Women In Tanzania Research Articles

Implementation and effectiveness of free health insurance for the poor pregnant women in Tanzania: A mixed methods evaluation

Demand side financing strategies have been a popular means of increasing coverage and availability of effective maternal and child health services in low and middle income countries (LMIC). However, most research to date has focused on the effects of demand side financing on the use and costs of care with less attention being paid to how they work to achieve outcomes. This study used a mixed methods evaluation to determine the effect of a targeted health insurance scheme on access to affordable quality maternal and child care, and assess implementation fidelity and how this affected programme outcomes.Programme effects on service access, affordability and quality were evaluated using difference in difference regression analysis, with outcomes being measured through facility, patient and household surveys and observations of care before the intervention started and eighteen months later. A simultaneous process evaluation was designed as a case study of the implementation experience. A total of 90 in-depth interviews (IDIs) and five focus group discussions were conducted during three rounds of data collection among respondents from management, facility and community. The scheme achieved high coverage among the target population and reduced the amount paid for antenatal and delivery care; however, there was no effect on service coverage and limited effects on quality of care. The lack of programme effects was partly due to the late timing of first antenatal care visits and registration for the scheme together with limited understanding of entitlements among beneficiaries and providers.Better communication of programme benefits is needed to enhance effects together with integration of such schemes within existing purchasing mechanisms and in financially decentralised health systems.

Competing needs: a qualitative study of cervical cancer screening attendance among HPV-positive women in Tanzania

ObjectivesThe aim of this study was to understand causes of attendance and non-attendance to a follow-up cervical cancer screening among human papillomavirus (HPV)-positive women.DesignSemistructured, individual interviews with HPV-positive women and...

Violence Against Women in Tanzania and its Association With Health-Care Utilisation and Out-of-Pocket Payments: An Analysis of the 2015 Tanzania Demographic and Health Survey.

Background:Violence against women is a major public health concern. In addition to adverse physical, mental, and sexual and reproductive health consequences, violence against women confers a considerable cost to health services and the health sector as well as to individuals and households in the form of out-of-pocket expenditures. This study aimed to assess whether physical or sexual violence against women is associated with higher health-care utilisation rates and out-of-pocket expenditures in Tanzania.Methods:This study used data from the 2015 Tanzania Demographic and Health Survey. Multivariate regression analysis was used to assess the association between health-care utilisation and partner and non-partner violence among 9,304 women. Outpatient and inpatient health expenditures were analysed using means and t-tests.Results:Women who had ever experienced physical or sexual violence (partner or non-partner) were significantly more likely to utilise health services, and in particular outpatient services, than never abused women. Out-of-pocket expenditures for out-patient care, however, did not differ by abuse status. This was in contrast to inpatient care, wherein, although abused women were not more likely to have higher utilisation rates compared with never abused women, abused women were significantly more likely to incur higher average out-of-pocket expenditures for inpatient visits. This significant difference in expenditure was possibly because of the different inpatient services sought—abused women were more likely to seek care because of illness, while never-abused women were more likely to seek care for pregnancy and delivery.Conclusion:This study highlights how violence against women in Tanzania potentially translates to higher health-care utilisation, possibly because of the long-term or chronic effects of persistent abuse. Health-care policies should, therefore, consider issues such as accessibility and affordability for health services. Additionally, governments should address the issue of violence against women more widely, thereby reducing their own costs as well.

SMS behaviour change communication and eVoucher interventions to increase uptake of cervical cancer screening in the Kilimanjaro and Arusha regions of Tanzania: a randomised, double-blind, controlled trial of effectiveness

BackgroundCervical cancer, although almost entirely preventable through cervical cancer screening (CCS) and human papillomavirus vaccination, is the leading cause of cancer deaths among women in Tanzania. Barriers to attending CCS...

Toxoplasma gondii seroprevalence among pregnant women attending antenatal clinic in Northern Tanzania

BackgroundAcute Toxoplasma gondii infection during pregnancy represents a risk for congenital disease, especially among women without previous exposure to infection. There is, however, a paucity of information about the epidemiology of T. gondii infection in pregnant women in Tanzania. This study aimed to determine the seroprevalence of T. gondii infection and associated demographic, clinical, and behavioral risk factors in pregnant women attending ante-natal clinic (ANC) at Kilimanjaro Christian Medical Center (KCMC), a referral medical center in Northern Tanzania.MethodsA hospital-based cross-sectional study was carried out from 1 February to 30 April 2017. Data on maternal demographic characteristics, obstetric history, knowledge, and practices related to T. gondii infection were collected from 254 pregnant women attending antenatal care at KCMC. A sample of 4 mL of blood was collected from each participant and sera prepared from each sample. Serum samples were tested for the presence of specific T. gondii IgG and IgM antibodies by indirect Enzyme-Linked Immunosorbent Assay (ELISA). DNA was extracted from whole blood for polymerase chain reaction (PCR) testing, targeting the DNA sequence coding for the Internal Transcribed Spacer 1 (ITS1).ResultsThe overall T. gondii seroprevalence, including both IgM- and IgG-positive individuals, was 44.5%. Of the 254 tested women, 102 and 23 were seropositive for T. gondii-specific IgG and IgM antibodies respectively and 113 individuals had antibodies of either or both classes. All IgM-positive samples were also tested by PCR, and all were negative. The majority (90%) of the women surveyed had never heard about toxoplasmosis. Consumption of raw vegetables [aOR = 0. 344; 95% CI 0.151–0.784; p = 0.011] and having regular contact with soil [aOR = 0.482; 95% CI 0.268–0.8681; p = 0.015] were both associated with T. gondii antibody status. Inverse relationships with probability of T. gondii exposure were observed, such that these practices were associated with reduced probability of antibody detection.ConclusionBased on serology results, we report widespread exposure to T. gondii infection among pregnant women attending ANC in KCMC. The complex interaction of risk factors for T. gondii infection needs to be studied in larger longitudinal studies.

Unequal power relations and partner violence against women in Tanzania: a cross-sectional analysis

BackgroundResearch on factors associated with partner violence against women is often framed within the context of gender inequality and power imbalances between husbands and wives—inequalities that are considered products of broader structural systems. Tanzania, a patriarchal society where high levels of partner violence exists, has gone through rapid economic and social changes over the past two decades. Increasing numbers of women are seeking paid work, and men’s ideals of manhood have reshaped with evidence of extra marital relations and alcohol use. Nationally representative population-based data documents 46.2% of ever-married women have experienced physical or sexual partner violence in their lifetime; 29.6% in the past year. In order to plan appropriate interventions to end violence against women, factors consistently associated with abuse need to be understood.MethodsThis study uses “couples” data from the 2015 Tanzania Demographic and Health Survey to examine correlates of past year partner violence against women. Multivariate regression analysis was used to explore individual and relational-level variables—including socio-demographic characteristics and history of abuse among women, partner behavioural characteristics, and indicators of gender and economic inequality—among 1278 married and cohabiting couples.ResultsAt the individual level, women’s experiences of non-partner violence (sexual abuse by a non-partner and witnessing violence in childhood) was strongly associated with risk and highlights that all forms of violence against women serve to keep them subordinated. Partner behavioural characteristics (polygamy and problematic alcohol use) were also associated with risk. Household socio-economic status, however, was not significantly associated with women’s risk in the final multivariate model. At the relational-level, men’s age difference of 10 or more years; and any employment (compared to none/unpaid) were associated with lower risk. When considering attitudes tolerant towards wife abuse, the strongest association with risk of violence was when both partners held tolerant views.ConclusionThe findings support the assertions of violence being associated with women’s prior/additional experiences of abuse and with men’s harmful expressions of masculinity. In addition to interventions that focus on transforming gender norms and attitudes (at the individual and community levels), addressing economic, legal and political structural barriers are also required.

A decade since sulfonamide-based anti-malarial medicines were limited for intermittent preventive treatment of malaria among pregnant women in Tanzania

BackgroundDespite the development of resistance to Plasmodium falciparum malaria, sulfadoxine–pyrimethamine is still effective for intermittent preventive treatment of malaria in pregnancy (IPTp). In Tanzania, more than 10 years have passed since sulfadoxine–pyrimethamine and sulfamethopyrazine–pyrimethamine (SPs) were reserved for IPTp only. However, the retail pharmaceutical outlet dispensers’ knowledge and their compliance with the policies have not been recently explored. Therefore, this study was designed to investigate dispensers’ knowledge about these medications together with their actual dispensing practices, a decade since they were limited for IPTp use only.MethodsThis descriptive cross-sectional study was conducted between February and July 2017 in all municipalities of Dar-es-Salaam city. Data were collected by direct interviews using a structured questionnaire to assess knowledge and a simulated client approach was used to assess the actual practice of medicine dispensers. Data analysis was done by using SPSS version 20 and Chi square test was used to test significant differences in proportions between different categorical variables. A p-value of less than 0.05 was considered to be statistically significant.ResultsA random sample of 422 medicine dispensers participated in this study whereby 185 (43.8%) were from community pharmacies and 237 (56.2%) from accredited drug dispensing outlets. The study revealed that SPs were available in 76% of the community pharmaceutical outlets in Dar es Salaam. In general majority of the dispensers (64%) had moderate to high knowledge about SPs and their indication. About 80% of the dispensers were aware that SP is reserved for IPTp. However, irrespective of the level of knowledge, almost all dispensers (92%) were willing to dispense the medicines for the purpose of treating malaria, contrary to the current Tanzania malaria treatment guideline.ConclusionMajority of the medicine dispensers in the community pharmaceutical outlets were knowledgeable about SPs and their indications. Disappointingly, almost all dispensers irrespective of their levels of knowledge were willing to dispense SPs for treatment of malaria contrary to the available treatment guidelines.

Disentangling the contributions of maternal and fetal factors to estimate stillbirth risks for intrapartum adverse events in Tanzania and Uganda.

ObjectiveTo estimate the stillbirth risk associated with intrapartum adverse events, controlling for fetal and maternal factors.MethodsThe present study was an analysis of cross‐sectional patient‐record and facility‐file data from women with viable fetuses who experienced obstetric adverse events at 23 hospitals and 38 health centers in Tanzania (between December 2015 and October 2016), and 22 hospitals, 16 level‐4 health centers, and five level‐3 health centers in Uganda (between May 2016 and September 2017). Adverse events were categorized in three severity groups (postpartum, intrapartum non‐near‐miss, and intrapartum near‐miss) to calculate stillbirth rates and adjusted prevalence ratios.ResultsData from 3816 women in Tanzania and 8305 in Uganda were included. Compared with postpartum adverse events, intrapartum near‐miss was associated with a 3.73‐ and 4.55‐fold higher prevalence of stillbirth in Uganda and Tanzania, respectively. Most women who experienced near‐miss had organ dysfunction on arrival or developed it soon after. The risk of stillbirth was higher among preterm deliveries compared with term deliveries, and was 42% and 59% lower in Tanzania and Uganda, respectively, for cesarean deliveries compared with vaginal deliveries after intrapartum non‐near‐miss adverse events.ConclusionStillbirth risk increased with severity of complications and was higher among premature deliveries. Survival was higher for cesarean deliveries in intrapartum non‐near‐miss complications, identifying the opportunity to prevent deterioration by timely actions.

Access to Communication Channels and Use of Family Planning among Women in Tanzania: Spatial and Socio-demographic Analysis

This study examined the relations and access to communication channels on the use of Family Planning (FP). Relationships between independent variables including access to communication channels and the use of FP services, and demographic characteristics were examined. This study used cross-sectional data from the Tanzania Demographic Health Survey and Malaria Indicator Survey (TDHS-MIS) of 2015-2016 from 11,127 women aged between 15-49 years. The sample was weighted to ensure representativeness. Univariate, bivariate and binary logistic regression analyses were used. Results in this study revealed a statically significant correlation between access to FP messages and use of family planning services (p<.001). Access to radio, television, printed media, and mobile phones was observed more among women who were never in a union, those with tertiary education, women in urban areas and among those within a high wealth index. Use of FP services increased with the fluency of access to FP messages. Printed media predicted more likelihood in the use of FP at 0.460, p<0.001; radio at 0.368, p<0.001; health facilities at 0.284, p<0.001 and education level at 0.276, p<0.001. The study concludes that despite the fact that there was a correlation between access to FP messages and the use of FP, the use or not use of the same is also influenced by factors.

Pre- and post-natal macronutrient supplementation for HIV-positive women in Tanzania: Effects on infant birth weight and HIV transmission.

ObjectiveTo determine if a protein-calorie supplement (PCS) plus a micronutrient supplement (MNS) improves outcomes for HIV-infected lactating women and their infants.DesignRandomized, controlled trial.SettingDar es Salaam, TanzaniaSubjects, participantsPregnant HIV-infected women enrolled in PMTCT programs who intended to breastfeed for 6 months.InterventionRandomization 1:1 to administration of a PCS plus MNS versus MNS alone among 96 eligible women beginning in the third trimester and continuing for 6 months of breast-feeding.Main outcome measure(s)Primary: infant weight at 3 months. Secondary: maternal BMI at 6 months.ResultsPCS resulted in significant increases in daily energy intake compared to MNS at all time points (range of differences: +388–719 Kcal); and increases in daily protein intake (range of differences: +22–33 gm). Infant birth weight (excluding twins) was higher in the PCS than MNS groups: 3.30 kg vs 3.04 kg (p = 0.04). Infant weight at 3 months did not differ between PCS and MNS groups: 5.63 kg vs 5.99 kg (p = 0.07). Maternal BMI at 6 months did not differ between PCS and MNS groups: 24.3 vs 23.8 kg/m2 (p = 0.68). HIV transmission occurred in 0 infants in the PCS group vs 4 in the MNS group (p = 0.03).ConclusionsIn comparison to MNS the PCS + MNS intervention was well tolerated, increased maternal energy and protein intake, and increased infant birth weight, but not weight at 3 months or maternal BMI at 6 months. Reduced infant HIV transmission in the PCS + MNS group was observed.Trial registrationClinical Trials.Gov NCT01461863.

Missed opportunities in antenatal care for improving the health of pregnant women and newborns in Geita district, Northwest Tanzania

BackgroundDespite the significant benefits of early detection and management of pregnancy related complications during antenatal care (ANC) visits, not all pregnant women in Tanzania initiate ANC in a timely manner. The primary objectives of this research study in rural communities of Geita district, Northwest Tanzania were: 1) to conduct a population-based study that examined the utilization and availability of ANC services; and 2) to explore the challenges faced by women who visited ANC clinics and barriers to utilization of ANC among pregnant women.MethodsA sequential explanatory mixed method design was utilized. Household surveys that examined antenatal service utilization and availability were conducted in 11 randomly selected wards in Geita district. One thousand, seven hundred and nineteen pregnant women in their 3rd trimester participated in household surveys. It was followed by focus group discussions with community health workers and pregnant women that examined challenges and barriers to ANC.ResultsOf the pregnant women who participated, 86.74% attended an ANC clinic at least once; 3.62% initiated ANC in the first trimester; 13.26% had not initiated ANC when they were interviewed in their 3rd trimester. Of the women who had attended ANC at least once, the majority (82.96%) had been checked for HIV status, less than a half (48.36%) were checked for hemoglobin level, and only a minority had been screened for syphilis (6.51%). Among women offered laboratory testing, the prevalence of HIV was 3.88%, syphilis, 18.57%, and anemia, 54.09%. In terms of other preventive measures, 91.01% received a tetanus toxoid vaccination, 76.32%, antimalarial drugs, 65.13%, antihelminthic drugs, and 76.12%, iron supplements at least once. Significant challenges identified by women who visited ANC clinics included lack of male partner involvement, informal regulations imposed by health care providers, perceived poor quality of care, and health care system related factors. Socio-cultural beliefs, fear of HIV testing, poverty and distance from health clinics were reported as barriers to early ANC utilization.ConclusionAccess to effective ANC remains a challenge among women in Geita district. Notably, most women initiated ANC late and early initiation did not guarantee care that could contribute to better pregnancy outcomes.

Breast Cancer Support Group at Ocean Road Cancer Institute in Dar es Salaam

Background and context: Breast cancer is a common type of cancer among women worldwide, with about 2 million new cases diagnosed in the yearly. It is the second common cancer and leading cause of cancer mortality among women in Tanzania, after cervical cancer. More than 70% of breast cancer patients in developed countries are diagnosed at early stages, whereas in low and middle-income countries, only 20%–60% of patients are diagnosed early. Physician in developed countries consults on average 15-20 breast cancer patients daily, while in developing countries the number triples. This high load does not allow a treating physician to spend ample time with patients explaining hence leaving patients not informed about their diagnosis, side effects of treatments and even living with the physical, emotional and psychological challenges of their disease. Residents at the Ocean Road Cancer Institute (ORCI), initiated a patient support group targeting breast cancer patients for feasibility. Aim: Provide forum for patients with same diagnosis to share common challenges Provide peer emotional, psychosocial support and cancer education Organize activities that will help to spread awareness to the community Initiate projects to improve socioeconomic status of breast cancer survivors in Tanzania Strategy/Tactics: Involved the ORCI administration from the beginning Involved the academic and research unit of ORCI Residents prepared session curriculum and teaching materials Sessions took place once a month Sessions were two hours long divided into three components, where the first is introduction of participants, then survivors led discussions or lectures prepared by an expert in the topic and lastly closing remarks by a physician Breakfast was provided Program/Policy process: Open membership for all breast cancer patients Physician lead face to face peer discussions Institutional acknowledgment of the support group Provision of primary registry of patients for follow-up Provision of a link to other social organizations Outcomes: Increase knowledge of cancer in general and breast cancer in particular A total of seven sessions were held to date For each session, participation ranged from 30-50 breast cancer survivors, and on average attendance was 4 sessions out of 7 Topics covered over a period of seven months included Coping with a cancer diagnosis and treatment Living with cancer and its changes to daily life Exercise Nutrition Breast cancer general knowledge Collaboration with other stake holders including IST secondary school students who initiated breast prosthesis knitting club What was learned: A need to reach out and give psycho-social support to ORCI patients Through education we can improve treatment adherence Possible partners are available if we reach out Exist a need to address misconceptions in the community so as to avoid stigma to patients.

The Impact of an Intervention to Prevent Intimate Partner Violence Against Women in Tanzania: Findings from the Maisha Cluster Randomised Controlled Trial

Background: Globally, about 30% of women have experienced physical and/or sexual violence from an intimate partner during their lifetime. We assessed the impact of a violence prevention intervention delivered to women participating in a group-based microfinance scheme. Methods: We conducted an unblinded, cluster randomized controlled trial among women in 66 microfinance groups, in Tanzania, to evaluate a 10-session participatory intervention that aims to empower women, prevent IPV and promote healthy relationships. If at least 70% of members consented, microfinance groups were randomly assigned to receive the intervention or be wait-listed for the intervention post-trial (control). Main outcomes, assessed 24 months post-intervention, were: a composite of reported past-year physical and/or sexual IPV (primary); past-year physical, sexual and emotional IPV; and acceptability and tolerance of IPV. An intention-to-treat analysis was conducted adjusting for age, education and baseline measure of the respective outcome. The trial is registered at ClinicalTrials.gov, NCT02592252. Findings: Between September 2014 and June 2015, 33 groups (n=544 women) were allocated to intervention and 33 (n=505 women) to control. Overall, 485 (89%) intervention and 434 (86%) control women completed outcomes assessment. Among intervention women, 112 (23%) reported past-year physical and/or sexual IPV compared with 119 (27%) among control women (adjusted odds ratio [aOR] 0·69, 95%CI 0·47-1·01, p=0·056). Intervention women reported significantly less physical IPV (aOR 0·64, 95%CI 0·41-0·99, p=0·043). They were also less likely to be accepting of IPV (aOR 0·45, 95%CI 0·34-0·61, p<0·001), believe IPV to be a private matter (aOR 0·51, 95%CI 0·32-0·81, p=0·005), or be tolerant of IPV (aOR 0·68, 95%CI 0·45-1·01, p=0·055). There were no significant differences in reported sexual or emotional IPV. Trial Registration Number: The trial is registered at ClinicalTrials.gov, NCT02592252. Interpretation: Over a two-year period, physical IPV was reduced by nearly a third, indicating that IPV is preventable in high-risk settings such as Tanzania. Funding: Anonymous donor and STRIVE Consortium funded by UK Aid. Declaration of Interest: Following initiation of the trial, CW has been seconded to the UK Government Department for International Development as their chief scientific advisor. Her ongoing role in this trial is in her academic capacity at LSHTM. No other interests declared. Ethical Approval: The trial was conducted following WHO recommendations on researching violence against women, and was approved by the Tanzanian National Health Research Ethics Committee of the National Institute for Medical Research (Ref: NIMR/HQ/R.8a/Vol. IX/1512), and the research ethics committee of the London School of Hygiene & Tropical Medicine (LSHTM, Ref: 11642).

Improving access to healthcare for women in Tanzania by addressing socioeconomic determinants and health insurance: a population-based cross-sectional survey

ObjectiveThis study was performed to explore the factors associated with accumulation of multiple problems in accessing healthcare among women in Tanzania as an example of a low-income country.DesignPopulation-based cross-sectional survey.SettingNationwide...

Perception, usage and barriers towards the utilisation of the Telecentre among rural women in Tanzania

PurposeThis paper aims to assess the usage pattern of telecentres, how rural women frame telecentres and barriers that limit use of telecentres. Further, the study examined the effects of demographic characteristics and location on telecentre usage.Design/methodology/approachThe study used a sequential mixed research design in three rural districts surrounding telecentres: Kongwa, Sengerema and Kilosa districts. The study population comprised rural women who were users and non-users of telecentres. The study conducted six focus group discussions (FGDs) with 37 users and six FGDs with 36 non-users in the first phase of the study in 2014; questionnaires were administered to 90 users and 90 non-users in the second phase of the study in 2015.FindingsThe primary use of telecentres among users was to access internet (71.4 per cent, n = 60), followed by information and communication technology (ICT) training courses (63.1 per cent, n = 53) and secretarial purposes (63.1 per cent, n = 53). Rural women used internet for educational purposes, followed by news, information on health issues, job opportunities, social and entertainment issues. Rural women currently using internet were more likely to be better educated (ß = 1.926, p = 0.001) and have higher incomes (ß = 5.318, p = 0.021) at both bivariate and multivariate analysis. Users indicated that they faced the following barriers towards using telecentre: short duration of ICT training, frequent power outages, low speed of internet and few computers at the telecentres. Non-users were not using telecentres because of lack of ICT skills and language barriers.Originality/valueThis study provides empirical evidence to telecentres, libraries and other rural ICT initiatives to design rural ICT services that are gender-sensitive and demand-driven.

Provider perspectives on PrEP for adolescent girls and young women in Tanzania: The role of provider biases and quality of care.

BackgroundOral pre-exposure prophylaxis (PrEP) has the potential to reduce HIV acquisition among adolescent girls and young women (AGYW) in sub-Saharan Africa. However, health care providers’ (HCPs) perspectives and interactions with potential clients can substantially influence effective provision of quality health services. We examine if HCPs’ knowledge, attitude, and skills, as well as their perceptions of facility readiness to provide PrEP are associated with their willingness to provide PrEP to AGYW at high risk of HIV in Tanzania.MethodsA self-administered questionnaire was given to 316 HCPs from 74 clinics in two districts and 24 HCPs participated in follow-up in-depth interviews (IDIs). We conducted bivariate and multivariable Poisson regression to assess factors associated with willingness to provide PrEP to AGYW. Thematic content analysis was used to analyze the IDIs, which expanded upon the quantitative results.ResultsFew HCPs (3.5%) had prior PrEP knowledge, but once informed, 61.1% were willing to prescribe PrEP to AGYW. Higher negative attitudes toward adolescent sexuality and greater concerns about behavioral disinhibition due to PrEP use were associated with lower willingness to prescribe PrEP. Qualitatively, HCPs acknowledged that biases, rooted in cultural norms, often result in stigmatizing and discriminatory care toward AGYW, a potential barrier for PrEP provision. However, better training to provide HIV services was associated with greater willingness to prescribe PrEP.Conversely, HCPs feared the potential negative impact of PrEP on the provision of existing HIV services (e.g., overburdened staff), and suggested the integration of PrEP into non-HIV services and the use of paramedical professionals to facilitate PrEP provision.ConclusionsPreparing for PrEP introduction requires more than solely training HCPs on the clinical aspects of providing PrEP. It requires a two-pronged strategy: addressing HCPs’ biases regarding sexual health services to AGYW; and preparing the health system infrastructure for the introduction of PrEP.

Motives, barriers, and ways of communicating in mother-daughter sexuality communication: a qualitative study of college women in Tanzania

In Tanzania, young women aged 15–24 are at high risk for HIV and nearly half (45%) of women experience pregnancy or childbirth before age 19. The HIV epidemic has motivated many parents to overcome cultural taboos and talk with their children about sexuality, but few studies in Tanzania have examined how young adults perceive these discussions. In-depth interviews with 31 Tanzanian college women (ages 18–25) reveal how they make sense of sexuality messages from mothers that are sometimes vague, admonishing and fear-based. Participants identified how mothers focused on the health, educational and social consequences of premarital sex and emphasised the avoidance of men as a strategy to maintain virginity. Mothers avoided providing specific information about safer-sex practices, or strategies to negotiate romantic relationships, sexual pressures or sexual desires. Findings offer insight into how relational and cultural contexts influence mothers’ sexual socialisation and can inform education and intervention approaches that consider the changing cultural landscape. Future qualitative research with mothers is recommended to develop programmes that are more responsive to mothers’ and daughters’ needs.

Can investment in quality drive use? A cluster-randomised controlled study in rural Tanzania

Abstract Background Reduction in maternal and neonatal mortality requires women's use of high-quality facilities for childbirth. Evidence that quality influences women's selection of place of delivery suggests that an investment in quality may increase use of facilities for childbirth. We assessed the impact of a quality improvement project on facility use for childbirth among women in Tanzania. Methods Of 24 government-managed primary care clinics in Pwani Region, Tanzania, we randomly selected 12 to receive an intervention consisting of: training, supportive supervision, infrastructure support, and peer outreach. The cluster was defined as the health clinic and the villages assigned to its catchment area by the ward. We collected household surveys of women living within the catchment area of each clinic with a birth in the past year at baseline (February–April 2012) and endline (January–April 2016). Women reported the location of birth for each of their deliveries, including the facility name. The primary outcome was report of facility use for childbirth for their most recent birth. The effect of the intervention was assessed using difference-in-difference analysis. We conducted an exploratory secondary analysis among women least likely to use the health system—ie, those whose prior delivery was a home birth. We investigated three pathways from the intervention to increased facility use: improved obstetric quality, improved antenatal care (ANC) quality, and improved links between the health system and the community. Findings In the intervention clusters, 999 (71·7%) of 1393 women gave birth in a facility at baseline and 1165 (85·3%) of 1365 did so at endline. The corresponding figures for the control clusters were 1146 (72·3%) of 1586 at baseline and 1411 (81·1%) of 1739 at endline. The intervention thus led to an increase in facility births of 6·7 percentage points (95% CI 0·6–12·8). The intervention was substantially more successful in increasing use among women least likely to utilise the health system, giving a 18·3 percentage point increase (95% CI 10·1–26·6). Among the hypothesised mechanisms, the most likely pathway of effect was through ANC: the intervention led to an increase in ANC quality, with providers performing an additional 0·8 (95% CI 0·21–1·34) actions among the low-use population and 0·5 actions among the full population (95% CI −0·01 to 1·01). Interpretation The quality improvement intervention led to a modest increase in facility use for childbirth and a strong increase among women whose previous delivery was at home. Our analysis provides empirical evidence that investment in quality can increase health care use. In an environment of rising use, quality may be a mechanism for encouraging remaining non-system users to engage in the health system, playing a role in achieving universal health coverage. Funding US National Institutes of Health 1R01AI093182.

Intimate partner violence (IPV): The validity of an IPV screening instrument utilized among pregnant women in Tanzania and Vietnam.

BackgroundIntimate partner violence (IPV) is a global problem that affects one-third of all women. The present study aims to develop and determine the validity of a screening instrument for the detection of IPV in pregnant women in Tanzania and Vietnam and to determine the minimum number of questions needed to identify IPV.MethodAn IPV screening instrument based on eight questions was tested on 1,116 Tanzanian and 1,309 Vietnamese women who attended antenatal care before 24 gestational weeks. The women were re-interviewed during their 30th-34th gestational week where the World Health Organization (WHO) IPV questionnaire was used as the gold standard. In all, 255 combinations of eight different questions were first tested on the Tanzanian study population where sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated. In the evaluation of the performance of the question combinations, different IPV types and the frequency of abusive acts were considered. The question combinations that performed best in Tanzania were subsequently evaluated in the Vietnamese study population.ResultsIn Tanzania, a combination of three selected questions including one question on emotional IPV, one on physical IPV and one on sexual IPV was found to be most effective in identifying women who are exposed to at least one type of IPV during pregnancy (sensitivity = .80; specificity = .74). The performance of the identified combination was slightly less effective in Vietnam (sensitivity = .74; specificity = .68). Focusing on different IPV types, the best performance was found for exposure to physical IPV in both Tanzania (sensitivity = .93; specificity = .70) and Vietnam (sensitivity = .96; specificity = .55). In both countries, the sensitivity increased with the frequency of abuse whereas the specificity decreased.ConclusionBy asking pregnant women three simple questions we were able to identify women who were exposed to IPV during pregnancy in two different countries. The question combination performed best in assessing physical IPV where it identified 93% and 96% of Vietnamese and Tanzanian women, respectively, who were exposed to physical IPV.

Factors Associated with Uptake of Emergency Contraception among Female Undergraduate Students in the University of Dar Es Salaam Main Campus, Tanzania

Background: Unwanted pregnancies among young women aged 18-24 remain global public health challenge despite the advancements of a variety of modern contraception methods. Emergency contraception (EC) is the only option available that can be used following an act of unprotected sex to prevent unwanted pregnancy. It reduces women’s risk of becoming pregnant by 99% depending on time taken. However, uptake of EC among young women in Tanzania is very low. The reasons for underutilization are not clear. None of the studies conducted in Tanzania have clearly delineated factors that influence uptake of EC among young women. Methodology: The study enrolled 384 female undergraduate students. A two-stage sampling technique was used; where four (4) departments were selected from the total of twenty-five (25) departments using a random lottery method. Then, the total sample size was allocated to each department proportional to the number of female students in the department. Secondly, study participants were selected from each department proportional to their year of study using simple random sampling technique. The number of study participants from the selected departments was determined using probability proportionate to population size allocation methods depending on the year of study. A structured questionnaire was used to collect data that was then coded and entered in the computer and analyzed using SPSS statistical computer software version 21.0. Exploratory factor analysis, descriptive statistical and logistic regressions analyses were conducted.