Bjørg Evjen Olsen

Avoidable stillbirths and neonatal deaths in rural Tanzania

Objective To determine the causes of stillbirths and neonatal deaths in the community in rural Tanzania and to evaluate whether the deaths were avoidable under the prevailing circumstances.

Anemia in pregnancy in the highlands of Tanzania

Background. Anemia in pregnancy is common in Tanzania, but many areas have not been investigated. This study describes prevalence and determinants of anemia among rural pregnant women living at 1300–2200 meters above sea level in Northern Tanzania.

Anemia in pregnancy in rural Tanzania: associations with micronutrients status and infections

Objective: We studied the association between anemia in pregnancy and characteristics related to nutrition and infections.Design: Cross-sectional study.Setting: Four antenatal clinics in rural northern Tanzania.Subjects/methods: A total of 2547 women were screened for hemoglobin (Hb) and malaria plasmodia in capillary blood and for infections in urine. According to their Hb, they were assigned to one of five groups and selected accordingly, Hb<70 g/l (n=10), Hb=70–89 g/l (n=61), Hb=90–109 g/l (n=86), Hb=110–149 g/l (n=105) and Hb≥150 g/l (n=50). The 312 selected subjects had venous blood drawn, were interviewed, and their arm circumference was measured. The sera were analyzed for ferritin, iron, total iron binding capacity (TIBC), cobalamin, folate, vitamin A, C-reactive protein (CRP), and lactate dehydrogenase (LD). Transferrin saturation (TFsat) was calculated. Urine was examined by dipsticks for nitrite.Main outcome measures: Unadjusted and adjusted odds ratio (OR and AOR) of anemia with Hb<90 g/l.Results: Anemia (Hb<90 g/l) was associated with iron deficiency (low s-ferritin; AOR 3.4). The association with vitamin deficiencies were significant in unadjusted analysis (low s-folate; OR 3.1, low s-vitamin A; OR 2.6). Anemia was also associated with markers of infections (elevated s-CRP; AOR 3.5, urine nitrite positive; AOR 2.4) and hemolysis (elevated s-LD; AOR 10.1). A malaria positive blood slide was associated with anemia in unadjusted analysis (OR 2.7). An arm circumference less than 25 cm was associated with anemia (AOR 4.0). The associations with less severe anemia (Hb 90–109 g/l) were similar, but weaker.Conclusions: Anemia in pregnancy was associated with markers of infections and nutritional deficiencies. This should be taken into account in the management of anemia at antenatal clinics.Sponsorship: The study was supported by the Norwegian Research Council (NFR) and the Centre for International Health, University of Bergen.

Causes and characteristics of maternal deaths in rural northern Tanzania

Background.  To assess causes and characteristics of maternal deaths in a poorly characterized area.

Estimates of maternal mortality by the sisterhood method in rural northern Tanzania: a household sample and an antenatal clinic sample

Objective To estimate maternal mortality in two samples of a population in northern Tanzania.

The diagnosis of urinary tract infections among pregnant women in rural Tanzania; prevalences and correspondence between different diagnostic methods

Background. To assess the prevalence of dysuria, dipsticks positive on nitrite and leukocyte esterase and positive Uricult® dip slides among pregnant women in rural Tanzania.

Maternal mortality in northern rural Tanzania: assessing the completeness of various information sources

Background. To assess the completeness of various information sources and the subsequent estimates on maternal mortality.

The silent HIV epidemic among pregnant women within rural Northern Tanzania

BackgroundMany national antenatal clinics (ANC) based HIV surveillance systems in sub-Saharan Africa have limited coverage of remote rural sites, a weakness that compromises adequate estimation, monitoring and development of effective preventive and care programmes. To address this void in rural Manyara and Singida within Northern Tanzania, we conducted antenatal clinic-based sentinel surveillance.MethodsWe consecutively enrolled 1377 counselled and consenting pregnant women attending ANC clinics for the first time during the current pregnancy. The study was conducted in six antenatal clinics, within three divisions of rural Manyara and Singida regions in 2003/2004. Interviews were conducted and blood samples for routine purposes were collected and tested for anti-HIV IgG antibody anonymously, using Bionor HIV-1 & 2 assay ®.ResultsAmong enrolees, 94% (1296/1377) participated fully. The overall prevalence of HIV was 2.0% (95%CI: 1.34–2.97). The highest HIV prevalence was among women aged between 15–19 years in both rural and remote rural populations. The odds of HIV infection was 4.3 (95%CI: 1.42–12.77) times among women reporting more than one lifetime sexual partners compared with those with one partner. HIV infection was associated with history of genital sores or foul smelling discharge, OR 6.8 (95%CI: 2.78–16.66) and age at first pregnancy (2.5 times higher likelihood of infection if before the age of 18 years versus at a later age).ConclusionIncluding rural remote sites, as part of the national ANC routine surveillance, is crucial in order to discover imminent silent epidemics such as the one described in this paper. Scaling up HIV prevention efforts is mandatory to prevent the imminent escalation of the HIV epidemic highly associated with a history of sexually transmitted infections (STIs), multiple sexual partners and pregnancies at a younger age. Ignorance of relevant knowledge and low utilisation of condoms underscores the urgency for large-scale preventive efforts. Research to capture a wider representation of the risk factors in the general population should be a priority to enable further customised HIV prevention efforts.

Low HIV‐seroprevalence in pregnant women in a rural area in Tanzania

According to estimates (December 2000) from the World Health Organization 36.1 million people live with HIV worldwide and 25.3 million of them are found in Sub-Saharan Africa. Tanzania is one of the countries hardest stricken. In 1995 the proportion of HIV-1 infected male blood donors in this country was 6.7% (2) and in 1998 the HIV prevalence rate among rural pregnant women was 12.3–24%. Population based surveys have shown a decreasing prevalence gradient from towns to areas of lower population density and the HIV prevalence for women of fertile age in Arusha town was estimated to be 11.6% in 1991–1994. Less is known about typically rural areas. A recent article reported low HIV prevalence (0.95– 2.23%) in rural traditional Maasai communities in Kenya but a high prevalence (up to 12%) of syphilis (5). The study was done in 1989–92. (excerpt)