months. Changes in the POPDI-6 and POPIQ-7 scores, complications and satisfaction associated with pessary use before and after the intervention were obtained. Pessary treatment was associated with a reduction in the overall POPDI score from 55.0 (50.0, 60.0) at baseline to 25.0 (25.0, 30.0) after 12-18months' use. The overall POPIQ score was reduced from 54.2 (41.7, 66.7) at baseline to 25.0 (25.0, 29.2) after 12-18months' use of the pessary. Vaginal discharge was reported in 72.4 and 32.4% of the women after 3 and 12-18months' use respectively, whereas 72.4 and 25% of the women had some degree of granuloma, erosion or infection at 3 and 12-18months respectively. Despite the reported complications, 78% of the women were satisfied with the pessary when interviewed after 12-18months and 81% wanted to continue using it. Vaginal pessary improves symptoms and quality of life associated with symptomatic POP. Therefore, it may be a treatment option in managing POP in low-income countries such as Tanzania.

Remittances and household nutrition: evidence from rural Kilimanjaro in Tanzania

This paper examines the role of remittances in the livelihoods of households in developing countries. Previous studies have shown that remittances are mostly utilized for investment in estates, agricultural inputs or education; however, remittances may also be useful for smoothing consumption by poor rural households. Hence, we estimated the differences in consumption patterns for macronutrients and micronutrients between remittance recipients and non-recipients using data from Kilimanjaro, Tanzania. An instrumental variable strategy was adopted in econometric estimations of nutrient consumption to address issues of self-selection and endogeneity of net income and remittances. Furthermore, the instrumental variable quantile regression method was used to estimate the distributional effects of remittances. A major finding was that remittances increased investment in intake of nutrients such as proteins, vitamin A, vitamin C and calcium; these are nutrients that are vitally important for physical development of children and for improving the health of adults. Remittances did not have a significant effect on consumption of macronutrients such as carbohydrates and fats, or total calories.

Hay fever, asthma, and eczema and early infectious diseases among children in Kilimanjaro, Tanzania.

To investigate the hygiene (or "old friends") hypothesis in a high-infectious disease (ID) environment, rural Kilimanjaro, Tanzania. Among a cross-sectional sample of 2- to 7-year-old children, we collected physician-diagnosed hay fever, asthma, and eczema, history of hospitalization, family size, and household environment information via questionnaire; performed active and passive surveillance for ID; and, evaluated total immunoglobulin E (IgE) and biomarkers of inflammation in dried blood spot specimens. We used regression models to describe patterns in allergic diseases. Complete information was available for 280 children: 12.5% had been diagnosed with hay fever; 18.9% with eczema; 2.1% with asthma. There was a positive association between hay fever and eczema diagnoses (π2 : 4.07; P = 0.044); total IgE was positively associated with eczema (β: 0.24; P = 0.100) and allergic diseases together (β: 0.26; P = 0.042). ID were common: the incidence of any ID diagnosis was 28 per 100 children per month. Hay fever was inversely associated with household animals (OR: 0.27; P = 0.006), and positively associated with earth housing materials (OR: 1.93; P = 0.079) and hospitalization in infancy with an ID (3.16; P = 0.066); patterns were similar when allergic disease outcomes were considered together. Few associations between these predictors and eczema or asthma alone were apparent. Allergic diseases were common among children in Kilimanjaro. The inverse association between household animals and allergy is consistent with the hygiene/old friends hypothesis; however, positive associations between allergic diseases and earth housing materials and early hospitalization with ID bear further explanation.

Cultural tourism and poverty alleviation in rural Kilimanjaro, Tanzania

The objective of this article is to investigate the impact of cultural tourism on welfare as perceived by communities in rural Kilimanjaro in Tanzania. The survey, which involved 85 randomly selected households in five villages during 2013, was qualitatively analysed through quasi-statistics, domain analysis and narratology. The research findings confirmed that cultural tourism contributes significantly to improving the livelihoods of people. Its impact differed from one village to another but what they all had in common was their ability to get a reliable source of income, unlike in the past when they solely depended on selling their livestock or seasonal crops. After the introduction of cultural tourism in the area 10 years ago, local people noticed significant social progress, ranging from a rise in household income to gaining access to education and health facilities. However, a good number of residents have limited skills and professional knowledge coupled with a negative attitude to the industry. Therefore, this study underlines the importance of instituting training programmes at community level that will ultimately provide opportunities for local people to be employed in various tourist businesses.

Middle class construction: domestic architecture, aesthetics and anxieties in Tanzania

ABSTRACTThis paper examines the new styles of houses under construction in contemporary Tanzania and suggests that they can be understood as the material manifestation of middle class growth. Through an examination of the architecture, interior decor and compound space in a sample of these new houses in urban Dar es Salaam and rural Kilimanjaro, the paper identifies four domestic aesthetics: the respectable house, the locally aspirant house, the globally aspirant house and the minimalist house, each of which map on to ideas aboutujamaa, liberalisation and the consumption of global consumer goods in distinct ways. The paper argues that these different domestic aesthetics demonstrate intra-class differences, and in particular the emergence of a new middle class.

Fertility desire and intention of people living with HIV/AIDS in Tanzania: a call for restructuring care and treatment services

BackgroundScaling up of antiretroviral therapy (ART) is currently underway in sub-Saharan Africa including, Tanzania, increasing survival of people living with HIV/AIDS (PLWHA). Programmes pay little attention to PLWHA’s reproductive health needs. Information on fertility desire and intention would assist in the integration of sexual and reproductive health in routine care and treatment clinics.MethodsA cross-sectional study of all PLWHA aged 15–49 residing in Kahe ward in rural Kilimanjaro Tanzania was conducted. Participants were recruited from the community and a local counselling centre located in the ward. Data on socio-demographic, medical and reproductive characteristics were collected through face-to-face interviews. Data were entered and analysed using STATA statistical software.ResultsA total of 410 PLWHA with a mean age of 34.2 and constituting 264 (64.4%) females participated. Fifty-one per cent reported to be married/cohabiting, 73.9% lived with their partners and 60.5% were sexually active. The rate of unprotected sex was 69.0% with 12.5% of women reporting to be pregnant at the time of the survey. Further biological children were desired by 37.1% of the participants and lifetime fertility intention was 2.4 children. Increased fertility desire was associated with living and having sex with a partner, HIV disclosure, good perceived health status and CD4 count ≥200 cells for both sexes. Reduced desire was associated with havingmore than 2 children among females, divorce or separation, and having a child with the current partner among both males and females.ConclusionFertility desire and intention of PLWHA was substantially high though lower than that of the general population in Tanzania. Practice of unprotected sexual intercourse with higher pregnancy rate was observed. Fertility desire was determined by individual perceived health and socio-family related factors. With increasing ART coverage and subsequent improved quality of life of PLWHA, these findings underscore the importance of integrating reproductive health services in the routine care and treatment of HIV/AIDS worldwide. The results also highlight a group of PLWHA with potentially high desire for children who need to be targeted during care.

Quality of Neonatal Health Care: Learning From Health Workers’ Experiences in Critical Care in Kilimanjaro Region, Northeast Tanzania

Background: Neonatal deaths are generally attributed to suboptimal standards of health care. Health care worker region. Methods: A descriptive study using a semi-structured interview for health care workers at a tertiary referral hospital and peripheral health facilities (regional referral, district hospitals and health centres).was used. Health Care Workers (HCW) were asked to recall a scenario of a critically ill neonate admitted in the wards and the treatment that was provided. The WHO Emergency Triage Assessment and Treatment (ETAT) guidelines were used as a standard reference for knowledge of critical care. Results: Birth asphyxia was the most recalled health problem requiring critical care, reported by 27.5% of 120 HCW at both peripheral hospitals and by 46.4% of 28 health workers in tertiary referral centres. Half of the HCW commented on their own performance (47.5%, n=140). HCW presented with low to moderate levels of knowledge for critical care were at 92%. Supplementary training was associated with a higher levels of knowledge of neonatal critical care (p value = 0.05). HCW in peripheral hospital had lower levels of knowledge (only 44.7% at peripheral hospitals had sufficient ratings compared to 82.1% at the referral centre). [Pearson χ 2 (2) = 12.10, p value = 0.002]. Conclusion: Guided Practical-Competence Diagnostic Specific neonatal health care training is highly needed in the peripheral facilities of rural Kilimanjaro region.

Attitudes towards and perceptions of reproductive health needs of persons living with HIV/AIDS in rural Kilimanjaro, Tanzania

The introduction of antiretroviral treatment has resulted in the resumption of socially productive and sexually active lives of people living with HIV/AIDS, together with the desire for children. However, factors affecting the reproductive health needs of people living with HIV/AIDS are not well understood. With this in mind, the aim of this paper was to investigate factors associated with these health needs using a qualitative approach. Findings indicate that attitudes and perceptions about reproductive health needs are influenced by fertility beliefs, the central role of family, procreation and the perceived social and clinical consequences of pregnancies among people living with HIV/AIDS. While there was mixed opinion about acceptability of people living with HIV/AIDS, having children, marriage and family were institutions important for partnerships maintenance and procreation. These findings suggest that living with HIV in a community with strong pro-life attitudes is challenging for people living with HIV/AIDS who do not have children. Apart from having to grapple with potential stigma of not having children, people living with HIV/AIDS also face social challenges in realising their reproductive choices. Interventions to address stigma, societal changes and the integration of reproductive-health education into HIV care and treatment are needed.

Food insecurity is associated with food consumption patterns and anthropometric measures but not serum micronutrient levels in adults in rural Tanzania

The purpose of the present paper is to assess the relationship between food insecurity and food consumption patterns, anthropometric measures and serum micronutrient levels in rural Kilimanjaro, Tanzania. A population-based cross-sectional study was carried out between March and May of 2005. Rural Kilimanjaro, Tanzania. Analysis was restricted to 1014 adults aged 15-44 years with children and complete data. A large majority of the participants (91 %) reported some kind of food insecurity. Food insecurity was significantly associated with age, marital status and occupation. Participants reporting food insecurity were significantly less likely to frequently consume animal products, fruits and vegetables compared with participants categorized as food secure. Women categorized as experiencing individual food insecurity had a larger waist circumference than food-secure women (P = 0.026) while the mean BMI of women appeared to decline if they had a child who was food insecure (P = 0.038). There were no observed differences in serum micronutrient levels by food insecurity status. Food insecurity is highly prevalent and associated with food consumption patterns, waist circumference and BMI of women in rural Tanzania. Further studies should apply self-report measures in assessing food insecurity to larger and more diversified populations.

Comparison of HIV-1 prevalence and risk factors between pregnant, non-pregnant, all women and the general population in Tanzania: implications for second-generation surveillance

The aim of this study was to compare HIV-1 prevalence between pregnant, non-pregnant, all women and the general population (men and women) and investigate how well risk behaviours of pregnant women reflect those of all women in the general population in rural Kilimanjaro, Tanzania. A cross-sectional survey involving all individuals aged 15-44 years was conducted in Oria village between March and May of 2005. All consenting individuals were interviewed and offered HIV-1 and syphilis testing. The response proportion among women was found to be 73.7% (914/1241). Age-adjusted HIV-1 prevalence among pregnant women (n = 92) was 32.5% lower (5.4% versus 8.0%, P < 0.001) than that of all women but only 8.5% (5.4% versus 5.9%, P = 0.639) lower compared with that of the general population. HIV-1 risk factors among pregnant women were comparable to that of all women in the general population. In conclusion, pregnant women in the general population underestimate the HIV-1 magnitude among women but closely approximate that of the general population. HIV-1 risk factors are similar between pregnant and all women in the general population. Second-generation surveillance could utilize pregnant women risk behaviours to approximate that of all women in the general population.

Ideologies of sexuality, menstruation and risk: girls' experiences of puberty and schooling in northern Tanzania

This paper examines girls' voiced experiences of menstruation, puberty and schooling in northern Tanzania. The study was conducted in Moshi and Rombo Districts of Kilimanjaro, a predominantly Chagga region with historically strong support for girls' education. The major question explored was how the onset of menses and puberty may be impacting on girls' school participation, given societal implications of pubertal onset and potentially gender discriminatory school environments. The methodology included a comparative case study using in‐depth interviews and participatory research with young women living in urban and rural Kilimanjaro. Along with important findings about how menstrual onset creates challenges for girls attending school emerged findings about the significant gaps in girls' knowledge about body changes, sexual health and HIV/AIDS. These findings underline the importance of identifying new girl‐centred approaches to guidance on bodily development and HIV prevention.

Prevalence and predictors of failure to return for HIV-1 post-test counseling in the era of antiretroviral therapy in rural Kilimanjaro, Tanzania: challenges and opportunities

In this era of antiretroviral therapy (ART) a limited number of population-based studies have investigated the extent of voluntary counseling and testing acceptance and completion in Africa. The aim of this study was to assess the prevalence and predictors of failure to return for HIV post-test counseling (PTC) among adults in rural Kilimanjaro, Tanzania. Following a cross-sectional survey, people aged 15–44 years living in Oria village were interviewed and offered individual HIV-1 pre-test counseling. They were asked to return for PTC two weeks after blood sample collection. HIV-1 testing was accepted by 1491 (97.6%) of participants with 98.9% expressing desire to know their results. The proportion of individuals who did not return for PTC was 50.9%. These proportions did not differ by sex. Seropositive HIV result (AOR: 2.2; 95%CI: 1.3–4.3 for women and AOR: 2.1, 95%CI: 1.2–5.7 for men), low HIV/AIDS-transmission and ART availability knowledge, perceived low risk of HIV infection, not accepting to share results (men only) and inability to self-prevent HIV infection (women only) predicted failure to return for PTC. Additionally, participants were more likely not to return for PTC if they had no-formal education or reported recent sexual-risk behaviors, for both sexes. Age, prior HIV testing or AIDS-related clinical symptoms were not associated with return for PTC in this population. These findings suggest that low returns for PTC, especially for HIV-seropositive individuals, result in a substantial missed opportunity for prevention and care. Knowledge of ART accessibility is necessary but not sufficient to promote adequate return for PTC. The high attendance for pre-test counseling should be utilized to identify potential individuals who may not return for PTC and to promote risk reduction and care.

Validation of the Radimer/Cornell food insecurity measure in rural Kilimanjaro, Tanzania

The objective of the present study was to assess the construct validity, criterion-related validity and internal consistency of the Radimer/Cornell food insecurity measure for use in rural Tanzania. A cross-sectional community-based survey was conducted from March to May 2005. Key adaptations to the nine-item Radimer/Cornell items included translation to Swahili, replacing the term 'balanced diet' with 'full meal' and constructing the items as questions rather than statements. Factor analysis and Cronbach's alpha were used to assess validity and reliability, respectively. Rural Kilimanjaro, Tanzania. Analysis was restricted to data from 530 women aged 15-44 years who had children under 5 years old. Principal component factor analysis revealed a two-factor solution: (1) altered eating pattern at household level and (2) altered eating pattern at child level. The two factors accounted for 66.2% of the total variance. The subscales developed had good reliability. Internal consistency of the scales was 0.853 and 0.784 for food insecurity at household level and food insecurity at child level, respectively. Only 14.0% of the women reported to be food-secure and 86.0% reported some kind of food insecurity. The Radimer/Cornell food insecurity measure showed significant associations with selected sociodemographic factors in the expected directions. There was also an association with the NHANES III (Third National Health and Nutrition Examination Survey) and CCHIP (Community Childhood Hunger Identification Project) indicators. Our findings suggest that the adapted Radimer/Cornell measure may have some utility in assessing food insecurity in settings like rural Tanzania.

The role of in-migrants in the increasing rural HIV-1 epidemic: results from a village population survey in the Kilimanjaro region of Tanzania

To investigate the magnitude of rural in-migration and the role of in-migrants in the observed increase in HIV-1 prevalence in rural Kilimanjaro, Tanzania. A cross-sectional study involving the adult population aged 15-44 years residing in a rural village was conducted from March to May of 2005. Participants were interviewed regarding their risk behaviors and gave blood for HIV-1 and syphilis testing. Overall, the response rate was 73.0% (1528/2093). A total of 699 (48.1%) participants reported having in-migrated to the village at some point during their life. The prevalences of HIV-1 infection were 1.8%, 2.3%, and 3.7% among non-in-migrant, long-term in-migrant, and recent in-migrant men, respectively (p(trend)<0.001). The corresponding prevalences among women were 9.2%, 11.5%, and 14.5%, respectively (p(trend)=0.048). The odds of HIV-1 infection were higher among recent in-migrants as compared to non-in-migrants (men: adjusted odds ratio (AOR) 2.4, 95% CI 1.8-6.6; women: AOR 2.3, 95% CI 1.1-5.0). Risk behaviors were inversely related to years since in-migration for both sexes. The results suggest that rural in-migration is common for both men and women. In-migrants were at higher risk for HIV-1 infection and contributed significantly to increased rural HIV-1 prevalence. More studies to examine the rate and broader causes of rural in-migration in similar communities are called for. These may help in the design of intervention strategies for curbing the rising rural HIV epidemic.

Food insufficiency in rural Kilimanjaro, Tanzania

To estimate the prevalence of reported food insufficiency associated socio-demographic factors and health indicators in rural Tanzania. A cross-sectional study. A rural community in Kilimanjaro, Tanzania. Eight hundred and ninety nine individuals aged 15-36 years. A structured questionnaire was administered to collect information on socio-demographic factors, health indicators and food insufficiency. Participants were tested for HIV-1 using saliva samples. The prevalence of food insufficiency was 25.3% with no sex difference. After controlling for potential confounders age (Adjusted Odds Ratio [AOR] = 1.05; 95% Confidence Interval [CI]: 1.02-1.08), low education level (AOR = 4.73; CI: 1.30-17.11), being a peasant (AOR = 2.29; CI: 1.04-5.04), poor self-rated health status (AOR = 4.35; CI: 1.71-11.00) and having health problems (AOR = 2.23; CI: 1.21-4.08) were associated with food insufficiency among women but not men. In unadjusted analysis, women with food insufficiency had over twice the odds of testing HIV positive although the association did not reach statistical significance (AOR = 2.12; CI: 0.87-5.19) in adjusted analysis. Food insufficiency was prevalent in rural Tanzania. It was associated with sociodemographic factors and health indicators among women but not men. Our findings suggest that food insufficiency may play a role in increasing vulnerability to HIV infection particularly among women however; more research is needed to explore further this relationship.