Janneth Mghamba

Preparedness of Tanzanian health facilities for outpatient primary care of hypertension and diabetes: a cross-sectional survey

Summary Background Historically, health facilities in sub-Saharan Africa have mainly managed acute, infectious diseases. Few data exist for the preparedness of African health facilities to handle the growing epidemic of chronic, non-communicable diseases (NCDs). We assessed the burden of NCDs in health facilities in northwestern Tanzania and investigated the strengths of the health system and areas for improvement with regard to primary care management of selected NCDs. Methods Between November, 2012, and May, 2013, we undertook a cross-sectional survey of a representative sample of 24 public and not-for-profit health facilities in urban and rural Tanzania (four hospitals, eight health centres, and 12 dispensaries). We did structured interviews of facility managers, inspected resources, and administered self-completed questionnaires to 335 health-care workers. We focused on hypertension, diabetes, and HIV (for comparison). Our key study outcomes related to service provision, availability of guidelines and supplies, management and training systems, and preparedness of human resources. Findings Of adult outpatient visits to hospitals, 58% were for chronic diseases compared with 20% at health centres, and 13% at dispensaries. In many facilities, guidelines, diagnostic equipment, and first-line drug therapy for the primary care of NCDs were inadequate, and management, training, and reporting systems were weak. Services for HIV accounted for most chronic disease visits and seemed stronger than did services for NCDs. Ten (42%) facilities had guidelines for HIV whereas three (13%) facilities did for NCDs. 261 (78%) health workers showed fair knowledge of HIV, whereas 198 (59%) did for hypertension and 187 (56%) did for diabetes. Generally, health systems were weaker in lower-level facilities. Front-line health-care workers (such as non-medical-doctor clinicians and nurses) did not have knowledge and experience of NCDs. For example, only 74 (49%) of 150 nurses had at least fair knowledge of diabetes care compared with 85 (57%) of 150 for hyptertension and 119 (79%) of 150 for HIV, and only 31 (21%) of 150 had seen more than five patients with diabetes in the past 3 months compared with 50 (33%) of 150 for hypertension and 111 (74%) of 150 for HIV. Interpretation Most outpatient services for NCDs in Tanzania are provided at hospitals, despite present policies stating that health centres and dispensaries should provide such services. We identified crucial weaknesses (and strengths) in health systems that should be considered to improve primary care for NCDs in Africa and identified ways that HIV programmes could serve as a model and structural platform for these improvements. Funding UK Medical Research Council.

Health policy for sickle cell disease in Africa: experience from Tanzania on interventions to reduce under-five mortality

Tanzania has made considerable progress towards reducing childhood mortality, achieving a 57% decrease between 1980 and 2011. This epidemiological transition will cause a reduction in the contribution of infectious diseases to childhood mortality and increase in contribution from non‐communicable diseases (NCDs). Haemoglobinopathies are amongst the most common childhood NCDs, with sickle cell disease (SCD) being the commonest haemoglobinopathy in Africa. In Tanzania, 10 313 children with SCD under 5 years of age (U5) are estimated to die every year, contributing an estimated 7% of overall deaths in U5 children. Key policies that governments in Africa are able to implement would reduce mortality in SCD, focusing on newborn screening and comprehensive SCD care programmes. Such programmes would ensure that interventions such as prevention of infections using penicillin plus prompt diagnosis and treatment of complications are provided to all individuals with SCD.

Birth preparedness and complication readiness among recently delivered women in chamwino district, central Tanzania: a cross sectional study

BackgroundUnacceptably high maternal mortality rates remain a challenge in developing countries such as Tanzania. Birth Preparedness and Complication Readiness is among the key interventions that can reduce maternal mortality. Despite this, its status in Tanzania is not well documented. We assessed the practice and determinants of Birth preparedness and complication readiness among recently delivered women in Chamwino district, Central Tanzania.MethodsA community based cross-sectional study was conducted to women who delivered two years prior to survey in January 2014 at Chamwino district, Tanzania. Woman was considered as prepared for birth and its complication if she reported at least three of these; know expected date of delivery, saved money, identified a skilled birth attendant/health facility, mode of transport and Identified two compatible blood donors. Descriptive, bivariate and multivariable logistic regression analyses were performed at P value < 0.05 level of significance.ResultsWe interviewed 428 women whose median age (IQR) was 26.5 (22–33) years. About 249 (58.2 %) of the respondents were considered as prepared for birth and its complications. After controlling for confounding and clustering effect, significant determinants of birth preparedness and complication readiness were found to be maternal education (AOR = 2.26, 95 % CI; 1.39, 3.67), spouse employment (AOR = 2.18, 95 % CI; 1.46, 3.25), booking at ANC (AOR = 2.03, 95 % CI; 1.11, 3.72), Four or more antenatal visits, (AOR = 1.94, 95 % CI; 1.17, 3.21) and knowledge of key danger signs (AOR = 4.16, 95 % CI; 2.32, 7.45). Prepared for birth was found to be associated with institutional delivery (AOR = 2.45, 95 % CI; 1.12, 5.34).ConclusionThe proportion of women who prepared for birth and its complications were found to be low. District reproductive and child health coordinator should emphasis on early and frequent antenatal care visits, since they were among predictors of birth preparedness and complication readiness.

Birth Prevalence of Selected External Structural Birth Defects at four Hospitals in Dar es Salaam, Tanzania, 2011-2012.

Background 94% of all birth defects (BD) and 95% of deaths due to the BD occur in low and middle income countries, many of which are preventable. In Tanzania, there is currently a paucity of BD data necessary to develop data informed prevention activities. Methods A cross-sectional analysis was conducted of deliveries identified with BD in the labor ward registers at four Dar es Salaam hospitals between October, 2011 and February, 2012. The birth prevalence of structural BD, case fatality proportion, and the distribution of structural defects associated deaths within total deaths were calculated. Results A total of 28 217 resident births were encountered during the study period. Overall birth prevalence of selected defects was 28.3/10 000 live births. Neural tube defects and indeterminate sex were the most and least common defects at birth (9.9 and 1.1/10 000 live births, respectively). Among stillbirths (66.7%) and deaths that occurred within less than 5 days of an affected live birth (18.5%), neural tube defects were the most frequently associated structural defect. Conclusion Structural BD is common and contributes to perinatal mortality in Dar es Salaam. More than half of perinatal deaths encountered among the studied selected external structural BD are associated with neural tube defects, a birth defect with well–established evidence based prevention interventions. By establishing a population–based BD surveillance program, Tanzania would have the information about neural tube defects and other major structural BD needed to develop and monitor prevention activities.

Factors associated with major structural birth defects among newborns delivered at Muhimbili National Hospital and Municipal Hospitals in Dar Es Salaam, Tanzania 2011 – 2012

Introduction Ninety-four percent of all birth defects and 95% of deaths due to the birth defects occur in low and middle income countries, Tanzania among them. In Tanzania there are currently limited birth defects prevention strategies in place due to limited information on factors associated with the occurrence of birth defects. Methods We conducted a case control study that included newborns born from October, 2011 through February, 2012 at 4 participating hospitals. A case was defined as any newborn of a Dar es salaam resident with a neural tube defect, orofacial clefts, limb reduction defects or musculo-skeletal defects (SBD) born during the study period. A control was defined as the next three newborns (delivered after the case) without birth defects. Univariate, bivariate and multivariate analysis were done using Epi Info version 3.5.1. Results A total of 400 newborns participated in the study, 100 cases and 300 controls. Factors associated with higher odds of a SBD included maternal fever (adjusted odds ratio (AOR) = 1.99; 95% confidence interval (CI): 1.14-3.52), maternal hypertension (AOR = 3.99; 95% CI: 1.67-9.54), and low birth weight (AOR = 3.48; 95% CI: 1.77-6.85). Antimalarial use during pregnancy was protective (AOR = 0.48; 95% CI: 0.28-0.84). Folic acid supplementation was protective only in bivariate analysis (OR = 0.56; 95% CI: 0.32-0.96). Conclusion Maternal fever, hypertension, and low birth weight are associated with higher odds of SBD. Antimalarial use during pregnancy was associated with lower odds of SBD. Early screening of pregnant mothers for hypertension and other causes of low birth weight may reduce SBD in Dar Es Salaam.

Cholera Mortality during Urban Epidemic, Dar es Salaam, Tanzania, August 16, 2015–January 16, 20161

In 2015, a cholera epidemic occurred in Tanzania; most cases and deaths occurred in Dar es Salaam early in the outbreak. We evaluated cholera mortality through passive surveillance, burial permits, and interviews conducted with decedents’ caretakers. Active case finding identified 101 suspected cholera deaths. Routine surveillance had captured only 48 (48%) of all cholera deaths, and burial permit assessments captured the remainder. We interviewed caregivers of 56 decedents to assess cholera management behaviors. Of 51 decedents receiving home care, 5 (10%) used oral rehydration solution after becoming ill. Caregivers reported that 51 (93%) of 55 decedents with known time of death sought care before death; 16 (29%) of 55 delayed seeking care for >6 h. Of the 33 (59%) community decedents, 20 (61%) were said to have been discharged from a health facility before death. Appropriate and early management of cholera cases can reduce the number of cholera deaths.

Prevalence of Helmet Use among Motorcycle Users in Dar Es Salaam, Tanzania.

Introduction The purpose of this study was to determine prevalence of helmet use among motorcyclists as one of the preventive measures for road traffic injuries. Methods A cross sectional observational survey was conducted in the 3 Districts (Kinondoni, Ilala and Temeke) that make Dar es Salaam. Tanzania. A standardized line-listing form and checklist were used to record the drivers and passengers use of helmet as observed by study investigators. Data for helmet use was collected on one weekday and one weekend day. Time for observation was during the rush hour in the morning, noon and evening. Then data were entered into Epi Info 3.5.1 analysis Results A total of 7,678 motorcycle drivers and 4,328 passengers observed in this study. Drivers were almost male (98.8%) and 73.2% of all passengers were males. The prevalence use of helmet use among motorcyclists riders was 82.1% and among passengers was 22.5%. Proportion of helmet use in drivers and passengers observed were relatively similar during weekday and weekend day and time of observation. Conclusion This study showed the relative high helmet use among motorcyclist riders though very low in passengers. This study recommends increased community awareness on helmet use among passengers and enforcement and revival of road safety laws of passengers and motorcyclists on helmet use.

Developing a multisectoral National Action Plan for Health Security (NAPHS) to implement the International Health Regulations (IHR 2005) in Tanzania

The Ebola outbreak in West Africa precipitated a renewed momentum to ensure global health security through the expedited and full implementation of the International Health Regulations (IHR) (2005) in all WHO member states. The updated IHR (2005) Monitoring and Evaluation Framework was shared with Member States in 2015 with one mandatory component, that is, States Parties annual reporting to the World Health Assembly (WHA) on compliance and three voluntary components: Joint External Evaluation (JEE), After Action Reviews and Simulation Exercises. In February 2016, Tanzania, was the first country globally to volunteer to do a JEE and the first to use the recommendations for priority actions from the JEE to develop a National Action Plan for Health Security (NAPHS) by February 2017. The JEE demonstrated that within the majority of the 47 indicators within the 19 technical areas, Tanzania had either ‘limited capacity’ or ‘developed capacity’. None had ‘sustainable capacity’. With JEE recommendations for priority actions, recommendations from other relevant assessments and complementary objectives, Tanzania developed the NAPHS through a nationwide consultative and participatory process. The 5-year cost estimate came out to approximately US

Decreased renal function and associated factors in cities, towns and rural areas of Tanzania: a community‐based population survey

86.6 million (22 million for prevent, 50 million for detect, 4.8 million for respond and 9.2 million for other IHR hazards and points of entry). However, with the inclusion of vaccines for zoonotic diseases in animals increases the cost sevenfold. The importance of strong country ownership and committed leadership were identified as instrumental for the development of operationally focused NAPHS that are aligned with broader national plans across multiple sectors. Key lessons learnt by Tanzania can help guide and encourage other countries to translate their JEE priority actions into a realistic costed NAPHS for funding and implementation for IHR (2005).

Integrated care for human immunodeficiency virus, diabetes and hypertension in Africa

Data on renal dysfunction in sub‐Saharan Africa, comparing urban and rural areas, have not yet been reported. Therefore, we aimed to determine the distribution of low estimated glomerular filtration rates (eGFRs) in urban and rural Tanzania, to describe factors associated with low eGFR and to quantify fractions attributable to common risk factors.