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Objectives : The aim of this study was to investigate whether chia ( Salvia hispanica ) seeds, which are rich in omega-3 fatty acids, amino acids, and vitamins with antioxidant properties, can mitigate the negative effects on male reproductive function caused by cyclophosphamide, a frequently used chemotherapeutic agent. Methods : Male wistar rats are divided into seven groups (n=6). All groups except the normal control (NC) received cyclophosphamide (30mg/kg, i.p.) for the first 5 days. The standard group received clomiphene citrate (0.25 mg/kg, p.o.). Treatment groups T1%, T5%, T10%, and ω-3 received 1%, 5%, and 10% chia seeds in the diet, and 880 mg/kg omega-3 fatty acid (p.o) respectively for 15 days. The effect on the reproductive system was evaluated by analysis of epididymal sperm characteristics, biochemical parameters, and serum testosterone level. Results : Clomiphene citrate improved oligospermia via hormone mediated effect. Chia seeds and omega-3 fatty acid treatment also showed improvement in reproductive parameters including oxidative stress and histological features of the testes. Omega-3 fatty acid treatment was more effective for the prevention of cyclophosphamide toxicity on testes as compared to chia seeds. Nasal bleeding was noted in several animals subjected to chia seed treatment. This occurrence might be attributed to chia seeds' impact on coagulation and/or platelet function, potentially heightened due to chemotherapy associated bone marrow suppression. Conclusions : In our study, chia seeds as well as omega-3 fatty acid treatment were found to be protective against cyclophosphamide-induced reproductive toxicity in rats. However, the adverse effect of hemorrhage associated with drug interaction of chia seeds with cytotoxic chemotherapeutic drugs needs careful attention and further investigation., (Copyright ©2023, Yale Journal of Biology and Medicine.)

Objective: The aim of this study is to explore nutrition-related health needs, the perceptions and beliefs regarding the double burden of malnutrition, as well as barriers and facilitators in accessing nutritious food among the local population in rural Tanzania., Design: A qualitative study design using semi-structured individual interviews and focus-group discussions (FGD) was used. Basic socio-demographic information was obtained from all participants., Setting: The study was conducted in four villages within the catchment area of the Shirati KMT Hospital in Rorya district, in north-western Tanzania., Participants: Men and women in the reproductive age as well as Community Health Workers (CHW) were included., Results: In total, we performed fourteen interviews ( N 41), consisting of four FGD, one dual and nine individual interviews. The three most significant topics that were identified are the large knowledge gap concerning overweight and obesity as a health problem, changing weather patterns and its implications on food supply and the socio-cultural drivers including gender roles and household dynamics., Conclusion: Environmental and socio-cultural factors play a crucial role in the determinants for DBM, which underlines the importance of understanding the local context and the nutrition practices and beliefs of the communities. Future nutritional interventions should aim towards more inclusion of men in project implementation as well as support of women empowerment. CHW could play a key role in facilitating some of the suggested interventions, including nutritional counselling and increasing awareness on the drivers of the double burden of malnutrition.

Objective: To examine screening outcomes for a rural screen-and-treat site as well as the referral completion rate, outreach programming, and screening costs., Methods: A retrospective cross-sectional analysis of demographic information and screening outcomes for all women screened at a rural screen-and-treat site between August 2011 and December 2018 was conducted. Referral completion rate for women with suspected cervical cancer was calculated for 2018., Results: A total of 10 157 screenings were conducted during the study period. Median age was 35 years and median parity was 5. In all, 545 (5.35%) women were positive on visual inspection with acetic acid (VIA+), and 461 (91.1%) of 506 eligible women received cryotherapy. In 2018, 93 women were referred for suspected cancer to the zonal referral center, but only 10 (10.8%) presented for treatment. Mean screening cost was US$ 6.62 per person., Conclusion: VIA+ rate was comparable to rates at urban sites in Tanzania, and outreach was an important component of screening. In contrast to other reports, few women suspected of having cancer reached treatment after being referred. Although the low cost of screening highlights the feasibility of rural screen-and-treat sites, additional research is needed to improve completion of referrals to a higher level of care., (© 2022 International Federation of Gynecology and Obstetrics.)

Background: Rates of maternal mortality and morbidity in Africa remain unacceptably high, as many women deliver at home, without access to skilled birth attendants and life-saving medications. In rural Tanzania, women face significant barriers accessing health care facilities for their deliveries., Methods: From January 2017 to February 2019 we conducted a multiple baseline (interrupted time series) trial within the four divisions of Rorya District, Tanzania. We collected baseline data, then sequentially introduced a complex intervention in each of the divisions, in randomized order, over 3 month intervals. We allowed for a 6 month transition period to avoid contamination between the pre- and post-intervention periods. The intervention included using community health workers to educate about safe delivery, distribution of birth kits with misoprostol, and a transport subsidy for women living a distance from the health care facility. The primary outcome was the health facility birth rate, while the secondary outcomes were the rates of antenatal and postpartum care and postpartum hemorrhage. Outcomes were analyzed using fixed effects segmented logistic regression, adjusting for age, marital status, education, and parity. Maternal and baby morbidity/mortality were analyzed descriptively., Results: We analyzed data from 9565 pregnant women (2634 before and 6913 after the intervention was implemented). Facility births increased from 1892 (71.8%) before to 5895 (85.1%) after implementation of the intervention. After accounting for the secular trend, the intervention was associated with an immediate increase in the odds of facility births (OR = 1.51, 95% CI 1.14 to 2.01, p = 0.0045) as well as a small gradual effect (OR = 1.03 per month, 95% CI 1.00 to 1.07, p = 0.0633). For the secondary outcomes, there were no statistically significant immediate changes associated with the intervention. Rates of maternal and baby morbidity/mortality were low and similar between the pre- and post-implementation periods., Conclusions: Access to health care facilities can be improved through implementation of education of the population by community health workers about the importance of a health care facility birth, provision of birth kits with misoprostol to women in late pregnancy, and access to a transport subsidy for delivery for women living at a distance from the health facility., Clinical Trials Registration: NCT03024905 19/01/2017., (© 2022. The Author(s).)

Background: Access to safe, high-quality surgical care in sub-Saharan Africa is a critical gap. Interventions to improve surgical quality have been developed, but research on their implementation is still at a nascent stage. We retrospectively applied the Exploration, Preparation, Implementation, Sustainment framework to characterize the implementation of Safe Surgery 2020, a multicomponent intervention to improve surgical quality., Methods: We used a longitudinal, qualitative research design to examine Safe Surgery 2020 in 10 health facilities in Tanzania's Lake Zone. We used documentation analysis with confirmatory key informant interviews (n = 6) to describe the exploration and preparation phases. We conducted interviews with health facility leaders and surgical team members at 1, 6, and 12 months (n = 101) post initiation to characterize the implementation phase. Data were analyzed using the constant comparison method., Results: In the exploration phase, research, expert consultation, and scoping activities revealed the need for a multicomponent intervention to improve surgical quality. In the preparation phase, onsite visits identified priorities and barriers to implementation to adapt the intervention components and curriculum. In the active implementation phase, 4 themes related to the inner organizational context-vision for safe surgery, existing surgical practices, leadership support, and resilience-and 3 themes related to the intervention-innovation-value fit, holistic approach, and buy-in-facilitated or hindered implementation. Interviewees perceived improvements in teamwork and communication and intra- and inter-facility learning, and their need to deliver safe surgery evolved during the implementation period., Conclusions: Examining implementation through the exploration, preparation, implementation, and sustainment phases offers insights into the implementation of interventions to improve surgical quality and promote sustainability., (Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Recent efforts to increase access to safe and high-quality surgical care in low- and middle-income countries have proven successful. However, multiple facilities implementing the same safety and quality improvement interventions may not all achieve successful outcomes. This heterogeneity could be explained, in part, by pre-intervention organizational characteristics and lack of readiness of surgical facilities. In this study, we describe the process of developing and content validating the Safe Surgery Organizational Readiness Tool., Materials and Methods: The new tool was developed in two stages. First, qualitative results from a Safe Surgery 2020 intervention were combined with findings from a literature review of organizational readiness and change. Second, through iterative discussions and expert review, the Safe Surgery Organizational Readiness Tool was content validated., Results: The Safe Surgery Organizational Readiness Tool includes 14 domains and 56 items measuring the readiness of surgical facilities in low- and middle-income countries to implement surgical safety and quality improvement interventions. This multi-dimensional and multi-level tool offers insights into facility members' beliefs and attitudes at the individual, team, and facility levels. A panel review affirmed the content validity of the Safe Surgery Organizational Readiness Tool., Conclusion: The Safe Surgery Organizational Readiness Tool is a theory- and evidence-based tool that can be used by change agents and facility leaders in low- and middle-income countries to assess the baseline readiness of surgical facilities to implement surgical safety and quality improvement interventions. Next steps include assessing the reliability and validity of the Safe Surgery Organizational Readiness Tool, likely resulting in refinements., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background/objectives: Sickle cell disease (SCD) is an important, hidden cause of childhood mortality worldwide. It is most prevalent in sub-Saharan Africa where national newborn screening programs remain unavailable and most children in rural areas are never diagnosed. We conducted a study at a rural district hospital in northern Tanzania to determine the birth prevalence and community awareness of SCD and to determine the feasibility of using point-of-care testing to enroll newborns in a new SCD clinic for ongoing treatment., Design/methods: We screened infants at Shirati KMT hospital for SCD using HemoTypeSC, an inexpensive point-of-care test. Infants who screened positive were enrolled in the SCD clinic and instructed to return at 6-12 weeks for confirmatory testing, counseling, and preventive care., Results: A total of 999 newborns were screened from February to September 2019. Among these, 31.6% (315/999) had sickle cell trait and 3.9% (39/999) had SCD. No hemoglobin C was detected. Very few parents knew their own sickle cell status (0.3%). At 5 months after completion, 12 infants from the screening study and 30 additional children had been seen at the SCD clinic for ongoing counseling and care., Conclusions: Birth prevalence of SCD in rural Tanzania is extremely high and community awareness is low. Newborn point-of-care testing enhances case finding and enables early enrollment in preventive care for SCD, even in rural sub-Saharan Africa with minimal laboratory capacity. SCD-specific clinical services implemented at the district hospital level could expand access to many children and significantly reduce early SCD morbidity and mortality., (© 2020 Wiley Periodicals LLC.)

Objectives: In order to improve maternal health and women's access to maternity care services in Rorya District, Mara, Northern Tanzania, we introduced several interventions across the district from 2018 to 2019. The interventions were workshops with nurses to encourage respectful care of women and transportation subsidies for women to reach the health facilities for delivery. In addition, we trained community health workers to educate couples about safe birthing options using m-health applications, to collaborate with nurses to distribute clean birth kits with misoprostol and to hold village meetings to shift community norms. This article reports on the experiences of women, community health workers and nurses during the study., Methods: Focus group discussions were conducted with a convenience sample of these groups to understand the successes and challenges of the interventions., Results: The workshops with nurses to encourage respectful maternity care and the birth kits with misoprostol were appreciated by all and were an incentive for women to seek health services. While the m-health applications were innovative, the system required significant oversight and a stable network. The village meetings demonstrated some success and should be expanded. Travel subsidies were problematic to implement and only helpful to the minority who received them., Conclusion: Multiple intervention strategies are needed to help women access maternity care services in rural locations and should be designed to meet needs within the local context. In Rorya District, access to quality health care was improved through training nurses to provide respectful care and using community health workers to educate the population about safe birthing practices and to provide women with clean birth kits. Despite the current limitations of m-health, there is much potential for development. Finding solutions to women's need for transport is a particular challenge and will likely require innovative community-based approaches.

Background: Disrespectful and abusive care of women during their pregnancies has been shown to be a barrier for women accessing health care services for antenatal care and delivery. As part of an implementation research study to improve women's access to health care services in Rorya District, Mara, Tanzania, we conducted a pilot study training reproductive health care nurses to be more sensitive to women's needs based on the "Health Workers for Change" curriculum., Methods: Six series of workshops were held with a total of 60 reproductive health care nurses working at the hospitals, health centres and dispensaries in the district. The participants provided comments on a survey and participated in focus groups at the conclusion of the workshop series. These qualitative data were analyzed for common themes., Results: The participants appreciated the training and reflected on the poor quality of health care services they were providing, recognizing their attitudes towards their women patients were problematic. They emphasized the need for future training to include more staff and to sustain positive changes. Finally, they made several suggestions for improving women's experiences in the future., Conclusions: The qualitative findings demonstrate the success of the workshops in assisting the health care providers to become aware of their negative attitudes towards women. Future research should examine the impact of the workshops both on sustaining attitudinal changes of the providers and on the experiences of pregnant women receiving health care services.

Objective: To determine community member and policy maker priorities in improving maternal health in rural Tanzania., Methods: The present participatory action research project was conducted in Rorya District, Mara Region, Tanzania, between November 20 and 25, 2015. A convenience sample of four community and one policy maker discussion groups were held to identify factors impacting on maternal health. The inclusion criterion for community members was a recent personal or partner experience with childbirth, or experience as a village leader. The policy maker participants were enrolled from all members of the District Council Health Management Team., Results: There was considerable overlap in priorities expressed by community members and policy makers. The most common priorities were to improve the transportation options for women to get to the health facility, the availability of supplies in the health facilities, and healthcare provider attitudes toward women, and to increase the number of skilled healthcare providers. Policy makers also prioritized improved health education of women, improved access to health facilities, and increased power in decision-making for women., Conclusions: Community members and policy makers have similar priorities for improving maternal health, which involve both social and structural changes., (© 2018 International Federation of Gynecology and Obstetrics.)

In rural Africa, deaths from childbirth are common and access to health care facilities with skilled providers is very limited. Leading causes of death for women are bleeding and infection. In this pilot study, we establish the feasibility of distributing oral medications to women in rural Tanzania to self-administer after delivery to reduce bleeding and infection. Of the 642 women provided with medications, 90% of the women took them appropriately, while the remaining 10% did not require them. We conclude that is it feasible to distribute oral medications to rural women to self-administer after delivery.