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The practice of Supply Chain Management is an application of the process view, focusing on delivering health commodities to clients and transitioning from functions to processes. The Prime Vendor system has been implemented through the existing institutional structures at various levels of government and funded exclusively by complementary funds. The availability of quality medicines in low-income and middle-income countries is often limited, especially in peripheral health facilities. This study provides a comprehensive understanding of the actual practice and associated factors of implementers on fidelity implementation of the prime vendor system. Materials and Methods: Data was collected from June to September 2023 using the ODK application from 356 respondents in the Dodoma, Morogoro, Mtwara, and Mwanza regions in Tanzania. They were analysed using SAS version 9.4. Statistical significance was determined at a 95% confidence level."5% confidence level. Results: In the study, 98.60% of health facility respondents reported procuring health commodities from prime vendors only when they received out-of-stock notifications from the Medical Stores Department. However, 85.67% disagreed with the practice of quarterly procurement. Additionally, 50.56% of respondents agreed they incurred costs upon consignment receipt, and 58.15% disagreed with health facility overseers being responsible for prime vendor preparation. The study revealed that 90.45% of respondents acknowledged the Health Facility Governing Committee/Medicine and Therapeutic Committee's role in approving orders and funds for health commodities procurement through the prime vendor system. Regarding payment timelines, 65.17% of respondents were uncertain about settling invoices within seven days. Most respondents (86.80%) disagreed with using online payment platforms when traditional banking services were unavailable. Furthermore, 88.76% relied on supplementary funds for procurement, while 73.60% disagreed with using in-kind receipts as a source of funds in implementing the prime vendor system. Regarding order submission and delivery, 73.60% did not support health facilities directly submitting their orders to prime vendors, and 56.18% were unaware of the delivery timelines used by the prime vendor to supply various destinations. Conclusion: The study elucidates the issues surrounding the procurement practices and procedures of health commodities through the prime vendor system, revealing significant variations in implementation fidelity among respondents. Factors influencing implementers' practices underscore the complex interplay between individual characteristics and systemic factors. Addressing these challenges requires targeted interventions, which are essential in enhancing smooth and consistent fidelity in the implementation of the prime vendor system, which will ensure equitable access to health commodities across healthcare facilities. [ABSTRACT FROM AUTHOR]

Background: Attitude-associated stigmas towards patients with mental illness affect most patients. However, the factors related to attitude-associated stigma among caregivers remain unknown. This might lead to the disruption of family relationships, low self-esteem, lack of socialization and other adverse effects. Therefore, the current study aimed to determine the associated stigma among caregivers of a patient with a mental illness Methods: A quantitative approach, with a cross-sectional study design, was used, involving two standardized questionnaires: Community Attitudes Towards the Mentally Ill (CAMI) Scale and Modified Consumer Experiences of Stigma Questionnaire (MCESQ), which were used to measure attitudes associated with stigma towards mentally ill patients, experienced stigma and discriminations among caregivers of patient with mental illness. Data were analyzed using SPSS version 20, and descriptive and appropriate inferential statistics such as Chi-square test, Pearson correction and logistic regression were used. Results: 422 caregivers living with mentally ill people attending Mirembe National Mental Hospital participated in the study. The overall prevalence of attitude-associated stigma towards mentally ill patients among caregivers was 95.3% in all four dimensions. However, in those who experienced stigma and discrimination, the overall prevalence was 63.3%. Factors that were statistically significantly associated with experiencing stigma and discrimination against mental disorders were age, education, occupation, place of residence, relationship and frequency of admission. Conclusion: Attitudes associated with stigma towards mentally ill patients among caregivers are associated with admissions, relationships and some demographic characteristics. Thus, the current study suggests that social support should be provided to caregivers with a family member having a mental illness. However, future studies with longitudinal study design might provide the risk factors that predispose caregivers to attitude-associated stigma. [ABSTRACT FROM AUTHOR]

Introduction: Access to safe, effective, quality and affordable essential medicines for all is a central component of Universal Health Coverage (UHC). However, the availability of quality medicines in low and middle-income countries is often limited, especially in peripheral health facilities. MSD, as the sole supplier of drugs and medical supplies to all public health facilities, has been facing difficulties that hinder its efficiency in supplying 100% of all facility’s needs. Despite significant reforms, including introducing the Prime Vendor System in 2018, challenges persist, leading to regional disparities in commodity availability at the facility level. Successfully establishing an intervention based on PPPs within the public sector in the health commodities supply chain system mostly requires high acceptability by the Government, implementers, and beneficiaries. Furthermore, the effectiveness of any activity is primarily influenced by the participants' attitudes. While most studies have extensively researched the effectiveness of the prime vendor system in bridging the supply chain gap, none have researched implementers' perceptions of the prime vendor system in complementing health commodities. This study seeks to understand the Implementer's perceptions of the prime vendor system implementation. Materials and Methods: This was a quantitative cross-sectional study. Data was collected from June to September 2023 using the ODK application from 356 respondents from Dodoma, Morogoro, Mtwara, and Mwanza in Tanzania. The data was analysed using SAS version 9.4. Statistical significance was determined at a 95% confidence level. Results: 77.84% of study participants strongly agreed that involving the private sector in health commodities supply chain management is the best approach to solving supply chain problems. Additionally, 81.53% of all study participants believe that the Prime Vendor System has contributed positively to the improved availability of health commodities at the facility level. Conclusion: Perceptions regarding the prime vendor system vary across different areas, including its impact on the overall availability of health commodities, streamlining of procurement processes, and the role of the private sector in addressing supply chain challenges within the country. Notably, the level of experience in the workplace emerges as a considerable influence on respondents' perceptions regarding the Prime Vendor System and its implementation nationwide. [ABSTRACT FROM AUTHOR]

Background: The United Republic of Tanzania's government has implemented various significant health commodities supply chain management reforms, including introducing and national rollout of the Prime Vendor System in October 2018. This initiative aimed to address and complement the 40% health commodities supply chain gap observed at the Medical Stores Department (HRSC-2017). Over the five years since its implementation, the Prime Vendor System has shown high acceptability by the Government, implementers, and the beneficiaries of the intervention; it resulted in increased availability of health commodities at health facilities, improved order fulfilment rates, and timely delivery of commodities, it made contributions to Tanzania's public health sector. However, despite the Government's strong commitment to the health sector, administrative reports indicate regional disparities in the Prime Vendor System bridging the health commodities supply chain gap. Little has been done to explore the knowledge level and influencing factors among Prime Vendor System implementers in addressing health commodities supply chain challenges. Therefore, this study aimed to understand the level of knowledge and its influencing factors among implementers regarding the Prime Vendor System Implementation in Tanzania Mainland. Methods: A quantitative cross-sectional study was conducted between June and September 2023, collecting data via the ODK application from 356 respondents across the Dodoma, Morogoro, Mtwara, and Mwanza regions. Statistical analysis was performed using SAS version 9.4, with significance set at a 95% confidence level. Results: All respondents (100%) were aware of the Prime Vendor System, with only 30.9% receiving formal orientation training. Most respondents (78.93%) reported having no prime vendor contracts in their health facilities yet recognized and acknowledged the PVS as complementary to the Medical Stores Department (MSD). However, only 60.76% knew of changes made since the PVS's introduction. Factors such as age and position within the healthcare organization influenced PVS knowledge. Conclusion: Respondents have a high level of knowledge and awareness of the prime vendor system's basic structure and transitional phases. However, there is a need for more sensitization and training in prime vendor contracts and continuous refresher training of the prime vendor system, especially for lower-level health facilities. [ABSTRACT FROM AUTHOR]

Background: Delayed Developmental Milestones are defined as slow to attain typical developmental milestones in one or more developmental areas. This study aimed to assess risk factors of delayed developmental milestones among infants in the Dodoma Region. Methods: We conducted a health facility-based cross-sectional descriptive study using the pathways developmental screening tool. A total of 262 mothers and their children were enrolled, and the study population consisted of neonates delivered at the study sites during the study period. Three data collection methods were utilized to obtain information for this study: observation, intervieweradministered questionnaires, and documentary review. Ethical approval was obtained from the Ethical Review Board of the University of Dodoma SAS version 9.4, which was used for data analysis. The association between developmental status and factors was assessed using Chi-square and binomial logistic regression. Results: Notably, infants born with birth asphyxia were more likely three times to develop delayed developmental milestones as opposed to those without birth asphyxia [adjusted risk ratio =3.22, 95%, [1.97, 5.46], probability value= <.0001]. Birth weight was significantly associated with delayed developmental milestones; infants who were born with a birth weight of =4000gm had more risk of developing delayed developmental milestones compared to those with a birth weight of 2500-3999gm [adjusted risk ratio 0.48, 95%, [0.26, 0.92], probability value = 0.0256]. Regarding mode of delivery, the risk of developing delayed developmental milestones was less among infants born via caesarean section compared to those who were born via spontaneous vaginal delivery [adjusted risk ratio 0.47[0.18, 0.99], probability value = 0.0461]. Conclusion: Delayed developmental milestones are a burden in developing countries. The risk factors are known, and they are based on the individual to the community level; birth asphyxia was identified as a possible risk factor that has been reported in many studies and has an impact on children's development. [ABSTRACT FROM AUTHOR]

Introduction: Obstetric Fistula (OF) among pregnant women remains a widespread condition with devastating consequences and poses a significant challenge in a community as well as globally. Objective: To determine the predictors and contributing factors associated with OF and birth outcomes in women undergoing fistula repair at the Dodoma Regional Referral Hospital (DRRH). Method: This retrospective study used hospital records of women repaired over 2013 and 2014. Data were analysed using SPSS version 21 for Window (SPSS Inc., Chicago, IL, USA). Frequency tables were generated and bivariate analyses were conducted to determine the contributing factors associated with OF using chi-squared statistics. Results: Fifty two women underwent surgical repair of a fistula; 47(90.2%) were primiparous and 5(9.6%) multiparous. There were 42(80.8%) vesico-vaginal fistulae (VVF), and 10(19.2%) recto-vaginal fistulae (RVF). Of those with VVF 5 (9.6%) had been living with urine leakage for 10 years, 25 (48.1%) for 17 years, and 12 (23.1%) for 20 years; all 10 (19.2%) with RVF had been living with the defect for 10 years. No patient had been living with both vaginal and recto fistulae. Most of the fistulas were associated with prolonged difficult spontaneous vaginal delivery but two were associated with surgery: Caesarean Section and hysterectomy. Surgical repair was by the transvaginal 47(90.4%) and trans abdominal 5(9.6%) routes. Female genital mutilation (FGM) was found in all the 28 women from the Gogo tribe but only in 12 of the 24 women from other tribes. Conclusion: Timely fistula repair by experienced fistula surgeons, adhering to fastidious basic surgical principles, will improve outcomes and limit the clinical insult and distress that OF invariably causes. Keywords: obstetrics fistula, recto-vaginal fistula, vesico-vaginal fistula, surgical repair, female genital mutilation, Tanzania.

Background: Tanzania has shown some improvements in the adoption of electronic medical record (EMR) systems in public health facilities; however, the rate of utilization of data generated from EMRs among health managers is not well documented. This study aims to assess the use of electronic medical record systems data in decision-making among health managers at public primary health facilities in Dodoma Region, Central Tanzania. Methods: A facility-based quantitative cross-sectional analytical study was conducted among 308 randomly selected health managers. A self-administered questionnaire supplemented with documentary review was used. Descriptive summary statistics and bivariable and multivariable logistic regression analyses (crude and adjusted odds ratios) were used. A P-value of <0.05 was used to declare statistically significant associations. Results: Overall, more than a third (40.6%) of the health managers, that is 174 of the 308 included in the study, reported using data generated by EMR systems in decision-making. One-third (33.4%) of the health managers were adequately using data generated by EMR systems, of which 39.3% used data to support continuous quality improvement initiatives. Among the facilities visited, only nine (30%) had good documented EMR systems data use. Access to computers [adjusted odds ratio (AOR) = 4.72, 95% confidence interval (CI): 1.65, 13.48, p-value (p) = 0.004] and discussions on EMRs during meetings (AOR = 2.77, 95% CI: 1.01, 7.58, p = 0.047) were independent predictors of EMR system data use. Those who reported having EMR systems in all working areas were seven times more likely to use EMR system data (AOR = 7.23, 95% CI: 3.15, 16.59, p = 0.001). The respondents with good perceived EMR system information quality were more likely to use EMR system data (AOR = 2.84, 95% CI: 1.50, 5.39, p = 0.001) than those with poor perception. Furthermore, health managers who had excellent knowledge of computers and data use had higher odds of using EMR system data (AOR = 1.84, 95% CI: 3.38, 10.13, p = 0.001) compared with their counterparts. Conclusions: The findings of this study indicate that utilization of EMR system data in decision-making among health managers was optimal. It was found that training in itself is insufficient to improve use of EMR, which points to more organizational aspects of work routine as a challenge. Hence, a comprehensive approach that addresses these factors is essential for maximizing EMR system data use in decision-making. [ABSTRACT FROM AUTHOR]

Background: The advantages of caesarean section (CS) in managing obstetric emergencies are abundant, but it is associated with several complications including surgical site infection (SSI). SSI significantly contributes to maternal morbidity and mortality rates. Mothers often do not receive adequate information about their at-home post-delivery care. Also, guidelines on post-CS care worldwide typically do not include home care recommendations. Because of the increased rate of CS and space constraints in the hospitals, mothers are often discharged home within 48 hours after CS. Therefore, it is anticipated that using an evidence-based home care guide would provide instruction to the mothers and is likely to prevent postpartum complications and promote the well-being of both the mother and the newborn. Aim: To design and test the effectiveness of a post-CS home care guide in preventing SSI in central Tanzania. Methodology: This is a sequential exploratory mixed-method interventional study conducted in two regional referral hospitals in central Tanzania. A qualitative study will be conducted to explore the experiences of nurse midwives, mothers who had caesarean deliveries and their caretakers regarding the care of mothers and newborns at home. The findings will inform the development of a post-CS home care guide. Following a series of validations of the guide, research assistants will employ the guidelines to instruct post-CS mothers about home care as part of the intervention. Thirty participants will purposively be recruited for the qualitative study and a random sample of 248 nurse-midwives and 414 post-CS mothers to assess the effectiveness of the guide in improving knowledge of home care and preventing SSI. SPSS version 25 will be used to analyse quantitative data and content analysis, and ATLAS.ti will guide in analysing the qualitative data. Conclusion: The post-CS home care guide will provide instructions to post-CS mothers and their caretakers about the care of the mothers after CS to enhance their recovery. [ABSTRACT FROM AUTHOR]

Understanding the managerial competency of healthcare managers is very important. However, more evidence is needed on the managerial competency of primary healthcare facility managers in low- and middleincome countries. This research examined the managerial competency of primary healthcare facility managers in the selected District Councils in Tanzania. This research is grounded on positivism philosophy, a cross-sectional survey descriptive research design, a complete enumeration sampling strategy, and a survey used to collect primary data from 102 public primary healthcare facility managers located in Kondoa, Iramba, and Sumbawanga District Councils in Tanzania. The study used version 25 of SPSS to analyze the data and adopted the MCAP framework to examine the managerial competency of primary healthcare facility managers. For the communication and relationship management domain, 74.5% were competent, while 25.5% were less than fully competent. Likewise, 65.68% of them were competent, while 34.32% needed to be more competent in the knowledge of the healthcare environment domain. 62.74% and 37.26% of the primary healthcare facility managers were competent and less than competent in operations, administration, and resources management. Correspondingly, 67.65% and 32.35% of primary healthcare facility managers needed to be more competent in evidence-informed decision-making. Similarly, 74.55% and 25.45% were competent and less competent in enabling and managing change. The study used primary data and contributed recently well-worth and highly demanded knowledge on the managerial competency of healthcare managers in the LMICs. [ABSTRACT FROM AUTHOR]