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Sickle cell anaemia (SCA) is a genetic disorder with multisystem manifestations. Paediatricians and general practitioners dealing with these patients need to know the overview of the genetics, diagnosis, clinical manifestations, and treatment of sickle cell anaemia associated complications. Poor growth and delayed pubertal development is often impaired in children with SCA. Abnormalities include low Z-scores for height and weight for age, delay in skeletal and sexual maturation. Poor growth and lack of sexual development may lead to emotional and social difficulties and in some patients their consequences can persist to adulthood.The magnitudes of delayed puberty in children with SCA in Tanzania have not been studied; however there is a study which evaluated the growth and pubertal development parameters for the non sickle cell children in Dar es Salaam City. In Africa few studies on pubertal development have been published and hence, the need for baseline reference data to facilitate the interpretation of sexual maturity assessments in Tanzanian children with sickle cell anaemia. To compare growth and pubertal development of children with SCA to normative references of urban Tanzanian children in Dar es Salaam. This was a hospital based cross-sectional study with historical control design. Anthropometric measurements of growth and Tanner stages of sexual development of children with sickle cell anaemia aged between 6 and 18 years were compared with normative references for growth and sexual maturity levels derived from a previous study of 3384 Dar es Salaam urban Tanzanian children aged 6-18 years. Data was analyzed using STATA IC version 9 statistical packages. In addition, z-scores were calculated based on UK population reference data which is probably currently the most comprehensive data set available for this age group. Results: During the study period, 301 children were recruited out of whom 144 (48%) were females .The mean age (SD) of the subjects was 12.4 (±3.5) years and the mean age by sex was not statistically significant (P=0.108). Girls with SCA were at puberty (breast Tanner stage 2) at a mean age (SD) of 14.8 (±4.6) years as compared to 11.5 (±1.5) years for non SCA controls and the difference was statistically significant (P0.05 throughout). Boys with SCA had low mean weight (P=0.001), height (P=0.009), and body mass index (P

Introduction: To improve healthcare provider knowledge of Tanzanian newborn care guidelines, we developed adaptive Essential and Sick Newborn Care (aESNC), an adaptive e-learning environment (AEE). The objectives of this study were to 1) assess implementation success with use of in-person support and nudging strategy and 2) describe baseline provider knowledge and metacognition., Methods: 6-month observational study at 1 zonal hospital and 3 health centers in Mwanza, Tanzania. To assess implementation success, we used the RE-AIM framework and to describe baseline provider knowledge and metacognition we used Howell's conscious-competence model. Additionally, we explored provider characteristics associated with initial learning completion or persistent activity., Results: aESNC reached 85% (195/231) of providers: 75 medical, 53 nursing, and 21 clinical officers; 110 (56%) were at the zonal hospital and 85 (44%) at health centers. Median clinical experience was 4 years [IQR 1,9] and 45 (23%) had previous in-service training for both newborn essential and sick newborn care. Efficacy was 42% (SD±17%). Providers averaged 78% (SD±31%) completion of initial learning and 7%(SD±11%) of refresher assignments. 130 (67%) providers had ≥1 episode of inactivity >30 day, no episodes were due to lack of internet access. Baseline conscious-competence was 53% [IQR:38-63%], unconscious-incompetence 32% [IQR:23-42%], conscious-incompetence 7% [IQR:2-15%], and unconscious-competence 2% [IQR:0-3%]. Higher baseline conscious-competence (OR 31.6 [95%CI:5.8, 183.5) and being a nursing officer (aOR: 5.6 [95%CI:1.8, 18.1]), compared to medical officer) were associated with initial learning completion or persistent activity., Conclusion: aESNC reach was high in a population of frontline providers across diverse levels of care in Tanzania. Use of in-person support and nudging increased reach, initial learning, and refresher assignment completion, but refresher assignment completion remains low. Providers were often unaware of knowledge gaps, and lower baseline knowledge may decrease initial learning completion or activity. Further study to identify barriers to adaptive e-learning normalization is needed., Competing Interests: Competing Interests. BR and MB are compensated by Area 9 Lyceum as Senior Learning Architect and Medical Director, respectively.