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Background: Unplanned pregnancy is major public health concern. Globally unintended pregnancies account for about 40% of all pregnancies annually. The problem is more in developed countries in which nearly half of all pregnancies are unintended. In Tanzania over 20 women die each day due to the complication of unplanned pregnancy and childbirth which contribute to high maternal mortality rate. Though EC can prevent unplanned pregnancies by nearly 95% to 99% but the practice is still very low in Africa as well as in Tanzania despite some of the study shown that there is moderate knowledge. Therefore, the current study aiming of assessing knowledge, practice and barrier or challenges which face female university students in using EC. Method: A cross-sectional study design was conducted among 365 female students at Kilimanjaro Christian Medical University College (KCMUCO), Mwenge Catholic University (MWECAU) and Moshi cooperative University (MOCU) in Kilimanjaro region. A simple random sampling technique was used to select study participants. Self-administered questionnaires were used during data collection. Results: About (65.7%) of the female university students had ever heard of EC and more than half of them had knowledge on when to use EC (54.4%), where to obtain (58.7%) and time for EC to be taken (41.5%). Moreover about 75.6% of female university students in this study reported never use emergency contraceptives (EC) while 24.4% reported having ever used emergency contraceptive and among 24.4% EC users reported that 90.2% use EC pills method. On the other hand, common barriers toward EC use reported by female university students were fear of side effects, personal barrier, and religion opposition 39.4%, 31.9% and 12.8% respectively.Conclusions: This study found that majority 65.7% of female university students had ever heard of emergence contraceptive (EC) in their lives. Practice of EC is still very low among female students where by only 24.4% reported having ever used emergency contraceptive. Fear of side effect and personal barrier were mostly reported as the common barrier by the female student towards EC usage 39.4%, 31.9% respectively. Thus, there is an urgent need to educate the female university students about EC.

Background Overweight and obesity have increased considerably in low- and middle-income countries over the past few decades, particularly among women of reproductive age. This study assessed the role of physical activity, nutrient intake and risk factors for overweight and obesity among women in Dar es Salaam, Tanzania. Methods We conducted a cross-sectional survey among 1004 women aged 15–49 years in the Dar es Salaam Urban Cohort Study (DUCS) from September 2018 to January 2019. Dietary intake was assessed using a food frequency questionnaire (FFQ). Physical activity was assessed using the Global Physical Activity Questionnaire (GPAQ) using metabolic equivalent tasks (MET). Modified poison regression models were used to evaluate associations between physical activity and nutrient intake with overweight/obesity in women, controlling for energy and other factors. Results The mean (±SD) age of study women was 30.2 (±8.1) years. Prevalence of overweight and obesity was high (50.4%), and underweight was 8.6%. The risk of overweight/obesity was higher among older women (35–49 vs 15–24 years: PR 1.59; 95% CI: 1.30–1.95); women of higher wealth status (PR 1.24; 95% CI: 1.07–1.43); and informally employed and married women. Attaining moderate to high physical activity (≥600 MET) was inversely associated with overweight/obesity (PR 0.79; 95% CI: 0.63–0.99). Dietary sugar intake (PR 1.27; 95% CI: 1.03–1.58) was associated with increased risk, and fish and poultry consumption (PR 0.78; 95% CI: 0.61–0.99) with lower risk of overweight/obesity. Conclusion Lifestyle (low physical activity and high sugar intake), age, wealth status, informal employment and marital status were associated with increased risk of overweight/obesity, while consumption of fish and poultry protein was associated with lower risk. The study findings underscore the need to design feasible and high-impact interventions to address physical activity and healthy diets among women in Tanzania.

Background: Overweight and obesity are global public health problems. Overweight or obesity is estimated to cause 4 million deaths, 3.9% of all Years of Potential Life Lost (YPLL) and 3.8% of all Disability Adjusted Life Years (DALYs). Overweight or obesity also leads to conditions such as diabetes and hypertension. It has been shown that teachers have a greater occurrence of overweight or obesity than the general population. This study aimed to determine the prevalence of overweight or obesity among primary and secondary school teachers and to assess factors associated with these problems in Moshi Municipality, Kilimanjaro region, Tanzania.Methods: This was a cross sectional study in which data was collected using a modified WHO-STEPS Survey tool. Data cleaning and analysis were conducted using STATA version 14.0. Frequency and percentage were used to summarize categorical data while mean/median with their respective measures of dispersion were used to summarize continuous data. The Modified Poisson regression model was used to determine factors associated with overweight or obesity among primary and secondary school teachers. The effect was estimated by Prevalence Ratio with 95% confidence intervals and P-value less than 5% considered to be statistically significant. Results: A total of 968 teachers were included in this study with median (IQR) age of 37, (32-48) years. Most of the participant were female (69.7%) about (51.6%) were secondary school teachers. Overall, the prevalence of overweight or obesity was 72.7%. Teachers who were 35+ years had a 27% (aPR: 1.27; 95%CI: 1.1 – 1.4; pConclusion: The Prevalence of overweight or obesity was high, suggesting the need for early intervention with lifestyle changes among teachers in Moshi Municipal. There is an urgent need to design lifestyle interventions targeting overweight or obesity among teachers - especially female teachers and those aged 35+.

Background: Contraceptive use reported to avert more than 1 million maternal deaths in Sub-Saharan Africa due to decline in fertility rate and thus help to achieve MDG 4 and 5. Therefore, this study aims to determine the prevalence of modern contraceptive use, describe common methods used, source of methods and factors that predict contraceptive use among women of reproductive age (WRA) in Arusha City and Meru District Council (DC) in northern Tanzania. Methodology: The study is based on data from a cross-sectional survey conducted from January – May 2018. The study enrolled women aged 16-44 years from five selected wards in each district. Interviews were conducted at participant’s homes using electronic data collection system. Descriptive and analytical statistics were used to analyze the data.Results: A total of 3,938 women were enrolled, of whom 3,658 were sexually active at the time of survey. The mean age of 3,658 women was 30.5 (SD 7.3) years. The prevalence of modern contraceptive use (mCPR) was 47%, with no significant difference between Arusha City (47%) and Meru DC (44%). Implants (26.9%), injectables (21.5%) and pills (13.0%) were three of the common contraceptives currently used among the users. Public health facilities were the main source (72.6%) of contraceptive methods. Married/cohabiting women were significantly using modern method of contraceptives compared to single women (Adjusted Prevalence Ratio [aPR = 2.1) as were women with two or more children than others (aPR=1.5). Cost, distance, and time due to busy schedules were key challenges to access family planning (FP) services as reported by the women. Conclusion: Nearly half of WRA in the two districts were using modern contraceptives. Implants have become the most common method of contraceptives than injectables and pills. Health management teams in the two districts will need to come with strategies for improving use of other modern FP methods and improving community-based availability of contraceptive services to contribute in improving mCPR to the 60% target.

Background Child stunting is a global health concern. Stunting leads to several consequences on child survival, growth, and development. The absolute level of stunting has been decreasing in Tanzania from from 50% in 1991/92 to 34% in 2016 although the prevalence is still high (34%)Stunting varyies across socioeconomic determinants with a larger burden among the socioeconomic disadvantaged group. The reduction of inequalities in stunting is very crucial as we aim to reduce stunting to 28% by 2021 and hence attain zero malnutrition by 2030 under Sustainable Development Goal 2.2.This study aimed at determining the trend, contributing factors and changes of inequalities in stunting among children aged 3–59 months from 2004 to 2016. Methods Data were drawn from the Tanzania Demographic and Health Surveys. The concentration index (CIX) was used to quantify the magnitude of inequalities in stunting. The pooled Poisson regression model was used to determine the factors for stunting, decision criterion for significant determinants was at 5% level of significance. The CIX was decomposed using the Wagstaff and Watanabe decomposition methods., the percentage contribution of each factor to the toal concentration index was used to rank the factors for socioeconomic inequalities in stutning. Results Inequalities in stunting were significantly concentrated among the poor; evidenced by CIX = − 0.019 (p p = 0.7658), from 2010 to 2015/6 was − 0.0081 (p = 0.1145). The overall change in CIX from 2004 to 2015/6 was 0.00965 (p = 0.0538). Disparities in the distribution of wealth index (mean contribution > 84.7%) and maternal years of schooling (mean contribution > 22.4%) had positive impacts on the levels of inequalities in stunting for all surveyed years. Rural-urban differences reduced inequalities in stunting although the contribution changed over time. Conclusion Inequalities in stunting declined, differentials in wealth index and maternal education had increased contribution to the levels of inequalities in stunting. Reducing stunting among the disadvantaged groups requires initiatives which should be embarked on the distribution of social services including maternal and reproductive education among women of reproductive age, water and health infrastructures in remote areas.

Background: Insufficient physical activity is a serious public health concern. Assessing physical activity accurately in children remains a challenge and valid tools for its assessment in African children are needed. This study compares self-reports versus accelerometry-captured physical activity.Methods: In this cross-sectional study, 51 primary school children aged 9 – 11 years from four primary schools in Kilimanjaro region were enrolled. Children were asked to complete a self-reported questionnaire on physical activity and wore an accelerometer for seven consecutive days. Accelerometry was used as a reference method to assess for child reporting accuracy.Results: Spearman correlation between self-reports and accelerometry was moderate (r=0.41, p=0.002). Children who reported walking to school had higher moderate to vigorous physical activity (MVPA) for both accelerometry and self- reports compared to their counterparts (p < 0.001). Intra-class correlation (ICC) showed that 32% of the variations in accelerometry weekly total MVPA was contributed by the differences in activities between children.Conclusions: Objective measures of physical activity such as accelerometers can be used to accurately measure physical activity in children where feasible. Self-reports have limited validity, and therefore more research is needed to develop better self-reported measures with specific activities which can easily be recalled by children.

Background: Child stunting is a global health concern. It has consequences on child survival, growth, and development. The absolute level of stunting has been decreasing in Tanzania although the prevalence is still high (34%), varying across socioeconomic determinants with a larger burden among the disadvantaged group. Reduction of inequalities in stunting are very crucial as we aim to reduce stunting to 28% by 2021. Objectives: This study aimed to determine the trend, contributing factors and changes of inequalities in stunting among children aged 3 – 59 months from 2004 to 2016 Methodology: Data were drawn from the Tanzania Demographic and Health Surveys. The dependent variable was stunting. The concentration index was used to quantify the magnitude of inequalities in stunting for each year. In order to get the contribution of each determinant on the inequality in stunting, the concentration index was decomposed by using the Wagstaff and Watanabe decomposition methods of the concentration index. Results: Inequalities in stunting insignificantly declined from -0.019 (p 84.7%) and maternal years of schooling (mean contribution > 22.4%) increased the levels of inequalities in stunting in all survey years. Rural-urban differences reduced inequalities in stunting although its contribution changed over time. Conclusion: Inequalities in stunting declined, differentials in wealth index and maternal education had increased contribution on the levels of inequalities. To significantly reduce the larder burden of stunting among the disadvantaged groups, initiatives should be embarked on distribution of social services like water, health infrastructures and education.

Background: Exclusive breastfeeding (EBF) practice is one of the interventions improving child survival. Health workers have been shown to be vital in influencing EBF practices.Objectives: To assess the level of knowledge and supportive practices on EBF among healthcare workers Kilimanjaro region, northern Tanzania.Methods: A cross sectional study was conducted between April - June 2011 health care providers working in 36 randomly selected health facilities of Hai and Siha districts. A questionnaire was used to obtain information. Observation of health worker-client interaction was conducted using a check list.Results: A total of 250 health workers participated in this study. The majority (80 %) had adequate knowledge of EBF. However, 36 % of providers believed light porridge should be introduced after 4 months and 43 % believed infants will feel thirsty on breast- milk alone. Only 7 % of providers answered correctly on skills of support, positioning and attachment. Fifty percent of the facilities with labour/maternity wards gave breastfeeding lessons to post delivery women. The majority (90 %) gave theoretical information, without practical demonstration with positioning and/or attachment of the baby to the breast.Conclusion: Providers had adequate theoretical knowledge of EBF but lacked important skills to support women in breastfeeding practices. Few labor/maternity facilities used the opportunity to educate women on EBF. Pre- and in-service health providers’ training on breastfeeding should target improved practical skills.

Background: Isoniazid Preventive Therapy (IPT) reduced Tuberculosis (TB) among People Living with HIV (PLHIV). Despite this, uptake has been reported to be sub-optimal . We describe characteristics of visits in which PLHIV were screened TB negative (as the main source for IPT initiation), determine characteristics of visits in which PLHIV were initiated on IPT as well as determined factors associated with IPT initiation to inform program scale up and improve quality of service.Methods : Retrospective cohort study design which involved PLHIV enrolled into care and treatment clinics in Dar es Salaam, Iringa and Njombe regions from January 2012 to December 2016. The study aimed at evaluating implementation of IPT among PLHIV. Data analysis was conducted using STATA.Results: A total 173,746 were enrolled in CTC in the 3 regions during the period of follow up and made a total of 2,638,876 visits. Of the eligible visits, only 24,429 (1.26%) were initiated on IPT. In multivariate analysis, 50 years and more (aOR=3.42, 95% CI: 3.07-3.82, P