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Rune Nathaniel Philemon,1 Blandina T Mmbaga,1,2 John Bartlett,3 Jenny Renju,4,5 Tara B Mtuy,4,6 Innocent B Mboya,4,7,8 Sia E Msuya4,7,9 1Department of Pediatrics and Child Health, Kilimanjaro Christian Medical University College (KCMUCo) & Kilimanjaro Christian Medical Centre (KCMC), Moshi, Kilimanjaro, Tanzania; 2Department of Research, Kilimanjaro Clinical Research Institute (KCRI), Moshi, Kilimanjaro, Tanzania; 3Duke Global Health Institute, Duke University, Durham, NC, USA; 4Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania; 5Department of Population Studies, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK; 6Faculty of Public Health and Policy and the Department of Global Health and Development, London School of Hygiene & Tropical Medicine (LSHTM), London, UK; 7Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania; 8School of Mathematics, Statistics & Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa; 9Department of Community Health, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Kilimanjaro, TanzaniaCorrespondence: Rune Nathaniel Philemon, Department of Pediatrics and Child Health, Kilimanjaro Christian Medical University College (KCMUCo) & Kilimanjaro Christian Medical Centre (KCMC), P O Box 2240, Moshi, Kilimanjaro, Tanzania, Tel +255 754 389 049, Email rphilemon@yahoo.co.ukPurpose: We sought to assess how HIV-positive mothers enrolled in the PMTCT program adhere to breastfeeding recommendations concerning early initiation of breastfeeding (EIBF), ie, within one hour of birth, pre-lacteal feeds, exclusive breastfeeding until six months (EBF), and continued breastfeeding to one year of age. This study was designed to assess the practices in response to changing recommendations for breastfeeding in HIV, which have differed drastically over the years.Patients and Methods: We recruited 524 mother-child pairs from 37 PMTCT clinics across Kilimanjaro, Tanzania. The 5 clinics with the highest patient load in each of the 7 districts of Kilimanjaro were chosen, plus the zonal and municipal referral hospitals. The children were below two years of age and currently in the PMTCT program. We administered a questionnaire to assess the mother’s practices in feeding the child. We used multiple logistic regression models to determine factors associated with EIBF, EBF, and continued breastfeeding.Results: EIBF was achieved for 73.1% of babies. Cesarean delivery, low birth weight, and partner disclosure of HIV status were significant risk factors for not achieving EIBF. About 19% of children did not breastfeed exclusively. Of the 247 children ≥ 12 months old, 43.3% had stopped breastfeeding before 12 months. Counseling on ARV, having had > 2 pregnancies while HIV-positive and EBF were associated with breastfeeding until 12 months old. Using ART for more than two years decreased the odds of EBF and continued breastfeeding to 12 months of age.Conclusion: Adherence to breastfeeding recommendations for HIV-positive women is suboptimal, particularly in aspects of recent changes in recommendations such as continuing breastfeeding for one year. There is a missed opportunity for interventions such as counseling, which has shown to favor adherence. Health education and counseling are needed for providers and mothers to keep them abreast with the frequently changing recommendations.Keywords: early initiation, continued breastfeeding, exclusive breastfeeding, feeding recommendations

Mussa N Sweya,1 Sia E Msuya,2,3 Michael J Mahande,2 Rachel Manongi1,3 1Community Health Department, Kilimanjaro Christian Medical University College, 2Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University, 3Community Health Department, Kilimanjaro Christian Medical Centre, Moshi, Tanzania Background: Previous studies have shown that knowledge of contraceptives, especially among the youth in universities, remains limited, and the rate of premarital sexual activity, unwanted pregnancies, and illegal abortions remains higher among university students. This study aimed to assess contraceptive knowledge, sexual behavior, and factors associated with contraceptive use among female undergraduate university students in Kilimanjaro region in Tanzania. Methods: A cross-sectional analytical study was conducted from May to June 2015 among undergraduate female students in four universities in Kilimanjaro region. A self-administered questionnaire was given to the participants. Data analysis was performed using Statistical Package for Social Sciences. Descriptive statistics were used to summarize the data. An odds ratio with 95% confidence interval for factors associated with modern contraceptive use was computed using multiple logistic regression models. A P-value of 18 years of age. Hence, advocacy for adolescent reproductive health education to promote the use of the available contraceptive services among university students is needed. Keywords: knowledge, contraception, utilization, university students, Tanzania