Women In Northern Tanzania Research Articles

Time trends in perinatal outcomes among HIV-positive pregnant women in Northern Tanzania: A registry-based study.

Maternal HIV infection is associated with increased risk of having a preterm delivery, low birth weight baby, small for gestational age baby and stillbirth. Maternal use of combination antiretroviral treatment is also associated with preterm delivery and low birth weight, although the effects vary by the type of drugs and timing of initiation. To examine time trends in adverse perinatal outcomes among HIV-positive compared with HIV-negative women. Registry-based cohort study. Northern Tanzania, 2000-2018. Mother-baby pairs of singleton deliveries (n = 41 156). Perinatal outcomes of HIV-positive women were compared with HIV-negative women during time periods representing shifts in prevention of mother-to-child transmission guidelines. Monotherapy was used as first-line therapy before 2007 while combination antiretroviral treatment was routinely used from 2007. Log binomial and quantile regression were used to analyze the data. Preterm delivery, low birth weight, perinatal death, stillbirth, low Apgar score, transfer to neonatal care unit and small for gestational age. Overall, maternal HIV infection was associated with a higher risk of low birth weight and small for gestational age. Moreover, this pattern became more pronounced over time for low birth weight, the last time period being an exception. For other outcomes we found none or only a small overall association with maternal HIV infection, although a trend towards higher risk over time in HIV-positive compared with HIV-negative women was observed for preterm delivery and perinatal death. Quantile regression showed an increase in birth weight in babies born to HIV-negative women over time and a corresponding decline in birth weight in babies born to HIV-positive women. Unfavourable trends in some of the selected perinatal outcomes were seen for HIV-positive compared with HIV-negative women. Potential side-effects of combination antiretroviral treatment in pregnancy should be further explored.

Pathways of romantic jealousy to intimate partner violence in Mwanza, northern Tanzania

AbstractObjectiveThe goal of this research is to establish the pathways through which romantic jealousy leads to intimate partner violence.BackgroundPhysical and/or sexual intimate partner violence is widespread, with one in four women reporting it globally. Romantic jealousy is a known risk factor for intimate partner violence, yet little is known about the pathways that link it to intimate partner violence, especially in Africa.MethodWe used a qualitative design, interviewing 18 adult women in Northern Tanzania to understand their experiences and reflections of intimate partner violence. To grasp the mechanisms through which jealousy can trigger intimate partner violence, our analysis utilizes the concept of hegemonic masculinity.ResultsIntimate partner violence and romantic jealousy emerged as major issues in women's lives in this study. We established six pathways linking these variables: women confronting their partners because of infidelity, partners' anger because women confronted their mistress, women refusing to have sex or talk with their partners because they were jealous, male partners failing to control or regulate their emotions and becoming violent, and men feeling that their masculinity is threatened.ConclusionIn this study, intimate partner violence against women was largely men's reaction to their interpretation of perceived triggers of romantic jealousy and emotions as a threat to their masculinity and dominance.ImplicationsInterventions aiming to prevent intimate partner violence need to address the pathways linking the violence to romantic jealousy and include this connection in their programming.

Cultural Factors Associated with Human Trafficking of Girls and Women in Northern Tanzania: The Case of Arusha Region

Human trafficking is persistent in many regions of Tanzania despite different efforts to reduce the practice by the Government and other stakeholders. Girls and young women are more affected by this practice in violation of their human rights than men and boys. This study explored the cultural factors attributing to the trafficking of girls and women in Northern Tanzania. The study involved 400 girls and young women for a quantitative and qualitative study on cultural determinants of human trafficking. The study found the following cultural practices pushed girls and women towards situations in which they could be trafficked: female genital mutilation (82%); son preference (78%); daughters not inheriting land and animals (77%); women not participating in decision making (70%); the workload for women and girls (88%); wife battering (87%); early marriage (82%); under estimating women and girls’ decision-making-making abilities (77%); and polygamy (76%).

The ecosocial self, place, and well-being: An ethnographic case study with Maasai women from northern Tanzania

This article expands on “ecosocial” theories to consider the importance of the “ecosocial self” as a relevant theoretical construct for understanding and enhancing well-being among individuals whose sense of self is intimately intertwined with their ecological context or place, such as their land and livestock. This concept emerged from long-term ethnographic research with Maasai women in northern Tanzania. Fieldnotes, unstructured interviews with 71 women in a nonclinical community sample, and feedback from key informants inform this manuscript. Place-based stress on the land and livestock related to the local climate seems to be a driver of emotional distress for the female pastoralists in this study. Attending to the “ecosocial self,” or the part of a person who experiences themselves as intimately tied with their place (here, land and livestock) offers new solutions, especially in a social context where emotional distress is not interpreted as a sign of mental illness. The article concludes with recommendations about addressing mental health concerns related to place-based stress through interventions that seem to have nourished the “ecosocial self” in other contexts, such as land-based and animal-based interventions.

Maasai women hearing voices: Implications for global mental health.

There is a sparse literature on women who hear voices globally, even though there are documented gendered dimensions of distress in the context of globalization and climate change and research indicates that trauma and psychosocial stress may be related to an increased prevalence of voice-hearing or auditory verbal hallucinations (AVHs). There is also a gap in the cultural phenomenology of voice-hearing in general, as well as idioms of distress for non-western peoples. This article presents results of a mixed methods study that: 1) estimated community prevalence of voice-hearing among Maasai women in northern Tanzania; 2) examined any demographic correlates and two specific hypothesized correlates (i.e., psychological stress and potentially traumatic events); and 3) engaged women in semi-structured interviews about their everyday lives and the phenomenological experience of voice-hearing. The prevalence of voice-hearing (39.4%) in this nonclinical sample (n = 71) was quite high compared to other studies in sub-Saharan Africa. Most women also reported high psychosocial stress and traumatic life events. They also talked about gendered conditions of social adversity in a context of rapid social, economic, and climate change. Women who reported hearing voices had a statistically significantly higher level of psychological distress, met criteria for severe psychological distress, and reported more potentially traumatic life events. In a logistic regression model, psychosocial stress predicted voice-hearing. The presence of distressing voices may offer a straightforward way to quickly identify people in the community experiencing the most extreme levels of psychosocial stress and traumatic events-a potentially simple but effective screening tool for health workers on the ground.

Maternal knowledge-seeking behavior among pregnant women in Tanzania.

Background:Maternal mortality continues to be a global challenge with about 830 women dying of childbirth and pregnancy complications every day. Tanzania has a maternal mortality rate of 524 deaths per 100,000 live births.Objective:Knowing symptoms associated with antenatal risks among pregnant women may result in seeking care earlier or self-advocating for more immediate treatment in health facilities. This article sought to identify knowledge-seeking behaviors of pregnant women in Northern Tanzania, to determine the challenges met and how these should be addressed to enhance knowledge on pregnancy risks and when to seek care.Methods:Interview questions and questionnaires were the main data collection tools. Six gynecologists and four midwives were interviewed, while 168 pregnant women and 14 recent mothers participated in the questionnaires.Results:With the rise in mobile technology and Internet penetration in Tanzania, more women are seeking information through online sources. However, for women to trust these sources, medical experts have to be involved in developing the systems.Conclusion:Through expert systems diagnosis of pregnancy complications and recommendations from experts can be made available to pregnant women in Tanzania. In addition, self-care education during pregnancy will save women money and reduce hospital loads in Tanzania.

Acute pesticide poisoning amongst adolescent girls and women in northern Tanzania

BackgroundAcute pesticide poisoning (APP) is reported to affect community health worldwide but its burden in Tanzania is unknown particularly in women. This study examines APP involving adult females and adolescent girls 10 to 19 years in 3 regions of Tanzania which are famous for coffee and vegetable production.MethodsOver the period of 12 months, health facility-based surveillance for cases of APP was implemented in 10 Tanzanian healthcare facilities in 2006.ResultsThe study identified 108 APP cases of whom 31 (28.7%) occurred amongst adolescent girls. Suicide was the leading poisoning circumstances (60.2%) and the most vulnerable women were 20–29 years old who comprised 38.4% of all cases with suicide as circumstance.Organophosphates (OPs), zinc phosphide, paraquat and endosulfan were common amongst known reported poisoning agents. The annual APP incidence, mortality and Case Fatality Rate for women were 5.1/100,000, 0.2/100,000 and 3.7/100, respectively.ConclusionAPP amongst women in Tanzania is common and this call for diverse preventive interventions to reduce poisoning incidents.

Factors influencing adoption of facility-assisted delivery - a qualitative study of women and other stakeholders in a Maasai community in Ngorongoro District, Tanzania

BackgroundTanzania’s One Plan II health sector program aims to increase facility deliveries from 50 to 80% from 2015 to 2020. Success is uneven among certain Maasai pastoralist women in Northern Tanzania who robustly prefer home births to facility births even after completing 4+ ANC visits. Ebiotishu Oondomonok Ongera (EbOO) is a program in Nainokanoka ward to promote facility births through a care-group model using trained traditional birth attendants (TBAs) as facilitators. Results to date are promising but show a consistent gap between women completing ANC and those going to a facility for delivery. A qualitative study was conducted to understand psychosocial preferences, agency for decision-making, and access barriers that influence where a woman in the ward will deliver.MethodsIn-depth interviews, focus group discussions and key-informant interviews were conducted with 24 pregnant and/or parous women, 24 TBAs, 3 nurse midwives at 3 health facilities, and 24 married men, living in Nainokanoka ward. Interviews and discussions were transcribed, translated, and analyzed thematically using a grounded theory approach.ResultsMost women interviewed expressed preference for a home birth with a TBA and even those who expressed agency and preference for a facility birth usually had their last delivery at home attributed to unexpected labor. TBAs are engaged by husbands and play a significant influential role in deciding place of delivery. TBAs report support for facility deliveries but in practice use them as a last resort, and a significant trust gap was documented based on a bad experience at a facility where women in labor were turned away.ConclusionsEbOO project data and study results show a slow but steady change in norms around delivery preference in Nainokanoka ward. Gaps between expressed intention and practice, especially around ‘unexpected labor’ present opportunities to accelerate this process by promoting birth plans and perhaps constructing a maternity waiting house in the ward. Rebuilding trust between facility midwives, TBAs, and the community on the availability of health facility services, and increased sensitivity to women’s cultural preferences, could also close the gap between the number of women who are currently using facilities for ANC and those returning for delivery.

Correction: Time trends in management of HIV-positive pregnant women in Northern Tanzania: A registry-based study.

[This corrects the article DOI: 10.1371/journal.pone.0184362.].

T161. HEARING VOICES AMONG INDIGENOUS MAASAI WOMEN IN TANZANIA: IMPLICATIONS FOR GLOBAL MENTAL HEALTH

BackgroundStudies of the health of indigenous and tribal people can shed light on health inequalities with implications for global mental health. Almost no previous studies of mental health among the Maasai in Kenya or Tanzania or even pastoralist groups in general are available, with the exception of one mentioning the stress of rural-to-urban migration. While engaged in ethnographic research in 2013, Myers interviewed 13 Maasai women in northern Tanzania about their everyday lives. Interested in the phenomenology of voice-hearing, she also asked them if they heard voices. Eleven of the women (85%) reported regularly hearing voices that they found to be distressing. Myers returned in 2015 to collect data from a larger sample, which has resulted in this report.MethodsFor this study, we used a convenience sample (n=73) of females taken from a broader study whose eligibility criteria included being a Maasai person living in the Arusha Region of Tanzania and over the age of 18. We excluded people who reported being psychiatric patients or family members of patients being seen by the local mental health coordinator to create a nonclinical community sample. This project conducted an initial survey to: 1) estimate the community prevalence of voice-hearing, or auditory verbal hallucinations (AVHs) in this specific population; and, 2) examine any demographic correlates and two specific hypothesized correlates based on previous literature about voice-hearing (e.g., psychological stress and potentially traumatic events).ResultsThe prevalence of AVHs in this community sample was quite high compared to other studies in sub-Saharan Africa, at 34.3%. There were no differences between participants who did and did not experience AVHs in terms of demographics, but those experiencing AVHs had a statistically significantly higher level of psychological distress (30.1, SD=6.0, compared to 25.1, SD=6.0), with a Cohen’s d effect size of .87. Even though a numerical difference was observed in terms of potentially traumatic events (4.6, SD=2.1, compared to 3.8, SD=2.3), this difference was not statistically significant (d=.38).DiscussionHearing distressing voices may be an indicator of mental ill health that is easily recognizable to community health workers and brings much-needed attention to communities in need. Maasai women face tremendous social adversity in this time of rapid social, economic, and climate change in the region. Evidence for a link between stressful life events, social disadvantage, and the development of psychotic symptoms is strong in Europe, but not as well-developed in this region. The high level of psychosocial stress and AVHs in our sample may also be indicative of extreme social adversity. Maasai women have been historically disenfranchised since the advent of colonial and postcolonial policies favoring men. Women in this region also experiences extreme states of deprivation, including a 21.5 year gap in life expectancy at birth compared to the local population (for all Maasai), 81% severe food insecurity, and a rate of 59% for the stunted growth of children (as compared to their neighbors, the Meru, with 21% of children with stunted growth). Due to local livelihood insecurity, the age of first marriage has been decreasing, resulting in increased pressure on women. This analysis contextualizes these findings and calls for further research on the epidemiology of voice-hearing in this region, as well as further work on the phenomenology of these AVHs so that we can best understand how to address them and improve mental health outcomes for this marginalized group.

Variability and validity of intimate partner violence reporting by couples in Tanzania.

In recent years, major global institutions have amplified their efforts to address intimate partner violence (IPV) against women—a global health and human rights violation affecting 15–71% of reproductive aged women over their lifetimes. Still, some scholars remain concerned about the validity of instruments used for IPV assessment in population-based studies. In this paper, we conducted two validation analyses using novel data from 450 women-men dyads across nine villages in Northern Tanzania. First, we examined the level of inter-partner agreement in reporting of men’s physical, sexual, emotional and economic IPV against women in the last three and twelve months prior to the survey, ever in the relationship, and during pregnancy. Second, we conducted a convergent validity analysis to compare the relative efficacy of men’s self-reports of perpetration and women’s of victimization as a valid indicator of IPV against Tanzanian women using logistic regression models with village-level clustered errors. We found that, for every violence type across the recall periods of the last three months, the last twelve months and ever in the relationship, at least one in three couples disagreed about IPV occurrences in the relationship. Couples’ agreement about physical, sexual and economic IPV during pregnancy was high with 86–93% of couples reporting concordantly. Also, men’s self-reported perpetration had statistically significant associations with at least as many validated risk factors as had women’s self-reported victimization. This finding suggests that men’s self-reports are at least as valid as women’s as an indicator of IPV against women in Northern Tanzania. We recommend more validation studies are conducted in low-income countries, and that data on relationship factors affecting IPV reports and reporting are made available along with data on IPV occurrences. Keywords: Intimate partner violence; measurement; validity; survey research; Tanzania.

Prevalence, predictors and challenges of gestational diabetes mellitus screening among pregnant women in northern Tanzania.

To determine the prevalence and predictors of gestational diabetes mellitus (GDM) as well as acceptability of returning for glucose tolerance testing among pregnant women in Moshi municipality, northern Tanzania. Cross-sectional study from October 2015 to April 2016 among women with gestation age of 24-28 weeks of pregnancy attending at Kilimanjaro Christian Medical Centre (KCMC) referral hospital, Majengo and Pasua Health Centres. Women were interviewed and requested to return the next day (window within a month, depending on gestational age) for fasting plasma glucose (FPG) testing, followed immediately by a 75 g oral glucose tolerance test (OGTT). GDM was diagnosed using the 2013 WHO criteria. Logistic regression was conducted to reveal independent predictors for GDM. Of 433 interviewed women, 100 (23%) did not return for FPG and OGTT testing. The prevalence of GDM among the 333 screened women was 19.5%, and 3% had diabetes in pregnancy (DIP). GDM was significantly associated with age ≥35 years (adjusted OR 6.75), pre-pregnancy obesity (AOR 2.22) and history of abortion (AOR 2.36). Prevalence of GDM is high in Moshi. We recommend introduction of routine screening for hyperglycaemia during pregnancy along with strategies for follow-up to prevent long-term effects of GDM and DIP in women and their children.

Time trends in management of HIV-positive pregnant women in Northern Tanzania: A registry-based study.

ObjectiveTo examine time trends in antenatal factors and delivery characteristics in Northern Tanzania, and relate these to national guidelines for HIV in pregnancy.DesignRegistry-based study.SettingNorthern Tanzania, 2000–2014.Population or sampleDeliveries (n = 33 346).MethodsHIV-positive women were compared with HIV-negative women during four periods spanning changing national guidelines.Main outcome measuresKnown maternal HIV status, HIV treatment for woman, number of antenatal care (ANC) visits, routine folate/iron in pregnancy, anemia, delivery complications/interventions.ResultsWe observed an increase in deliveries with known maternal HIV status and women receiving HIV treatment, and a decline in deliveries with positive maternal HIV status (p-values for trend <0.001). The proportion of women with less than four ANC visits increased to above 30 percent irrespective of HIV status. Use of routine folate/iron increased, corresponding to a decrease in anemia which was strongest in HIV-negative women. Incidence of elective caesarean section (CS) and emergency CS remained unchanged for HIV-positive women (7.1% and 25.5%, respectively, in the last period). Use of invasive procedures declined in both groups of women. Mothers who were young, single, had low education, high parity or lived in the rural area more often had indicators of poor antenatal care.ConclusionsIncreasing adherence to national guidelines over time was found for most selected outcomes. Still, a high occurrence of insufficient ANC, anemia and emergency CS call for efforts to explore and identify barriers that hinder optimal care.

Reproductive Health and Bodily Integrity in Tanzania.

Several policy initiatives support the empowerment of women to improve their reproductive health. Little is known, however, about the inverse effect that reproductive health might have on women's empowerment. Women are pressured to conform to their reproductive role, and an inability to do so might affect their empowerment, including control over their own body. Using a panel dataset of 504 married women in Northern Tanzania, we find that women who experienced a pregnancy loss show more tolerant views of partner violence and that child mortality lowers their perceived control over the sexual relationship with their spouse. The number of living children did not affect bodily integrity. These results confirm that women's bodily integrity is partly dependent on the ability to fulfill their reproductive role. They strengthen the case for policies and programs that improve women's reproductive health and underline the importance of counselling after pregnancy or child loss.

Eating practices during pregnancy: perceptions of select Maasai women in Northern Tanzania

BackgroundGlobally, pregnant women are challenged to meet sufficient and necessary dietary intake in order to improve maternal and neonatal outcomes. These challenges are amplified in traditional communities, such as the Maasai, where the historical and cultural practices may further curtail, or impact on this dyad’s potential success. The research is intended to enhance understanding of Maasai women’s pregnancy and nutrition traditions as well as their beliefs.Method Interviews with 12 pregnant Maasai women, all originally from the (Ngorongoro Conservation Area Authority NCAA) area and have spent most or all of their adult lives in the NCAA, sought to answer two research questions: how do these women describe their current dietary pattern and what do they believe is the role of nutrition during pregnancy.ResultsInterpretive description methodology was used to reveal five themes: (1) Eating less food makes baby come easier, (2) Not producing food means more dependence, (3) Working hard harms my baby, (4) Knowing what is needed for a good pregnancy and (5) Preferring our traditional ways for pregnancy and birth.ConclusionsThere is an imperative to address nutrition throughout the perinatal period within the Maasai population and the women recognize how important nutrition is for them and their babies. Opportunities to incorporate cultural values and practices must be embedded in programmes/services to achieve success and sustainability. It is important for future prenatal programming with the Maasai in northern Tanzania and other vulnerable groups of pregnant women to build on the women’s knowledge of what leads to good pregnancy outcomes.

Gender Ideology and Social Transformation: Using Mixed Methods to Explore Processes of Ideological Change and the Promotion of Women’s Human Rights in Tanzania

Despite growing international interest in policies and practices to enhance women’s status and well-being in the Global South, ideological constraints to structural transformation and increasing opportunities available to women are widespread. There is thus considerable need to examine how ideological processes surrounding women’s status and value can be challenged. In the current study we used mixed method analyses to examine a process of deideologization—the contestation and transformation of traditional ideology—among a group of Maasai women in northern Tanzania. First, thematic analysis was used to analyze qualitative interviews conducted with 16 Maasai women. Themes involving traditional ideology, the value of popular education, and components of a deideologization process were identified and assessed. Second, quantitative structural equation modeling was used to test a process model connecting women’s participation in popular education classes to increased political efficacy, decreased discomfort speaking at community meetings, and, in turn, deceased patriarchal beliefs about women. Overall, findings provided evidence for an iterative deideologization process catalyzed by popular education that led to improvements in women’s lives. The importance of promoting processes of deideologization via locally driven efforts to improve the status and well-being of women are discussed.

Alcohol consumption among pregnant women in Northern Tanzania 2000-2010: a registry-based study.

BackgroundAlcohol can be harmful to the development of the foetus. In most developed countries, pregnant women are recommended to abstain from alcohol, however in developing countries, women are less likely to receive these recommendations. With respect to pregnant women in Northern Tanzania, this study aims to 1) describe time trends in level of alcohol consumption, 2) assess socio-demographic predictors of alcohol consumption, and 3) describe associations between alcohol consumption and health-related maternal and foetal outcomes.MethodsData related to 34,090 births between 2000 and 2010 was obtained from the Medical Birth Registry at Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania and analysed. Poisson regression analysis was used to assess associations between potential risk factors and alcohol consumption, and between alcohol consumption during pregnancy and maternal and foetal health outcomes.ResultsFrom 2000 to 2010, the proportion of women reporting alcohol consumption during pregnancy decreased from 49.5 to 21.5 %. The socio-demographic predictors most strongly related to alcohol consumption were religion (Catholics 53.6 %, Protestants 25.9 %, Muslims 14.8 %) and tribe (Chaggas 45.2 %, Pares 17.3 %, Maasais 6.6 %). Pregnant women consuming alcohol were more likely to be older, taller, and have higher pre-pregnancy body mass index, and were less likely to present with anaemia (Hb < 11.0 g/dl) at last antenatal care (ANC) visit/at admission; adjusted relative risk (ARR) 0.84 (95 % confidence interval 0.79–0.90) for alcohol consumption vs. abstinence. Maternal alcohol consumption during pregnancy was associated with a decreased risk of being small for gestational age (ARR 0.87 (0.80–0.94) and a decreased risk of gestational age less than 37 weeks (ARR 0.89 (0.81–0.99).ConclusionsThe proportion of pregnant women reporting alcohol consumption decreased by 56.5 % from 2000 to 2010. Alcohol intake was strongly associated with socio-demographic factors. The association between alcohol intake and favourable perinatal outcomes remained significant after maternal factors were adjusted for. Information on diet, lifestyle factors and maternal health might give further insight into this unexpected observation. The proportion of pregnant women consuming alcohol in Northern Tanzania is high, and greater awareness of health outcomes associated with alcohol consumption is advised.

Antenatal depression is associated with pregnancy-related anxiety, partner relations, and wealth in women in Northern Tanzania: a cross-sectional study.

BackgroundPsychosocial health problems, specifically depression during pregnancy, can have negative impact on birth outcomes, postnatal mental health of the mother, and infant health. Antenatal depression is more prevalent among women in low- and middle-income countries than among women in high-income countries. Risk factors for antenatal depression reported in the literature relate to pregnant women in South Asia. Consequently, this study assessed depression in pregnancy and related psychosocial risk factors among select pregnant women residing in Mwanza region, Northern Tanzania.MethodsWe analysed data from 397 pregnant women recruited from three antenatal clinics for the period June—August 2013 for this cross-sectional study. Women provided data at one time point during their pregnancy by completing the Edinburgh Postnatal Depression Scale and a structured questionnaire assessing psychosocial, demographic, and behavioural risk factors related to antenatal depression. Multiple logistic regression analysis was performed to determine the relationship between risk factors examined and antenatal depression.ResultsOverall, 33.8 % (n = 134) of pregnant women had antenatal depression. Pregnancy-related anxiety was associated with antenatal depression (odds ratio (OR) 1.36, 95 % confidence interval (CI) 1.23 to 1.5). Pregnant women with poor relationship with partner and low/moderate socio-economic status had the highest OR for antenatal depression (82.34, 95 % CI 4.47, 1516.60) after adjusting for other covariates. Pregnant women with poor relationship with partner and high socio-economic status had an OR of 13.48 (95 % CI 1.71, 106.31) for antenatal depression. “Reference” pregnant women were those with very good relationship with partner and high socio-economic status.ConclusionsHigh proportion of self-reported depression among select pregnant women attending antenatal clinics in Mwanza, Tanzania merit integrating depression assessment into existing antenatal care services. Health care providers need to assess pregnancy-related risk factors (pregnancy-related anxiety), socio-demographic factors (socio-economic status), and interpersonal risk factors (relationship with partner). Future research should appraise effectiveness of interventions that enhance partner relationships in reducing antenatal depression across all wealth distributions.

O18.1 Prevalence and factors associated with modern contraceptive use among hiv- positive women aged 15–49 years in kilimanjaro region, northern tanzania

Background Of 270,000 new HIV infections in children, 90% are in Sub-Saharan Africa. High fertility levels and high number of women infected with HIV results in high rates of Mother-to-Child-Transmission (MTCT) in SSA. To date, most efforts to prevent MTCT of HIV have focused on the third prong, a strategy that offers ARV drugs to HIV infected pregnant women and their exposed infants. However, the effective use of contraceptives to prevent unwanted pregnancies among HIV-positive women has the ability to reduce the rates of MTCT of HIV at a lower cost compared to the third prong. There is limited information on the levels of contraceptive use and associated factors among HIV positive women in Northern Tanzania. Methods This was a cross-sectional study conducted in February–May 2014 in three randomly selected districts of Kilimanjaro region. Univariate and multivariate logistic regression analysis were used to describe data and determine independent predictors of modern contraceptives use respectively. Results Of the 672 HIV-positive women participated in this study, 93% were aware of modern contraceptive methods, 54% were current modern contraceptives users and 21% were using dual contraceptive methods. Commonly modern contraceptives method used included male condom (41%), Depo-Provera (13%) and oral contraceptive pills (10%). Modern contraceptive use was significantly higher among HIV-positive women with; secondary education (aOR = 3.6, 95% CI 1.4–9.5), who do not plan to have more children (aOR = 2.2, 95% CI 1.5–3.2), counselled on contraceptives at CTC (aOR = 3.7, 95% CI 2.7–5.1), disclosed their HIV status to their partner (aOR = 2.5, 95% CI 1.8–3.4). Conclusions Prevalence of modern contraceptive use was higher than the national level. 46% of HIV-positive women are not using any method of contraception despite being sexually active. Strategies are required to increase use of long-term contraceptive methods to those who do not want more children and strengthening counselling to target non-users.

Participation: Structural and relational power and Maasai women’s political subjectivity in Tanzania

Across the world, women remain seriously underrepresented in governmental politics. Moreover, limited opportunities for political participation and decision-making reflect a widespread societal problem substantiated and perpetuated through gender inequities that operate at numerous levels of society. Challenging and ending systemic gender-based power imbalances is critical to understanding the potential for women’s political participation worldwide. The current study uses a liberation psychology approach to test a model that examines how the dynamics of structure, power, and agency enable (or limit) women’s political participation. In particular, the study examines how women’s landownership influences the dynamics of relational power and individual agency that enable political participation among Maasai women in Tanzania. Surveys conducted among 225 women in northern Tanzania revealed that landownership was related to relationship power which predicted individual agency and, in turn, higher levels of women’s participation at political meetings. The findings suggest that when women have access to structural resources, they gain power within their marital relationships and are thereby more likely to become engaged in political participation and decision-making. Implications for the discussion of women’s political participation worldwide are addressed.