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This paper reflects on the development process (2015-2020) of the Learning Initiative for Norms, Exploitation, and Abuse (LINEA) Intervention. The LINEA Intervention is a multi-component social norms intervention to prevent agedisparate transactional sex in Tanzania. This paper aims to: (1) critically reflect on the LINEA Intervention development process by retrospectively comparing it with a pragmatic, phased framework for intervention development in public health, the Six Essential Steps for Quality Intervention Development (6SQuID); and (2) discuss the usefulness and applicability of this framework to guide intervention development for gender-based violence prevention. This paper contributes to a growing field of intervention development research to improve the designs of interventions to prevent gender-based violence. Findings showed that the LINEA Intervention development approach mostly aligned with the steps in 6SQuID framework. However, the LINEA Intervention development process placed particular emphasis on two phases of the 6SQuID framework. First, the LINEA Intervention development process included significant investment in formative research, feasibility testing, and refinement; and second, the LINEA Intervention was informed by a clearly articulated behavior change theory--social norms theory. Beyond the 6SQuID framework the LINEA Intervention development process: (i) followed a non-linear, iterative process; (ii) applied ongoing feasibility testing to refine the intervention, and (iii) relied on co-development with local implementers and participants. This paper suggests future components for a robust intervention development process, highlighting beneficial additions to the 6SQuID approach, a well-recognized intervention development sequence. Particularly useful additions include incorporating sufficient time, flexibility, and resources to foster meaningful collaborations and iteration on the intervention design. [ABSTRACT FROM AUTHOR]

One of the challenges confronting higher learning institutions in the global south is the constrained capacity to carry out research, expand student enrolment and address pertinent problems facing local communities. This challenge has compelled institutions to solicit resources and forge partnerships to build the needed capacity for improved functioning as viable academic entities nationally and internationally. This paper analyses the capacity-building programme that has been and is still being implemented by Ardhi University in Dar es Salaam, Tanzania and examines its impacts. The methods employed in examining capacity included a literature review, programme documents, reports from the University website, workshop proceedings, evaluation and facts and figure reports. Empirical evidence from these reports indicates that the capacitybuilding programme has increased staff with Doctoral (PhD) qualifications, increased student enrolment, research projects and publications, and national and international collaboration links. On a broader scale, the capacity built has increased Ardhi University's contribution to the national development agenda, increased national and international relations and innovative approaches to addressing community problems. This paper recommends continued capacity-building to sustain the achievements registered over the two decades and contribute to national development. [ABSTRACT FROM AUTHOR]

Background: Insecticide resistance is a serious threat to the continued effectiveness of insecticide-based malaria vector control measures, such as long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS). This paper describes trends and dynamics of insecticide resistance and its underlying mechanisms from annual resistance monitoring surveys on Anopheles gambiae sensu lato (s.l.) populations conducted across mainland Tanzania from 2004 to 2020. Methods: The World Health Organization (WHO) standard protocols were used to assess susceptibility of the wild female An. gambiae s.l. mosquitoes to insecticides, with mosquitoes exposed to diagnostic concentrations of permethrin, deltamethrin, lambdacyhalothrin, bendiocarb, and pirimiphos-methyl. WHO test papers at 5× and 10× the diagnostic concentrations were used to assess the intensity of resistance to pyrethroids; synergist tests using piperonyl butoxide (PBO) were carried out in sites where mosquitoes were found to be resistant to pyrethroids. To estimate insecticide resistance trends from 2004 to 2020, percentage mortalities from each site and time point were aggregated and regression analysis of mortality versus the Julian dates of bioassays was performed. Results: Percentage of sites with pyrethroid resistance increased from 0% in 2004 to more than 80% in the 2020, suggesting resistance has been spreading geographically. Results indicate a strong negative association (p = 0.0001) between pyrethroids susceptibility status and survey year. The regression model shows that by 2020 over 40% of An. gambiae mosquitoes survived exposure to pyrethroids at their respective diagnostic doses. A decreasing trend of An. gambiae susceptibility to bendiocarb was observed over time, but this was not statistically significant (p = 0.8413). Anopheles gambiae exhibited high level of susceptibility to the pirimiphos-methyl in sampled sites. Conclusions: Anopheles gambiae Tanzania's major malaria vector, is now resistant to pyrethroids across the country with resistance increasing in prevalence and intensity and has been spreading geographically. This calls for urgent action for efficient malaria vector control tools to sustain the gains obtained in malaria control. Strengthening insecticide resistance monitoring is important for its management through evidence generation for effective malaria vector control decision. [ABSTRACT FROM AUTHOR]

This paper primarily aimed at examining the influence households' demographic characteristics on the level of their financial literacy in Tanzania. The paper employs secondary data from the FinScope survey conducted by Financial Sector Deepening Trust (FSDT). To do so, the study employed both bivariate and multivariate analytical techniques. The study, reveals that the adult population exhibits large financial literacy gap- and, therefore, adults should not be considered as a homogenous group- rather gender, age, education and income levels of the households, which are showcased in this study, to also be taken into consideration while designing financial literacy improvement public initiatives. In particular, the study concludes that men are more inclined to have higher levels of financial literacy than women something which limits their financial decisions making ability. It is also concluded that younger households and those with higher income levels are equipped with higher financial literacy levels. Likewise, more educated and employed households tend to have higher levels of financial literacy. It, therefore, follows that programs to foster financial knowledge among households should be targeted at marginalized groups like women, the elderly and those with low incomes and educational attainment. As the main contribution of the research, it is highlighted that this is a pioneer study in the Tanzanian context, by proposing a model that identifies which socioeconomic and demographic factors influence the propensity for a low or high financial literacy level. [ABSTRACT FROM AUTHOR]

Strengthening surgical services in resource-constrained settings is contingent on using high-quality data to inform decision making at clinical, facility, and policy levels. However, the evidence is sparse on gaps in paper-based medical record quality for surgical and obstetric patients in low-resource settings. We aim to examine surgical and obstetric patient medical record data quality in health facilities as part of a surgical system strengthening initiative in northern Tanzania. To measure the incidence of Surgical Site Infections (SSIs), sepsis and maternal sepsis surgical and obstetric inpatients were followed prospectively, over three months in ten primary, district, and regional health facilities in northern Tanzania. Between April 22nd to May 1st, 2018, we retrospectively reviewed paper-based medical records of surgical and obstetric patients diagnosed with SSIs, post-operative sepsis, and maternal sepsis in the three-month follow-up period. A data quality assessment tool with18 data elements related to documentation of SSIs and sepsis diagnosis, their respective symptoms and vital signs, inpatient daily monitoring indicators, and demographic information was developed and used to assess the completeness of patient medical records. Among the 157 patients diagnosed with SSI and sepsis, we found and reviewed 68% of all medical records. Among records reviewed, approximately one third (34%) and one quarter (23%) included documentation of SSI and sepsis diagnoses, respectively. 6% of reviewed records included documentation of all SSI and sepsis diagnoses, symptoms and vital signs, inpatient daily monitoring indicators, and demographic data. Strengthening data quality and record-keeping is essential for surgical team communication, continuity of care, and patient safety, especially in low resource settings where paper-based records are the primary means of data collection. High-quality primary health information provides facilities with actionable data for improving surgical and obstetric care quality at the facility level. [ABSTRACT FROM AUTHOR]

Introduction: Schistosomiasis is a parasitic disease in Tanzania affecting over 50% of the population. Current control strategies involve mass drug administration (MDA) campaigns at the district level, which have led to problems of over- and under-treatment in different areas. WHO guidelines have called for more targeted MDA to circumvent these problems, however a scarcity of prevalence data inhibits decision makers from prioritizing sub-district areas for MDA. This study demonstrated how geostatistics can be used to inform planning for targeted MDA. Methods: Geostatistical sub-district (ward-level) prevalence estimates were generated through combining a zero-inflated poisson model and kriging approach (regression kriging). To make predictions, the model used prevalence survey data collected in 2021 of 17,400 school children in six regions of Tanzania, along with several open source ecological and socio-demographic variables with known associations with schistosomiasis. Results: The model results show that regression kriging can be used to effectively predict the ward level parasite prevalence of the two species of Schistosoma endemic to the study area. Kriging was found to further improve the regression model fit, with an adjusted R-squared value of 0.51 and 0.32 for intestinal and urogenital schistosomiasis, respectively. Targeted treatment based on model predictions would represent a shift in treatment away from 193 wards estimated to be over-treated to 149 wards that would have been omitted from the district level MDA. Conclusions: Geostatistical models can help to support NTD program efficiency and reduce disease transmission by facilitating WHO recommended targeted MDA treatment through provision of prevalence estimates where data is scarce. Author summary: In Tanzania, schistosomiasis is a vast public health problem treated through mass drug administration (MDA) campaigns that target large groups of the population. Such mass drug administration (MDA) campaigns require significant amounts of resources challenging the capacity of chronically underfunded schistosomiasis control programs to sustain annually. The way in which MDA campaigns have been conducted, by targeting whole districts believed to be endemic, have not had optimal results for reducing disease transmission, have facilitated problems of under-treating in many population groups while over-treating other non-endemic areas, and have placed a significant strain on the limited resources available. To circumvent such problems, the World Health Organization (WHO) has recommended that treatment efforts need to be more targeted to endemic communities and administrative areas within districts, and that MDA campaigns should be conducted at a sub-district level. The WHO also provides explicit guidelines for treatments of communities based on parasitological prevalence of schistosomiasis. While there is sound rationale in making this switch, most schistosomiasis endemic countries including Tanzania do not have adequate surveillance data to make such informed decisions at this level. Limited data on schistosomiasis prevalence inhibits disease control programs from making data informed decision on where to treat, as well as adhering to WHO recommendations for conducting targeted treatment at the sub-district level. Geostatistical models are spatial analysis tools that have been used in the past to help predict the likelihood of disease prevalence in nearby areas where there is limited data. They are particularly helpful in predicting diseases like schistosomiasis that have strong associations with environmental and socio-demographic elements that we do have data on widespread across much of the world. Publications on the use geostatistical models to predict schistosomiasis prevalence in different settings date back more than 20 years, but have not yet been integrated to aid the decision process of making of national programs, nor have they been specifically advocated for by the WHO. The study seeks to examine the implications of using model predictions to guide targeted, sub-district level treatment, in terms of populations requiring treatments when compared with conventional district level approaches. This publication demonstrates that use of geostatistical models for predicting schistosomiasis is possible, can be a valuable tool to inform where to treat. It furthermore estimates that the populations eligible for targeted treatment are considerably different than the populations who would be receiving treatment under conventional district level treatment approached, placing emphasis on the importance of switching to targeted treatment. The paper argues that uptake of geostatistical models can enable targeted planning below the district level, a major step to facilitate a systematic change that the WHO believes will drive down transmission of the disease, the importance of which cannot be understated in an area that is so historically burdened by the disease and its associated health complications. [ABSTRACT FROM AUTHOR]

Country's economic growth depends among other factors on the extent to which labour particularly female labour force participates on economic growth enhancing activities. Being the largest contributor in economic activities particularly agriculture in developing countries (over 50%), their participation enables economies to grow in response to higher labour inputs injected. As an outcome, as countries develop; women's capabilities typically improve as well, whereas social constraints weaken, which enables females to participate on work outside the home. However, the existing literature on this topic is scant and has mixed results. This study sought to analyse female fertility rate and its influence on provision of labour in Tanzania using females aged 15–49 years from the Tanzania Demographic and Health Survey 2015–2016. The study used instrumental variable-probit and a two-stage residual inclusion as methods of analysis. Results showed that, an increase in female's fertility rate reduces participation of females in provision of market labour by about 1.1–13%. Similarly, household size, education, contraceptive use, self-employment of their husbands and residing in rural areas was associated with increased participation while female's age exhibited an inverted U-shaped relationship with female participation. The results imply that, to foster a more sustainable female participation in labour force, family planning, educating females as well as fostering self-employment and improving rural infrastructures is inevitable. [ABSTRACT FROM AUTHOR]

Background: After a decade of successful control, malaria is on the rise again. The prevalence of malaria in Tanzania has increased from 7% in 2017 to 8% in 2022 and reached 18% in Kagera region in the North West of Tanzania. Malaria vectors in Muleba district Kagera have high level of pyrethroid resistance. The aim of this paper is to explore factors associated with malaria infection prevalence in children aged 6 months to 14 years in Muleba, where Long Lasting Insecticidal Net (LLIN) combining a pyrethroid insecticide and synergist piperonyl butoxide (PBO) that counteract resistance in the mosquitoes, was first distributed under trial conditions in 2015. Methods: The trial was a community randomized control in which there were two malaria prevalence cross-sectional household surveys each year (June and December) from 2015 to 2017 in Muleba. In this study we conducted a secondary data analysis of the December surveys only. Multilevel Poisson regression analysis was used to assess factors associated with malaria infection. Results: A total of 10,941 children and 4,611 households were included in this study. Overall malaria prevalence was 35.8%, 53.3% and 54.4% in the year 2015, 2016 and 2017 respectively. Living in an area with standard LLIN as opposed to the novel PBO synergist LLIN, being a male child, above 5 years of age, living in a house with open eaves, living in house without IRS, having head of household with no formal education, lower socioeconomic status and survey year were associated with increased risk of malaria infection. Conclusions: Using PBO LLIN reduced the risk of malaria infection. However, additional measures could further reduce malaria infection in areas of insecticide resistance such as housing improvement. [ABSTRACT FROM AUTHOR]

Many higher learning Institutions (HLIs) in underdeveloped nations, especially in Tanzania, are not moving quickly enough to embrace eLearning. This study seeks to design a model for enhanced adoption and use of eLearning at Tanzanian higher learning Institutions. A quantitative cross-section survey design was used for data collection. Data were examined using SEM under AMOS software. The results showed that the level of eLearning adoption and use was significantly influenced by technological, user, pedagogical, social, and environmental factors. Based on this paper, policymakers and other stakeholders should embrace this model to give enough support for the adoption of eLearning and to enhance the performance in teaching and learning. To develop an appropriate, successful, effective, and long-lasting eLearning environment, decision makers can have a clear image of how to implement an appealing, conducive, and positive meaningful learning environment. As a result, the paper adds to the body of knowledge the factors (such as social, environmental, and human ones) that significantly affect the adoption of eLearning in Tanzania's HLIs. In addition, a model for the adoption and use of successful and improved eLearning in Tanzanian's HLIs and other countries with comparable features was developed and validated in the paper. [ABSTRACT FROM AUTHOR]

Accountability and transparency procurement principles have played a significant role in establishing good governance in any procurement regime. These principles also safeguard the protection of human rights under human rights principles. These principles if well utilized and implemented, also encourage compliance with human rights norms. In the Tanzanian procurement regime, accountability and transparency procurement principles are also covered under procurement statutory rules. The covered principles are also articulated under regional and international procurement rules to which Tanzania is a party. Accountability as a principle is a form of liability that introduces to whom for what and what is accountable in procurement undertakings. The transparency principle, on the other hand, its essence is to show openness during in entire procurement process. The liability created by the accountability principle and openness in the entire procurement process by authorities, in general, promote good governance and enhance compliance with human rights norms in procurement regimes. Compliance with accountability and transparency procurement principles also improves public confidence in government performance. Absolute compliance with these procurement principles in the procurement regimes ensures taxpayers' resource utilization trust. In particular, accountability and transparency procurement principles have a close link with good governance and human rights. The two procurement principles are inseparable. The author of this article believes that there is a close link between accountability and transparency procurement principles with good governance and human rights. As earlier noted, it is strongly believed that good governance and human rights play a significant role in enhancing implementation and compliance with procurement principles in public procurement. Further in this paper that despite Tanzania to belief in various human rights principles as articulated by human rights norms, and also belief in human good governance as enshrined under the national Constitution, the current procurement system lacks a constitutional base, and procurement principles under discussion are only recognized under enabling Acts of the Parliament. This article emphasizes that there is a need for the current procurement system to be constitutionalized so that public entities conduct procurement based on the procurement principles named above in order to ensure that human rights and good governance goals are fully achieved by public entities, without which value for money will never be accomplished in Mainland Tanzania. [ABSTRACT FROM AUTHOR]

Open and Distance Learning (ODL) is increasingly gaining popularity and is seen as a viable means to promote access to education. This paper stems from a study--originally conducted in 2014-- that examined the students’ perceptions towards the provision of higher education through ODL at the Open University of Tanzania (OUT). The issue was subsequently re-visited by examining the students’ perceptions toward the provision of support services, curriculum design and the use of Information and Communication Technology (ICT). Findings demonstrate that support services, curriculum design and the use of ICT are generally perceived as satisfactory by students. However, still some challenges exist. These challenges potentially inhibit them from learning at a distance successfully. It is recommended that OUT should secure right technologies, such as employing video-conferencing and teletutoring, with the view to refraining from the use of costly outdated technologies. It should also review its support services system to allow flexible learning environment to students. [ABSTRACT FROM AUTHOR]

Background: High-quality neonatal care requires sufficient functional medical devices, furniture, fixtures, and use by trained healthcare workers, however there is lack of publicly available tools for quantification and costing. This paper describes development and use of a planning and costing tool regarding furniture, fixtures and devices to support scale-up of WHO level-2 neonatal care, for national and global newborn survival targets. Methods: We followed a systematic process. First, we reviewed planning and costing tools of relevance. Second, we co-designed a new tool to estimate furniture and device set-up costs for a default 40-bed level-2 neonatal unit, incorporating input from multi-disciplinary experts and newborn care guidelines. Furniture and device lists were based off WHO guidelines/norms, UNICEF and national manuals/guides. Due to lack of evidence-based quantification, ratios were based on operational manuals, multi-country facility assessment data, and expert opinion. Default unit costs were from government procurement agency costs in Kenya, Nigeria, and Tanzania. Third, we refined the tool by national use in Tanzania. Results: The tool adapts activity-based costing (ABC) to estimate quantities and costs to equip a level-2 neonatal unit based on three components: (1) furniture/fixtures (18 default but editable items); (2) neonatal medical devices (16 product categories with minimum specifications for use in low-resource settings); (3) user training at device installation. The tool was used in Tanzania to generate procurement lists and cost estimates for level-2 scale-up in 171 hospitals (146 District and 25 Regional Referral). Total incremental cost of all new furniture and equipment acquisition, installation, and user training were US$93,000 per District hospital (level-2 care) and US$346,000 per Regional Referral hospital. Estimated cost per capita for whole-country district coverage was US$0.23, representing 0.57% increase in government health expenditure per capita and additional 0.35% for all Regional Referral hospitals. Conclusion: Given 2.3 million neonatal deaths and potential impact of level-2 newborn care, rational and efficient planning of devices linked to systems change is foundational. In future iterations, we aim to include consumables, spare parts, and maintenance cost options. More rigorous implementation research data are crucial to formulating evidence-based ratios for devices numbers per baby. Use of this tool could help overcome gaps in devices numbers, advance efficiency and quality of neonatal care. [ABSTRACT FROM AUTHOR]

Background and Aims: Lower‐ and middle‐income countries have decentralized decision‐making at the community level, as well as community governance structures, to encourage community participation in governance processes, particularly in primary healthcare (PHC). In Tanzania, decentralization resulted in the establishment of Health Facility Governing Committees (HFGCs) to encourage community participation in the governance of primary health facilities to improve the quality and responsiveness of health service delivery. Nonetheless, despite the presence of HFGCs, PHC delivery remains ineffective and of poor quality. It is unclear who makes governance decisions at PHC facilities to ensure that services delivered are of expected quality and respond the community's needs, tastes, and preferences. This paper aims to assess the perspectives of members of the HFGC on who make governance decision in the context of fiscal decentralization. Design and Methods: A cross‐section design was used to collect both quantitative and qualitative data. A four‐multistage sampling technique was adopted to selects regions, council, health facilities, and HFGC members. Respondents who participated in structured questionnaire responses were chosen using proportional sampling, whereas those who participated in in‐depth interviews and Focus Group Discussions were chosen using purposive selection. The data was analyzed descriptively and thematically. Results: The study revealed that HFGCs members perceive that governance decisions in primary health facilities are primarily made by the health facility management, and later are presented in HFGCs. As such, HFGCs are used a passively used to justify participation in decision that was already made by the management, which contradict with the principal of decentralization that emphasizes community participation on fiscal decisions. Conclusion: Decentralization of PHC facilities does not guarantee the participation of community members in fiscal decision of their respective primary health facilities through HFGCs. HFGC is passively used governance structure to substitute community participation in primary health facilities' fiscal decisions. Enforcement mechanisms are required to facilitate effective community participation. [ABSTRACT FROM AUTHOR]

Background: The standard face-to-face training for the integrated management of childhood illness (IMCI) continues to be plagued by concerns of low coverage of trainees, the prolonged absence of trainees from the health facility to attend training and the high cost of training. Consequently, the distance learning IMCI training model is increasingly being promoted to address some of these challenges in resource-limited settings. This paper examines participants' accounts of the paper-based IMCI distance learning training programme in three district councils in Mbeya region, Tanzania. Methods: A cross-sectional qualitative descriptive design was employed as part of an endline evaluation study of the management of possible serious bacterial infection in Busokelo, Kyela and Mbarali district councils of Mbeya Region in Tanzania. Key informant interviews were conducted with purposefully selected policymakers, partners, programme managers and healthcare workers, including beneficiaries and training facilitators. Results: About 60 key informant interviews were conducted, of which 53% of participants were healthcare workers, including nurses, clinicians and pharmacists, and 22% were healthcare administrators, including district medical officers, reproductive and child health coordinators and programme officers. The findings indicate that the distance learning IMCI training model (DIMCI) was designed to address concerns about the standard IMCI model by enhancing efficiency, increasing outputs and reducing training costs. DIMCI included a mix of brief face-to-face orientation sessions, several weeks of self-directed learning, group discussions and brief face-to-face review sessions with facilitators. The DIMCI course covered topics related to management of sick newborns, referral decisions and reporting with nurses and clinicians as the main beneficiaries of the training. The problems with DIMCI included technological challenges related to limited access to proper learning technology (e.g., computers) and unfriendly learning materials. Personal challenges included work-study-family demands, and design and coordination challenges, including low financial incentives, which contributed to participants defaulting, and limited mentorship and follow-up due to limited funding and transport. Conclusion: DIMCI was implemented successfully in rural Tanzania. It facilitated the training of many healthcare workers at low cost and resulted in improved knowledge, competence and confidence among healthcare workers in managing sick newborns. However, technological, personal, and design and coordination challenges continue to face learners in rural areas; these will need to be addressed to maximize the success of DIMCI. [ABSTRACT FROM AUTHOR]

Purpose: Microcredits will remain crucial to rural households over a long period as they provide small loans to the needy, making it an essential aspect of rural finance. Due to the rural credit market's structure and financial inclusion problem, rural households often have trouble accessing microcredit. This paper analyzes the influence of financial literacy (FL) on microcredit accessibility in rural households in Tanzania. Methodology: Using a large dataset of Finscope households survey in Tanzania, a binary logit estimation technique was utilized to determine the influence of financial literacy on credit accessing decisions of rural households. In addition, a descriptive analysis was done from the selected sample. Findings: Generally, the analysis showed that financial literacy had a negative and significant effect on the micro-credit accessibility decision of rural households in Tanzania. Education level has a significant positive influence on micro-credit attaining decisions. Practical implication: The outcome of this research is helpful to policymakers and micro-credit institutions as they provide an insight into the influence of financial literacy on microcredit accessibility. The study recommends financial literacy programmes be established in rural areas to enlighten the citizens about the benefit and proper uses of borrowed money. Originality/Value: This paper used actual surveyed data from Tanzanians in all regions. The results are robust to different categories of households and control variables that can also affect micro-credit accessibility decisions. [ABSTRACT FROM AUTHOR]

Globally, there have been calls for an integrated zoonotic disease surveillance system. This study aimed to assess human and animal health surveillance systems to identify opportunities for One Health surveillance platform in Tanzania. A desk review of policies, acts and strategies addressing disease surveillance that support inter-sectoral collaboration was conducted. A semi-structured questionnaire was administered to key informants from the two sectors. Databases with potential relevance for surveillance were assessed. One Health-focused policies, acts, strategic plans and guidelines emphasising inter-sectoral collaboration strengthening were in place. Stable systems for collecting surveillance data with trained staff to implement surveillance activities at all levels in both sectors were available. While the human surveillance system was a mix of paper-based and web-based, the animal health system was mainly paper-based. The laboratory information system existed in both sectors, though not integrated with the epidemiological surveillance systems. Both the animal and human surveillance systems had low sensitivity to alert outbreaks. The findings indicate that individual, organisational, and infrastructure opportunities that support the integration of surveillance systems from multiple sectors exist. Challenges related to data sharing and quality need to be addressed for the effective implementation of the platform. [ABSTRACT FROM AUTHOR]

Background: Healthcare outcomes in child, adolescent and maternal in Tanzania are poor, and mostly characterised by fragmentary service provision. In order to address this weakness, digital technologies are sought to be integrated in the milieu of health as they present vast opportunities especially in the ability to improve health information management and coordination. Prior to the design and implementation of the Afya-Tek digital intervention, formative research was carried out to ensure that the solution meets the needs of the users. The formative research aimed to examine: the burden of disease and related health seeking behaviour; workflow procedures and challenges experiencing healthcare actors; adolescent health and health seeking behaviour; and lastly examine technological literacy and perceptions on the use of digital technologies in healthcare delivery. This paper therefore, presents findings from the formative research.Methods: The study employed exploratory design grounded in a qualitative approach. In-depth interview, focus group discussion, participant observation and documentary review methods were used for collecting data at different levels. The analysis was done thematically, whereby meaning was deduced behind the words which the participants used.Results: Findings suggest that the perceived burden of diseases and health seeking behaviour differ across age and social group. Multiple work-related challenges, such as lack of proper mechanism to track referrals and patient's information were noted across healthcare actors. There was a keen interest in the use of technologies shown by all study participants to improve care coordination and health outcomes among health system actors. Participants shared their views on how they envision the digital system working.Conclusion: The formative research provided insightful background information with regard to the study objectives. The findings are used for informing the subsequent phases of the co-development and implementation of the Afya-Tek digital health intervention; with a view to making it relevant to the needs of those who will use it in the future. As such, the findings have to a large extent met the purpose of the current study by envisaging the best ways to design digital intervention tailored to meet the needs of those who will be using it. [ABSTRACT FROM AUTHOR]

Background: Achieving equity in healthcare services has been a global priority. According to the literature, a slew of initiatives aimed at increasing household equity in healthcare financing have exacerbated the problem, making it hard for most developing countries to understand the real cause of the problem. Method: The non-experimental research design has been used to explore the Tanzania Panel Survey (NPS) data 2019/2020, to investigate equity differential in household healthcare financing in Tanzania by the use of conventional instrumental variable methods of Two-stage and Three-stage least square methods Results: Despite the global agenda of universal health coverage, this paper reveals that 86 percent of Tanzania lacks health insurance with a high degree of inequitable distribution of health facilities as 71.54 percent of the population is in rural areas, yet these areas have poor health systems compared to urban ones. These disparities increase pressure on household healthcare financing and widen the inequity and equality gaps simultaneously. Additionally, a household's income, education, health care waivers, out-of-pocket expenditure, and user fees have been found to have a significant impact on household equity in healthcare financing. Conclusion: To reverse the situation and increase equity in household healthcare financing in most developing countries, this paper suggests that an adequate pooling system should be used to allow more people to be covered by medical prepayment programs, and the donor-funded programs in developing countries should focus on health sector infrastructure development and not the capacity building. [ABSTRACT FROM AUTHOR]

The potential of the environmental impact assessment (EIA) process to respond to climate change impacts of development projects can only be realized with the support of policies, regulations, and actors' engagement. While considering climate change in EIA has become partly mandatory through the EU revised Directive in Europe, African countries are still lagging. This paper assesses Tanzanian policies, laws, regulations, and EIA reports to uncover consideration of climate change impacts, adaptation, and mitigation measures, drawing from the transformational role of EIA. The methodology integrates content analysis, interpretive policy analysis, and discourse analysis. The analyses draw from environmental policy, three regulatory documents and three EIA reports in Tanzania using a multi-cases study design. The aim was to understand how considering Climate Change issues in EIA has played out in practice. Results reveal less consideration of climate change issues in EIA. The policy, laws, and regulations do not guide when and how the EIA process should consider climate change-related impacts mitigation and adaptation. The practice of EIA in the country is utterly procedural in line with regulations provisions. Consequently, environmental impact statements only profile the climatology of the study area without conducting a deeper analysis of the historical and future climate to enhance the resilience of proposed projects. The weakness exposed in the laws and regulations contributes to the challenges of responding to the impacts of climate change through the EIA process. It is possible to address climate change issues throughout the project life cycle, including design, approval, implementation, monitoring, and auditing, provided the policy and regulations guide how and when the EIA process should consider climate change issues. Additionally, increasing stakeholders' awareness and participation can enhance the EIA process's potential to respond to the impacts of climate change. [ABSTRACT FROM AUTHOR]

This paper reflects on the ethics of research and knowledge co-production aimed at addressing urban inequality. It draws on work within the Knowledge in Action for Urban Equality (KNOW) programme, which aimed to co-produce knowledge to activate transformation. We employ a lens of feminist care ethics to examine ethical challenges in research partnerships, which derive from interrelated layers of power asymmetry and inequality. We focus on ethical dilemmas that emerged during the planning stage of research work led by the NGO Centre for Community Initiatives (CCI), Tanzania, in collaboration with University College London's Institute of Global Prosperity (IGP). We argue that contextualizing the value of knowledge co-production in generating transformation in the long term reveals a necessity for simultaneously addressing the immediate needs of intersectionally marginalized research participants. We suggest that ethical awareness of both long- and short-term modes of "caring for" could better support initiatives for addressing urban inequalities in context. [ABSTRACT FROM AUTHOR]

The existing literature on urban governance regards street vendors as passive victims of evictions and re-allocations threats, focusing largely on their inability to cope. Using the case study of the urban street vendors in Dar es Salaam, Tanzania, this paper suggests that urban street vendors are not just passive victims of evictions and re-allocations but also utilize various capabilities to cope with this threat. The paper examines evictions and re-allocations threat among urban street vendors in Dar es Salaam Tanzania, to determine the vendors' capability to cope with the threat and recommend factors for supporting the vendors to cope more competently. Based on the multilayered social resilience framework, a qualitative approach was utilized and drew data on a sample of 50 respondents through in-depth interviews, focus group discussions (FGDs), observations, and a review of secondary data. Findings indicated that on the one hand, the vendors managed to develop reactive and less proactive capacities of coping with the evictions and re-allocations threat mainly based on the individual, household, community level, and to a lesser degree, national and international levels. On the other hand, vendors' coping capacities were impeded by their lack of financial ability, less supportive government structures and politics, lack of union among the vendors, and business skills. These factors should be considered in supporting the vendors to more competently cope with the threat. These findings provide insights on alternative ways of understanding and alleviating the negative consequences of evictions and re-allocations of the urban street vendors in Dar es Salaam and other cities in Tanzania. [ABSTRACT FROM AUTHOR]

Purpose: This paper examines the accountability and governance mechanisms and the challenges in a multi-stakeholder partnership seeking to implement the Sustainable Development Goals (SDGs) in a developing country (DC), namely Tanzania. Design/methodology/approach: The paper draws on work on the shift from government to governance to meta-governance to examine the SDGs framework's governance regime. The data stems from documentation, focussed group discussions and face-to-face interviews with key stakeholders involved in the localisation of SDGs in Tanzania. Findings: Despite the emphasis given by promoters of SDGs on the need for multi-stakeholder engagement, and network and market-based governance, Tanzania's hierarchical governance framed in national legislations dominated the localisation of the SDGs. The national-level meta-governance structures were somewhat dysfunctional, partly due to a lack of well-designed coordination mechanisms for collaborative engagement with key stakeholders. The limited involvement of different meta-governors, and particularly network and market-based governance arrangements, has had severe implications for achieving the SDGs in DCs in general and Tanzania, in particular. Practical implications: The paper calls for a more explicit SDG policy and strategy, alongside strengthening institutional structures and related governance arrangements in Tanzania, to promote the realisation of the SDGs. For the SDGs framework to succeed, the authors suggest that, in addition to adopting SDG friendly policies, the Tanzanian government should devise plans for financial resources, strategies for empowering and engaging with key stakeholders and promote an integrative governance system that underpins accountability at the local level. Originality/value: Focussing on Tanzania, the paper sheds light on how context in DCs, interactions between state and non-state actors, modes of governance and accountability mechanisms shape the localisation of SDGs and realising the SDGs' agenda. The implementation in Tanzania focussed on priorities in the development plan, thereby neglecting some important SDGs. This raises doubts about the possibility of meeting the SDGs by 2030. The localisation of SDGs remained within the top-down governance structure, as Tanzania's government failed to enact the policy and strategy for multi-stakeholder partnership consistent with the SDGs' principle of "leave no-one behind". Consequently, meta-governors' efforts and ability to monitor and demand accountability from the government was constrained by the political context, the governance system and regulations enacted to side-line them. [ABSTRACT FROM AUTHOR]

This paper examines factors affecting operating efficiency of 36 commercial banks in Tanzania for the period between 2000 and 2017. The paper employs robust random-effect regression model to estimate the relationship between bank operating efficiency and its determinants. The results show that bank liquidity and capital adequacy have a positive relationship with bank operating efficiency. This suggests that capital adequacy and liquidity, not only strengthen financial stability by providing a larger capital cushion and bank required liquidity level, but also improve bank operating efficiency by lowering moral hazard between shareholders and debt-holders. Furthermore, the study shows that bank profitability and operating efficiency are directly related—implying that banks should put emphasis on improving their earning generating power to increase their operational efficiency. This paper suggests banks to increase their profitability by investing more on financial innovations and branch networks, and expand their market shares to boost their operational efficiency. Further, the paper argues that banks should optimally use their asset capacity to enhance their earnings profiles. At the same time, banks should avoid reckless lending that would increase the level of unsecured credits in banks' portfolio. Finally, the results encourage banks in Tanzania to monitor and evaluate these factors for improvement to enable the sustainability of banks and industry for economic growth. [ABSTRACT FROM AUTHOR]

This paper studies whether an increase in women's intrahousehold bargaining power causes couples to allocate more resources to their child's education, and, if so, what the underlying mechanisms for this might be. We conduct a between‐subject lab experiment with couples and vary the relative bargaining power between spouses. The paper provides two main insights. First, increasing the wife's bargaining power improves gender equality in allocation to children's education. However, it does not increase the amount invested in the child's education. Second, we show that the difference in time preferences between spouses matters for how much the household invests in the child's education. It benefits the child that the most patient spouse has more relative bargaining power. This implies that increasing the wife's bargaining power may reduce the allocation to the child's education if she is the less patient spouse. The results provide new insights into the current debate on female empowerment, and highlight the importance of incorporating a broader set of preferences in the analysis of intrahousehold decision‐making. [ABSTRACT FROM AUTHOR]

Background: Real-time polymerase chain reaction (PCR) is a sensitive and specific method for diagnosing schistosomiasis. However, this method should be performed in a laboratory, usually located distant from the sample collection site. Therefore, it is important to have fast sampling preservation methods, which allow simple transport prior to DNA extraction and amplification. The aim of this study was to verify if blood samples applied to filter paper are suitable for analysis of Schistosoma mansoni DNA by real-time PCR. Methods: A cross-sectional study was conducted among 100 study participants aged 17 to 70 years in a fishing village on the southern shore of Lake Victoria, Tanzania. Serum samples and ethylenediaminetetraacetic acid (EDTA)-anticoagulated whole blood for preparation of dried blood spots (DBS) were collected to test for Schistosoma mansoni infection by real-time PCR. A combined diagnostic reference of positive results of serum-based real-time PCR and the Kato-Katz (KK) method was used for analysis. Sensitivity and negative predictive value (NPV) were calculated. The Wilcoxon signed-rank test was chosen to compare the mean cycle threshold (Ct) values from serum and DBS. Results: According to the reference, 92.5% S. mansoni positive samples were determined. The serum-based real-time PCR performed excellently with 95.4% sensitivity, whereas the DBS-based real-time PCR showed a low sensitivity (45.4%). The Ct-values were significantly higher in DBS (median: 37.3) than in serum samples (median: 27.5, P < 0.001), reflecting a lower parasite-specific DNA load on the filter cards. With increasing egg counts, an increase in sensitivity was observed for all methods. The POC-CCA test and the serum-based real-time PCR showed a sensitivity of 100% for medium and severe infections. The DBS real-time PCR showed a sensitivity of only 85.7% even for severe infections. Conclusions: DBS-based real-time PCR did not provide good results in our study and therefore should not be recommended or must be tested concerning temperature of storage, storage duration, use of different filter papers and extraction methods before it is used in future studies. In contrast, our results showed that the POC-CCA test is a sensitive and precise test for detecting S. mansoni infections. [ABSTRACT FROM AUTHOR]

Harmful algal blooms (HABs) pose a significant threat to aquatic ecosystems and human health due to the production of toxins. The identification and quantification of these toxins are crucial for water quality management decisions. This study used DNA analysis (PCR techniques) to identify toxin-producing strains and liquid-chromatography-tandem mass spectrometry (LC-MS/MS) to quantify microcystins in samples from Mindu and Nyumba ya Mungu Dams in Tanzania. The results showed that HABs were detected in both dams. The BLAST results revealed that the 16S gene sequences of uncultured samples were very similar to an Antarctic cyanobacterium, Leptolyngbya sp, Anabaena sp, and Microcystis aeruginosa. Sequences of the cultured samples were most similar to Nodularia spumigena, Amazoninema brasiliense, Anabaena sp, and Microcystis aeruginosa. Further analyses showed that the nucleotide sequence similarity of uncultured isolates from this study and those from the GenBank ranged from 85 to 100%. For cultured isolates from this study and others from the GenBank, nucleotide identity ranged from 81 to 100%. The molecular identification of Microcystis aeruginosa confirmed the presence of HABs in both Mindu and Nyumba ya Mungu Dams in Tanzania. At Mindu Dam, the mean concentrations (± standard deviation) of microcystin-LR, -RR, and -YR were 1.08 ± 0.749 ppm, 0.120 ± 0.0211 ppm, and 1.37 ± 0.862 ppm, respectively. Similarly, at Nyumba ya Mungu Dam, the concentrations of microcystin-LR, -RR, and -YR were 1.07 ± 0.499 ppm, 0.124 ± 0.0224 ppm, and 0.961 ± 0.408 ppm, respectively. This paper represents the first application of PCR and LC-MS/MS to study microcystins in small freshwater reservoirs in Tanzania. This study confirms the presence of toxin-producing strains of Microcystis aeruginosa in both dams and also provides evidence of the occurrence of microcystins from these strains. These findings contribute in improving the monitoring of HABs contamination and their potential impact on water quality in Tanzanian reservoirs. [ABSTRACT FROM AUTHOR]

Despite the increasing popularity of private secondary education in sub-Saharan Africa, little is known about the return. In this paper, I estimate a private school learning premium in Tanzania, using administrative exam records for 635,000 students. I compare secondary school students with their primary school classmates who achieved the same primary school exam scores and control for peer effects and unobserved ability. On average, private schools improve exam scores by 0.54 of a standard deviation in 2 years. A regression discontinuity design suggests that the effect is causal, and subject-specific estimates are all positive but higher for mathematics relative to Kiswahili and English. [ABSTRACT FROM AUTHOR]

Background: Because of critical shortage of physician anaesthesiologists, the government of Tanzania adopted a task shifting strategy for provision of anaesthesia services. This paper describes the results of an operational study designed to increase the number of anaesthesia providers for emergency obstetric surgeries in order to reduce maternal and perinatal mortality in underserved rural Tanzania. Methods: In 2016 a before-after cohort study was conducted in seven health centres in rural Tanzania. Five health centres received an intervention and two were selected to track secular trends (control group). Ten associate clinicians, i.e. assistant medical officers, clinical officers, and nurse midwives, from five health centres were trained in anaesthesia skills for emergency obstetric surgeries for three months followed by quarterly supportive supervision, mentoring and teleconsultation to reinforce skills. Primary and secondary outcome measures included Caesarean delivery (CD) rate, quality and safety of anaesthesia, and uptake of the educational program for anaesthesia. Results: Out of the 2,179 CDs performed in the intervention facilities from 2016 to 2019, two women died from complications of anaesthesia. The risk of death from anaesthetic complications was 0.9 per 1000 CD (95% CI 0.1–3.3. The risk of death was not established in the control group because of inadequate documentation and records keeping. The proportion of CD performed under spinal anaesthesia in intervention facilities doubled from 28% (60/214 with 95% CI 22–35) at baseline (July 2014 – June 2016) to 57% (558/971 with 95% CI of 54–61) in year three (July 2018 - June 2019), while in the control group increased by only 40% from 19% (92/475 with 95% CI of 16–23) at baseline and 27% (68/251 with 95% CI of 22–33) in year three. In 2020I, this educational training program was then adopted by the government with minor content changes and increasing duration of training to six months. Conclusions: This three month educational training program for associate clinicians in anaesthesia, complemented by supportive supervision, can increase the CD rate to one that fills the "unmet need" and the proportion of operations performed under spinal anaesthesia, the gold standard technique for CD. The program can be used to meet the urgent demand for anaesthesia services in other underserved areas in Africa. [ABSTRACT FROM AUTHOR]

Context and background: With the advent of rising global initiatives to address climate change and sustainability, interest in addressing theoretical and practical alignment of how professional valuers consider environmental attributes has become the focus of much attention. Yet the overlap between consideration and non-consideration of environmental factors might significantly impact the value. Goal and objectives: This paper evaluates the perceptions of professional valuers on the consideration of environmental features during their valuation. Methodology: Data to inform the study was collected through questionnaires distributed to 89 randomly selected valuers registered with the VRB. The collected data were analyzed by using SPSS, and Cronbach's alpha was used to determine the reliability of the questionnaire survey. The relative importance index was used to rank the importance of environmental factors, whereas the Chi-square test was used to examine existing practices in terms of prominent tools and methodologies used to incorporate environmental attributes into their valuation assignments. Results: The study reveals that, in Tanzania, there is a growing consciousness of the need to consider environmental attributes in practice though indicated that there is a challenge with how they consider these attributes using prominent valuation techniques in place. The study suggests that valuers and other stakeholders are eager to learn how to consider and integrate environmental features and contemporary valuation techniques to provide up-to-date estimates to support informed decision. The study recommends introducing Environmental, Social, and Governance (ESG) factors in terms of their theoretical foundation and practical implication on property valuation studies. [ABSTRACT FROM AUTHOR]

Background: Adolescent pregnancy remains a major global health issue, increasing the risk of complications during pregnancy and childbirth in mothers and babies. In Tanzania, adolescent pregnancy threatens girls' education and makes it difficult for them to obtain a proper job; hence, the majority fall into poverty. Previous studies have developed and conducted reproductive health education for adolescent students; however, they evaluated only the effect immediately after education. Therefore, this study investigated the effects of reproductive health education on attitudes and behaviors toward reproductive health among adolescent girls and boys one year after the intervention in rural Tanzania. Methods: A longitudinal quasi-experimental study was conducted with 3295 primary and secondary students (2123 in the intervention group, 1172 in the control group) from three purposefully selected wards in Korogwe District. In the intervention group, the students received reproductive health education. We used paper-based questionnaires to evaluate the effect of the adolescent education program on attitudes and behaviors toward reproductive health education. To analyze the association between the intervention and each outcome, mixed-effect multiple regression analyses was conducted. Results: The mean age, primary school proportion, and female proportion of the intervention and the control group was 13.05 (standard deviation (SD) 1.59), 14.14 (SD 1.7), 77.9% and 34.3%, and 54.2% and 52.6%, respectively. There was no statistically significant effect of reproductive health education on adolescent health attitudes and behaviors in the multiple regression analyses (coefficient: − 0.24 (95% confidence interval (CI): − 0.98 to 0.50), coefficient: 0.01 (95%CI: − 0.42 to 0.43)). Conclusion: A statistically significant effect of reproductive health education on adolescent health attitudes and behaviors was not found. An effective reproductive health education intervention to improve the attitude and behaviors of reproductive health among Tanzania adolescents in the long term remain to be determined, particularly in real-world settings. Trial registration The National Institute for Medical Research, Tanzania (NIMR/HQ/R.8a/Vol. IX988). Plain Language Summary: Adolescent pregnancy increases the risk of complications during pregnancy and childbirth, which could cause death among 15–19-year-old girls. In Tanzania, one in four adolescents aged 15–19 began childbearing. However, there is no officially recognized curriculum for reproductive health in schools. Additionally, cultural and traditional norms prevent parents from discussing sexuality with their children. A solution to this issue is for a third party, such as a non-profit organization, to provide adolescents with adequate reproductive health education in schools. Previous studies have developed and evaluated a reproductive health education program and found significant effects on improved knowledge and behavior among adolescent girls and boys immediately after the intervention. This study examined the effects of reproductive health education on adolescents' attitudes and behavior toward reproductive health one year after the intervention in rural Tanzania. We could not find a statistically significant effect of reproductive health education on adolescents' attitudes and behavior during a one-year period in the multiple regression analyses. These results could have been influenced by the location of the intervention, contents, period of evaluation, and other potentially unknown factors. [ABSTRACT FROM AUTHOR]

Background: Over 150 million people, mostly from low and middle-income countries (LMICs) suffer from catastrophic health expenditure (CHE) every year because of high out-of-pocket (OOP) payments. In Tanzania, OOP payments account for about a quarter of the total health expenditure. This paper compares healthcare utilization and the incidence of CHE among improved Community Health Fund (iCHF) members and non-members in central Tanzania. Methods: A survey was conducted in 722 households in Bahi and Chamwino districts in Dodoma region. CHE was defined as a household health expenditure exceeding 40% of total non-food expenditure (capacity to pay). Concentration index (CI) and logistic regression were used to assess the socioeconomic inequalities in the distribution of healthcare utilization and the association between CHE and iCHF enrollment status, respectively. Results: 50% of the members and 29% of the non-members utilized outpatient care in the previous month, while 19% (members) and 15% (non-members) utilized inpatient care in the previous twelve months. The degree of inequality for utilization of inpatient care was higher (insured, CI = 0.38; noninsured CI = 0.29) than for outpatient care (insured, CI = 0.09; noninsured CI = 0.16). Overall, 15% of the households experienced CHE, however, when disaggregated by enrollment status, the incidence of CHE was 13% and 15% among members and non-members, respectively. The odds of iCHF-members incurring CHE were 0.4 times less compared to non-members (OR = 0.41, 95%CI: 0.27–0.63). The key determinants of CHE were iCHF enrollment status, health status, socioeconomic status, chronic illness, and the utilization of inpatient and outpatient care. Conclusion: The utilization of healthcare services was higher while the incidence of CHE was lower among households enrolled in the iCHF insurance scheme relative to those not enrolled. More studies are needed to establish the reasons for the relatively high incidence of CHE among iCHF members and the low degree of healthcare utilization among households with low socioeconomic status. [ABSTRACT FROM AUTHOR]

Copyright of Africa Spectrum is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This scientific paper examines the role of Integrated Coastal Management (ICM) approach in the protection of coastal and marine resources in Tanzania. It engages coastal resource users and practitioners in focus group discussions and interviews, and complements the data obtained with documented sources. A modified version of the Benefit Analysis Framework is adopted from Wenger et al. (2011) to analyze the extent to which ICM yields a wide range of benefits that may potentially promote the protection of coastal ecosystem and enhance the commitment of communities that live adjacent to the coastal strip to manage mangroves, fisheries, coral reefs, and coastal land in a sustainable manner. [ABSTRACT FROM AUTHOR]

This paper reports on the design of a study to examine the policy landscape relevant to sugar-sweetened beverage taxation in seven sub-Saharan African countries. The study responds to the need for strong policy to address the rising burden of non-communicable diseases in the region. Sugar-sweetened beverage taxation has been widely recommended as a key component of a comprehensive policy approach to NCD prevention. However, it has proved a contentious policy intervention, with industry strongly opposing the introduction of such taxes. The aim was to identify opportunities to strengthen sugar-sweetened beverage taxation- related policy for the prevention of nutrition-related NCDs in a subset of Eastern and Southern African countries: Kenya, Tanzania, Botswana, Rwanda, Namibia, Zambia, Uganda. The study was conducted as a collaboration by researchers from nine institutions; including the seven study countries, South Africa, and Australia. The research protocol was collaboratively developed, drawing on theories of the policy process to examine the existing availability of evidence, policy context, and stakeholder interests and influence. This paper describes the development of a method for a policy landscape analysis to strengthen policies relevant to NCD prevention, and specifically sugar-sweetened beverage taxation. This takes the form of a prospective policy analysis, based on systematic documentary analysis supplemented by consultations with policy actors, that is feasible in low resource settings. Data were collected from policy documents, government and industry reports, survey documentation, webpages, and academic literature. Consultations were conducted to verify the completeness of the policy-relevant data collection. We analysed the frames and beliefs regarding the policy 'problems', the existing policy context and understandings of sugar-sweetened beverage taxation as a potential policy intervention, and the political context across relevant sectors, including industry interests and influence in the policy process. This study design will provide insights to inform public health action to support sugar- sweetened beverage taxation in the region. [ABSTRACT FROM AUTHOR]

This paper is primarily based on collections in Tanzania and Ghana in 1990-1991 and 1991-1994, respectively. In all, 46 species of Chimarra were collected, 31 of them new species. All these species are illustrated or re-illustrated and described in the paper. Additionally, five species from Africa from collections in Illinois and Minnesota, four of them new, are included. This provided the incentive to review the species of Chimarra from the African subregion and assign the majority of them to species groups and subgroups. In the process, several species were synonymized. In all 147 valid species are recognized, of which 51 are treated in this paper. Two major species groups are recognized for Africa, the marginata Group and the georgensis Group. The former is based on the type species for the genus; this is the first formal characterization of this group, as distinct from other species groups in the subgenus. Mainland African species in the marginata Group mostly fall into four large species-diverse subgroups, but a number of smaller subgroups are also recognized. Membership in these subgroups is specified for the majority of African species and characters defining the subgroups informally discussed. The georgensis Group includes a single Asian species and nine previously described African species. They are assigned to two subgroups, one newly recognized in this paper. Several additional species were considered unassigned to subgroup within the georgensis Group. The majority of the new species described in this paper belong to the georgensis Group. [ABSTRACT FROM AUTHOR]

Simple Summary: A key tool in the fight against mosquitoes, which transmit malaria, is the application of insecticidal indoor residual spray (IRS) to the internal walls of buildings where mosquitoes alight and rest to digest their blood-meals. When evaluating the effectiveness of IRS formulations for killing mosquitoes when applied to a wall, it is important that the insecticide is applied evenly at the target dose. Traditionally, IRS is applied using a hand-held pump, but this study showed that an automated track sprayer delivered the desired dose to wall surfaces more accurately and more evenly. This was first shown using a fluorescent tracer to measure spray deposit on the wall of a laboratory, and then by spraying different IRS formulations onto the walls of an experimental hut. Indoor residual spraying (IRS) has changed little since its introduction in the 1940s. Manual spraying is still prone to variation in insecticide dose. To improve the application of IRS in experimental hut trials, an automated track sprayer was developed, which regulates the speed of application and the distance of the nozzle from the wall, two key sources of variation. The automated track sprayer was compared to manual spraying, firstly using fluorescein solution in controlled indoor settings, and secondly in experimental huts in Tanzania using several IRS products. Manual spraying produced greater variation with both fluorescein and insecticide applications. Both manual and automated spray methods under-dosed the actual dose sprayed compared to the target dose. Overall, the track sprayer treats surfaces more consistently, offering a potential improvement over manual spraying for experimental hut evaluation of new IRS formulations. [ABSTRACT FROM AUTHOR]

Drugs have been used by many farmers for the treatment of most infectious diseases in chicken regardless of their residue effects to human health if proper management has not adhered. This paper focuses on finding out the common chicken diseases, their prevalence, drugs used for treatment, and their residue implication in the chicken products and by-products. A systematic literature-review was used to synthesis the information from soft and hard copy sources of information. In this paper, it was noted that different infectious diseases were affecting chicken in Tanzania and other countries including Newcastle (Prevalence 7-90% per flock), Infectious bursal disease (Prevalence 7-100% per flock), Fowl Cholera (Prevalence 1-60% per flock), and Fowl Typhoid (Prevalence 0-20% per flock). As a remedy, drugs such as Amprolium, oxytetracycline, and sulphanilamide were used for treatment which could prompt antibiotic residues in chicken products and by-products. The antibiotic residue was reported in meat, eggs, liver, and kidneys of the chicken which are considered edible to a human thus posing public health challenges. In this regard, there is a need to create awareness to the farmers on the proper use of the drugs. In this case, the understanding of the withdrawal period for the applied drugs can minimize the risk of drug residues in chicken products [ABSTRACT FROM AUTHOR]

This paper presents data from Vwanji, an under-documented Bantu language spoken by approximately 28,000 people in southwestern Tanzania. Bantu languages are well known for having multiple degrees of past time reference grammaticalized in their TAM systems, and Vwanji is a good example of such a language, but one with some interesting typological differences from certain general TAM trends in Bantu languages noted in Nurse (2008). Three past TAM forms, in particular, are the focus of the research: P1/Anterior sm-vb-ile, P2 sm-a-vb-a, and the Near Past Habitual sm-a-vb-aa. The analysis of data from a corpus of narrative and non-narrative texts (both written and oral) reveals that these three TAM forms have multiple discourse functions which do not necessarily follow in expected ways from their places in the TAM system as a whole. Comparing the Vwanji findings with those of neighbouring languages suggests some possible directions in which the verb forms in Vwanji may be changing functionally or being lost. The goal of this investigation is to increase understanding of a typologically interesting language which has not been well described and for which there is very little published data. The paper also shows the importance of taking natural discourse data into account when considering TAM functions in a language. Relying on elicited data alone may hide interesting complexities and variation. [ABSTRACT FROM AUTHOR]

This paper deals with a morphosyntactic phenomenon found in the under-described Bantu language Luguru, spoken in central Tanzania: the verbal marker tsa. This marker encodes shared knowledge or shared reference. The meanings conveyed by the marker stretch from 'at a specific time' or 'at that place' to 'as we know', or even 'for that reason'. In Mkude's grammatical description of Luguru from 1974, there is a mention of a marker (zaa) signalling what he calls "recollected reference", which restricts the event to one specific moment in the past; this marker is believed to have developed into today's tsa. [ABSTRACT FROM AUTHOR]

This study was carried out to investigate the risks of simultaneous exposure to pesticide residues and bacteria contaminants in locally produced fresh vegetables and vegetables in Tanzania. A total of 613 samples were analyzed for pesticide residues, out of which 250 were also analyzed for bacterial contamination. Overall, 47.5% had pesticide residues, 74.2% exceeded Maximum Residue Levels (MRLs). Organophosphorus (95.2%), organochlorines (24.0%), pyrethroids (17.3%), and carbamates (9.2%) residues dominated. MRL values were mostly exceeded in tomatoes, onions, watermelons, cucumbers, Chinese cabbage, and sweet paper. Tetramethrin (0.0329–1.3733 mg/kg), pirimiphos-methyl (0.0003–1.4093 mg/kg), permethrin (0.0009–2.4537 mg/kg), endosulfan (beta) (0.0008–2.3416 mg/kg), carbaryl (0.0215–1.5068 mg/kg), profenofos (0.0176–2.1377 mg/kg), chlorpyrifos (0.0004–1.2549 mg/kg) and dieldrin (0.0011–0.5271 mg/kg) exceeded MRLs. The prevalence of bacteria contamination was high (63.2%). Enterobacter (55.6%) Pseudomonas aeruginosa (32.4%), E. coli (28.2%), Citrobacter (26.8%), Klebsiella oxytoca (14.8%), and Salmonella (7.7%) were isolated. Furthermore, 46.4% tested positive for both pesticide residues and bacterial contaminants. Vegetables from farms (60.7%) contained more dual contaminants than market-based vegetables (41.8%). This may have resulted from excessive pesticide use and unhygienic handling of fresh fruits and vegetables at production level. Binary logistic regression showed that fresh fruits and vegetables with pesticide residues were 2.231 times more likely to have bacteria contaminants (OR: 2.231; 95% CI: 0.501, 8.802). The contamination levels of pesticide residues and bacterial contaminants could be perceived as a serious problem as most fresh fruits and vegetables recorded values of pesticide residues far above the MRLs with pathogenic bacteria isolated in higher proportions. MRLs was higher in most vegetables consumed raw or semi-cooked such as watermelons, carrots, cucumber, tomatoes, onion and sweet paper. There is an urgent need to develop pesticide monitoring and surveillance systems at farmer level, educating farmers and promoting the use of greener pesticides to mitigate the health effects of pesticides and bacterial contaminants. [ABSTRACT FROM AUTHOR]

Between half and three-quarters of new housing development in African cities has been taking place on land acquired through informal channels. This paper offers insights from a study of self-builders' investments in informal land and housing in Dar es Salaam and Mwanza, two of the largest and fastest-growing cities in Tanzania. The findings demonstrate that self-builders' investments in informal land and self-built housing are inextricably linked with household wealth accumulation processes and long-term security. In light of the research findings, the paper offers reflections on the potential impacts of ongoing land formalization processes. The paper argues that the informal housing system has far more advantages than appreciated by proponents of formalization, that the vision of bringing "dead capital" to life is misleading, and that the anticipated emergence of active formal markets for land and housing may not serve the needs or interests of low- and middle-income households. [ABSTRACT FROM AUTHOR]

This paper aims at understanding the implication of pension debt on fiscal policy in Tanzania. The paper employed a modified projected benefit obligation (PBO) approach for a period between 2010 and 2018. The results of the paper indicate a mismatch between benefit payments and members' contributions, in that outflows are found to exceed inflows for a large part of the examined period, which tends to imply that pensions adequacy is questionable, and that the system cannot be sustained for a longer period if no rescue is put in place immediately. Further, drawing from the computed life expectancy of pensioners, it is indicative that the size of the retirement age cohort will continue to enlarge over time; which would result in increasing pension obligations. Since increased pension expenditure would not be fully covered from the existing pension assets, the Government as a guarantor would be required to cover the matured pension obligations through its annual fiscal budget. Unfortunately, looking at the current National Debt sustainability report pension debt is not part of the proposed national debt. Following these findings, and since neither increasing the contribution rate nor the retirement age may not be sustainable options, the reduction of accrual rate is the most suitable option the government is recommended to implement so as to rescue the current situation. However, in a long run, the paper recommends the government to undertake a systemic pension reform, which would change the entire pension system from a defined benefits scheme to a defined contributions scheme. [ABSTRACT FROM AUTHOR]

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Over the last two decades, scholars and organizations across the world have carried out research projects and promoted dissemination tools aimed at promoting food and food-related elements embedded in local and traditional foodways. In this regard, the documentation of food and biocultural heritage has been seen as the starting point of processes directed toward their safeguarding and promotion. Drawing from this premise, the paper presents an original methodological approach, designed within the framework of the Ark of Taste project, to map, inventory, and document food and food-related resources to produce a comprehensive dissemination tool for the promotion of local food and biocultural heritage. To this end, the paper discusses the case study of the Atlas of the Ark of Taste in Tanzania, looking at the approach used, and the challenges faced, in undertaking field and desk activities aimed at inventorying Tanzanian food products and in the creating of the gastronomic atlas of this country. Drawing from this experience, the paper highlights the potentially crucial role that food and gastronomic inventories may have in achieving UN Sustainable Development Goals from a grassroots perspective. Acknowledging the limitations and possible unintended effects of these initiatives on the protection of food and biocultural resources, the authors recognize the promising role that these tools could have in fostering the achievement of environmental (SDGs 13, 14, 15) and social sustainability (SDGs 1, 2, 3, 10) objectives. [ABSTRACT FROM AUTHOR]

Family and cultural contexts can constrain the effectiveness of evidence-based interventions designed to improve the health and wellbeing of women and their children. Unequal power relationships within the household may underlie the failure of many programs targeting women to achieve their intended impact. To reduce these unequal power dynamics within the households, many programs or interventions aim to both assess and improve the gender dynamics between husbands and wives within the household. Decision-making is one important facet of these dynamics and has been linked to health outcomes for women and children. However, household decision-making is rarely observed and often difficult to capture. This study aimed to use qualitative research to further understand one aspect of decision-making, namely on how to spend money. In two regions of Tanzania, we used surveys and interviews to explore different perspectives on spending and allocation of resources among 58 couples in rural farming households. While many men and women initially reported that they made decisions jointly, most women stated they would often concede if there was a disagreement or argument around spending. These results highlight the different perceptions of joint decision-making between men and women. We compared these results to survey responses on decision-making and found differences within and between couples across interview and survey responses. Based on the differences in qualitative and survey responses within couples and how they reported dealing with disagreement, our study found households were on a spectrum from no cooperation in decision-making to full cooperation. Our results highlight challenges for assessing decision-making on spending and ultimately improving these decision-making dynamics within the household. These challenges are especially important for maternal and child behavioral change and provide insights on why many interventions aimed at improving women's decision- making power on money may not reach their full potential. [ABSTRACT FROM AUTHOR]

Background: Same-sex attracted men in Tanzania and globally carry a disproportionate burden of HIV. Drawing on qualitative research, this article explores healthcare providers' ideas and recommendations regarding how to improve HIV prevention among same-sex attracted men. Methods: We carried out a qualitative study among healthcare workers in the cities of Dar es Salaam and Tanga in Tanzania between August 2018 and October 2019. Data were collected using qualitative methods of data collection, specifically in-depth interviews, focus group discussions, and participant observation. Study participants were recruited through a purposive sampling strategy that aimed to ensure variation in age, education, and work experience. Forty-eight interviews with 24 healthcare workers, six focus group discussions, and participant observation were conducted. A total of 64 persons participated in the study. Results: This paper describes five different "ways of reasoning" that were identified among healthcare workers regarding how to strengthen HIV prevention among same-sex attracted men. One held that punitive measures should be taken to prevent HIV transmission, another that health services needed to become more friendly towards men who have sex with men, a third that healthcare workers should reach out to provide more education to this population, a fourth called for strengthened collaboration between healthcare providers and same-sex attracted men in healthcare delivery, and the fifth proposed that activistic efforts be taken to remove structural barriers for same-sex attracted men to access healthcare. Conclusion: When reflecting on what is needed to strengthen HIV prevention among men who have sex with men, healthcare workers described six different ideas. One was that restrictive and punitive measures ought to be taken to prevent HIV transmission through same-sex sex. The remaining five promoted understanding of and support for same-sex attracted men. They prescribed more healthcare education, measures to improve attitudes among healthcare workers, healthcare delivery with user involvement, and political action to achieve law reform. Finally, some study participants raised concerns about the implementation of the national comprehensive package for key populations. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Rare cancer originating from parathyroid parenchymal cells. Preoperative diagnosis is often difficult. Presents with normal serum levels of calcium and parathyroid hormone. Treated by en bloc resection. Benefits of adjuvant therapy are unclear. Parathyroid carcinoma is an uncommon endocrine tumor. Its typical presentation is that of primary hyperparathyroidism with elevated serum calcium and parathormone levels. Nonfunctioning carcinoma of the parathyroid gland with normal serum calcium levels is extremely rare. This paper describes a case of nonfunctioning parathyroid carcinoma and brief literature review thereof. [ABSTRACT FROM AUTHOR]

Fiscal and local content policies aimed at promoting linkages between mining and other economic sectors have been informed by theories built on historical observations dating back to the 1950s. This paper contends that there is a need to rethink theories about mining-based economic linkages and the prospects for structural change based on an improved understanding of existing and potential inter-sectoral linkages. Using the input–output tables for Tanzania and Botswana, we apply the Partial Hypothetical Extraction Method within the Leontief and Gosh input–output frameworks to examine the linkages between the mining and quarrying sector and other economic sectors within these two economies. We find that, for Botswana, possible linkage pathways lie in scaling-up coal, soda ash and salt mining and investing in glass, polymer, and chemicals manufacturing. For Tanzania, opportunities for linkage pathways lie with the mining and manufacturing of non-metallic and construction materials as well as metallic minerals and natural gas. For both countries, the prospects for transforming their economies away from a heavy reliance on mineral extraction hinges on leveraging extractives for infrastructure, innovative technology, and technical skills, as well as capturing business opportunities, knowledge, and financial returns to invest in more diversified economic activities. [ABSTRACT FROM AUTHOR]

Purpose of the article: This study was set to determine the influence of institutional framework on service quality in both private and public hospitals. The paper sought to establish the perception of respondents regarding the institutional factors that explain the existence of variations in service quality between public and private hospitals. The institutional framework aspects that were considered in comparing health service quality in public and private hospitals were: institutional culture, control, stability and structure. A descriptive survey design was used because the study sought to know the perception of respondents regarding the factors that influence quality of service in hospitals.Research methods: A multistage sampling method was used to select three public hospitals and three private hospitals from the health service sector. The three public hospitals were Muhimbili referral hospital in Dar es Salaam City, Dodoma regional referral hospital and Geita referral hospital in Geita municipality. Private hospitals included in the study were Bugando referral hospital in Mwanza City, St Francis referral hospital in Ifakara town in Morogoro region and Nkinga referral hospital in Tabora region. Medical doctors, nurses and patients were selected using a systematic random sampling method and patients were selected using a convenience sampling method. The total population for the study comprised 10,650 people (i.e. 2,610 doctors and nurses and 8,040 patients) and the selected sample size, which was determined using McCall’s Table was 400 people. Both primary and secondary data collection sources were used. Analysis of the quantitative data was done using the Statistical Package for Social Sciences (SPSS) and qualitative data were transcribed verbatim, coded and analysed manually. All ethical considerations were observed. Main findings: The findings revealed that private hospitals were better in cleanliness compared to public hospitals and physical arrangement was user friendly in private hospitals compared to public hospitals. There was also more control in private hospitals compared to public hospitals in management of resources and this demonstrates an application of strong institutional framework in private hospitals compared to public hospitals in terms of control, structure and culture. Likewise, there was a more friendly atmosphere in private hospitals compared to public hospitals. However, there was more stability in public hospitals compared to private hospitals in terms of financial stability, affordability of service and medical supplies. It is concluded that quality of service provided in private hospitals is higher compared to quality of service in public hospitals. The possible explanation for the causes for differences in levels of service quality could be the existence of strong institutional framework in private hospitals. It is recommended that for higher service quality, organizations should practice the institutional framework aspects in terms of culture, control, stability and structure. [ABSTRACT FROM AUTHOR]

Background : A key factor driving the development and maintenance of antibacterial resistance (ABR) is individuals' use of antibiotics (ABs) to treat illness. To better understand motivations and context for antibiotic use we use the concept of a patient treatment-seeking pathway: a treatment journey encompassing where patients go when they are unwell, what motivates their choices, and how they obtain antibiotics. This paper investigates patterns and determinants of patient treatment-seeking pathways, and how they intersect with AB use in East Africa, a region where ABR-attributable deaths are exceptionally high. Methods: The Holistic Approach to Unravelling Antibacterial Resistance (HATUA) Consortium collected quantitative data from 6,827 adult outpatients presenting with urinary tract infection (UTI) symptoms in Kenya, Tanzania, and Uganda between February 2019- September 2020, and conducted qualitative in-depth patient interviews with a subset (n = 116). We described patterns of treatment-seeking visually using Sankey plots and explored explanations and motivations using mixed-methods. Using Bayesian hierarchical regression modelling, we investigated the associations between socio-demographic, economic, healthcare, and attitudinal factors and three factors related to ABR: self-treatment as a first step, having a multi-step treatment pathway, and consuming ABs. Results: Although most patients (86%) sought help from medical facilities in the first instance, many (56%) described multi-step, repetitive treatment-seeking pathways, which further increased the likelihood of consuming ABs. Higher socio-economic status patients were more likely to consume ABs and have multi-step pathways. Reasons for choosing providers (e.g., cost, location, time) were conditioned by wider structural factors such as hybrid healthcare systems and AB availability. Conclusion: There is likely to be a reinforcing cycle between complex, repetitive treatment pathways, AB consumption and ABR. A focus on individual antibiotic use as the key intervention point in this cycle ignores the contextual challenges patients face when treatment seeking, which include inadequate access to diagnostics, perceived inefficient public healthcare and ease of purchasing antibiotics without prescription. Pluralistic healthcare landscapes may promote more complex treatment seeking and therefore inappropriate AB use. We recommend further attention to healthcare system factors, focussing on medical facilities (e.g., accessible diagnostics, patient-doctor interactions, information flows), and community AB access points (e.g., drug sellers). [ABSTRACT FROM AUTHOR]