Women In Tanzania Research Articles

Accessibility to Gender-based Violence Health Services for Adolescent Girls and Young Women in Tanzania

Background and Objective: Gender-based violence (GBV) health services can offer lifesaving prevention and treatment, particularly for GBV survivors among adolescent girls and young women (AGYW), which includes post-exposure prophylaxis (PEP) provisions, counseling, and referrals to other GBV programs. Although there are many benefits to GBV services, such as HIV prevention, sexual and reproductive health rights, and mental well-being, the number remains small for GBV survivors who access these services following the violence. This study was focused on identifying and describing the perceived barriers and facilitators of accessing GBV health services among AGYW in Tanzania. Methods: This was a qualitative study in which a structured and in-depth interview process was used for AGYW (N = 20) aged between 15 - 24 years old in two districts of Dar es Salaam: Temeke and Kinondoni. The interviewer explored the participants’ perspectives on barriers and facilitators relating to GBV healthservice access. Audiotapes from the participants’ responses were transcribed and later translated. Thematic areas were identified using the Social-Ecological Model. Transcripts were analyzed using inductive content analysis. Results: The study findings were divided into barriers and facilitators. Key barriers included lack of knowledge on available GBV health services, stigma, low self-esteem, negative attitude, fear of HIV testing, fear of disclosing perpetrator(s), and lack of parental support. Key facilitators included community and parental support, positive-prior experiences, and peer support. Conclusion and Implication for Translation: It is paramount to strengthen existing interventions to address community and GBV health facility stigma and to empower survivors in the overcoming of fear- and esteem-related issues. Additionally, it is necessary to increase GBV survivors’ access to related GBV health services through strengthening facilitators’ abilities and influences.

The Influence of Social Demographic Factors on the Use of Extended Post-Partum Family Planning Methods Among Post-Delivery Women in Tanzania

Extended Post-Partum Family Planning (EPPFP) refers to the prevention of unplanned and/or closely spaced pregnancies from six (6) weeks to 12 months period after childbirth. It is revealed that 61% of women in the world do not use effective contraception within 24 months postpartum to prevent unplanned pregnancy. This study examined the influence of social demographic factors on the use of Extended Post-Partum Family Planning (EPPFP) methods among post-delivery women from four selected health care facilities in Tanzania. 255 post-delivery women aged 15-49 years who delivered a child between January 1, 2019 and January 31, 2020 were subjected to a facility-based cross-section study design through convenience sampling. Data were analyzed by SPSS version 20; multiple regression analyses were done to establish the relationships between social demographic factors and the use of Extended Post-Partum Family Planning (EPPFP) methods. It was found that there is a significant relationship between social demographic factors and the use of Extended Post-Partum Family Planning (EPPFP). The study recommends provision of family planning education to the community through mass and social media.

The Role of ODL System in Promotion and Protection of the Right to Education for Women in Tanzania: Challenges and Prospects

Right to education is both constitutional and human right protected in the constitution of the United Republic of Tanzania. Being a constitutional right, education ought to be protected and promoted by the state apparatuses so as to ensure optimum utilization of it. Among others, establishing academic institutions is one amongst initiatives implemented by the governments to ensure access to education for all. Women being one sect of the population, considered to be disadvantageous group in the country for enjoyment of rights, including right to education. Since its inception in 1992 the Open University of Tanzania distinguished itself from traditional conventional academic institutions in the country, for adopting the ODL system that allow beneficiaries to study while continuing with other roles. Its main focus is to be a leading academic institution for affordable and quality education for all. Having the phrase ‘for all’ signifies among others, highly respect for gender and other disadvantageous groups in terms of physical disability and those who couldn’t secure access to full time study schedules in conventional Universities. This paper highlights the role played by ODL system in insuring the protection and promotion of the rights to education for women. In discussion the paper provides analysis of achievements made by ODL system in providing quality and affordable education for women vis a vis other conventional academic institutions. The hypothesis this paper intends to prove is that, ODL system is the best and reliable alternative for women to attain their educational rights once faced challenges for not being accepted in the conventional systems.

Scaling Girls’ Technical Education (GTE): bringing coding skills to women in Tanzania

Learning outcomes The learning outcomes are as follows. Students can assess effective business strategies, determine the role of business in shaping informal institutions, understand managing issues in social enterprises, from talent management to expansion to mission drift, and develop deeper understanding of the African context. Case overview/synopsis The case presents the challenges facing the award-winning CEO/Founder of Tanzanian social enterprise Girls’ Technical Education (GTE). GTE provides technology and coding skills in Tanzania, focussing on educating women and girls. GTE has experienced significant success – expanding into neighbouring Malawi. GTE has a strong vision and mission, clearly articulated and prioritised by the Founder and his Board. Hybrid organisations, blending a social and financial mission, are expected to experience management tensions or mission drift, yet GTE seems to have avoided this. As an emerging organisational form, social enterprises – like GTE – often face hurdles regarding legitimacy and acceptance in the markets in which they operate. GTE is working to understand the Tanzanian and regional contexts and challenges in these ecosystems, seeking to influence norms and bring about positive impact. Complexity academic level Postgraduate courses including MBA, Executive Education and courses focussing on Organisation Studies, Management and Strategy. Supplementary materials Teaching Notes are available for educators only. Subject code CSS: 7 Management Science.

Pay-for-performance reduces bypassing of health facilities: Evidence from Tanzania.

Many patients and expectant mothers in low-income countries bypass local health facilities in search of better-quality services. This study examines the impact of a payment-for-performance (P4P) scheme on bypassing practices among expectant women in Tanzania. We expect the P4P intervention to reduce incidences of bypassing by improving the quality of services in local health facilities, thereby reducing the incentive to migrate. We used a difference-in-difference regression model to assess the impact of P4P on bypassing after one year and after three years. In addition, we implemented a machine learning approach to identify factors that predict bypassing. Overall, 38% of women bypassed their local health service provider to deliver in another facility. Our analysis shows that the P4P scheme significantly reduced bypassing. On average, P4P reduced bypassing in the study area by 17% (8 percentage points) over three years. We also identified two main predictors of bypassing - facility type and the distance to the closest hospital. Women are more likely to bypass if their local facility is a dispensary instead of a hospital or a health center. Women are less likely to bypass if they live close to a hospital.

Urbanization and health: The effects of the built environment on chronic disease risk factors among women in Tanzania.

Sub-Saharan Africa is experiencing rapid urban growth. Cities enable greater access to health services and improved water and sanitation infrastructure, leading to some improvements in health. However, urban settings may also be associated with more sedentary, stressful lifestyles and consumption of less nutritious food. C-reactive protein (CRP) is a measure of chronic inflammation predictive of cardiovascular disease, and high body mass index (BMI), a ratio of weight to height, indicates overweight or obesity and is associated with an increased risk of many chronic diseases. To explore the association between urbanicity and these two markers, we overlaid data from the 2010 Tanzania Demographic and Health Survey (DHS) with a satellite-derived measure of built environment. Linear regression models were constructed for the outcomes of BMI and CRP, by 1) administratively defined urban/rural categorization from the DHS, 2) satellite derived built environment, and 3) built environment stratified by urban/rural. A total of 2,212 women were included; 23% had elevated CRP, 21% were overweight or obese. A third (33%) lived in a highly built up area and 29% lived in an area classified as urban. A strong positive association between both CRP and BMI and built environment was detected; log CRP increased 0.43 in the highest built up areas compared to not built up (p<0.05); log BMI increased 0.02 in the most built up areas compared to not built up (p<0.05). However, comparing urban to rural category was only significant in unadjusted models. Models stratified by urban/rural category highlight that the variation in CRP and BMI by built environment is mainly driven by rural areas; within urban areas there is less variation. Our findings highlight the potential negative effects of urbanicity on chronic disease markers, with potentially more change detected for those transitioning from rural to urban lifestyles. Satellite-derived urbanicity measures are reproducible and provide more nuanced understanding of effects of built environment on health.

Predictors of uptake of cervical cancer screening among women in Urban Tanzania: community-based cross-sectional study.

The proportion of women screened for cervical cancer in Tanzania remains small at 6-21%. Even though some studies have been conducted to address barriers, the screening uptake remains low, which denotes the presence of unidentified barriers. The main objective of this study is to assess the predictors in the uptake of cervical cancer screening (CCS) among women in Tanzania. This is a community-based cross-sectional study conducted to obtain quantitative data through validated questionnaires to assess predictors of CCS. 1013 (91.8%) of the respondents had not been screened for cervical cancer. Three predictors of CCS were identified in this study; screening intention, health beliefs, and knowledge level. 600 (54.4%) of respondents had no screening intention. 552 (50%) had negative health beliefs, and 585 (53%) had inadequate knowledge of cervical cancer and CCS. Respondents who had no intention to screen were 0.482 (AOR) times less likely to uptake CCS (P = 0.002; 95% CI: 0.305, 0.761). The ongoing community-awareness raising campaigns should be coupled with community knowledge-raising campaign, and there should be an establishing of peer-supporting screening programs in communities.

Adaptation and validation of social accountability measures in the context of contraceptive services in Ghana and Tanzania

BackgroundChanges in the values, attitudes, and interactions of both service users and health care providers are central to social accountability processes in reproductive health. However, there is little consensus on how best to measure these latent changes. This paper reports on the adaptation and validation of measures that capture these changes in Tanzania and Ghana.MethodsThe CaPSAI theory of change determined the dimensions of the measure, and we adapted existing items for the survey items. Trained data collectors used a survey to collect data from 752 women in Tanzania and 750 women in Ghana attending contraceptive services. We used reliability analysis, exploratory, and confirmatory factor analysis to assess the validity and reliability of these measures in each country.ResultsThe measure has high construct validity and reliability in both countries. We identified several subscales in both countries, 10 subscales in Tanzania, and 11 subscales in Ghana. Many of the domains and items were shared across both settings.ConclusionThe study suggests that the multi-dimensional scales have high construct validity and reliability in both countries. Though there were differences in the two country contexts and in items and scales, there was convergence in the analysis that suggests that this measure may be relevant in different settings and should be validated in new settings.Trial registrationACTRN12619000378123.

Fecal carriage and factors associated with extended-spectrum \u03b2-lactamase-producing Enterobacteriaceae among pregnant women at the tertiary referral hospital, Tanzania

BackgroundInfections due to extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) are increasing worldwide. Evidence indicates that fecal carriage of ESBL-E in pregnancy predisposes women to potential life-threatening urinary tract infections and subsequently increasing the risk of neonatal infections. There is limited data regarding fecal carriage of ESBL-E and associated factors among pregnant women in Tanzania. We aimed to address the gap by determining the proportion of pregnant women with ESBL-E fecal carriage and identify the related factors.MethodologyA hospital-based cross-sectional study was conducted at Muhimbili National Hospital in Dar es Salaam, Tanzania. A total of 182 pregnant women at the gestational age of 37 weeks and above were enrolled. Participants’ socio-demographic, clinical, and hygienic information were collected by using a well-structured questionnaire. Rectal swabs were collected and processed for isolation of ESBL-E. The extended-spectrum β-lactamase production and antibiotic susceptibility test (AST) were performed using a double-disc synergy test and Kirby-Bauer disc diffusion method, respectively.ResultsA total of 117 (64.3%) pregnant women were found to carry ESBL-E. Factors such as self-prescription of antibiotic medication during pregnancy, low education level, and toilet sharing were independently associated with ESBL-E fecal carriage. Five ESBL-E species that were isolated include Escherichia coli (84.6%), Klebsiella pneumoniae (8.9%), Klebsiella oxytoca (3.3%), Citrobacter spp. (1.6%), and Enterobacter spp. (1.6%). ESBL-E isolates demonstrated high resistance to aztreonam and sulphamethoxazole-trimethoprim.ConclusionThis study has revealed a relatively high fecal carriage of ESBL-E among pregnant women, suggesting that there is a need for routine screening among that population. We recommend further studies to explore comprehensively the factors associated with high fecal carriage of ESBL-E in pregnancy and the potential transmission kinetics to their newborn babies.

A one-year cohort study of complications, continuation, and failure rates of postpartum TCu380A in Tanzania

BackgroundLess than 1% of married women in Tanzania use an Intrauterine Contraceptive Device (IUD) for contraception. An initiative by the International Federation of Gynecology and Obstetrics (FIGO) has been in progress since 2015 resulting in escalated method uptake in implementing hospitals. This study investigates failure rate, complications, and risk factors for one-year continuation of TCu380A IUD when used for immediate postpartum contraception under the initiative in Tanzania.MethodologyA prospective cohort study of women who had TCu380A insertion within 48 h of delivery in 6 hospitals in Tanzania between 1st December 2017 and 18th April 2018 was conducted. Face to face post insertion interviews were made with 1114 clients before discharge and later through phone calls up to the beginning of 13th month postpartum. Postpartum Intrauterine Device (PPIUD) continuation status, complications, duration of time they stayed with the IUD and the currently used method if PPIUD was discontinued were enquired. The outcome variable was PPIUD continuation at one year of IUD insertion. Data were analyzed using Statistical Product and Service Solutions software (SPSS) for Windows version 20 (IBM SPSS Statistics, Chicago, IL, USA).ResultsIn total 511(45.8%)clients had consented and availed to complete the one-year follow-up. Out of these, 440 still had IUD, giving a one-year continuation rate of 86.1%. Most (63%) IUD discontinuations occurred in the period between 7th week and 6 months of insertion. One-year method expulsion rate was 2.1%. There was one reported pregnancy that gives a method failure rate of about 2 per 1000. The independent risk factors in favor of method continuation at one year were absence of medical or social problem, being a youth (16–24 years), and delivery by Cesarean section.ConclusionsThe continuation rate when CuT380A is used for immediate postpartum contraception is high, with low complication and failure rates. Some medical and social factors are important for method continuation, hence the need to consider in training, counselling and advocacy.

Return on Investment of a Breast Cancer Screening Program in Tanzania: Opportunity for Patient and Public Education.

Breast cancer is the second incident and second cause of cancer mortality among women in Tanzania due to late-stage presentation. The screening clinic at the Ocean Road Cancer Institute (ORCI) can help detect cases early and reduce cost of treatment. We calculated the return on investment (ROI) of the ORCI breast screening clinic. Screening and treatment data of all newly diagnosed breast cancer patients seen at ORCI during 2016-2018 were abstracted from the medical records. Also, data on time, resources, and cost of screening and treatment were obtained. The cost of treating screened patients was compared with cost of treating unscreened patients, and differences in cost of treatment were compared with cost of operating the screening program. Of the 730 total patients, 58 were screened prior to treatment, and 672 were not. There was no significant difference between stage at diagnosis and treatments received by screened and unscreened patients (79.3% late- stage vs 72.2% late-stage diagnosis, respectively (p = .531), or cost of treatment between the two groups (cost, in Tanzanian Shillings, for screened (2,167,155.14 or $954.27) vs unscreened (1,918,592.28 or $844.52), (p = .355). There was also no significant difference in cost of treatment between the screened and unscreened groups and a slightly negative ROI (- 0.05%) from implementing the program. The breast screening clinic in Tanzania has not yet proven its cost-effectiveness in reducing stage with screening. The likelihood that patients have utilized the clinic for treatment rather than early detection is a possible reason for the lack of cost-effectiveness. Future studies should focus on educational initiatives to encourage screening at early disease stage. Public education should increase awareness about the clinic for early detection. The experience of this program is ideal for dissemination to other low-income countries that are initiating cancer early detection and cancer education programs.

Sexual Risk Behaviors and Menstrual and Intravaginal Practices Among Adolescent Girls and Young Women in Tanzania: A Cross-Sectional, School-Based Study

Objectives Objectives were to describe menstrual and intravaginal practices and sexual risk behaviors among adolescent girls and young women (AGYW) in Tanzania. Methods A cross-sectional survey was conducted in secondary schools in Tanzania. Data on menstrual practices (e.g., product use), intravaginal practices (e.g., douching), and sexual risk were analyzed using chi-square and loglinear analyses. Results Menstrual risk practices were common. Sexual risk behaviors and intravaginal practices were high among AGYW reporting sexual debut. Conclusions High levels of menstrual, intravaginal, and sexual risk practices highlight the need to improve menstrual, sexual, and intravaginal practices, particularly among sexually active AGYW.

Factors associated with underweight, overweight, and obesity in reproductive age Tanzanian women.

Underweight, overweight, and obesity are major public health challenges among reproductive-age women of lower- and middle-income countries (including Tanzania). In those settings, obesogenic factors (attributes that promote excessive body weight gain) are increasing in the context of an existing high burden of undernutrition. The present study investigated factors associated with underweight, overweight, and obesity among reproductive age women in Tanzania. This study used 2015-16 Tanzania Demographic and Health Survey data (n = 11735). To account for the hierarchical nature of the data (i.e., reproductive age women nested within clusters), multilevel multinomial logistic regression models were used to investigate the association between individual-level (socioeconomic, demographic and behavioural) and community-level factors with underweight, overweight, and obesity. Reproductive age women who were informally employed (relative risk ratio [RRR] = 0.79; 95% confidence interval [CI]: 0.64, 0.96), those who were currently married (RRR = 0.59; 95% CI: 0.43, 0.82) and those who used contraceptives (RRR = 0.70; 95% CI: 0.54, 0.90) were less likely to be underweight. Reproductive age women who attained secondary or higher education (RRR = 1.48; 95% CI: 1.11, 1.96), those who resided in wealthier households (RRR = 2.31; 95% CI: 1.78, 3.03) and those who watched the television (RRR = 1.26; 95% CI: 1.06, 1.50) were more likely to be overweight. The risk of experiencing obesity was higher among reproductive age women who attained secondary or higher education (RRR = 1.79; 95% CI: 1.23, 2.61), those who were formally employed (RRR = 1.50; 95% CI: 1.14, 1.98), those who resided in wealthier households (RRR = 4.77; 95% CI: 3.03, 7.50), those who used alcohol (RRR = 1.43; 95% CI: 1.12, 1.82) and/or watched the television (RRR = 1.70; 95% CI: 1.35, 2.13). Our study suggests that relevant government jurisdictions need to identify, promote, and implement evidence-based interventions that can simultaneously address underweight and overweight/obesity among reproductive age women in Tanzania.

The transformative effects of a participatory social empowerment intervention in the MAISHA intimate partner violence trial in Tanzania

Intimate partner violence is an important public health problem, with far-reaching consequences for women’s physical and emotional health and social well-being. There is evidence that intimate partner violence is preventable. The MAISHA study, a randomised controlled trial of the impact of a gender training intervention on intimate partner violence for women in Tanzania, found that those who participated in gender training were less likely to report past-year physical violence. As part of the study, a sample of women participated in longitudinal qualitative enquiry. To better understand the processes of change associated with intimate partner violence prevention, we explored narratives from in-depth interviews and focus group discussions with women who had participated in the training. The study drew on feminist political theory on agency and change, which we sought to understand in a setting with high rates of intimate partner violence that a standalone intervention was unlikely to change. The study found that gender training, which seeks to develop political consciousness and transformation, can promote a sense of efficacy amongst participants who feel validated through the collective learning process. Important yet under examined cognitive elements of change processes deserve more attention in the design, delivery and evaluation of violence prevention gender training.

The psychometric properties of PHQ-4 anxiety and depression screening scale among out of school adolescent girls and young women in Tanzania: a cross-sectional study

BackgroundLiterature suggests that most mental disorders have their onset in childhood and adolescence, but go undiagnosed until adulthood. Shorter versions of the screening tools such as the Patient Health Questionnaire with four items (PHQ-4) may help to improve screening coverage. This study assessed the psychometric properties of the PHQ-4 in screening for core symptoms of depression and anxiety among out of school adolescent girls and young women (AGYW).MethodsThis is a cross-sectional analysis of data from a cluster randomized controlled trial conducted among AGYW between June and July 2018 in North-West Tanzania. Two thousand four hundred twenty-six out-of-school AGYW aged 15 to 23 years were included. Data were collected on tablets using audio computer-assisted self-interviews (ACASI). Cronbach’s α was used to measure the reliability of the PHQ-4 while confirmatory factor analysis (CFA) and principal components analysis (PCA) were used for construct validity assessment. In CFA, three criteria were used to assess how well the model fits the data: Standardized Root Mean Square Residual (SRMR), the Comparative Fit Index (CFI), the Root Mean Square Error of Approximation (RMSEA) and 90% confidence interval for RMSEA.ResultsOf the 2426 participants, 33.8 and 35.5% screened positive for core symptoms of anxiety (GAD-2 ≥ 3) and depression (PHQ-2 ≥ 3), respectively. Cronbach’s α of the PHQ-4 was 0.81. Both items-correlation and corrected items-correlation of the PHQ-4 had total correlations above 0.5 (p < 0.01). CFA showed that all items loaded significantly onto the single factor, and loadings were strong, ranging from 0.67 to 0.77 (p < 0.01). CFA indicates that the PHQ-4 scale stand for a unidimensional construct with good model fit (CFI = 0.995, SRMR = 0.013, RMSEA = 0.054 and 90% CI for RMSEA (0.031–0.079)). PCA confirmed two distinct components; GAD-2 (anxiety) and PHQ-2 (depression). Those who reported having suicidal thoughts and social function problems had significantly higher scores on PHQ-2, GAD-2, and PHQ-4 screening items (p < 0.01).ConclusionsThe findings suggest that the PHQ-4 scale can reliably and validly screen for core symptoms of depression and anxiety among out of school AGYW. This tool is short and easy to administer. Thus, the PHQ-4 scale can be very useful in screening for anxiety and depression symptoms in the community, primary health facilities, research and programmatic settings.

Prevalence of chronic HBV infection in pregnant woman attending antenatal care in a tertiary hospital in Mwanza, Tanzania: a cross-sectional study

BackgroundTanzania has a high prevalence (7.17%) of chronic hepatitis B infection. Mother to Child transmission is very common, resulting in high rate of chronic infections. Currently, there is no screening program for HBV in pregnant women. This study investigated the prevalence and risk factors for chronic HBV infection in pregnant women in a tertiary hospital in Mwanza, Tanzania.MethodsSeven hundred and forty-three women attending antenatal care and/or delivering at the Bugando Medical Centre were enrolled. All answered a questionnaire on sociodemographic and other risk factors and were tested for HBsAg using a rapid test. In HBsAg positive mothers, maternal blood and umbilical cord blood samples collected after delivery were analyzed for serological (HBsAg, HBeAg and anti-HBe) and virologic (HBV-DNA viral load and genotype) markers. All their babies were vaccinated within 24 h of delivery. The children were followed up at 3 years of age. Data was analyzed using the Mann-Whitney U-test, independent sample T-test and logistic regression.ResultsOf the 743 participants, 22 (3%) were positive for HBsAg, and 2 (9%) had detectable HBe-antigen. Low condom use was the only statistically significant risk factor for chronic HBV infection (OR = 3.514, 95%CI = 1.4–8.0). Of 14 maternal blood samples genotyped, 10 (71%) were genotype A and 4 (29%) were genotype D. HBV-DNA was detected in 21/22 samples, with a median of 241 IU/ml (range: 27.4–25.9 × 107 IU/ml). Five (33%) of 15 available cord blood samples were positive for HBsAg and 10 (67%) were negative. At follow-up, one child showed chronic HBV infection characteristics, one had anti-HBs level of 7 mIU/ml and 5/7(71%) had protective anti-HBs levels (> 10 mIU/ml).ConclusionThis cohort of pregnant women showed a lower-intermediate prevalence of HBV of 3%. In the 3 years follow-up only 1 out of 7 children showed evidence of chronic HBV infection. The child’s mother with high viral load (25.9 × 107 IU/ml), was positive for HBeAg with a high degree of sequence similarity suggesting vertical transmission. These results highlight a need for improved diagnosis and treatment of HBV infection in pregnant women in Tanzania, in order to prevent vertical transmission.

Understanding Women's Help-Seeking With Intimate Partner Violence in Tanzania.

Intimate partner violence (IPV) is a serious global health problem affecting millions of women worldwide. Despite increased investments into its reduction, little research has been conducted into how women in low- and middle-income countries deal with IPV. This study seeks to explore this by looking in depth into help-seeking strategies utilized by abused women in Tanzania, using the 2015-2016 Tanzania Demographic and Health Survey. The prevalence of lifetime physical and/or sexual IPV was 41.6% in this study, but only half of all affected women sought help from anyone. The only clear association found with help-seeking was the severity of IPV.

Developing survivorship services in Ghana and Tanzania.

e24132 Background: The incidence of breast cancer is increasing in low- &amp; middle- income countries (LMICs). Alongside attempts to reduce the disparity in cancer survival between high-income countries (HIC) &amp; LMICs, it is important that survivorship is well understood and managed in an evidence based, resource and culturally sensitive manner. This project aimed to develop knowledge, skills and services concerning living with and beyond breast cancer primary treatment. Methods: This 3-phase study used mixed methods. Phase 1 used participant observation and focus group interviews (FGIs) to scope experience, resources, current practice, and challenges to implementing a recovery package. In Phase 2 nurses used the adapted Holistic Needs Assessment (HNA) with 500 women in Tanzania and Ghana, who were also offered a recovery care plan and treatment summary following their breast cancer primary treatment. Data was entered into a macro database &amp; analysed using descriptive statistics. Phase 3 was the development of a culturally sensitive “Foundations in Cancer Care” training toolkit for nurses. The toolkit was based on a “train the trainer” model and included slides, an existing palliative care toolkit and exercises. The training programme consisted of 5 days teaching covering theory and practice. Data collection included: Initial FGIs to ascertain learning needs, confidence in knowledge &amp; skills, assessed pre &amp; post teaching course, and course evaluation. Data were analysed using descriptive statistics. Results: In Phase 1 six themes were identified concerning experience of breast cancer which included cultural beliefs &amp; practices and access to treatment &amp; support. Phase 2 data from Tanzania showed a similar level of unmet need at the end of treatment to a previous similar published analysis from the UK. Data from Ghana showed a much higher level of unmet need. Evaluation following Phase 3 showed a positive change in nurses’ confidence in their knowledge. Conclusions: This mixed methods three-phase study has documented experience, resources and current practise around breast cancer survivorship in two African centers treating breast cancer. The feasibility of using HNA to identify unmet needs in these women has been demonstrated and needs the identified. Results from the HNA informed a training toolkit which was implemented and positively received and could be adapted for use in other LMICs.

Exclusive breastfeeding patterns in Tanzania: Do individual, household, or community factors matter?

BackgroundAlthough there is a broad knowledge about exclusive breastfeeding among women in Tanzania, exclusive breastfeeding (EBF) remained lower than 50% for about 50 years since her independence in 1961. Previous research has mainly focused on either individual or household determinants of breastfeeding patterns. This study takes a holistic approach and examines the extent to which combined individual, household, and community factors matter in explaining exclusive breastfeeding patterns in Tanzania.MethodsA cross-sectional analysis was carried out using a nationally representative sample from the 2015/16 Tanzanian Demographic and Health Survey. The dependent variable was exclusive breastfeeding, defined as the proportion of infants below 6 months of age who were exclusively breastfed in the last 24 h. Univariable and multivariable logistic regression analyses were conducted to determine factors associated with exclusive breastfeeding.ResultsIn general, the rate of exclusive breastfeeding was 59%. Delivery in the short rainy season (95% Confidence Interval [CI] Adjusted Odds Ratio [AOR] 1.21, 2.65) was associated with higher odds of practicing exclusive breastfeeding. On the one hand, mothers aged between 15 and 19 years of age (95% CI AOR 0.36, 0.93), the average size of infants at birth (95% CI AOR 0.38, 0.80), whether postnatal check-up was attended by a doctor (95% C AOR 0.06, 0.46), and the infant’s age above 2 months (95% CI AOR 0.23, 0.53) were associated with lower odds of practicing exclusive breastfeeding. There was weak evidence (95% CI AOR 0.48, 1.05) that living in an urban area was associated with a reduced practice of exclusive breastfeeding.ConclusionBreastfeeding rates are lower among young mothers, mothers whose husbands/partners decide on childcare, and mothers whose postnatal check-ups were conducted by doctors. Thus, breastfeeding programs and interventions need to focus more on young mothers, husbands/partners, and on training female nurses and midwives to increase the EBF rates. Women who tend to practice exclusive breastfeeding most often live in rural areas. There is an urgent need to understand why exclusive breastfeeding rates among urban women are lower.

Contribution of Microfinance Institutions in Empowering Women in Tanzania (A Case of Serengeti District Council)

In Tanzania the position of women in terms of economic and social status has been low compared to men. Majority of women are poorer, have low education and suffer from traditions and customary beliefs. Thus, empowering women is one of the main issues in Tanzania and sub- Sahara Africa context. Microfinance services are considered to be the entry point towards empowering women in economic and social status. However, it is also considered that Microfinance Institutions are extorting money from poor women through high interest rates, causing higher social pressure and domestic violence. The study use quantitative and qualitative data from Serengeti District council at Mara region of Tanzania. The study used cross-sectional studies, whereby data was collected at a single point in time. In total 20 women participated in the survey. The data obtained was analyzed by using Statistical Package for Social Sciences (SPSS). The study found that, the impact of Microfinance Institutions on women empowerment is very crucial in Tanzania. Women members of Microfinance Institutions have more control over savings and income generated from the business, greater role in decision making, and greater contribution in household income. However, the women do not participate in decisions regarding inheritance of household assets. With this regard, microfinance institutions have more contribution in women empowerment. Keywords: Microfinance, Institutions, Empowerment, Household, Decision making DOI: 10.7176/JAAS/63-06 Publication date: April 30 th 2020