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Teachers and pupils co-construct classroom reality, but existing studies examining learner-centred pedagogy (LCP) in the Global South have primarily focused on teachers. Pupils' experiences with LCP and its contribution to their learning have attracted little scholarly attention. This article seeks to address this gap to some extent by exploring not only teaching and learning practices observed in classrooms but also pupils' narratives about their experiences in Tanzania. This research utilised focus group discussions with pupils and classroom observations to understand pupils' perspectives on classroom experiences. Pupils spoke of discussions, group work and pupil-initiated Q&A as their favourite classroom activities; however, classroom observations revealed virtual absence of LCP-related practices. Analysis of pupil–teacher interactions and relationships with teachers indicates pupils' fear of teachers and their view of the latter as a respected source of knowledge. The paper underscores pupils' perspectives as a step to make LCP policies truly centre on learners. [ABSTRACT FROM AUTHOR]

Demand for land planning and surveying services has increased significantly over the years in Tanzania and as a result, the public sector has not been able to cope. Private firms have therefore emerged to provide land use planning and surveying services for landholders in peri-urban areas, most of whom have accessed land through the informal sector. This paper explores the experiences of private firms in delivering land use planning and surveying services in peri-urban areas of Dar es Salaam City. Using a case study approach involving in-depth interviews, focus group discussions and document analysis, the study reveals that private firms face legal, policy and technical obstacles in land service delivery. Despite these challenges, private firms have been instrumental in facilitating the regularisation of informally accessed land. Supportive policies and other institutional reforms are deemed necessary to improve the delivery of land services and strengthen the participation of private firms. [ABSTRACT FROM AUTHOR]

This paper explores adolescent girls' and young women's (AGYW) aspirations, factors that influence aspirations, and how their aspirations inform their sexual decision-making and behaviour. This study employed a qualitative design involving six participatory focus group discussions and 17 in-depth interviews with AGYW in – and out-of-school. Fieldwork was undertaken in rural and urban Tanzania. Thematic analysis was conducted using NVIVO software. Aspirations of AGYW's were categorised as short and long-term. Short-term aspirations were associated with the social status derived from obtaining trendy items such as nice clothing, or smart phones. Long-term aspirations included completing secondary education, having a professional job, being respected, getting married and having children. Aspirations were influenced by aspects of the social context, such as peers and structural factors that dictated what was acceptable for respectable AGYW. AGYW lacked the independent capabilities to meet long-term aspirations such as completing education. In pursuit of their short – and long-term aspirations, AGYW engaged in higher risk sexual behaviours such as transactional sex, age-disparate sex and condomless sex. AGYW's aspirations were important in determining their sexual decision making. Interventions should capitalise on AGYW's aspirations when addressing their SRH risks by finding innovative ways of engaging them based on their circumstances and aspirations. [ABSTRACT FROM AUTHOR]

Young men in coastal Tanzania are often blamed for damaging marine habitats by engaging in unsustainable and destructive fishing practices, including dynamite fishing, but their perceptions have not been sufficiently documented. While marine scientists, international environmental NGOs, and activists have called attention to the destructive fishing practices' devastating impacts, insights into the contextual factors that motivate those who engage in dynamite fishing are limited. Additionally, risk perceptions and concerns regarding the environmental impact and dangers of dynamite fishing among the youth are also understudied. This paper provides ethnographic insights into the historical and contextual factors underlying dynamite fishing in rural coastal Mtwara. It draws on ethnographic data gathered through participant observation, focus group discussions and in-depth interviews with residents from two neighboring coastal villages – one located inside a marine protected area (MPA), and another located outside the MPA's boundary. The paper first examines the views of elderly men and women to provide the historical context of dynamite fishing in coastal Mtwara. It then juxtaposes youth perceptions regarding marine conservation and dynamite fishing in the two villages, vis-à-vis ongoing efforts to curb destructive fishing practices and to enhance marine biodiversity and ecotourism in the region. Results of the study reveal that unresolved tensions between the MPA authorities and local fishers surrounding enforcement practices and unfulfilled gear-exchange-related promises, and allegations of poor governance, are important contextual factors in the persistence of dynamite fishing. The paper concludes by articulating possible remedial measures to mitigate the tensions between youth concerns about their livelihoods, and the goals of marine biodiversity conservation as a way forward in preventing dynamite fishing. [ABSTRACT FROM AUTHOR]

This study evaluated a mobile training pilot prototype designed for micro business owners in Tanzania. The paper focused on the extent to which features of the pilot prototype developed under frugal innovation confirmed the defined user requirements of the mobile training and met usability perception of the potential end users in solving the practical problem. The practical problems addressed are time, low education level and geographical challenges facing the training service. The evaluation assessed whether the features of the mobile training pilot prototype met the previously identified user requirements and investigated users' perceptions of the pilot prototype's attractiveness and perspicuity and their enthusiasm for it. In this mixed-methods study, data were drawn from a questionnaire and focus group discussions. The study found positive views on the features of the pilot prototype based on the defined user requirements, as well as the usability elements of attractiveness, perspicuity, and enthusiasm. The participants thought that the pilot prototype's navigation and interaction features needed further modifications to make use of the mobile training application easier. This study contributed that, the artefact developed through frugality innovation within DSR framework confirmed earlier identified user requirements and met usability criteria of attractiveness, perspicuity, and enthusiasm. [ABSTRACT FROM AUTHOR]

This paper explores assets for health and well-being for women in extremely poor rural areas in Ghana, Haiti, India, the Philippines, and Tanzania. Data were collected through individual interviews and focus group interviews with local women. The paper asks (i) which assets women draw on for well-being in resource-poor settings, and (ii) whether an assets approach, as understood in the Salutogenic Model, is appropriate and meaningful in the most deprived areas. Low levels of natural, material and infrastructural resources were reported by the respondents to cause stress, and assets of a human, social and cultural character were identified as being important in coping with this stress. By mobilizing the capacity and assets of people and places, local development initiatives will make sense logically (comprehensibility), they will be perceived to be practically realistic (manageability), and they will be motivating because they are meaningful, based on involvement in decision-making (meaningfulness). The assets focus must co-exist with initiatives to improve distributional justice. We conclude that an asset approach to well-being is not only appropriate, but also necessary, in even the poorest contexts. [ABSTRACT FROM PUBLISHER]

Background: Community participation can provide increased understanding and more effective implementation of strategies that seek to improve outcomes for women and newborns. There is limited knowledge on how participatory processes take place and how this affects the results of an intervention. Objective: This paper presents the results of two years of implementing (2013–2015) community groups for maternal health care in Magu District, Tanzania. Method: A total of 102 community groups were established, and 77 completed the four phases of the participatory learning and action cycle. The four phases included identification of problems during pregnancy and childbirth (phase 1), deciding on solutions and planning strategies (phase 2), implementation of strategies (phase 3) and evaluation of impact (phase 4). Community group meetings were facilitated by 15 trained facilitators and groups met monthly in their respective villages. Data was collected as an ongoing process from facilitator and meeting reports, through interviews with facilitators and local leaders and from focus group discussions with community group participants. Results: The majority of groups prioritized problems related to the availability of and accessibility to health services. The most commonly actioned solution was the provision of health education to the community. Almost all groups (95%) experienced a positive impact on the community as results of their actions, including increased maternal health knowledge and positive behaviour changes among health care workers. Facilitators were positive about the community groups, stating that they were grateful for the gained knowledge on maternal health, and positively regarded the involvement of men in community groups, which are traditionally women-only. Conclusion: The process of establishing and undertaking community groups in itself appeared to have a positive perceived impact on the community. However, sustained behaviour change, power dynamics and financial incentives need to be carefully considered during implementation and sustaining the community groups. [ABSTRACT FROM AUTHOR]

Despite four decades of global experience with community-based primary health care, the strategic details of community health worker (CHW) recruitment, training, compensation, and deployment remain the subject of continuing discussion and debate. Responsibilities and levels of clinical expertise also vary greatly, as well as contrasting roles of public- versus private-sector organisations as organisers of CHW effort. This paper describes a programme of implementation research in Tanzania, known as the Connect Project, which aims to guide national policies with evidence on the impact and process of deploying of paid, professional CHWs. Connect is a randomised-controlled trial of community exposure to CHW integrated primary health-care services. A qualitative appraisal of reactions to CHW implementation of community stakeholders, frontline workers, supervisors, and local managers is reviewed. Results highlight the imperative to plan and implement CHW programmes as a component of a broader, integrated effort to strengthen the health system. Specifically, the introduction of a CHW programme in Tanzania should draw upon community structures and institutions and strengthen mechanisms to sustain their participation in primary health care. This should be coordinated with efforts to address poorly functioning logistics and supervisory systems and human resource and management challenges. [ABSTRACT FROM PUBLISHER]

Mining projects affect the health of surrounding communities by inducing environmental, economic, social and cultural changes in different population groups. Health impact assessment (HIA) offers an opportunity to manage these impacts. This paper aims to explore gender differences of impacts on the wider determinants of health as described by communities impacted by industrial gold mining and consider the implications for impact assessment. We conducted 24 gender-separated, participatory focus group discussions at three study sites in northwestern Tanzania. Participants reported on a broad range of impacts on the wider determinants of health. Based on a thematic analysis, we identified gendered health impacts on men and women; in addition, children and adolescent boys and girls emerged as differently affected subpopulation groups. Located in the theory of the 'triple role of women', we suggest that different gender needs should be addressed more explicitly by HIA. Increased use of mitigation measures that recognise and address impacts on women's engendered roles, and their health, through addressing women's strategic gender needs, would strengthen HIA as a tool towards sustainable development. [ABSTRACT FROM AUTHOR]

Polygyny has been identified both as a ‘benign’ form of concurrency and as the cultural basis of concurrent partnerships that are considered important drivers of the HIV epidemic in sub-Saharan Africa. This paper investigates the changing cultural and economic dynamics of polygyny in concurrency in Iringa, Tanzania, a region with traditions of polygyny and high prevalence of HIV. Our analysis of focus group discussions, in-depth interviews and key informant interviews indicate that contemporary concurrent partnerships differ from regional traditions of polygyny. Whereas in the past, polygyny reflected men's and their kin group's wealth and garnered additional prestige, polygyny today is increasingly seen as a threat to health, and as leading to poverty. Nevertheless, participants evoked the social prestige of polygyny to explain men's present-day concurrency, even outside the bounds of marriage, and despite continued social prohibitions against extramarital affairs. Difficult economic conditions, combined with this prestige, made it easier for men to engage in concurrency without the considerable obligations to wives and children in polygyny. Local economic conditions also compelled women to seek concurrent partners to meet basic needs and to access consumer goods, but risked greater moral judgement than men, especially if deemed to have excessive ‘desire’ for money. [ABSTRACT FROM PUBLISHER]

The World Health Organization estimates that 340 million new cases of curable sexually transmitted infections (STIs) occur every year, while 33 million individuals are estimated to be living with HIV. The AIDS and STI epidemics are not independent with untreated STIs increasing HIV acquisition and transmission. Female sex workers have increased prevalence of untreated STIs and have been hypothesized to affect the health and HIV incidence of the general population. This paper aims to investigate why some female sex workers who experience symptoms of vaginal discharge or genital ulcers seek treatment while others do not. Data were collected from a cohort study conducted between 2002 and 2005 among female bar and hotel workers in Moshi, Tanzania. Study subjects were recruited from 7 out of 15 administrative wards in Moshi as part of the Moshi's Women's Health Project. Data were restricted to women self-reporting symptoms of vaginal discharge or genital ulcers (n=459) within the past year. Logistic regression was performed with SAS 9.1. Qualitative analysis was performed using in-depth interviews and focus group discussions among a convenience sample (n=42) of women already enrolled in the study. All interviews and focus group discussions were tape-recorded and transcribed, and data were analyzed thematically. Sixty-four percent of the sample sought treatment for either ailment. Multivariate analysis identified relationship to man of last sexual intercourse, ever experiencing a pregnancy, and age as significant predictors to seeking treatment. Four salient themes of threats to fertility, stigma correlated with prostitution, discomfort with the physical exam, and perceived views of clients were revealed as predictors to why women seek or intentionally ignore symptoms. Understanding the motivations and barriers for seeking treatment of STIs has far ranging public health implications that could help curtail the unnecessary associated morbidity and mortality and curtail the transmission of HIV. [ABSTRACT FROM AUTHOR]

HIV status disclosure rates to sexual partners are low in Tanzania, despite the benefits it confers to both partners. This qualitative study drew on the Disclosure Decision Model to explore the decision by people living with HIV (PLHIV) to disclose, or not, their HIV status to their partner. Six focus group discussions and thirty in-depth interviews were conducted in Mwanza, Tanzania in 2019 with PLHIV. Topics covered decision-making around disclosure and disclosure experiences. Thematic content analysis was conducted. Most respondents reported having disclosed their status to their partners. Disclosure was reported to facilitate or hinder the attainment of social goals including having intimate relationships, raising a family, relief from distress and accessing social support. Decisions made by PLHIV about whether to disclose their status were made after weighing up the perceived benefits and risks. The sense of liberty from a guilty conscious, and not "living a lie" were perceived as benefits of disclosure, while fears of stigma, family break-up or abandonment were perceived as risks. Many participants found disclosure was beneficial in promoting their adherence to treatment and clinic appointments. Interventions to support PLHIV with disclosure should include enhanced counselling, strengthening HIV support groups and enhanced assisted partner notification services. [ABSTRACT FROM AUTHOR]

Little is known about interprofessional practice (IPP) and interprofessional learning (IPL) in rural health services, despite national funding and continuing emphasis on increasing students' clinical placements in rural areas. This short paper outlines a study in Tasmania, Australia, which investigated how and under what contexts and conditions IPP and IPL occur in rural clinical settings, and the enabling factors and strategies that promote this learning and practice. This study employed a mixed method design comprising focus group discussions and a survey involving health professionals from two rural health services. The findings demonstrate that formal and informal arrangements, the collaborative nature of small, close-knit healthcare teams and patient-centred models of care employed in rural practice settings, provide ideal contexts for IPP and IPL. The study has implications for promoting organisational readiness for IPP and IPL and harnessing the potential of rural services to promote and develop students' interprofessional capability. [ABSTRACT FROM AUTHOR]

Gender equity is an important element of health promotion and is vital to ensuring that the benefits and burdens of participation in health promotion activities are fairly distributed. Yet, the gendered consequences of participatory interventions are often overlooked. This is particularly relevant for water and sanitation initiatives, given that women are generally responsible for maintaining domestic hygiene and procuring water. This study uses a qualitative approach to assess the gender dynamics of participation in community-led total sanitation (CLTS) activities in Mpwapwa District, Tanzania. We used semi-structured interviews and focus-group discussions to investigate men's and women's involvement in health promotion initiatives and their key motivators for and challenges to participation. We interviewed 77 community members from four villages and analysed the responses using qualitative content analysis. The study supports the notion that participation reinforces gender inequity and reproduces gendered norms due to activity-specific participation, women's passive participation within activities, and their limited opportunities for decision-making. However, there were also indications that participation provided a platform to increase the status of women, prioritise women's needs and demand a stronger position in decision making within the household and the community. CLTS organisers should, therefore, harness the opportunity to address gender inequalities within the community. [ABSTRACT FROM AUTHOR]

Background: Maternal and infant mortality rates in Tanzania have decreased over the past decades, but remain high. One of the challenges the country faces, is the lack of skilled health care workers. High fertility rates make midwives and their patients particularly susceptible to stress as a result of understaffing. Objective: This paper explores the challenges midwives face in their day-to-day practice at a regional referral hospital in Tanzania, and investigates which measures the midwives themselves find necessary to implement to improve their situation. Methods: A qualitative study design with focus group discussions (FGDs) was employed to explore which challenges the midwives experienced. Each focus group consisted of five to six midwives. A FGD topic guide covering challenges, consequences, motivation, ideal situation and possible solutions was used. These data were analyzed using Systematic Text Condensation. Results: A total of 28 Midwives, six men and 22 women, participated in five FGDs. Four categories emerged from the collected material: Feelings of demoralization, shortage of resources, societal challenges and personal struggles. A feeling of demoralization was especially prevalent and was caused by a lack of support from the leaders and little appreciation from the patients. Shortage of resources, and shortage of personnel in particular, was also highlighted as it led to an excessive workload resulting in difficulties with providing adequate care. These difficulties were intensified by lack of equipment, facilities and a non-optimal organization of the healthcare system. Conclusion: The challenges revealed during the FGDs prevent the midwives from providing sufficient midwifery care. To improve the situation, measures such as supportive leadership, reduction of workload, increasing availability of equipment and increasing knowledge of reproductive health in society, should be taken. [ABSTRACT FROM AUTHOR]

The concept of IS has gained importance in understanding the interactions among actors as determinants of innovation. Determinants of innovation are not viewed individually but within the context of a complex IS involving many actors and interactions. Therefore, this study examined the interactions among actors in the IRVIS in the Eastern Zone of Tanzania. Structured interviews, focus group discussion and documentary review methods were used in data collection. Both content and social network analysis were used to depict the different actors' interactions in the IRVIS. The findings show that the intensity of actors' interactions ranged from weak to medium. IRVIS is thus characterized by asymmetric power relationship among actors causing asymmetric knowledge and information flow. TARI, MATI, policymakers and DCs were important and influential over other actors; hence they largely control the knowledge flow of IRVs. The FIs, traders and millers had the least influence with weak interactions, and hence played peripheral roles. Farmers were the most prominent, but had the least influence on other actors. The study recommends that more effort be made to strengthen actors' interactions in the IRVIS for an increase of knowledge and information sharing among actors, so as to increase the use of IRVs and improve rice productivity. [ABSTRACT FROM AUTHOR]

Mentoring has been pointed out as one of the strategies for early career academics (ECAs) preparation and support for smooth transition into academia. Although ECAs mentoring has been widely studied, and the findings have indeed been informative and illuminating, the issues facing ECAs have yet to be adequately addressed, particularly in Tanzania. Drawing from open-ended questionnaires, focus group discussions, and interviews, we examined the issues surrounding the mentoring of ECAs in selected Tanzanian universities. Academic exploitation, isolation, and lack of support from senior academics were among the key issues facing ECAs. The findings further revealed that regular mentorship training, peer support, and institutional policy framework as strategies in place to subdue the mentoring challenges. We argue for universities to have policy framework on professional development through ECAs mentoring to fill out the gap on pedagogical, research and public engagement deficits for ensuring capable next generation of academics. [ABSTRACT FROM AUTHOR]

Climate change poses major threats to people and ecosystems. In many areas, climate change impacts have affected the availability of basic necessities including freshwater, food security, and energy. Developing countries are more adversely impacted by climate change and are less prepared to cope with its impacts. Over the years, local communities in these countries have been using their local based knowledge commonly known as indigenous knowledge (IK) to adapt to any form of uncertainty including climate change. This article assesses the IK used by the mixed farmers in Tanzania to adapt to the impacts of climate change. The study that informed this article was conducted in Missenyi and Muleba Districts, Kagera Region along the Ngono River Basin in Tanzania. It employed different techniques and methods to gather information from both primary and secondary sources including focus group discussions, key informant interviews, observation and desk reviews. The findings revealed that local communities within the basin have developed a sophisticated body of knowledge to withstand impacts of climate change. This knowledge is socially constructed and embedded within the socio-cultural context of the local communities. The findings further established that IK is mostly used in a situation of long drought season, infestation of diseases and pests for both livestock and crops as well as during occurrence of strong winds. In such circumstances, most oft-cited adaptation practices used include farming and grazing in wetlands, growing of drought resistant crops, using locally made pesticides, and grain storage, to mention but a few. The article recommends that despite the fact that some IK seems to be helpful at the local level, it is necessary that local communities are assisted in their adaptive strategies so that they can respond to climate change effectively and enhance their resilience. [ABSTRACT FROM AUTHOR]

The integration of upgrading strategies (UPS) as part of the livelihood strategies of small farmers is vital for enhancing their food systems. The success of the UPS implementation largely relies on the interactions among key actors. Understanding the complex social realities of farmers is essential for adapting strategies to the local context. Therefore, the objective of this study is to determine the impact of UPS on the livelihood of participants in two case study areas in Tanzania. We used a mixed-method approach to understand the relations between, roles, and motivations of relevant actors in the participatory implementation of their UPS using the Net-Map tool for social network analysis and focus group discussions. Our results reveal why the implementation of UPS improved people´s livelihoods and allowed us to derive some success factors. Motivations for participating in a UPS group differed to some extent among all UPS groups and all types of actors. Based on our results, we found that UPS allow participants to enhance their social networks within their communities and develop skills that improve their livelihood strategies, resulting in more diverse livelihood outcomes. This research provides a knowledge base for UPS considerations and other participatory actions with local subsistence stakeholders. [ABSTRACT FROM AUTHOR]

Despite the implementation of various initiatives to address low enrollment in voluntary micro health insurance (MHI) schemes in sub-Saharan Africa, the problem of low enrollment remains unresolved. The lack of process evaluations of such interventions makes it difficult to ascertain whether their poor results are because of design failures or implementation weaknesses. In this paper, we describe a process evaluation protocol aimed at opening the 'black box' to evaluate the implementation processes of the Redesigned Community Health Fund (CHF) program in the Dodoma region of Tanzania. The study employs a cross-sectional mixed methods design and is being carried out 3 years after the launch of the Redesigned CHF program. The study is grounded in a conceptual framework which rests on the Diffusion of Innovation Theory and the Implementation Fidelity Framework. The study utilizes a mixture of quantitative and qualitative data collection tools (questionnaires, focus group discussions, in-depth interviews, and document review), and aligns the evaluation to the Theory of Intervention developed by our team. Quantitative data will be used to measure program adoption, implementation fidelity, and their moderating factors. Qualitative data will be used to explore the responses of stakeholders to the intervention, contextual factors, and moderators of adoption, implementation fidelity, and sustainability. This protocol describes a systematic process evaluation in relation to the implementation of a reformed MHI. We trust that the theoretical approaches and methodologies described in our protocol may be useful to inform the design of future process evaluations focused on the assessment of complex interventions, such as MHI schemes. [ABSTRACT FROM AUTHOR]

Background: In many low-resource settings, in-service training is a common strategy to improve the performance of health workers and ultimately reduce the persistent burden of maternal mortality and morbidities. An evaluation of the Helping Mothers Survive Bleeding After Birth (HMS BAB) training as a single-component intervention in Tanzania found some positive albeit limited effect on clinical management and reduction of postpartum haemorrhage (PPH). Aim: In order to better understand these findings, and particularly the contribution of contextual factors on the observed effects, we explored health workers' perceptions of their health facilities' readiness to provide PPH care. Methods: We conducted 7 focus group discussions (FGDs) and 12 in-depth interviews (IDIs) in purposively selected intervention districts in the HMS BAB trial. FGDs and IDIs were audio-recorded, transcribed and translated verbatim. Thematic analysis, using both inductive and deductive approaches, was applied with the help of MAXQDA software. Results: Health workers perceive that their facilities have a low readiness to provide PPH care, leading to stressful situations and suboptimal clinical management. They describe inconsistencies in essential supplies, fluctuating availability of blood for transfusion, and ineffective referral system. In addition, there are challenges in collaboration, communication and leadership support, which is perceived to prevent effective management of cases within the facility as well as in referral situations. Health workers strive to provide life-saving care to women with PPH despite the perceived challenges. In some health facilities, health workers perceive supportive clinical leadership as motivating in providing good care. Conclusion: The potential positive effects of single-component interventions such as HMS BAB training on clinical outcome may be constraint by poor health facility readiness, including communication, leadership and referral processes that need to be addressed. [ABSTRACT FROM AUTHOR]

Striga spp. severely affect maize yields in Tanzania causing yield losses varying from 20% to 100%. The use of Striga resistant varieties is an economical and environmentally friendly option that can be easily adopted by smallholder farmers. Uptake of newly developed varieties would be high if the breeding process is inclusive and consultative to farmer preferred traits and preferences. The aim of this study was to identify farmers' maize production constraints, current Striga control options, trait preference and perceptions among smallholder farmers in western Tanzania. Surveys were conducted in four districts, namely Igunga, Shinyanga rural, Urambo and Uyui during the 2017/2018 cropping season. Data were collected from 324 farmers using a semi-structured questionnaire (166), focus group discussions (158) and field observations. The major maize production constraints reported by farmers were; drought (97.2%), Striga infestation (93.1%), insect pests in field (90.1%) and in stores (72.7%). The main Striga control options described by farmers across the studied districts were: hoe weeding, uprooting, manure application and crop rotation in descending order. Only 59% of the farmers used the seed of improved maize varieties of either hybrids or open-pollinated varieties (OPV) which are Striga susceptible and the remaining used home saved seed. A breeding programme aiming at improving maize varieties for Striga resistance, including farmers' preferred traits, should be designed and executed to control Striga infestations thus improving maize production, productivity and profitability in western Tanzania. [ABSTRACT FROM AUTHOR]

Parental death and HIV are associated with poor mental health for orphans in sub-Saharan Africa. This study aimed to evaluate a theory-based intervention for orphaned children on treatment in Tanzania, in terms of feasibility, acceptability and preliminary outcomes. A pilot RCT with nested focus group (FGD) allocated 48 children to usual care or residential "Memory Work Therapy". Children completed outcome measures at T0 (baseline), T1 (2 weeks following intervention) and T2 (9 weeks from T0). Forty percent of eligible children assented. T1 intervention effects were found on all total measures: Brief Symptom Inventory d = 0.99, p < .001; Rosenberg Self Esteem Scale d = 0.65, p = .001; Strengths and Difficulties Questionnaire d = 0.64, p = .002; Self-efficacy questionnaire for children both "social" and "emotional" subscales, d = 0.54, p = .008 and d = 0.63, p = .002, respectively. At T2, significant effects remained for all measures and SES effect increased from medium to large (T1 = 0.65, T2 = 1.33). FGD data found children valued a calm environment that met their basic needs, enabling them to reflect, highlight support resources, and strengthen ability to recognize personal skills. The intervention has strong feasibility and acceptability, with no attrition or missing data. Memory Work Therapy has high potential effect size and should be tested in a fully powered trial. Clinical trials.gov NCT02180750. [ABSTRACT FROM AUTHOR]

Female sex workers experience high rates of gender-based violence and HIV. Alcohol has been shown to facilitate women's risk of both gender-based violence and HIV; however, little research has explored how aspects of the sex work environment shape this risk. Drawing on structuration theory, this study explored how social conduct is patterned across time and space within the sex work environment to influence alcohol consumption, gender-based violence and HIV risk among female sex workers. Qualitative in-depth interviews were conducted with 24 female sex workers enrolled in an ongoing community randomised controlled trial of a combination HIV prevention intervention in Iringa, Tanzania. Data were analysed using both inductive and deductive approaches. Findings reveal how routine interactions between female sex workers and their clients occur at three moments of time and space during the sex exchange process to facilitate alcohol consumption and increase women's risk of gender-based violence and HIV. Findings also highlight how sex workers utilise collective agency to address aspects of the sex work environment that place them at risk of alcohol abuse, gender-based violence and HIV. Implications for future interventions to prevent gender-based violence and HIV among female sex workers in Tanzania and similar contexts are discussed. [ABSTRACT FROM AUTHOR]

Migration and population mobility has long been regarded as an important structural driver of HIV. Following initial concerns regarding the spatial spread of the disease, mobile populations are viewed to engage in higher levels of risky sexual behaviours than non-mobile groups. However, beyond the case studies of mineworkers and truck drivers, the statistical evidence is inconclusive, suggesting that the relationship between mobility and risk is not well understood. This study investigated how engaging in specific livelihoods that involve mobility influences sexual behaviour and HIV risk. A qualitative research project, including focus groups and in-depth interviews with key mobile groups, was conducted in Northern Tanzania. The findings show that the patterns and conditions of moving related to the requirements of each different economic activity influence the nature of relationships that mobile groups have whilst away, how and where local sexual networks are accessed, and the practicalities of having sex. This has further implications for condom use. Risk behaviours are also shaped by local sexual norms related to transactional sex, emphasising that the roles of mobility and gender are interrelated, overlapping and difficult to disentangle. [ABSTRACT FROM PUBLISHER]

Efforts to eliminate mother-to-child transmission of HIV in Tanzania are guided by a four-prong strategy advocated by the World Health Organization (WHO). Prong 2, prevention of unintended pregnancies among women living with HIV, has, however, received the least attention and contraceptive use to prevent unintended pregnancies remains low. This study explored the perceived barriers to the use of modern methods of contraception, and factors influencing contraceptive choice among HIV-positive women in urban Dar-es-Salaam, Tanzania. A qualitative multi-site study was conducted, utilising in-depth interviews and focus group discussions with 37 sexually active HIV-positive women aged between 20 and 44 years, attending three health facilities within Dar-es-Salaam. The theoretical framework was a patient centred model. Four barriers were identified: the influence of the women’s spousal relationships; personal beliefs and the relationship of these in understanding her disease; the influence of the social demands on the woman and her relationships; and the importance of a woman’s relationship with her healthcare provider/healthcare system. Being the bearers of bad news (HIV-positive status) the pregnant women experienced conflicts, violence, abandonment and rejection. The loss in negotiating power for the women was in relation to their intimate partners, but also in the patient–healthcare provider relationship. The role of the male partner as a barrier to contraceptive use cannot be understated. Therefore, the results suggest that healthcare providers should ensure patient-focused education and provide support that encompasses the importance of their relationships. Additional research is required to elucidate the functional association between contraceptive choices and personal and social relationships. [ABSTRACT FROM AUTHOR]

Although HIV is identified as a family disease, the overall response to the global HIV epidemic continues to predominantly focus on individuals. The aim of this qualitative study was to explore how the role of the family in HIV prevention is perceived by community-based stakeholders. Understanding the role of the family within the context of the HIV/AIDS is essential for community/public health nurses. In total, 34 stakeholders participated in the study. Three major categories were identified namely: fostering positive intra-familial relations, utilizing external resources, and barriers to family roles. The study findings have implications for community-based HIV family interventions. [ABSTRACT FROM AUTHOR]

Tanzania introduced the decentralisation of its health systems in the 1990s in order to provide opportunities for community participation in health planning. Health facility governing committees (HFGCs) were then established to provide room for communities to participate in the management of health service delivery. The objective of this study was to explore the challenges and benefits for the participation of HFGCs in health planning in a decentralised health system. Data were collected using semi-structured interviews and focus group discussions (FGDs). A total of 13 key informants were interviewed from the council and lower-level health facilities. Five FGDs were conducted from five health facilities in one district. Data generated were analysed for themes and patterns. The results of the study suggest that HFGCs are instrumental organs in health planning at the community level and there are several benefits resulting from their participation including an opportunity to address community needs and mobilisation of resources. However, there are some challenges associated with the participation of HFGCs in health planning including a low level of education among committee members and late approval of funds for running health facilities. In conclusion, HFGCs potentially play a significant role in health planning. However, their participation is ineffective due to their limited capacities and disabling environment. [ABSTRACT FROM PUBLISHER]

The young urban population of Tanzania is growing rapidly, primarily due to rural-urban migration. More information is needed on the challenges facing young adult urban women and men in using family planning (FP). The purpose of this study is to identify perceptions, interpersonal and familial attitudes, and sociocultural norms regarding FP among young adults (18–25 years) in Dar es Salaam, Tanzania, comparing responses by sex, marital status and migration status. We conducted 12 focus groups with young adult men and women (n= 74) in Dar es Salaam in December 2009. Participants knew of modern contraceptive methods, but had serious concerns about side effects. Single men and women preferred condoms. Female migrants stated that traditional methods were ineffective, yet commonly used in rural areas. Men's desires for more children frequently led female migrants not to use FP, while many married long-term residents used FP discreetly. Single women sometimes received the support of their parents/boyfriends to access and use contraception. Findings highlight differences in experiences among young adult men and women based on their migrant and marital status at the individual, interpersonal and normative levels. Future efforts to promote FP should engage existing social support systems and cultivate new ones in response to barriers. [ABSTRACT FROM AUTHOR]

Men as sexual partners, fathers and household heads have a direct bearing on women's reproductive health. However, little is known about the influence of changing norms and values on men's role in ensuring women's health during pregnancy and childbirth. This study from rural south-eastern Tanzania explores men's and women's discussions on men's roles and responsibilities in prenatal care and links them to an analysis of norms and values at the household level and beyond. Data from eight focus group discussions with men and women were consensually coded and analysed using a qualitative content analysis. Four dimensions of norms and values, which emerged from analysis, bear upon men's support towards pregnant women: changing gender identities; changing family and marriage structures; biomedical values disseminated in health education; and government regulations. The findings suggest that Tanzanian men are exposed to a contradictory and changing landscape of norms and values in relation to maternal health. [ABSTRACT FROM AUTHOR]

This article explores the resilience of orphaned young people in safeguarding physical assets (land and property) inherited from their parents and sustaining their households without a co-resident adult relative. Drawing on the concept of resilience and the sustainable livelihoods framework, the article analyses the findings of an exploratory study conducted in 2008–2009 in Tanzania and Uganda with 15 orphaned young people heading households, 18 of their siblings, and 39 NGO workers and community members. The findings suggest that inherited land and property were key determining factors in the formation and viability of the child- and youth-headed households in both rural and urban areas. Despite experiences of stigma and marginalisation in the community, social networks were crucial in enabling the young people to protect themselves and their property, providing access to material and emotional resources, and enhancing their skills and capabilities to develop sustainable livelihoods. Support for child- and youth-headed households needs to recognise young people's agency and should adopt a holistic approach to their lives by analysing the physical assets, material resources, and human and social capital available to the household, as well as giving consideration to individual young people's wellbeing, outlook and aspirations. Alongside cash transfers and material support, youth-led collective mobilisation that is sustained over time may also help build resilience and foster supportive social environments in order to challenge property-grabbing and the stigmatisation of child- and youth-headed households. [ABSTRACT FROM PUBLISHER]

The World Health Organisation and the Joint United Nations Programme on AIDS recommend male circumcision (MC) as an additional intervention against HIV infection. Various sub-Saharan African countries are at different stages of rolling out MC programmes. Despite initial fears, studies conducted among traditionally non-circumcising communities in Africa have shown that MC is widely accepted as a biomedical intervention. However, little is known on how traditionally circumcising communities where MC carries considerable social meaning and significance would respond to such programmes. This study was conducted among a traditionally circumcising community in Tarime district in Tanzania as part of a national situation analysis prior to initiating a national MC programme. It employed key informant interviews and focus group discussions for data collection. Results show that the Kurya ethnic group practice MC as a rite of passage from childhood to adulthood. Each clan organises its own circumcision ceremony, which takes place every even numbered years. Clan leaders and traditional circumcisers are central to its organisation. Among the Kurya, there is high regard for traditional MC as it is perceived as upholding cultural practice and identity. It also embodies notions of bravery since anaesthetics are not used. On the other hand, medical MC is not viewed as prestigious since anaesthetics are used to suppress pain. Social pressure for traditional MC is applied through ridiculing of those uncircumcised or circumcised at health facilities. In general, there are positive attitudes towards MC as it is perceived as enhancing personal hygiene and having a protective effect against sexually transmitted infections. For the success of nation-wide MC programmes, there is need to develop programmes that incorporate both clinical and sociocultural interests. [ABSTRACT FROM AUTHOR]

HIV/AIDS prevention strategies often neglect traditions and cultural practices relevant to the spread of HIV. The role of women in the HIV/AIDS context has typically been relegated to high-risk female groups such as sex workers, or those engaged in transactional sex for survival. Consequently, these perceptions are born out in the escalation of HIV/AIDS among communities, and female populations in particular where prevention frameworks remain culturally intolerant. We have attempted to address these issues by using an adapted Rapid Assessment Response and Evaluation (RARE) model to examine the impact of HIV/AIDS in the Maasai community of Ngorongoro. Our adapted RARE model used community engagement venues such as stockholder workshops, key informant interviews, and focus groups. Direct observations and geomapping were also done. Throughout our analysis, a gender and a pastoralist-centered approach provided methodological guidance, and served as value added contributions to out adaptation. Based in the unique context of a rural pastoralist community, we made recommendations appropriate to the cultural setting and the RARE considerations. [ABSTRACT FROM AUTHOR]

The article presents a synthesis of data from three village case studies focusing on how structural and cognitive social capital may have influenced the progression of the HIV epidemic in the Kagera region of Tanzania. Grounded theory was used to develop a theoretical model describing the possible links between structural and cognitive social capital and the impact on sexual health behaviours. Focus group discussions and key informant interviews were carried out to represent the range of experiences of existing social capital. Both structural and cognitive social capital were active avenues for community members to come together, empower each other, and develop norms, values, trust and reciprocal relations. This empowerment created an enabling environment in which members could adopt protective behaviours against HIV infection. On the one hand, we observed that involvement in formal and informal organisations resulted in a reduction of numbers of sexual partners, led people to demand abstinence from sexual relations until marriage, caused fewer opportunities for casual sex, and gave individuals the agency to demand the use of condoms. On the other hand, strict membership rules and regulations excluded some members, particularly excessive alcohol drinkers and debtors, from becoming members of the social groups, which increased their vulnerability in terms of exposure to HIV. Social gatherings (especially those organised during the night) were also found to increase youths' risk of HIV infection through instances of unsafe sex. We conclude that even though social capital may at times have negative effects on individuals' HIV-prevention efforts, this study provides initial evidence that social capital is largely protective through empowering vulnerable groups such as women and the poor to protect against HIV infection and by promoting protective sexual behaviours. [ABSTRACT FROM AUTHOR]

Little is known about what adolescents think about faithfulness and partner reduction for HIV prevention (the “B” in the ABC HIV prevention behavior change strategy), including how they understand its implementation within relationships. In addition, because adolescents face the twin threats of HIV and unintended pregnancy, it is important to understand how adolescents may integrate their thinking on pregnancy prevention if they are using faithfulness or partner reduction as their HIV prevention strategy. This study gathered evidence by conducting 20 focus group discussions (FGDs) with 158 adolescents, aged 14-20. The FGDs were stratified by sex, age, current school attendance, rural or urban residence, and marital status. Results showed that the vast majority of groups felt that “B” messages are important and relevant for unmarried (as well as married) youth to hear for HIV prevention, but the messages need to be explicit (e.g., “being faithful means having only one tested sexual partner at a time”). Faithful relationships are perceived as ideal in terms of romantic expectations and HIV prevention, but were considered unrealistic if the relationship had a power imbalance. Adolescents acknowledged the risks of multiple partners and a few recognized that concurrent partnerships are riskier than serial partnerships. Condoms were given as the primary method for pregnancy prevention among youth, yet faithfulness was usually seen as precluding condom use and many youth considered condom use as evidence of a lack of faithfulness. Overall, adolescents recognized that practicing fidelity is complex. Young people need life skills education for how to establish and maintain faithful relationships with one tested partner and how to integrate condom use for pregnancy prevention within that relationship. Programs also need to more explicitly address the issues of trust and repeat HIV testing within “faithful” relationships which is an uncomfortable but necessary reality for many adolescents. [ABSTRACT FROM AUTHOR]

Purpose: Screening school students for refractive errors is a component of many primary eye care programs. In 2004 a trial of two approaches of spectacle-delivery to Tanzanian secondary school students found that only one third of students were using their spectacles at three months. Barriers to spectacle use were investigated using questionnaires and focus group discussions. Methods: At the three months follow-up survey a questionnaire explored satisfaction with spectacles and the attitudes of trial participants (median age 15 years). Attitudes and reactions of friends, teachers and families were also explored. Students also discussed their experience with spectacle use and reasons for non-use in 8 focus groups divided by intervention, sex and spectacle use. Results: In general, students seemed happy with the appearance of their spectacles and the beneficial impact on their vision. Peer pressure and parental concerns about safety of spectacle use, cost of purchasing spectacles and difficulties in accessing good local optical services were identified as the main barriers. Students criticized prescribing practices of local opticians and favored alternative and traditional treatments for visual impairment. Conclusion: To increase the effectiveness of school vision screening in Tanzania, barriers such as peer pressure or concerns about safety need to be addressed, in addition to provision of affordable, good quality spectacles. Barriers to spectacle use in children are likely to exist in all populations, but may vary in their nature and importance and therefore should be investigated in existing and new screening programs. [ABSTRACT FROM AUTHOR]