Impact of school health programme on urinary schistosomiasis control in schoolchildren in Kilosa, Tanzania

No Abstract. Tanzania Health Research Bulletin Vol. 7(3) 2005: 198-20

Capacity of health facilities for diagnosis and treatment of HIV/AIDS in Ethiopia

Background: There are dearth of literature on the capacity of the health system to diagnose and treat HIV/AIDS in Ethiopia. In this study we evaluated the capacity of health facilities for HIV/AIDS care, its spatial distribution and variations by regions and zones in Ethiopia. Methods: We analyzed the Service Provision Assessment plus (SPA+) survey data that were collected in 2014 in all regions of Ethiopia. We assessed structural, process and overall capacity of the health system based on the Donabedian quality of care model. We included 5 structural and 8 process indicators and overall capacity score was constructed by taking the average of all indicators. Multiple linear regression was done using STATA 14 to assess the association of the location and types of health facilities with overall capacity score. Maps displaying the average capacity score at Zonal level were produced using ArcGIS Desktop v10.3 (Environmental Systems Research Institute Inc., Redlands CA, USA). Results: A total of 873 health facilities were included in the analysis. Less than 5% of the private facilities provided antiretroviral therapy (ART); had national ART guideline, baseline CD4 count or viral load and tuberculosis screening mechanisms. Nearly one-third of the health centers (34.9%) provided ART. Public hospitals have better capacity score (77.1%) than health centers (45.9%) and private health facilities (24.8%). The overall capacity score for urban facilities (57.1%) was higher than that of the rural (38.2%) health facilities (β = 15.4, 95% CI: 11.7, 19.2). Health centers (β = − 21.4, 95% CI: -25.4, − 17.4) and private health facilities (β = − 50.9, 95% CI: -54.8, − 47.1) had lower overall capacity score than hospitals. Facilities in Somali (β = − 13.8, 95% CI: -20.6, − 7.0) and SNNPR (β = − 5.0, 95% CI: -9.8, − 0.1) regions had lower overall capacity score than facilities in the Oromia region. Zones located in emerging regions such as Gambella and Benishangul Gumz and in remote areas of Oromia and SNNPR had lower capacity score in terms of process indicators. Conclusions: There is a significant geographical heterogeneity on the capacity of health facilities for HIV/AIDS care and treatment in Ethiopia. Targeted capacity improvement initiatives are recommended with focus on health centers and private health facilities, and emerging Regions and the rural and remote areas

Availability of nutritional support services in HIV care and treatment sites in sub-Saharan African countries

Objective: To examine the availability of nutritional support services in HIV care and treatment sites across sub-Saharan Africa. Design: In 2008, we conducted a cross-sectional survey of sites providing antiretroviral therapy (ART) in nine sub-Saharan African countries. Outcomes included availability of: (i) nutritional counselling; (ii) micronutrient supplementation; (iii) treatment for severe malnutrition; and (iv) food rations. Associations with health system indicators were explored using bivariate and multivariate methods. Setting: President's Emergency Plan for AIDS Relief-supported HIV treatment and care sites across nine sub-Saharan African countries. Subjects: A total of 336 HIV care and treatment sites, serving 467 175 enrolled patients. Results: Of the sites under study, 303 (90%) offered some form of nutritional support service. Nutritional counselling, micronutrient supplementation, treatment for severe acute malnutrition and food rations were available at 98%, 64%, 36% and 31% of sites, respectively. In multivariate analysis, secondary or tertiary care sites were more likely to offer nutritional counselling (adjusted OR (AOR): 2·2, 95% CI 1·1, 4·5). Rural sites (AOR: 2·3, 95% CI 1·4, 3·8) had increased odds of micronutrient supplementation availability. Sites providing ART for >2 years had higher odds of availability of treatment for severe malnutrition (AOR: 2·4, 95% CI 1·4, 4·1). Sites providing ART for >2 years (AOR: 1·6, 95% CI 1·3, 1·9) and rural sites (AOR: 2·4, 95% CI 1·4, 4·4) had greater odds of food ration availability. Conclusions: Availability of nutritional support services was high in this large sample of HIV care and treatment sites in sub-Saharan Africa. Further efforts are needed to determine the uptake, quality and effectiveness of these services and their impact on patient and programme outcomes

Developing a logic model for communication-based interventions on Antimicrobial Resistance (AMR)

The importance of communication in enhancing people’s awareness and understanding of antimicrobial resistance (AMR) is consistently recognised in global and national action plans (NAPs). Despite this, there have been relatively few national AMR communication campaigns which use a structured approach to take account of the local context, encompass co-design with the target audience and use a logic model to help inform its design, implementation and evaluation. Designing a logic model for communication-based interventions can help map out the planning, resources, messaging, assumptions and intended outcomes of the campaign to maximise its impact, ensure it is fit for context and minimise any unintended consequences on individuals and society. Building on an AMR research project in Tanzania, Supporting the National Action Plan for AMR (SNAP-AMR), we co-designed the SNAP-AMR Logic Model with key stakeholders to implement AMR communication campaigns and related legacy materials to be employed in support of the Tanzanian NAP, but with broader relevance to a range of contexts. In developing the SNAP-AMR Logic Model, we reviewed relevant communication theories to create and target messages, and we considered behavioural change theories. We defined all key elements of the SNAP-AMR Logic Model as follows: (1) resources (inputs) required to enable the design and implementation of campaigns, e.g. funding, expertise and facilities; (2) activities, e.g. co-design of workshops (to define audience, content, messages and means of delivery), developing and testing of materials and data collection for evaluation purposes; (3) immediate deliverables (outputs) such as the production of legacy materials and toolkits; and (4) changes (outcomes) the campaigns aim to deliver, e.g. in social cognition and behaviours. The SNAP-AMR Logic Model efficiently captures all the elements required to design, deliver and evaluate AMR communication-based interventions, hence providing government and advocacy stakeholders with a valuable tool to implement their own campaigns. The model has potential to be rolled out to other countries with similar AMR socio-cultural, epidemiological and economic contexts

The reality of task shifting in medicines management - a case study from Tanzania

Tanzania suffers a severe shortage of pharmaceutical staff. This negatively affects the provision of pharmaceutical services and access to medicines, particularly in rural areas. Task shifting has been proposed as a way to mitigate the impact of health worker shortfalls.The aim of this study was to understand the context and extent of task shifting in pharmaceutical management in Dodoma Region, Tanzania. We explored 1) the number of trained pharmaceutical staff as compared to clinical cadres managing medicines, 2) the national establishment for staffing levels, 3) job descriptions, 4) supply management training conducted and 5) availability of medicines and adherence to Good Storage Practice.; A cross-sectional study was conducted in 270 public health facilities in 2011. A pre-tested questionnaire was administered to the person in charge of the facility to collect data on staff employed and their respective pharmaceutical tasks. Availability of 26 tracer medicines and adherence to Good Storage Practice guidelines was surveyed by direct observation. The national establishments for pharmaceutical staffing levels and job descriptions of facility cadres were analysed.; While required staffing levels in 1999 were 50, the region employed a total of only 14 pharmaceutical staff in 2011. Job descriptions revealed that, next to pharmaceutical staff, only nurses were required to provide dispensing services and adherence counselling. In 95.5% of studied health facilities medicines management was done by non-pharmaceutically trained cadres, predominantly medical attendants. The first training on supply management was provided in 2005 with no refresher training thereafter. Mean availability of tracer medicines was 53%, while 56% of health facilities fully met criteria of Good Storage Practice. Task shifting is a reality in the pharmaceutical sector in Tanzania and it occurs mainly as a coping mechanism rather than a formal response to the workforce crisis. In Dodoma Region, pharmacy-related tasks and supply management have informally been shifted to clinical staff without policy guidance, explicit job descriptions, and without the necessary support through training. Implicit task shifting should be recognized and formalized. Job orientation, training and operational procedures may be useful to support non-pharmaceutical health workers to effectively manage medicine supply

Usawiri Wa Mwanamke Kama Kiongozi Katika Tamthiliya: Uchunguzi Wa Kivuli Kinaishi Na Nguzo Mama

Ndugu msomaji wangu, waswahili wanamsemo wao kuwa “chanda chema huvishwa pete” na mimi kutoka moyoni mwangu naitabaruku kazi hii kwa wazazi wangu, kwanza Baba yangu mpendwa, Cleopa Elinisafi Mapunjo Mpembeni na Mama yangu Kalolina Kitungutu waliopenda sana kunihimiza nisome kwa bidii. Kwani maisha ni magumu na bila elimu utanyanyaswa. Alipenda kusema “unamsomea nani au unamwandikia nani”, kwa ufupi tu na kwa ujasiri nilijibu kuwa; nawaandikia wote ili waelimike. Pili, Mama yangu mpendwa Dkt Rose Cleopa Mapunjo Mpembeni kwa ushauri wake wa mara kwa mara kuhusu umuhimu wa elimu. Nawapenda wote na Mungu awabariki

Usawiri wa Mwanamke Kama Kiongozi Katika Tamthiliya: Uchunguzi wa Kivuli Kinaishi na Nguzo Mama

Kazi hii ilichunguza dhima ya usawiri wa mwanamke kama kiongozi katika tamthiliya: Uchunguzi wa Kivuli kinaishi na Nguzo mama. Lengo la jumla ya utafiti huu ilikuwa kutafiti na kubainisha usawiri wa mwanamke kama kiongozi na kuonesha suala la uongozi linavyoibua visa na linavyojenga dhamira katika tamthiliya teule. Ili kufanikisha utafiti huu, mtafiti ametumia mbinu ya maktabani katika kukusanya na kuwasilisha data kimaelezo. Vilevile marejeleo mbalimbali kutoka katika wavuti yalipitiwa. Nadharia ya U-feministi ndiyo iliyotumika katika kufanikisha utafiti huu. Nadharia hii imemsaidia mtafiti kuweza kubaini mawazo mbalimbali ya waandishi katika riwaya zao ambazo ni aina za uongozi, visa na maudhui yanayotokana na uongozi kutoka katika tamthiliya ya Kivuli Kinaishi na Nguzo Mama. Kwa ujumla matokeo ya uchanganuzi wa data yaliweza kujibu maswali ya utafiti kwani yalibainisha uongozi ulivyo na dhamira zake katika jamii. Dhamira hizo ni uvivu, ushirikina, ushirikiano na suala zima la mapinduzi ya kijamii, kisiasa, kiutamaduni na kiuchumi. Pia matokeo hayo ya utafiti yalibainisha mnyonge kumshinda mwenye nguvu, utundu na ubunifu. Matokeo mengine ni umalaya, mauaji ya wenye kudai haki, ulevi, tamaa ya binadamu na ndoto za kutawala milele. Dhamira zinazotokana na suala la uongozi kutoka katika tamthiliya ya Kivuli Kinaishi na Nguzo Mama yana mchango mkubwa katika fasihi kwa ujumla

Determinants of enrollment to improved community health fund: a case of Kilosa District, Tanzania

DissertationThe Community Health Fund (CHF) is one of the programs that has been actively promoted in rural areas to ensure that communities have access to basic health services. People in rural areas, on the other hand, have a low rate of enrolment in the scheme. The study on which this dissertation is based aimed at assessing the determinants of households’ enrollment to improved CHF in Kilosa District. The specific objectives were to: assess local peoples’ awareness of CHF and determine factors influencing household enrolment in CHF. The study used a cross-sectional research approach, in which data was collected from 120 respondents through a questionnaire and analyzed using non- parametric tests and binary logistic regression to quantify variables and determine differences in CHF awareness among CHF and non-CHF members. Findings from the study showed that, there was a statistically significant difference in awareness between CHF members and non-members (P = 0.01). CHF members were more aware of the program than non-CHF members. According to local people's perceptions of the quality of CHF services, members of the CHF were satisfied with the services. In addition, the binary logistic regression revealed that socioeconomic characteristics such household size, married status, CHF-covered services and the sex of the household head strongly predicted household membership in the CHF program by 5%. As a result, the study concludes that CHF members were aware of the scheme's services but lacked specific information about the services covered. In addition, socioeconomic and demographic variables (demand side) and the kind of CHF services and facilities in the research region were found to have an impact on household participation in CHF. To increase enrolment, the government and local health institutions should encourage people in rural areas to enroll in the program by expanding the number of services covered by the CHF scheme in rural areas. In addition, while working to increase the number of health workers, expand the services offered and promote them to raise awareness among the local people

QUALITY STANDARDS IN PROVISION OF FACILITY BASED HIV CARE AND TREATMENT: A CASE STUDY FROM DAR ES SALAAM REGION, TANZANIA

Objective: A cross- sectional descriptive study was conducted to assess the quality standards of health facilities providing antiretroviral treatment (ART) in Dar es Salaam from May to July 2005. Methods: All ten health facilities (both public and private) already designated by Ministry of Health (MOH) to provide ART, six of them since October 2004 and four since May 2005, were included in the study purposively . The other two not designated were randomly picked and added. A checklist with the MOH required standards was used to assess the availability of infrastructure (equipment and staff) for provision of ART, and noted the number of patient eligible, started on ART and their follow ups. Results: The study findings indicated that there were inadequate trained personnel, inadequate laboratory equipments, inadequate antiretroviral drugs and isoniazed was under utilized. There were inadequate confidential places for counseling and information system was weak. Not all the eligible patients were able to start ART and comprehensive HIV care and treatment was not provided in all the designated facilities. Conclusion: Quality standards for providing ART in eligible health facilities in Dar es Salaam varied from facility to facility with better quality standards in facilities that were designated earlier than those designated later indicating a potential for improvement in future. However fast Improvement in staff training, infrastructure, equipment and drugs supplies, health management information system is needed if we are to treat estimated more than 400,00 HIV/AIDS patients by the year 2010.