The East African health research journal最新文献

Background: Breastfeeding is a key intervention to improve global targets on nutrition, health and survival. The World Health Organization recommends initiating breastfeeding within the first hour of birth to prevent infections, strengthen neonatal-maternal bonding, maintain thermoregulation and promote long term breastfeeding success. Global prevalence of early initiation of breastfeeding is 46% while in Tanzania it is 70%. The target set by the Baby Friendly Hospital Initiative guidelines for hospital deliveries is at least 80%.

Objectives: This study aimed to explore barriers to early initiation of breastfeeding in a hospital setting using a descriptive qualitative approach.

Methods: Semi-structured individual interviews were conducted to explore barriers to early initiation of breastfeeding from the perspective of midwives and post-partum mothers. Data was analysed using Systematic Text Condensation as described by Malterud.

Results: Participants perceived that inadequate and sometimes conflicting information during antenatal period, especially on ideal time to start breastfeeding contributed to delayed initiation. Post-delivery practices such as perineal tear repair, along with environmental factors, including perceptions of unclean labour rooms and the presence of male personnel in the delivery room further hindered timely initiation. Overall, barriers were linked to gaps in knowledge, non-conducive postpartum environments and restrictive hospital practices.

Conclusions: Improving early initiation of breastfeeding requires policies and programs aimed at strengthening the provision of breastfeeding related education to mothers during antenatal visits and enhancing the knowledge of midwives. At the health facility level, creating a supportive post-partum environment with individualised care, and implementing evidence-based practices are essential for promoting timely initiation.

Background: COVID-19 is a respiratory disease caused by Severe Acute Respiratory Syndrome coronavirus 2 (SARS-COV-2). Drug dispensers are at risk of contracting COVID-19. This study aimed to assess the knowledge, attitude, and COVID-19 vaccination uptake among drug dispensers in community pharmacies.

Methods: A cross-sectional study was conducted among drug dispensers in community pharmacies in Dar es Salaam from January to June 2022. Participants in the study were pharmacists, pharmaceutical technicians, pharmaceutical assistants, and Accredited Drugs Dispensing Outlets (ADDO) dispensers. The calculated minimum sample size was 360. A stratified sampling technique was used to obtain the number of pharmacies and drug dispensers required for each district. Data was collected using a self-administered, semi-structured questionnaire. To determine the predictors of COVID-19 vaccination status by the drug dispensers, multivariable binary logistic regression was performed.

Results: A total of 375 participants were included. More than half (57.0%) of participants had good knowledge of COVID-19 vaccines, while 203 (54.1%) of respondents had a positive attitude. About 111 (29.6%) of respondents had received the COVID-19 vaccine. Drug dispensers aged 50 years and above and pharmacists were more likely to have received the COVID-19 vaccine (AOR 58.82; 95% CI, 7.407 to 500.0; P<.001) and (AOR 5.025; 95% CI, 2.062 to 12.346, P=.005), respectively.

Conclusion: Drug dispensers in community pharmacies possessed a good level of knowledge regarding COVID-19 vaccination; however, gaps in attitude and vaccine uptake persisted. Strengthening educational campaigns through professional associations, utilizing digital platforms for information dissemination, and integrating vaccine promotion into continuing professional development programs can enhance their role in public health response efforts.

Background: The availability of free HIV self-test kits in the community may alter people's sexual behaviours in some way. However, little evidence exists to confirm or refute this assertion. We assessed changes in sexual risk-taking behaviours among men living in a fishing community before and after participating in an HIV self-testing (HIVST) intervention.

Methods: This was a secondary analysis of data collected as part of a large peer-led HIVST intervention for men (PEST4MEN) in two fishing communities located in Kalangala (1) and Buvuma (1) Island districts. Following a baseline interview in July 2022, enrolled men (n=400) received oral fluid-based HIV self-test kits from their peer leaders and were followed up in September 2022 (n=361) to determine use. Data were collected on socio-demographic and behavioural characteristics using a structured questionnaire, configured in the KoboCollect tool, and loaded on mobile phones. We assessed changes in the proportion of men reporting multiple (2+) sexual partners, alcohol use before sex and condom use frequency before and after HIVST. We conducted descriptive analysis using STATA (version 14.0). Comparisons between proportions were made using Pearson's chi-square test.

Results: Of 361 men, 239 had complete HIVST and sexual behaviour data at the baseline and follow-up visits. Of these, 34.3% (n=82) were aged between 25 and 34 years with a mean age of 30.8 years (Standard Deviation: ±9.0). Fifty-six percent (n=134) were engaged in fishing or fishing-related activities. The proportion of men reporting multiple sexual partners reduced significantly from 52.3% (n=125) to 42.3% (n=101), P=.0279. However, there was a non-significant increase in condom use at last sex (from 17.2%, n=41, to 18.4%, n=44; P=.7197) and alcohol use before sex (from 10.0%, n=24, to 11.7%, n=28; P=.5568). Consistent condom use reduced somewhat between the two study visits (from 10.0%, n=24, to 8.0%, n=19; P=.4241).

Conclusion: The proportion of men reporting multiple sexual partnerships reduced significantly between the two study visits. However, this reduction was not observed in the other sexual risk behaviours. These findings suggest a need for integrating sexual risk-reduction messages into HIVST interventions in order to reduce sexual risk-taking behaviors among potential users of HIV self-test kits.

Background: Central line-associated bloodstream infection (CLABSI) is one of the major complications for patients with central lines (CLs) and a leading hospital-acquired infection. This infection is associated with increased length of hospitalization, medical costs, high morbidity, and mortality. As primary caregivers for patients with CLs in the ICU, nurses are crucial in preventing CL-related infections and complications. Despite this key role, there is limited knowledge about ICU nurses' understanding of CLABSI, especially in low-income countries like Tanzania. Aim: This study aimed to assess knowledge on CLABSI prevention strategies and associated factors among ICU nurses in Dar es Salaam, Tanzania.

Methods: A quantitative cross-sectional analytical study was conducted among 250 ICU nurses in 3 tertiary hospitals. Data were collected from May to July 2023 using a self-administered questionnaire, with CLABSI knowledge assessed using 32 items. SPSS version 25 was employed to analyze data, and logistic regression was performed to identify factors associated with knowledge of CLABSI prevention strategies. In all analyses, statistical significance was set at a p-value <.05.

Results: The mean knowledge score was 52.2% (SD = 10.7), with a median of 50%. Among the participants, only 52 (28.2%; 95% CI: 22.6%-33.8%) demonstrated a high level of knowledge regarding CLABSI prevention strategies and care. Receiving in-service CL training (AOR = 5.20; 95% CI: 1.79-15.07; p =.002), the availability of CLABSI prevention guidelines (AOR = 2.52; 95% CI: 1.05-6.03; p=.038), and the absence of pre-service CL training (AOR = 3.05; 95% CI: 1.33-6.97; p=.008) were significantly associated with higher knowledge of CLABSI prevention strategies and care.

Conclusion: ICU nurses demonstrated generally inadequate knowledge of CLABSI prevention strategies, with less than one-third (28.2%) showing a high level of knowledge. In-service CL training, availability of CLABSI guidelines, and absence of pre-service training were significantly associated with higher knowledge, suggesting the strong influence of practical, workplace-based learning. Targeted in-service training and consistent provision of evidence-based guidelines are essential to strengthen ICU nurses' competence, reduce CLABSI incidence, and improve patient safety.

Sigmoid volvulus in pregnancy is a rare condition occurring during the third trimester with a high recurrence rate and having fatal complications to both fetus and mother. It requires a prompt diagnosis and multidisciplinary approach. We present a case of a 33 year old, pregnant woman, Gravida 4, Para 3, at 32 weeks of gestation, who presented with abdominal pain, distension, and tenderness. A Plain abdominal X-ray showed a dilated loop of the sigmoid colon. This was her second admission with similar symptoms. Having previously diagnosed with sigmoid volvulus one month earlier, she was treated conservatively, recovered, and discharged. On this admission she was diagnosed with recurrent sigmoid volvulus, after stabilization she underwent laparotomy which revealed sigmoid colon volvulus at 180 degrees twist. A resection of redundant sigmoid was done, resulting in uneventful postoperative care, discharge, and follow-up. A timely diagnosis and surgical interventions, especially through a multidisciplinary approach during late gestation can lead to favorable outcome for the baby and mother.

Background: The coronavirus disease 2019 (COVID-19) has contributed to massive disturbances in people's economic, social, and cultural affairs. Such experiences were brought about by the pandemic itself and the intervention measures put in place to contain the transmission of the disease. This study assessed the impacts of the COVID-19 pandemic on social and economic dimensions in selected regions of Tanzania.

Methods: The study was conducted in Unguja, Pemba and Dar es Salaam, Tanzania, employing a qualitative design. Thirty four interviews were conducted with key informants at the national, regional and district levels, comprising influential people, leaders, and healthcare workers. A total of 14 focus group discussions with community members and health care workers were conducted. All data were thematically analysed.

Results: Study participants revealed the main impact of COVID-19 to be on businesses and trade, with loss of wage earnings due to a reduction in touristic activities and flow from abroad of essential goods for trade. This, in turn, was reported to affect people's purchasing power to fend for themselves, causing food insecurity at the household level. Trading activities of essential goods such as sugar and cooking oil were affected due to the reduction of their importation, which in turn caused their rental prices to rise. Restrictions imposed on gatherings created an atmosphere of fear that harmed traditional forms of support in times of need.

Conclusion: The findings from this study demonstrates how COVID-19 mitigation strategies significantly disrupted the social and economic fabric of the communities studied. We recommend that future pandemic preparedness plans should prioritize the implementation of comprehensive support programs for at-risk households and enact price controls on essential goods to protect the most vulnerable from economic hardship.

Background: Excessive consumption of alcohol contributes to gut dysbiosis, leading to adverse gut health outcomes such as gastrointestinal diseases. About 1.6%, or 200,000, Rwandans between 14 and 64 years old abuse alcohol. But there is a paucity of information on the effects of alcohol on intestinal health. This was a cross-sectional study carried out to determine the gut microbial imbalance and associated outcomes among alcohol consumers in the Musanze district.

Methods: A total of 50 participants were recruited, of which 25 were alcohol consumers, while the remaining 25 were control subjects. Stool samples were collected and transported to the INES Ruhengeri clinical microbiology laboratory for microbial identification. Gut outcomes associated with alcohol consumption were evaluated by an interview-administered questionnaire. An independent t-test was performed to test for the microbial mean difference between alcohol consumers and non-alcohol consumers, while a chi-square test was performed to evaluate associations between gut dysbiosis and outcomes.

Results: Escherichia coli (17.5%) was the most predominant among alcohol consumers, while Lactobacillus (17.3%) was the most predominant among control subjects. There was a significant association between alcohol consumption and gut microbial alteration to E. coli (x² = 4.2, P=.04), Enterococcus faecalis (x² = 9.9, P=.00165), Lactobacillus sp. (x² = 16.4, P=.000051), Bacillus sp. (x² = 5.8, P=.016), S. epidermidis (x² = 11.7, P =.000625), S. pyogenes (x² = 3.9, P=.048), and the overall association was statistically significant (x² = 65.75, P <.00001). The association between gut microbiota dysbiosis and gut health outcomes was also significant for Pseudomonas aeruginosa (x² = 18.3, P=.001078), S. pyogenes (x² = 12.1, P=.016623), Enterococcus faecalis (x² = 11, P=.026564) and the overall association (x² = 113.703, P<.00001) with the imbalanced microbiota and outcomes being statistically significant. The odd ratio (OR) for pathogenic bacteria to non-pathogenic bacteria was OR = 5.11>1.

Conclusion: Alcohol consumption is associated with gut microbiota dysbiosis, which predisposes to intestinal disorders. Excessive consumption of alcohol should be stopped to prevent devastating outcomes to intestinal health.

Background: Unintended pregnancies pose a significant health risk for Female Commercial Sex Workers (FCSW), a highly vulnerable population. Despite the availability of emergency contraceptives (EC) to prevent such outcomes, concerns still exist regarding potential misuse as a regular contraceptive method, and the specific factors influencing EC use among FCSWs remain underexplored. This study aimed to evaluate the prevalence and determinants of EC use among FCSWs to address this critical knowledge gap.

Methods: This analytical cross-sectional study involved 326 randomly selected female commercial sex workers in Tanzania. Data were collected using a structured questionnaire created from previous literature and analyzed using SPSS version 29. Given the sensitive nature of this population, detailed ethical procedures were followed to ensure voluntary participation and confidentiality. Our sampling approach utilized community-based outreach rather than a formalized registry.

Results: The study found that a significant majority of the respondents (64.4%) had never used EC. Multivariate logistic regression analysis identified several key factors independently associated with EC use. Education level showed an inverse relationship, with those having ordinary secondary education (AOR=0.37, 95% CI=0.16-0.88, P=.024) and college-level education (AOR=0.13, 95% CI=0.04-0.47, P=.002) being significantly less likely to use EC compared to those with no formal education. Furthermore, a history of drug use was strongly associated with a reduced likelihood of EC use (AOR=0.35, 95% CI=0.19-0.61, P<.001). Conversely, prior awareness of emergency contraceptives emerged as a powerful predictor of use, with those who had ever heard about EC being substantially more likely to use them (AOR=6.20, 95% CI=3.44-11.17, P<.001).

Conclusion: The use of emergency contraceptives among FCSW is still low for various reasons including educational attainment, and drug use. While awareness is a strong facilitator of EC use, higher education levels surprisingly showed an inverse relationship. This suggests that interventions are needed to address the unique barriers faced by this vulnerable group, including misconceptions among the educated and the compounding challenges posed by drug use. Several approach combining comprehensive education, integrated health services, and sustained awareness campaigns is essential to improve EC access and utilization for FCSW.

Background: Cardiovascular diseases (CVD) encompass a range of non-communicable conditions that share a common pathophysiological process related to atherosclerosis. Currently, CVD are the leading cause of death worldwide, with an estimated 17.9 million deaths attributed to these conditions in 2019. In Africa, the burden of CVD is steadily increasing, leading to a rise in years lived with disability. In Burundi, however, cardiovascular diseases are poorly documented, and there is a lack of data on the extent to which general practitioners (GPs) assess cardiovascular risk among their patients. This study aimed to evaluate the knowledge and practices of GPs regarding global cardiovascular risk assessment, providing evidence to inform policymakers and training institutions on potential strategies for improving cardiovascular care.

Methods: A descriptive, cross-sectional study was conducted in three national hospitals in Burundi: Centre Hospitalo-Universitaire de Bujumbura (CHUK), Hôpital Prince Régent Charles (HPRC), and Hôpital Militaire de Kamenge (HMK), all located in Bujumbura capital city. Study participants were general practitioners working in the outpatient departments of these hospitals. Data were collected using a validated questionnaire, and descriptive statistics were generated to analyse the findings. The level of knowledge regarding cardiovascular disease was assessed based on scoring systems derived from the questionnaire. The study received ethical approval from the Institutional Review Board of the Faculty of Medicine, University of Burundi.

Results: The participation rate was 86.8%, with 66 participants out of 76 completing the study. Among respondents, 68% had less than five years of professional experience. Only 40.9% demonstrated adequate knowledge of cardiovascular disease, and a mere 18.18% possessed sufficient knowledge of therapeutic objectives and treatment strategies. In practice, 77.3% of participants reported routinely assessing cardiovascular risk; however, 42% of those in need of lipid-lowering therapy did not prescribe such medications, highlighting gaps between clinical practice and guideline adherence.

Conclusions: Identified gaps in the knowledge, attitudes, and practices of general practitioners concerning cardiovascular disease prevention highlight the need for decision-makers, training institutions, and universities to prioritise the development of ongoing in-service training programmes to enhance their capacity in this area.

Introduction: Neonatal mortality remains high globally, with Kenya reporting a rate of 20 deaths per 1,000 live births. Essential Newborn Care (ENC) is crucial for preventing neonatal deaths, yet the provision of this care for the newborns is varied.

Methods: This cross-sectional analytical study evaluated the provision of PNC-ENC across four scheduled visits in Kakamega County, Kenya. Data were collected from 325 mothers through structured questionnaires. Descriptive and inferential statistics, including ANOVA, were used to assess care provision.

Results: The overall mean provision of expected newborn interventions across the four visits was 57.82%. Provision was highest at the first visit (59.55%), declined at 2 to 4 weeks (55.16%), improved at 4 to 6 weeks (59.06%), and slightly declined at 4 to 6 months (57.50%).

Conclusions: This study highlights gaps in the delivery of essential newborn care, particularly in physical examinations. Targeted interventions, including training and resource allocation, are recommended to improve provision to PNC care interventions and reduce neonatal mortality.