Poverty and the Challenge of Quality Primary and Secondary School Education Access in Mara-Tanzania

Although poverty draws global deliberations, still it continues to be a complicated parable, driving people to the scarceness of opportunities, resources and capability deprivation as a result of education limitation–leading to ignorance decease, again poverty, and its consequences. As I write, education has been promoted in Tanzania, and more children have access to education than ever, and yet, it doesn\u27t warrant that children have a fair access to quality education. The marginalized children, including children from poor families, orphans, children with disabilities, street children, and nomadic children hang on struggling to access quality education. The goal of this study was to explore the views of participants regarding poverty and the challenge of quality education access for the marginalized children. Eight subjects from Iramba-Serengeti, and Makoko-Musoma, in Mara, participated in the phenomenological interview. The survey involved teachers and former students–– through unstructured face to face interview. Virtually, half of the subjects lived and experienced poverty in their lifetime and struggled to acquire an education, beyond standard seven. Sharing their lived experience, they insisted that poverty exists beyond how experts could explain it, and children with disabilities encounter education access limitation more than any group of children

Readability of Pre-Tertiary English Course Books in Ghana: Unpacking the Metric-Grader Assessment Interface

Readability of texts is generally determined by the application of readability metrics. In most cases, the learner (grader) is not directly involved in assessing the readability of texts assigned to his/her grade. This study sought to determine the extent of reconcilability of metric and grader readability assessment values on the same texts. The textual data was culled from the Global Series English textbook series used in Ghanaian Senior High Schools for the teaching of the English language. Applying the mixed methods research, primary data was also collected from a total of 150 graders across the 3 grades of SHS in Ghana. Using a descriptive research design, within the constructivist research paradigm, the study reveals that metric and grader readability assessments do not agree to a very large extent. Only two percent (2%) of the texts were found to be suitable for their intended grades at the senior high school. The grader readability assessment of texts was found to be at variance with the metric readability assessment. Whilst most graders found most texts to be readable (over 96%), metric readability assessment found the same texts to be unreadable (about 98%). Both metric and grader readability assessments need to be conducted on the same texts to conclude properly on their realistic readability status before assigning them to respective grades. This is a result of the wide metric-grader readability assessment disparity. Where the grader readability assessment reveals a text to be readable and the metric readability assessment finds the same text to be unreadable, the grader assessment should be considered as that is a more realistic assessment

Local Government Reform Programme and Health Service Delivery in Kasulu District, Tanzania

The study investigates how the local government reforms shaped health service delivery in Kasulu District council. Firstly, the study intended to find out how reforms assisted management of quality and capacity to offer health services in Kasulu. Secondly, the study examined the challenges to offer adequate and quality health services in Kasulu District. The other objective was to assess how health service reform attracted community involvement in planning and implementation of health services in Kasulu.  The expo-facto descriptive design used to explore changes after the health service reforms in Kasulu. Whereby, the interest was to know both challenge and improvement encountered through the reforms undertaken. The study involved ( ) respondents as a sample to represent the whole population in the study area. A structured questionnaire was administered to health service officers and heads of household in order to fill in questions. The questionnaire analyzed through frequencies and mean which were presented in percentages, charts as well as figures. The percentage distribution formed a basis for conclusions. It was revealed that there were inadequate health facilities and staffs; this led into poor service provision. For instance, still there is good number of people trust traditional healers than doctors. This is due to poor services offered such as unsuccessful treatment, long waiting and inadequate expertise.  The Local Government Reform Programme (LGRP) was formulated and implemented by the Tanzania Government with an intention of addressing problems which constrained the performance of the local government authorities such as the human resource capacity and management being weak and this seriously constrained performance by Local Government Authorities, weak leadership and poor management of the councils, shortage of properly qualified, disciplined and committed personnel, shortage of revenue due to narrow tax base, over-employment within the Councils and lack of transparency and accountability in the conduct of Councils' business.  The study concludes that effectiveness of health service delivery is mainly determined by both local government system and the community involvement. That is local government policy reforms, critical resources management and full engaged community. From which the community can play their role to promote a dynamic health delivery environment. Keywords: Service delivery, Local Government Reform Programme, Accountability and Local Government Authoritie

Marketing Strategies, Cultural Dynamism and Psychological Issues in Tanzania

This study attempts to investigate marketing strategies both challenges and opportunities caused on culture and psychology in developing countries.  The following business actions e.g. promotion, pricing, placing and production were examined to and its influence towards customers behaviors. For instance; describing culture the research examined language, belief and life style as well as perception. Meanwhile; on psychology the study focused customers’ action, decision, perception and attitude.  A descriptive survey was carried out to determine, how marketing strategies can change cultural and human psychology in developing world. Either, the study revealed that activities such branding, product design and product distribution are sources of changes on culture and human psychology. Furthermore the study discusses the impact of activities such as pricing and promotion in the market. Whereby, business malpractice and inadequate marketing skills appear to be the major challenges. That means some of cultural and psychological challenges such as drug abuse; organized crime and sex innuendos were related to improper marketing. The study recommended marketing regulatory board to regulate marketing strategies and manage individual welfare. Keywords: culture, psychology, marketing strategies, social and economic

Navigating the Paradox of Decentralisation by Devolution: An Evaluation of Public Healthcare Service Delivery in Developing Countries

Decentralisation by devolution has emerged as a strategic approach in developing countries to enhance public healthcare service delivery through increased local responsiveness and community participation. However, this shift presents a paradox: while aimed at empowering local authorities, decentralisation often exacerbates existing disparities, hinders effective resource allocation, and complicates cohesive healthcare policy implementation. This study examined the interplay between efficacy and accountability in decentralised health systems, drawing on case studies from Uganda, Kenya, Ghana, Indonesia, Brazil, South Africa, and Tanzania, employing a systematic literature review and mixed-methods approach. Key findings indicated that decentralisation can improve local healthcare service delivery, but its effectiveness is frequently constrained by governance capacity and resource allocation challenges. The research highlights the importance of strengthening local governance capabilities, fostering community engagement, and addressing contextual factors like local government competencies and fiscal resources. Limitations include a reliance on English-language publications, potentially excluding valuable insights from other languages, and the selected case studies may not represent all decentralised healthcare experiences. The study recommends comprehensive capacity-building initiatives, stronger accountability frameworks, and active community involvement to ensure equitable healthcare outcomes. By acknowledging the paradox of decentralisation, policymakers can better design and implement reforms, ultimately enhancing health service delivery in developing

Effectiveness of Decentralisation by Devolution Approaches in Public healthcare services Delivery in Ilala Municipal Council and Geita Town Council, Tanzania

This study investigates the effectiveness of Decentralisation by Devolution (D-by-D) in public healthcare service delivery within Ilala Municipal Council and Geita Town Council, Tanzania. Employing a mixed-methods approach, including quantitative surveys and qualitative interviews with local key informants, the research reveals critical insights into how D-by-D frameworks impact healthcare quality and accessibility. Findings indicate that while some approaches, such as project monitoring and budget allocation, are perceived as effective, others—particularly multi-stakeholder involvement, participation, and strategic planning—are regarded as ineffective. The average effectiveness score across both councils suggests a moderate perception of D-by-D functioning, yet significant gaps exist regarding community engagement, resource allocation, and local governance capabilities. Challenges include inadequate funding, personnel shortages, and a lack of transparency, which hinder the realization of Decentralisation’s intended benefits. The study underscores a prevalent sense of skepticism regarding healthcare quality in both councils and highlights the necessity for reforms to better align local health priorities with community needs. To enhance the effectiveness of D-by-D, the research recommends strengthening financial support to Local Government Authorities, enhancing human resource capacity, fostering community participation, and promoting accountability and transparency in healthcare governance. This research contributes to the understanding of local governance in Tanzania and offers essential insights for policymakers aiming to improve healthcare outcomes through decentralized frameworks

The Professorial Chair (<i>kursī ‘ilmī</i> or <i>kursī li-l-wa‘ẓ wa-l-irshād</i>) in Morocco

Moroccan congregational mosques are equipped with a minbar (pulpit) which is used for the Friday sermon. Many mosques in Morocco are also equipped with one or more smaller chairs, which differ in their form and function from the minbar. These chairs are used by professors to give regular lectures to students of traditional education, and by scholars to give occasional lectures to the general public. This tradition of the professorial chair was probably introduced to Morocco from the Middle East in the thirteenth century. Most of the existing chairs in Morocco seem to date from the nineteenth and twentieth centuries, and they continue to be made and used today. The chairs always have two steps, a seat, a backrest and armrests. This form probably evokes the original minbar of the Prophet in Medina, which had two steps and a seat, and this is one of many aspects of the conservatism and se parate evolution of Moroccan Malikism.Las mezquitas congregacionales en Marruecos suelen tener un almimbar (p?lpito) que se utiliza durante el sermón de los viernes. Muchas mezquitas de Marruecos cuentan también con una o más sillas, diferenciadas del almimbar en su forma y su función ya que son utilizadas por los profesores para ensenar a los estudiantes de la educación tradicional, y por eruditos que dan conferencias ocasionales al p?blico en general. Esta tradición de cátedras se introduce probablemente en Marruecos desde Próximo Oriente en el siglo XIII. La mayoría de las cátedras existentes parecen datar de los siglos XIX y XX, manteniéndose hasta nuestros días la fabricación y utilización de estas sillas. Las cátedras siempre tienen dos peldanos, un asiento, un respaldo y apoyabrazos. La forma de las sillas parece evocar el almimbar original del Profeta en Medina, tradición que se muestra como uno de los muchos aspectos del conservadurismo y de la evolución distinta del Malikismo marroquí

Neuropsychiatric manifestations and sleep disturbances with dolutegravir-based antiretroviral therapy versus standard of care in children and adolescents: a secondary analysis of the ODYSSEY trial

BACKGROUND: Cohort studies in adults with HIV showed that dolutegravir was associated with neuropsychiatric adverse events and sleep problems, yet data are scarce in children and adolescents. We aimed to evaluate neuropsychiatric manifestations in children and adolescents treated with dolutegravir-based treatment versus alternative antiretroviral therapy. METHODS: This is a secondary analysis of ODYSSEY, an open-label, multicentre, randomised, non-inferiority trial, in which adolescents and children initiating first-line or second-line antiretroviral therapy were randomly assigned 1:1 to dolutegravir-based treatment or standard-of-care treatment. We assessed neuropsychiatric adverse events (reported by clinicians) and responses to the mood and sleep questionnaires (reported by the participant or their carer) in both groups. We compared the proportions of patients with neuropsychiatric adverse events (neurological, psychiatric, and total), time to first neuropsychiatric adverse event, and participant-reported responses to questionnaires capturing issues with mood, suicidal thoughts, and sleep problems. FINDINGS: Between Sept 20, 2016, and June 22, 2018, 707 participants were enrolled, of whom 345 (49%) were female and 362 (51%) were male, and 623 (88%) were Black-African. Of 707 participants, 350 (50%) were randomly assigned to dolutegravir-based antiretroviral therapy and 357 (50%) to non-dolutegravir-based standard-of-care. 311 (44%) of 707 participants started first-line antiretroviral therapy (ODYSSEY-A; 145 [92%] of 157 participants had efavirenz-based therapy in the standard-of-care group), and 396 (56%) of 707 started second-line therapy (ODYSSEY-B; 195 [98%] of 200 had protease inhibitor-based therapy in the standard-of-care group). During follow-up (median 142 weeks, IQR 124–159), 23 participants had 31 neuropsychiatric adverse events (15 in the dolutegravir group and eight in the standard-of-care group; difference in proportion of participants with ≥1 event p=0·13). 11 participants had one or more neurological events (six and five; p=0·74) and 14 participants had one or more psychiatric events (ten and four; p=0·097). Among 14 participants with psychiatric events, eight participants in the dolutegravir group and four in standard-of-care group had suicidal ideation or behaviour. More participants in the dolutegravir group than the standard-of-care group reported symptoms of self-harm (eight vs one; p=0·025), life not worth living (17 vs five; p=0·0091), or suicidal thoughts (13 vs none; p=0·0006) at one or more follow-up visits. Most reports were transient. There were no differences by treatment group in low mood or feeling sad, problems concentrating, feeling worried or feeling angry or aggressive, sleep problems, or sleep quality. INTERPRETATION: The numbers of neuropsychiatric adverse events and reported neuropsychiatric symptoms were low. However, numerically more participants had psychiatric events and reported suicidality ideation in the dolutegravir group than the standard-of-care group. These differences should be interpreted with caution in an open-label trial. Clinicians and policy makers should consider including suicidality screening of children or adolescents receiving dolutegravir

Dolutegravir twice-daily dosing in children with HIV-associated tuberculosis: a pharmacokinetic and safety study within the open-label, multicentre, randomised, non-inferiority ODYSSEY trial

Background: Children with HIV-associated tuberculosis (TB) have few antiretroviral therapy (ART) options. We aimed to evaluate the safety and pharmacokinetics of dolutegravir twice-daily dosing in children receiving rifampicin for HIV-associated TB. Methods: We nested a two-period, fixed-order pharmacokinetic substudy within the open-label, multicentre, randomised, controlled, non-inferiority ODYSSEY trial at research centres in South Africa, Uganda, and Zimbabwe. Children (aged 4 weeks to <18 years) with HIV-associated TB who were receiving rifampicin and twice-daily dolutegravir were eligible for inclusion. We did a 12-h pharmacokinetic profile on rifampicin and twice-daily dolutegravir and a 24-h profile on once-daily dolutegravir. Geometric mean ratios for trough plasma concentration (Ctrough), area under the plasma concentration time curve from 0 h to 24 h after dosing (AUC0–24 h), and maximum plasma concentration (Cmax) were used to compare dolutegravir concentrations between substudy days. We assessed rifampicin Cmax on the first substudy day. All children within ODYSSEY with HIV-associated TB who received rifampicin and twice-daily dolutegravir were included in the safety analysis. We described adverse events reported from starting twice-daily dolutegravir to 30 days after returning to once-daily dolutegravir. This trial is registered with ClinicalTrials.gov (NCT02259127), EudraCT (2014–002632-14), and the ISRCTN registry (ISRCTN91737921). Findings: Between Sept 20, 2016, and June 28, 2021, 37 children with HIV-associated TB (median age 11·9 years [range 0·4–17·6], 19 [51%] were female and 18 [49%] were male, 36 [97%] in Africa and one [3%] in Thailand) received rifampicin with twice-daily dolutegravir and were included in the safety analysis. 20 (54%) of 37 children enrolled in the pharmacokinetic substudy, 14 of whom contributed at least one evaluable pharmacokinetic curve for dolutegravir, including 12 who had within-participant comparisons. Geometric mean ratios for rifampicin and twice-daily dolutegravir versus once-daily dolutegravir were 1·51 (90% CI 1·08–2·11) for Ctrough, 1·23 (0·99–1·53) for AUC0–24 h, and 0·94 (0·76–1·16) for Cmax. Individual dolutegravir Ctrough concentrations were higher than the 90% effective concentration (ie, 0·32 mg/L) in all children receiving rifampicin and twice-daily dolutegravir. Of 18 children with evaluable rifampicin concentrations, 15 (83%) had a Cmax of less than the optimal target concentration of 8 mg/L. Rifampicin geometric mean Cmax was 5·1 mg/L (coefficient of variation 71%). During a median follow-up of 31 weeks (IQR 30–40), 15 grade 3 or higher adverse events occurred among 11 (30%) of 37 children, ten serious adverse events occurred among eight (22%) children, including two deaths (one tuberculosis-related death, one death due to traumatic injury); no adverse events, including deaths, were considered related to dolutegravir. Interpretation: Twice-daily dolutegravir was shown to be safe and sufficient to overcome the rifampicin enzyme-inducing effect in children, and could provide a practical ART option for children with HIV-associated TB