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Introduction: During the COVID-19 pandemic, there was no known specific treatment for coronavirus Disease. Because of this, different countries and institutions have used different regimens to manage disease symptoms. In Tanzania, well-known and long-used herbal preparations believed to have antiviral activities were used as supplements to standard care for COVID-19 management. This study assessed the clinical presentation and outcomes of hospitalized COVID- 19 patients receiving standard care plus herbal preparations in Tanzania. Methods: An observational cohort study was conducted between February and May 2021 at 12 health facilities. Sociodemographic information, clinical presentation, past medical history, baseline, and follow-up laboratory records were documented. Each study participant was followed up for 14 days from enrolment. Results: 285 participants were enrolled; their mean age was 59.2 ± 16.5 years, and males constituted 56% of the study participants. Nearly 33% were aged 50 years and above. The majority (72%) reported having at least one form of co-morbidities (raised blood pressure, diabetes mellitus, asthma, Chronic Obstructive Pulmonary Diseases (COPD) and other forms of heart problems apart from hypertension). More than 60% of the study participants reported to have used at least one form of locally available herbal preparations. Symptoms and signs reported at enrolment subsided relatively faster among those supplemented with herbal preparations than among their counterparts. PCR results of nearly 66% of the study participants had converted to PCR negative at different rates by day 7 (61 vs 78%) and by day 14 (64.3% vs 36.4%) among herbal and non-herbal users, respectively. Overall, proportionally mortality was higher among those who used standard care alone (23.3% vs 16.9%) compared to those supplemented with herbal preparations. Conclusion: The use of herbal preparations in addition to standard care treatment showed a positive effect in subsiding signs and symptoms and decreasing mortality among COVID-19 patients. The findings from this study call for further research, especially clinical trials, to ascertain these findings. Keywords: Herbal preparations, COVID-19 outcome, Clinical presentation [ABSTRACT FROM AUTHOR]

Background: Access to essential health commodities is fundamental to healthcare system efficacy. These commodities are vital in delivering health services and form integral elements within the World Health Organization's strengthening framework, encompassing the six foundational building blocks. Regrettably, there has been a global increase in shortages and stockouts of essential health commodities in recent years. Objective: The study aimed to identify factors influencing the availability of essential health commodities throughout all levels of the supply chain in Tanzania. Methods: A cross-sectional convergent parallel mixed method study that employed both qualitative and quantitative data collection techniques was conducted. Quantitative data were analyzed using STATA version 16, while qualitative data were thematically analyzed. Results: Factors contributing to stockouts of essential commodities at the national level included increased demand, delayed shipments from donors, decreased funding commitments, delayed disbursement of funds, global shortages, inadequate governance, debt within the Medical Stores Department, donor dependency for vertical programme commodities, and long lead times by Medical Stores Department's suppliers. At the regional and district levels, such factors include a shortage of human resources, lack of electronic medical records, limited interoperability of information systems, poor quality of logistics data, inadequate use of data for decision-making, and poor inventory management. At the healthcare facility level, factors included; an overwhelming number of exempted clients, which reduces facility revenues. Conclusion: More efforts are still needed to address both the upstream and downstream challenges required to ensure sustainable access and availability of essential health commodities at service delivery points, as a pathway for improving health sector performance. [ABSTRACT FROM AUTHOR]

Introduction: Differentiated Service Delivery Models (DSDM), a strategy to promote retention in HIV care and/or ART adherence, is now increasingly recognized as an important and sustainable approach that could contribute significantly toward the UNAIDS 90-90-90 by 2020 and 95-95-95 by 2030 targets and ultimately an AIDS-free generation. This study was conducted to determine the outcomes of DSDM among people living with HIV in Tanzania. Methods: A Cross-sectional analytical design approach employing both quantitative and qualitative data collection methods was adopted in this study that was implemented in 9 regions of Tanzania. We conducted record reviews and in-depth interviews with key informants at national and facility levels where their data was summarized and arranged in sub-themes and then analyzed according to the specific objectives by using Thematic Analysis. We further conducted a bivariate analysis using Chi-Square to assess the association between each outcome and explanatory variable. Unadjusted and adjusted analysis was conducted to determine predictors of unfavourable outcomes using logistics regression models. Results: Data was collected from 50 health facilities comprising 15 (30.0%) hospitals, 22 (44.0%) health centres and 13 (26.0%) dispensaries. Record reviews were for different outcomes as follows; Mis-categorization (13,056 records), Missed appointments (62,222 records), Advanced HIV disease (29,995 records), and Attrition (62,222 records). Among the 320 unstable clients, the rate of miscategorization significantly decreased after the introduction of DSDM, from 63% to 36% (p < 0.001). After the introduction of DSDM, more clients missed their appointments compared to the period before the introduction of DSDM (1.7% vs 0.8% respectively). Missed appointments were associated with an urban setting ( AOR 1.1, 95% CI 1.1-1.2) and older age of 50 years and more (AOR 1.2, 95% CI 1.1-1.4) in comparison to a rural setting and younger age of fewer than 15 years respectively. Furthermore, DSDM led to a decrease (from 56% to 49%) of those with advanced WHO stage among the first-time testers. Attrition among the clients was higher after the introduction of DSDM compared to that before DSDM (ARR 1.1, 95% CI 1.04-1.2). Contributors to attrition were those related to individuals and institutions including beliefs in faith healing, fear of stigma and wrong interpretation of viral load monitoring results. Conclusion: Decentralized Community-based ART model is a promising entry point to improved HIV/AIDS service delivery. Strategies are needed to harmonise the comprehensiveness and quality of services across facilities providing HIV services. [ABSTRACT FROM AUTHOR]

Background Different measures have been taken to treat and control the spread of COVID-19. One of these measures is the use of locally available herbal preparations. Despite their long-time use, still, information on their safety is scarce. Methods This observational cohort study was conducted from February to May 2021 among COVID-19 patients admitted at one of 12 (10 public and two private) health facilities in Tanzania. Participants were grouped into two - those who were using standard care alone and those who reported to be supplementing standard care with herbal preparations for the treatment of COVID-19. A review of medical records and interviews were done to obtain socio-demographic, clinical and laboratory information. All participants were followed up for 14. Results Half of the participants had normal hemoglobin levels at baseline and on day 14. Renal insufficiency was observed more among non-herbal users compared to herbal users (38.5% vs 21.8%) on day 7 (p = 0.04) and 54% vs 49% on day 14. Creatinine levels were significantly raised among non-herbal users than among herbal users at baseline (p = 0.002) and at day 14 (p = 0.045). There was no significant difference in INR level among both groups on day 7, however at day 14, the raise was more among non-herbal compared to herbal users (100% vs 20.5%). Conclusion There were no noticeable haematological, renal or liver parameters derangements among COVID19 patients who used herbal preparations plus standard care compared to those who used standard care alone. [ABSTRACT FROM AUTHOR]

Background: Starting Antiretroviral Treatment (ART) on time and being retained in care reduces the risk of HIV transmission, impoverishment of chronic end-organ effects of untreated viremia, and an overall increase in life expectancy. This study aimed at establishing available strategies for the linkage and retention of HIV clients as well as the costs associated with the strategy. Method: A retrospective cross-sectional design was conducted in eight regions of Tanzania mainland. A total of 60 facilities and affiliated communities providing linkage and ART services were involved. Mixed methods of collecting data were used with comprehensive document review. Information collected was for the period between 1st January to 31st December 2019. Cost evaluation was based on both patient and provider perspectives. Results: In general, 91% of the clients were successfully linked to care and the cost per client linked was $14.0 across regions. The cost of facility linkage strategy was $14.73 with personnel, commodities and supplies and training costs emerging as the cost drivers. The cost for client linkage to care using the community strategy was lower ($11.89) than the facility strategy ($14.73). The overall retention rate was 99% with no difference between retention strategies. The Cost of retention per client in facilities without outreach services was $14.73 while in facilities with outreach, the cost was $11.89. Personnel cost was the primary costs’ driver in both strategies. Of 1,039 participants involved, to establish patient incurred cost for retention to care. Females were 65.4% and 57.8% of participants were from rural settings. Clients incurred annual out-of-pocket payments was $12.06. Conclusion: There is no difference in the yield of the HIV-positive and overall percentage of clients successfully linked to care based on facility and community strategies. However, there is regional variations in terms of per-client cost for HIV linkage and retention services. The overall cost per client linked using the facility strategy was higher than the community strategy and personnel cost was the main cost driver in both linkage and retention costs. [ABSTRACT FROM AUTHOR]

Abstract Background Hemorrhage is the leading cause of obstetric mortality. Studies show that Active Management of Third Stage of Labor (AMTSL) reduces Post Partum Hemorrhage (PPH). This study describes the practice of AMTSL and barriers to its effective use in Tanzania. Methods A nationally-representative sample of 251 facility-based vaginal deliveries was observed for the AMTSL practice. Standard Treatment Guidelines (STG), the Essential Drug List and medical and midwifery school curricula were reviewed. Drug availability and storage conditions were reviewed at the central pharmaceutical storage site and pharmacies in the selected facilities. Interviews were conducted with hospital directors, pharmacists and 106 health care providers in 29 hospitals visited. Data were collected between November 10 and December 15, 2005. Results Correct practice of AMTSL according to the ICM/FIGO definition was observed in 7% of 251 deliveries. When the definition of AMTSL was relaxed to allow administration of the uterotonic drug within three minutes of fetus delivery, the proportion of AMTSL use increased to 17%. The most significant factor contributing to the low rate of AMTSL use was provision of the uterotonic drug after delivery of the placenta. The study also observed potentially-harmful practices in approximately 1/3 of deliveries. Only 9% out of 106 health care providers made correct statements regarding the all three components of AMTSL. The national formulary recommends ergometrine (0.5 mg/IM) or oxytocin (5 IU/IM) on delivery of the anterior shoulder or immediately after the baby is delivered. Most of facilities had satisfactory stores of drugs and supplies. Uterotonic drugs were stored at room temperature in 28% of the facilities. Conclusion The knowledge and practice of AMTSL is very low and STGs are not updated on correct AMTSL practice. The drugs for AMTSL are available and stored at the right conditions in nearly all facilities. All providers used ergometrine for AMTSL instead of oxytocin as recommended by ICM/FIGO. The study also observed harmful practices during delivery. These findings indicate that there is a need for updating the STGs, curricula and training of health providers on AMTSL and monitoring its practice.

Background: Regular street food consumers (RSFCs) in Africa are at an increased risk of unhealthy eating practices, which have been associated with intermediate risk factors of cardio-metabolic diseases. However, knowledge of the magnitude and correlates of these risk factors is limited in Tanzania. This study aimed to fill this gap using data collected from RSFCs in Dar es Salaam, the largest city in Tanzania. Methodology: A cross-sectional study was carried out among 560 RSFCs in three districts of Dar es Salaam between July and September 2018. Information on socio-economic factors and demographics, behavioral risks, anthropometric and biochemical indicators was collected. Adjusted odds ratios (OR) and prevalence ratio (PR) with corresponding 95% confidence intervals (CI) were estimated using multivariable binary logistic and modified Poisson regression models, respectively. Results: On average, participants consumed 11 street food meals/week. The prevalence (95% CI) of cardio-metabolic risk factors was 63.9% (60.6– 69.9%) for overweight/obesity, 42.5% (38.3– 46.9%) for raised blood pressure, 13.5% (10.9– 16.8%) for raised triglycerides and 6.6% (4.9– 9.3%) for raised glucose levels. The correlates of overweight/obesity were female vs male sex (APR=1.3; 95% CI 1.2– 1.5), age of 41– 64 vs 25– 40 years (APR=1.4; 95% CI 1.2– 1.6), high vs low income (APR=1.2; 95% CI 1.04– 1.3), being married/cohabiting vs other (APR=1.2; 95% CI 1.01– 1.4) and family history of diabetes vs no family history (APR=1.2; 95% CI 1.01– 1.3). Age 41– 64 vs 25– 40 years, was the only significant factor associated with raised blood pressure APR (95% CI) 2.2 (1.7– 2.9) and raised glucose AOR (95% CI) 3.9 (1.5– 10.5). Conclusion: Our study revealed that RSFCs are at risk of cardio-metabolic health problems, especially women, middle-aged people and those with higher incomes. Transdisciplinary studies to understand the drivers of street food consumption are needed in order to inform interventions to mitigate the risk of developing cardio-metabolic diseases. These interventions should target both street food vendors and their consumers. [ABSTRACT FROM AUTHOR]

Abstract Objective To assess the magnitude and factors responsible for delay in TB management. Design A cross sectional hospital based survey in Dar es Salaam region, May 2006. Results We interviewed 639 TB patients. A total of 78.4% of patients had good knowledge on TB transmission. Only 35.9% had good knowledge on the symptoms. Patient delay was observed in 35.1% of the patients, with significantly (X2 = 5.49, d.f. = 1, P = 0.019) high proportion in females (41.0%) than in males (31.5%). Diagnosis delay was observed in 52.9% of the patients, with significantly (X2 = 10.1, d.f. = 1, P = 0.001) high proportion in females (62.1%) than in males (47.0%). Treatment delay was observed in 34.4% of patients with no significant differences among males and females. Several risk factors were significantly associated with patient's delays in females but not in males. The factors included not recognizing the following as TB symptoms: night sweat (OR = 1.92, 95% CI 1.20, 3.05), chest pain (OR = 1.62, 95% CI 1.1, 2.37), weight loss (OR = 1.55, 95% CI 1.03, 2.32), and coughing blood (OR = 1.47, 95% CI 1.01, 2.16). Other factors included: living more than 5 Km from a health facility (OR = 2.24, 95% CI 1.41, 3.55), no primary education (OR = 1.74, 95% CI 1.01, 3.05) and no employment (OR = 1.77, 95% CI 1.20, 2.60). In multiple logistic regression, five factors were more significant in females (OR = 2.22, 95% CI 1.14, 4.31) than in males (OR = 0.70, 95% CI 0.44, 1.11). These factors included not knowing that night sweat and chest pain are TB symptoms, a belief that TB is always associated with HIV infection, no employment and living far from a health facility. Conclusion There were significant delays in the management of TB patients which were contributed by both patients and health facilities. However, delays in most of patients were due to delay of diagnosis and treatment in health facilities. The delays at all levels were more common in females than males. This indicates the need for education targeting health seeking behaviour and improvement in health system.

Background A randomized trial demonstrated that among people living with late-stage human immunodeficiency virus (HIV) infection initiating antiretroviral therapy, screening serum for cryptococcal antigen (CrAg) combined with adherence support reduced all-cause mortality by 28%, compared with standard clinic-based care. Here, we present the cost-effectiveness. Methods HIV-infected adults with CD4 count <200 cells/μL were randomized to either CrAg screening plus 4 weekly home visits to provide adherence support or to standard clinic-based care in Dar es Salaam and Lusaka. The primary economic outcome was health service care cost per life-year saved as the incremental cost-effectiveness ratio (ICER), based on 2017 US dollars. We used nonparametric bootstrapping to assess uncertainties and univariate deterministic sensitivity analysis to examine the impact of individual parameters on the ICER. Results Among the intervention and standard arms, 1001 and 998 participants, respectively, were enrolled. The annual mean cost per participant in the intervention arm was US$339 (95% confidence interval [CI], $331–$347), resulting in an incremental cost of the intervention of US$77 (95% CI, $66–$88). The incremental cost was similar when analysis was restricted to persons with CD4 count <100 cells/μL. The ICER for the intervention vs standard care, per life-year saved, was US$70 (95% CI, $43–$211) for all participants with CD4 count up to 200 cells/μL and US$91 (95% CI, $49–$443) among those with CD4 counts <100 cells /μL. Cost-effectveness was most sensitive to mortality estimates. Conclusions Screening for cryptococcal antigen combined with a short period of adherence support, is cost-effective in resource-limited settings. [ABSTRACT FROM AUTHOR]

Introduction: In 2018, there were appropriately 20.6 million [18.2 million-23.2 million] people living with HIV in Eastern and Southern Africa, and an estimated 67% of them were on antiretroviral therapy (ART). A major challenge in the scale-up of ART services in Sub-Saharan Africa is the severe shortage of clinical staff. Methods: We conducted a randomised trial in Tanzania and Zambia to test an innovative intervention that involved the use of lay health workers and screening for cryptococcal meningitis and tuberculosis. Here we describe the model of care with a particular focus on the trained lay worker component. Lay workers carried out home visits to patients in the intervention arm to deliver antiretroviral drugs, provide adherence counselling, and conduct simple monitoring for treatment side effects and other medical conditions. Lay workers were responsible for referring patients with conditions that might require further medical attention as well as discouraging self-referral. A total of 1999 participants were enrolled in the trial. Lay workers were recruited through public advertisements. Results: Six lay workers were recruited in each country and trained for two weeks. Each lay worker was paid a monthly salary of US$ 487.61 in Zambia and US$ 524.61in Tanzania. They were also paid communication and transport expenses for home visits. The median number of visits per patient was 3 for Tanzania and 4 for Zambia. On average a lay worker was responsible for 72.3 patients in Tanzania and 94.5 in Zambia for 1 year. Referrals were made in 9% of the home visits and self-referral was discouraged in 64% of visits. Conclusion: The use of paid lay workers to provide HIV/AIDS services in urban settings where there is a shortage of clinical staff may help to identify ART related side effects/adverse reactions and prevent unnecessary referrals. [ABSTRACT FROM AUTHOR]

Background: Until about a decade or so ago, African health services were dealing principally with acute communicable diseases. HIV programmes in sub-Saharan Africa are well-funded and crucially over 60% of people with HIV-infection are in regular care with good viral suppression. The programmes for diabetes and hypertension are weak, and the burden of these conditions is rising where only 10%-20% of people with these conditions are said to be in regular care. Objective: To assess the effectiveness of the integration of services for diabetes, hypertension, and HIV-infection. Methods: A total of 32 primary care health facilities in Tanzania and Uganda were randomised to either integrated or standard vertical care in a 1:1 ratio. In integrated care, services are organised from a single clinic where patients with either HIV-infection, diabetes, hypertension, or combinations of these have access to the same waiting area, triage, and health information, managed by the same clinical team and use the same pharmacy and laboratory services. Standard care involves separate clinics as routinely conducted. The trial has 2 primary endpoints: retention in care of people with HIV, hypertension, diabetes, and plasma viral load suppression. Preliminary results: Between March 2020 and April 2021, 7602 participants were screened of whom 7033(93%) were enrolled in the trial. 16 sites were randomized to the intervention arm and 16 sites to the standard of care arm. Of the participants enrolled, 3441(48.9%) were enrolled to Arm A and 3592(51.1%) enrolled in Arm B. About 50% of participants are less than 50 years old, over 70% of participants are female and about 20% of those enrolled had multiple conditions. Participants are still being followed up and are anticipated to complete follow-up in April 2022. Discussion: This is the only randomised trial of its kind evaluating a one-stop integrated clinic for common high-burden diseases in Africa, designed to generate policy-relevant evidence on the reorganisation of chronic care services in Africa. These early findings could lead to identification of a sustainable and effective integration model and could result to substantially improved health services for these chronic conditions in resource poor settings. [ABSTRACT FROM AUTHOR]