Tanzania Health Research Articles

Antibiotic prescription, dispensing and use in humans and livestock in East Africa: does morality have a role to play?

Antimicrobial resistance (AMR) is a global threat to human and livestock health. Although AMR is driven by use of antimicrobials, it is often attributed to "misuse" and "overuse", particularly for antibiotics. To curb resistance, there has been a global call to embrace new forms of moral personhood that practice "proper" use, including prescription, dispensing and consumption of antimicrobials, especially antibiotics. This paper seeks to reflect on complex questions about how morality has become embedded /embodied in the AMR discourse as presented in the data collected on antimicrobial prescription, dispensing and use in human and livestock health in Tanzania, primarily focusing on antibiotics. This reflection is anchored on Jarrett Zigon's morality framework that is comprised of three dimensions of discourse; the institutional, public, and embodied dispositions. The data we use within this framework are derived from a qualitative study targeting human and animal health care service providers and community members in northern Tanzania. Data were collected through 28 in-depth interviews and ten focus group discussions and analysed through content analysis after translation and transcription. In addition, a review of the Tanzania's National Action Plans on antimicrobial resistance was conducted. Application of the framework demonstrates points of convergence and divergence in the institutional morality discourse articulated by the Tanzania National Action Plans, the public discourse and the embodied dispositions/ lived experiences of human and animal health care service providers and community members. We demonstrate that AMR is not just associated with "inappropriate" behaviour on the part of drug prescribers, dispensers, and users but also with shortcomings in health systems and service delivery. Antibiotic dispensing and use practices that may be associated with the development of AMR should not be viewed in isolation from the broader health context within which they occur.

Assessment of Risk Management Practices in Public Higher Learning Institutions: A Case of Muhimbili University of Health and Allied Sciences

This study explores the risk management practices at Muhimbili University of Health and Allied Sciences (MUHAS) in Tanzania. It examines employees' perceptions, the challenges faced by management during the implementation of risk management programs, and the efforts made to address these challenges. Findings indicate a significant gap in awareness regarding risk management policies, substantial resistance to change, and financial constraints. The study underscores the need for enhanced communication, continuous training, and strategic resource allocation to improve risk management practices at MUHAS.

Abstracts of the 10th Tanzania Health Summit

Abstracts of the 10th Tanzania Health Summit

Oral Health in Tanzania: Unmasking Its Neglected Dimension

ABSTRACTThe World Health Organization's definition of oral health underscores its holistic nature encompassing physiological, psychosocial, and functional dimensions. The current estimates of oral diseases in Tanzania and around the world underscore the urgency of intervention, particularly in light of rising sugar consumption trends. The unique challenges facing Tanzania, including inadequate knowledge, limited infrastructure, and disparities in oral healthcare access, are analyzed within the broader context of sub‐Saharan Africa's health priorities. This article addresses the multifaceted challenges of oral health neglect in Tanzania, emphasizing the imperative need for a comprehensive and integrated approach. The discussion offers a detailed exploration of determinants contributing to oral health neglect, spanning socioeconomic, behavioral, and commercial factors, with a focus on their implications for Tanzanian communities. Recommendations are presented as a strategic roadmap, encompassing public health education, integrated healthcare services, government intervention, educational programs, community engagement, financial accessibility, and research initiatives. By synthesizing these recommendations into a cohesive framework, a proactive and collaborative approach to mitigate the consequences of oral health neglect in Tanzania, emphasizing the need for transformative policies and cultural sensitivity, is therefore envisioned.

Disclosure of HIV Status to Sexual Partners Among People With HIV in Singida Regional Referral Hospital of Tanzania: A Cross-Sectional Study.

HIV status nondisclosure to sexual partners remains a major challenge in Tanzania's health system. This hospital-based, descriptive, cross-sectional study design recruited 380 people living with HIV (PLWH) to assess voluntary HIV status disclosure to sexual partners, the associated factors, and outcomes among PLWH in Tanzania. Approximately 78% (n = 297) of the study participants reported disclosing their HIV status to their sexual partners. Adjusted multivariable logistic regression analysis revealed that HIV status disclosure to sexual partners was significantly associated with living with a sexual partner (adjusted odds ratio [AOR] = 3.91, 95% CI [1.43-10.72]), knowledge of HIV disclosure (AOR = 11.71, 95% CI [2.88-47.63]), known serostatus of the sexual partner (AOR = 40.20, 95% CI [15.31-105.56]), and HIV disclosure-related stigma (AOR = 0.92, 95% CI [0.85-0.99]). Addressing these significant factors will maximize the magnitude of voluntary disclosure to sexual partners.

School health and nutrition services for children and adolescents in Tanzania: A review of policies and programmes.

School health and nutrition programmes are effective strategies to address the health problems among school-going children and adolescents. We examined the policy environments, successesand bottlenecks associated with school health and nutrition programmes in Tanzania. We used the 'policy triangle framework' to examine 22 national and regional school health and nutrition policies and programmes in Tanzania. We also interviewed 16 key informants to gain further insights into school health and nutrition programmes. Several school health and nutrition policies in Tanzania outline the basic elements of school-based health and nutrition services. Yet, these documents neither recognise vulnerable groups, recommend age-appropriate strategies to address children's and adolescents' varied and transient needs, nor provide a framework for implementing and tracking recommended activities. In these documents, underweight and infectious diseases, including humanimmunodeficiency virus/acquired immunodeficiency syndrome, are frequently identified as major concerns of young people, with little or no consideration of social determinants. Diverse strategies including school feeding, water and sanitation services, health and nutrition educationand promotion of healthy behaviours are identified. In doing so, these documents adequately define the roles and responsibilities of all government actors, but young people and their guardians are not actively engaged in design and implementation. Additionally, there are several challenges to implementing these policies including budgetary constraints, limited resources, a lack of inter-sectoral coordinationand insufficient capacity within targeted schools. To improve the health and nutritional status of school-going children and adolescents in Tanzania, adequate budgets, strengthened coordination and implementation efforts, the development of school-based stakeholders' capacity, as well as the involvement of all other stakeholders, including adolescents, are imperative.

Using digital technology as a platform to strengthen the continuum of care at community level for maternal, child and adolescent health in Tanzania: introducing the Afya-Tek program

Inadequate care within Tanzania’s primary health system contributes to thousands of preventable maternal and child deaths, and unwanted pregnancies each year. A key contributor is lack of coordination between three primary healthcare actors: public sector Community Health Workers (CHWs) and health facilities, and private sector Accredited Drug Dispensing Outlets (ADDOs). The Afya-Tek program aims to improve the continuity of care amongst these actors in Kibaha district, through a mobile-application based digital referral system that focuses on improving maternal, child and adolescent health. The digital system called Afya-Tek was co-created with users and beneficiaries, and utilises open-source technology in-line with existing government systems. The system guides healthcare actors with individualised decision support during client visits and recommends accurate next steps (education, treatment, or referral). From July 2020 to June 2023, a total of 241,000 individuals were enrolled in the Afya-Tek program covering 7,557 pregnant women, 6,582 postpartum women, 45,900 children, and 25,700 adolescents. CHWs have conducted a total of 626,000 home visits to provide health services, including screening clients for danger signs. This has resulted in 38,100 referrals to health facilities and 24,300 linkages to ADDOs. At the ADDO level, 48,552 clients self-presented; 33% of children with pneumonia symptoms received Amoxicillin; 34% of children with diarrhoea symptoms received ORS and zinc; and 4,203 referrals were made to nearest health facilities. Adolescents preferred services at ADDOs as a result of increased perceived privacy and confidentiality. In total, 89% of all referrals were attended by health facilities. As the first digital health program in Tanzania to demonstrate the linkage among public and private sector primary healthcare actors, Afya-Tek holds promise to improve maternal, child and adolescent health as well as for scale-up and sustainability, through incorporation of other disease conditions and integration with government’s Unified Community System (UCS).

Levels, trends and inequalities in mortality among 5-19-year-olds in Tanzania: Magu Health and Demographic Surveillance Study (1995-2022).

For the past two decades, health priorities in Tanzania have focussed on children under-five, leaving behind the older children and adolescents (5-19 years). Understanding mortality patterns beyond 5 years is important in bridging a healthy gap between childhood to adulthood. We aimed to estimate mortality levels, trends, and inequalities among 5-19-year-olds using population data from the Magu Health and Demographic Surveillance Site (HDSS) in Tanzania and further compare the population level estimates with global estimates. Using data from the Magu HDSS from 1995 to 2022, from Kaplan Meir survival probabilities, we computed annual mortality probabilities for ages 5-9, 10-14 and 15-19 and determined the average annual rate of change in mortality by fitting the variance weighted least square regression on annual mortality probabilities. We compared 5-19 trends with younger children aged 1-4 years. We further disaggregated mortality by sex, area of residence and wealth tertiles, and we computed age-stratified risk ratios with respective 95% confidence intervals (CIs) using Cox proportional hazard model to determine inequalities. We further compared population-level estimates in all-cause mortality with global estimates from the United Nations Inter-agency Group for Child Mortality Estimation and the Global Burden of Disease study by computing the relative differences to the estimates. Mortality declined steadily among the three age groups from 1995 to 2022, whereby the average annual rate of decline increased with age (2.2%, 2.7%, and 2.9% for 5-9-, 10-14-, and 15-19-year-old age groups, respectively). The pace of this decline was lower than that of younger children aged 1-4 years (4.8% decline). We observed significant mortality inequalities with boys, those residing in rural areas, and those from poorest wealth tertiles lagging behind. While Magu estimates were close to global estimates for the 5-9-year-old age group, we observed divergent results for adolescents (10-19 years), with Magu estimates lying between the global estimates. The pace of mortality decline was lower for the 5-19-year-old age group compared to younger children, with observable inequalities by socio-demographic characteristics. Determining the burden of disease across different strata is important in the development of evidence-based targeted interventions to address the mortality burden and inequalities in this age group, as it is an important transition period to adulthood.

Nurse Practitioners (NPs) as Game Changers in Tanzania Health Delivery System: Lessons Learnt from Fujita Bantane Hospital in Japan

Nurse Practitioners (NPs) as Game Changers in Tanzania Health Delivery System: Lessons Learnt from Fujita Bantane Hospital in Japan

Organizational learning in surgery in Tanzania's health system: a descriptive cross-sectional study.

Organizational learning is critical for delivering safe, high-quality surgical care, especially in low- and middle-income countries (LMICs) where perioperative outcomes remain poor. While current investments in LMICs prioritize physical infrastructure, equipment, and staffing, investments in organizational learning are equally important to support innovation, creativity, and continuous improvement of surgical quality. This study aims to assess the extent to which health facilities in Tanzania's Lake Zone perform as learning organizations from the perspectives of surgical providers. The insights gained from this study can motivate future quality improvement initiatives and investments to improve surgical outcomes. We conducted a cross-sectional analysis using data from an adapted survey to explore the key components of organizational learning, including a supportive learning environment, effective learning processes, and encouraging leadership. Our sample included surgical team members and leaders at 20 facilities (health centers, district hospitals, and regional hospitals). We calculated the average of the responses at individual facilities. Responses that were 5+ on a 7-point scale or 4+ on a 5-point scale were considered positive. We examined the variation in responses by facility characteristics using a one-way ANOVA or Student's t-test. We used univariate and multiple regression to assess relationships between facility characteristics and perceptions of organizational learning. Ninety-eight surgical providers and leaders participated in the survey. The mean facility positive response rate was 95.1% (SD 6.1%). Time for reflection was the least favorable domain with a score of 62.5% (SD 35.8%). There was variation by facility characteristics including differences in time for reflection when comparing by level of care (P = .02) and location (P = .01), and differences in trying new approaches (P = .008), capacity building (P = .008), and information transfer (P = .01) when comparing public versus faith-based facilities. In multivariable analysis, suburban centers had less time for reflection than urban facilities (adjusted difference = -0.48; 95% CI: -0.95, -0.01; P = .046). Surgical team members reported more positive responses compared to surgical team leaders. We found a high overall positive response rate in characterizing organizational learning in surgery in 20 health facilities in Tanzania's Lake Zone. Our findings identify areas for improvement and provide a baseline for assessing the effectiveness of change initiatives. Future research should focus on validating the adapted survey and exploring the impact of strong learning environments on surgical outcomes in LMICs. Organizational learning is crucial in surgery and further research, funding, and policy work should be dedicated to improving learning cultures in health facilities.

Impact of Outdoor Recreation Programs on Mental Health in Tanzania

Purpose: The aim of the study was to assess the impact of outdoor recreation programs on mental health in Tanzania. Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: The study show that programs, often designed to immerse individuals in nature through activities like hiking, camping, and outdoor sports, have been shown to reduce symptoms of anxiety, depression, and stress. Engaging with nature fosters a sense of calmness and relaxation while promoting physical activity, which in turn contributes to improved mood and overall well-being. Moreover, participation in outdoor recreation programs encourages social interaction and a sense of belonging, which are crucial factors in combating loneliness and enhancing mental resilience. Studies also indicate that spending time outdoors can lead to increased mindfulness and a greater appreciation. Implications to Theory, Practice and Policy: Biophilia hypothesis, attention restoration theory and stress reduction theory may be used to anchor future studies on assessing impact of outdoor recreation programs on mental health in Tanzania. Designing outdoor recreation programs that are tailored to the specific needs and preferences of target populations can optimize their effectiveness. Implementing policies that prioritize the preservation and accessibility of green spaces in urban and rural areas is crucial for promoting mental health at the population level.

What We Can Learn When Impacts Fail to Replicate: Lessons From an Empowerment Programme for Young Women in Tanzania

We evaluate the Empowerment and Livelihood for Adolescents programme that combines life and livelihood skills trainings with a safe space where young women can network and learn. The same multifaceted intervention was highly effective in raising adolescent girls’ economic and social empowerment when implemented in Uganda. In contrast, this randomised evaluation, using panel data on more than 3100 adolescents, finds no programme impact on any economic, health, or social outcomes in Tanzania. We propose implementation quality as one plausible explanation of why the programme’s effectiveness could not be successfully replicated in Tanzania.

Government Expenditure and Economic Growth in Tanzania

This study examines the impact of government expenditure on economic growth, focusing on health, infrastructure, education, and agriculture in Tanzania. The data from 1970–2020 were analysed using the STATA software. Government expenditure on education, health, agriculture, and infrastructure sectors were the independent variables, while GDP was the dependent variable. Wagner’s law of increasing state activity and Keynesian economic theory were used to guide the study. Unit root test and Johansen co-integration test were conducted. The Johansen co-integration test results indicated the absence of a long-run relationship between all explanatory variables and economic growth. However, the ARDL model revealed that government health expenditure had a low effect on economic growth compared to infrastructure, education, and agriculture expenditures; all of which had higher effects. The study recommends that more government resources be spent on substantial infrastructure.

Ill Health and Labour Market Participation in Tanzania: Empirical Evidence from Tanzania National Panel Surveys

This paper examines the effect of ill health status on labour participation in Tanzania using panel methods with data extracted from three waves of the National Panel Survey datasets of 2010/11, 2012/13, and the extended panel of 2019/20. Based on estimated random effect probit models, the results show that chronic ill health status has a significant negative effect on labour market participation in Tanzania. By locality, both chronic and acute ill health are significant and negative on labour participation in rural areas; whereas by sex chronic ill health is significant and negative on male’s participation. Therefore, the study recommends the adoption of more effective policies and interventions to reduce the prevalence of chronic and acute illness so as to bring more Tanzanians into the labour force. Also, it recommends mainstream employment policy actions to support those with partial work capacity from incurable ill health conditions to take up jobs.

Co-occurrence of bacteria and viruses and serotype distribution of Streptococcus pneumoniae in the nasopharynx of Tanzanian children below 2 years of age following introduction of the PCV13.

Pneumococcal conjugate vaccines have reduced severe disease attributed to vaccine-type pneumococci in children. However, the effect is dependent on serotype distribution in the population and disease development may be influenced by co-occurrence of viral and bacterial pathogens in the nasopharynx. Following introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) in Tanzania we performed repeated cross-sectional surveys, including 775 children below 2 years of age attending primary healthcare centers. All children were sampled from nasopharynx and pneumococci were detected by single-target PCR. Pneumococcal serotypes/groups and presence of viruses and other bacteria were determined by two multiplex PCR assays. The prevalence of PCV13 vaccine-type pneumococci decreased by 50%, but residual vaccine-types were still detected in 21% of the children 2 years after PCV13 introduction. An increase in the non-vaccine-type 15 BC was observed. Pneumococci were often co-occurring with Haemophilus influenzae, and detection of rhino/enterovirus was associated with higher pneumococcal load. We conclude that presence of residual vaccine-type and emerging non-vaccine-type pneumococci in Tanzanian children demand continued pneumococcal surveillance. High co-occurrence of viral and bacterial pathogens may contribute to the disease burden and indicate the need of multiple public health interventions to improve child health in Tanzania.

How Effective Was the Global South Knowledge Exchange? The Chinese-Funded Medical Projects in Tanzania, 1968-1990s.

Knowledge circulation scholars have examined the North-South exchange as mainly one-way traffic, where the Global South is perceived as the recipient of knowledge from the Global North. In contrast, this article underscores Southern countries' role in technoscientific development by examining actors in Chinese-funded medical projects in Tanzania. It shows that Chinese sponsorship of Tanzania's health sector was critical not only in breaking the yoke of dependency on medical knowledge from the North but also in debunking the Global North narratives positing Africa as backward and lacking initiative in medical and industrial technologies. Employing qualitative analytical methods on pertinent archival, oral accounts and published sources, this article shows that despite the Sino-Tanzanian cooperation's potential, knowledge exchanges were arguably one-way rather than reciprocal, and the exchanged knowledge remained ineffective and unsustainable owing to ill-thought modus operandi from the onset.

Biomedical and Spiritual Approaches to Mental Health in Tanzania: How Power and the Struggle for Public Authority Shaped Care

Biomedical and Spiritual Approaches to Mental Health in Tanzania: How Power and the Struggle for Public Authority Shaped Care

FEeSU - A Framework for Evaluating eHealth Systems Usability: A Case of Tanzania Health Facilities

FEeSU - A Framework for Evaluating eHealth Systems Usability: A Case of Tanzania Health Facilities

Implementing Innovative Approaches to Improve Health Care Delivery Systems for Integrating Communicable and Non-Communicable Diseases Using Tuberculosis and Diabetes as a Model in Tanzania.

Background: Many evidence-based health interventions, particularly in low-income settings, have failed to deliver the expected impact. We designed an Adaptive Diseases Control Expert Programme in Tanzania (ADEPT) to address systemic challenges in health care delivery and examined the feasibility, acceptability and effectiveness of the model using tuberculosis (TB) and diabetes mellitus (DM) as a prototype. Methods: This was an effectiveness-implementation hybrid type-3 design that was implemented in Dar es Salaam, Iringa and Kilimanjaro regions. The strategy included a stepwise training approach with web-based platforms adapting the Gibbs' reflective cycle. Health facilities with TB services were supplemented with DM diagnostics, including glycated haemoglobin A1c (HbA1c). The clinical audit was deployed as a measure of fidelity. Retrospective and cross-sectional designs were used to assess the fidelity, acceptability and feasibility of the model. Results: From 2019-2021, the clinical audit showed that ADEPT intervention health facilities more often identified median 8 (IQR 6-19) individuals with dual TB and DM, compared with control health facilities, median of 1 (IQR 0-3) (p = 0.02). Likewise, the clinical utility of HbA1c on intervention sites was 63% (IQR:35-75%) in TB/DM individuals compared to none in the control sites at all levels, whereas other components of the standard of clinical management of patients with dual TB and DM did not significantly differ. The health facilities showed no difference in screening for additional comorbidities such as hypertension and malnutrition. The stepwise training enrolled a total of 46 nurse officers and medical doctors/specialists for web-based training and 40 (87%) attended the workshop. Thirty-one (67%), 18 nurse officers and 13 medical doctors/specialists, implemented the second step of training others and yielded a total of 519 additional front-line health care workers trained: 371 nurses and 148 clinicians. Overall, the ADEPT model was scored as feasible by metrics applied to both front-line health care providers and health facilities. Conclusions: It was feasible to use a stepwise training and clinical audit to support the integration of TB and DM management and it was largely acceptable and effective in differing regions within Tanzania. When adapted in the Tanzania health system context, the model will likely improve quality of services.

Abstracts of the 9th Tanzania Health Summit

Abstracts of the 9th Tanzania Health Summit