Background: Women of reproductive age experience a lower quality of life and considerable morbidity as a result of heavy menstrual bleeding. This issue needs to be addressed to achieve gender equality and permit women and girls to engage in a range of economic activities. In this study, we aimed to determine the prevalence and the most common factors associated with heavy menstrual bleeding.
Methodology: Cross-sectional study was conducted at a zonal referral hospital in Northern Eastern, Tanzania. Data was extracted from women files who attended the hospital obstetrics and gynaecology clinic retrospectively. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20.0. Descriptive statistics were used to summarize the data. A univariate logistic regression model was fitted to assess the strength of the association between heavy menstrual bleeding and exposure variables.
Results: A total of 162 women aged 15-54 years were enrolled. The prevalence of heavy menstrual bleeding was found to be 24.1%. The following factors were found to be significantly associated with heavy menstrual bleeding; age range of 20-44 years (OR: 0.16;95% CI: 0.02-1.01), hormonal contraceptives (OR: 3.16; 95% CI: 1.15-8.69), having no clots on menstrual blood (OR: 0.19; 95% CI: 0.58-0.651), low haemoglobin level (OR: 5.61; 95% CI: 1.44-21.90), and uterine fibroid (OR: 0.35; 95% CI: 0.17-0.73).
Conclusion: Despite the extreme measurements of Heavy Menstrual Bleeding (HMB) in this study, its prevalence remained high. To spread awareness of HMB and its consequences, we recommend screening the general public and offering health education initiatives.
Background: Essential newborn care (ENC) is one of the significant strategies for neonatal survival, especially immediately after delivery. Nurses and midwives are the key healthcare providers who care for neonates immediately after birth, their knowledge and skills on ENC are very important for the preventable causes of neonatal deaths. Therefore, this study aimed to assess essential newborn care knowledge and skills among nurses/midwives in Zanzibar.
Methods: A hospital-based analytical cross-sectional study that included 246 nurses-midwives was conducted in Zanzibar from January to February 2021. The purposive sampling method was used to select district and regional hospitals. Simple random sampling was used to select primary health facilities. A systematic random sampling technique was used to select study participants. A standard structured self-administered questionnaire was used. Predictors of knowledge and skills of ENC were determined using Binary Logistic regression under multivariate analysis using SPSS version 23.0. P<.05 was considered to be significant.
Result: Among the total (246) participants, 89 (36.2%) and 66 (26.8%) had adequate knowledge and appropriate skills of ENC, respectively. Having a BSc in Nursing (AOR = 8.83, 95%CI = 2.00-38.96) and the presence of guidelines (AOR = 3.52, 95%CI = 1.59 -7.80) were significantly associated with knowledge of ENC. Residing in Pemba (AOR = 0.30, 95%CI = 0.11-0.80), availability of staff (AOR = 0.80, 95%CI = 0.02-0.32), adequate knowledge (AOR = 2.80, 95%CI = 1.15-6.84) were factors significantly associated with ENC skills.
Conclusion: Generally, nurses-midwives had suboptimal knowledge and skills on essential newborn care. Nurses-midwives are in urgent need of positive supportive supervision and low-dose- high-frequency skills training in ENC for the prevention of neonatal morbidity and mortality. Also, policymakers should be aware of this gap and should plan necessary interventions to close the gap to resecure newborns' survival.
Background: The Staphylococcus sciuri group constitutes animal-associated bacteria but can comprise up to 4% of coagulase-negative staphylococci isolated from human clinical samples. They are reservoirs of resistance genes that are transferable to Staphylococcus aureus but their distribution in communities in sub-Saharan Africa is unknown despite the clinical importance of methicillin-resistant S. aureus.
Objectives: We characterised methicillin-resistant S. sciuri group isolates from nasal swabs of presumably healthy people living in an informal settlement in Nairobi to identify their resistance patterns, and carriage of two methicillin resistance genes.
Method: Presumptive methicillin-resistant S. sciuri group were isolated from HardyCHROM™ methicillin-resistant S. aureus media. Isolate identification and antibiotic susceptibility testing were done using the VITEK®2 Compact. DNA was extracted using the ISOLATE II genomic kit and polymerase chain reaction used to detect mecA and mecC genes. Results: Of 37 presumptive isolates, 43% (16/37) were methicillin-resistant including - S. sciuri (50%; 8/16), S. lentus (31%; 5/16) and S. vitulinus (19%; 3/16). All isolates were susceptible to ciprofloxacin, gentamycin, levofloxacin, moxifloxacin, nitrofurantoin and tigecycline. Resistance was observed to clindamycin (63%), tetracycline (56%), erythromycin (56%), sulfamethoxazole/trimethoprim (25%), daptomycin (19%), rifampicin (13%), doxycycline, linezolid, and vancomycin (each 6%). Most isolates (88%; 14/16) were resistant to at least 2 antibiotic combinations, including methicillin. The mecA and mecC genes were identified in 75% and 50% of isolates, respectively.
Conclusion: Colonizing S. sciuri group bacteria can carry resistance to methicillin and other therapeutic antibiotics. This highlights their potential to facilitate antimicrobial resistance transmission in community and hospital settings. Surveillance for emerging multidrug resistant strains should be considered in high transmission settings where human-animal interactions are prevalent. Our study scope precluded identifying other molecular determinants for all the observed resistance phenotypes. Larger studies that address the prevalence and risk factors for colonization with S. sciuri group and adopt a one health approach can complement the surveillance efforts.
Introduction: The Electronic Medical Record (EMR) has significant benefits in improving the quality of hospital services in low resources settings. Despite efforts to implement various EMRs in different health facilities, there is scarce information on the challenges and success factors regarding EMR Implementation in Regional hospitals. The aim of this study is to assess the success and challenging factors in the implementation of an electronic medical record system at the regional referral Hospital.
Methodology: This was a cross-sectional design study involving qualitative and quantitative approaches that was conducted at Haydom Lutheran Hospital a Regional Referral Hospital in northern Tanzania. The semi-structured questionnaires and the Key Informant Interview Guide questions were used for quantitative and qualitative data collection respectively. The quantitative data were analyzed using Stata Version 13.0. The quantitative data was summarized using descriptive statistics. Thematic method was used to analyze the qualitative data.
Results: Among 303 participants more than half were male 167(55.1%) and 119(39.3%) aged between 31 and 40 years. The nurses and medical attendants were the predominant group 188(62%). Most of the staff were on full-time employment 273(90.1%) and more than thirty percent 118(38.09%) have worked for over 10 years. The age group of between 31-60 years had a higher influence on the EMR net benefit compared to respondents aged 20 to 30 years and 60 years. The easy use, learning, usefulness, and relevance to work as well as leadership, staff involvement in processes, and use of champions were among of success factors for EMR implementation. Challenges include inadequate training, lack of funding, and inadequate IT equipment. The net benefit includes increases in efficiency in service delivery and better resource management.
Conclusion: Staff involvement, use of champions and the fact that the system is easy to use contributed to the success of EMR system. In order to scale up and sustain the EMR system in hospitals, adequate funding, training as well as continuous support to all staff in the hospital is required.
Introduction: Poor quality of health care services remains an important challenge in health care delivery systems. Here, we validate clinical audit tools and describe audit results of selected clinical standards related to communicable disease (CD) and non-communicable disease (NCD) integration at the primary health care level.
Methodology: A multi-methods approach, including a retrospective cohort and cross-sectional design, was deployed concurrently at Health Centres. Separate evaluators assessed the Health Centres using an audit tool and the inter-rater/inter-observer reliability was estimated. The extent of adherence to clinical standards was measured in proportions for: infection prevention control, tuberculosis (TB) diagnosis including advanced TB/Human Immunodeficiency Virus (HIV), the diagnosis of chronic lung diseases, and the bidirectional screening and clinical management of TB and Diabetes Mellitus (DM).
Results: The inter-rater reliability for the clinical audit tools based on 130 individuals' charts was 99.5% (CI:99-100). The total estimated maximum score for infection prevention control was 114 and on average health centres scored 42 (37%). Only 3 (4%) of 80 individuals' medical charts with unexplained productive cough were evaluated for TB. None of the 24 individuals with HIV infection medical charts had vitals measured and only 6 (25%) patients with advanced HIV had a TB test performed, whereas 4 (17%) had a cryptococcal antigen test, and 1 (4%) had a chest radiograph. Also, 24 patients' chart from documented HIV negative with chronic cough had no records of spirometry or peak flowmeter or a chest radiograph. However, a diagnosis of asthma and chronic obstructive pulmonary disease as made in 17 (71%) and 7 (29%), respectively. TB was confirmed for 102 patients among whom only 12(12%) were screened for DM. The DM clinics had no TB presumptive registers. Patients with TB/DM (n=2) had a glycated haemoglobin (HbA1c) measurement done and received appropriate management.
Conclusion and recommendation: The developed clinical audit tools were reliable and could contribute to quality measurement for metrics-related integration of CD and NCD in Tanzania. Further investigations will determine if the clinical audit tools widely used in cycles can improve the quality of care in health care delivery systems.
Background: Male partner involvement in maternity care is critical to improving neonatal and maternal health by reducing maternal mortality, particularly in settings where males play a significant role in decision-making. This study aimed to assess factors associated with male partners involvement in maternity care in Mbeya, Tanzania.
Methods: A community-based cross-sectional study was conducted among men in Mbeya City, Tanzania, from April to June 2021. A semi-structured questionnaire was used to collect information from participants. Male involvement level was measured as low, moderate or high. X2 test and multinomial logistic regression models were applied to determine association between male involvement levels and related factors.
Results: A total of 201 males participated in the study. The overall level of male involvement during antenatal care, labour and delivery and postnatal care indicated that 44 (21.7%) had a high level of involvement, 116 (58%) had a moderate level of involvement and 41 (20.3%) had a low level of involvement. Demographic and health facilities factors indicated a significant association with male partner level of participation (P<.001). The likelihood of a man accompanying the partner was significantly associated with staff attitude and the time spent at the health facility (AOR 1.726 at 95% CI 1,394-2.136 P<.001).
Conclusions: Findings indicated a generally moderate level of male partner involvement as a critical concern that can accelerate the decline in maternal mortality and improve maternal health. Enhancing the male-friendliness of health facilities in terms of infrastructure, organisation of services and staff attitudes, as well as educating the community, particularly men, to sensitise them to the negative attitudes toward male participation in maternity care, can increase male participation.
Background: Female Genital Mutilation/Cutting (FGM/C) is a harmful traditional practice with severe health complications, deeply rooted in many sub-Saharan African countries. In Kenya, the prevalence of FGM/C is 15% in women aged between 15 and 49 years. The Kenyan Somalis practice FGM/C with a prevalence above 90%. FGM/C practice continues to persist in Alungu village, Mandera County in the North Eastern of Kenya despite efforts by anti-FGM programs. However, the underlying factors behind FGM practice in the area have not been explored. Objective: To assess factors contributing to female genital mutilation practice among women living in Alungu village of Mandera County, Kenya.
Methods and materials: This study utilised a descriptive cross sectional design. The study population was women of reproductive age (from 18 to 49 years) who resided in Alungu village in Mandera County, Kenya. A study sample of 98 women was selected using simple random sampling technique. Data was collected using a researcher-administered questionnaire and analysed using the Statistical Package for Social Science (SPSS).
Results: Most of the respondents were aged 35 - 44 (45.8%), married (100%), had no formal education (74.7%) and had no formal employment (89.2%). All participants agreed that traditional beliefs, customs and rite of passage to womanhood contributed to FGM, 90.4% of the participants acknowledged that FGM is a symbol of ethnic identity and inclusivity. Factors affecting prevention of and response to FGM were low involvement of women in anti-FGM programs (91.6%); support for FGM by local leaders and elders (100%); failure by authorities to take action against those perpetuating FGM (100%); indifference to FGM practice continuation among local religious and political leaders (96.4%) and poor enforcement of existing laws against FGM (100%).
Conclusion: A wide range of socio-cultural factors did contribute to FGM practice among women living in Alungu village, Mandera County.
Background: Adolescent pregnancy increases the risk of maternal and child morbidity and mortality. We aimed to determine trends and factors associated with adolescent pregnancy in Tanzania from 2004 to 2016 using the Tanzania Demographic and Health surveys (TDHS).
Methods: We carried out an analytical cross-sectional study using the TDHS data for the years 2004 to 2005, 2010 and 2015 to 2016 among adolescent girls aged 15 to 19 years. Data analysis was performed using STATA version 15. Data analysis considered the complex survey design inherent in the demographic and health survey (DHS) data. The Poisson regression model was used to estimate Prevalence Ratios (PR) and 95% confidence intervals for factors associated with adolescent pregnancy.
Results: We analysed data for a total of 10,972 adolescents for the three TDHS rounds. The proportion of adolescent pregnancy significantly decreased from 26% to 22.8% from the year 2004/05 to 2010 and then increased again to 26.7% in 2015/16. Adolescents who were aged 18 to 19 years (APR 1.52; 95% CI, 1.38 to 1.68) married or cohabiting with their partners (APR 2.15; 95% CI, 1.93 to 2.40; P<.001), widowed/divorced/separated (APR 2.32; 95% CI, 2.03 to 2.66; P<.001), and among those who started sexual activity before 15 years of age (APR 1.20; 95% CI, 1.11 to 1.31; P<.001) were more likely to become pregnant during adolescence. In contrast, adolescents with secondary school education level and above were the least likely to become pregnant (APR 0.62; 95% CI, 0.51 to 0.75; P<.001) compared to those with no formal education.
Conclusion: One in four adolescent girls aged 15 to 19 in Tanzania have already started childbearing and despite fluctuation, high rate of adolescent pregnancy persists. Preventive interventions should focus on adolescents with low education level, married/cohabiting with their partners, and who have started sex before 15 years of age. We advocate for the increase of school attendance until high school level to reduce the risk of early pregnancy in adolescents. Furthermore, qualitative studies are crucial to explore reasons for the rising trend of adolescent pregnancy in most zones of Tanzania, particularly between 2010 and 2015/16.
Introduction: Upper respiratory tract infections (URTIs) are common illnesses, especially in children and account globally for a substantial proportion of consultations with family doctors. The objective of this study was to assess knowledge, attitude and practice of caretakers regarding antibiotic usage in treating URTIs in Southern Tanzania.
Methods: A cross-sectional hospital-based study was conducted at Iringa Regional Referral Hospital in Southern Tanzania from March to June 2022 involving 300 caregivers. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 23.
Results: About two-thirds (71.7%) of the caregivers had poor knowledge regarding antibiotic usage in treating children's URTIs. In this study, 96.7% of the caregivers correctly identified amoxicillin as the most prescribed medication for treatment of children's URTIs. However, about two-thirds (65.0 %) of the parents were aware of the antibiotic resistance that could be caused by misuse of antibiotics. In this study 50.7% of the respondents had poor attitude while 49.3% had good attitude regarding antibiotic usage in treating children's URTIs. Similarly, 53% of the respondents thought local medications are better than antibiotics in treatment of URTIs. Regarding practices, 75.3% of the respondents used to complete the dose of antibiotics when prescribed for treatment of URTIs and 69.7% used to treat their children at home when having URTIs. A significant association was found between the majority of the socio-demographic characteristics of the respondents and the level of knowledge. Similarly, there was a statistically significant association between knowledge and attitude of caregivers pertaining to antibiotic usage in treating children's URTIs.
Conclusions: There is lack of knowledge among caregivers regarding antibiotic usage for treating children's URTIs at the regional hospital and also more than half of the caregivers had poor attitude towards antibiotic usage. Therefore, caregiver's educational interventions should be implemented through health promotions and educational campaigns that should be mainly conducted by medical doctors since they were reported by the caregivers to be the commonest source of information.
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