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ABSTRACT The World Health Organization's definition of oral health underscores its holistic nature encompassing physiological, psychosocial, and functional dimensions. The current estimates of oral diseases in Tanzania and around the world underscore the urgency of intervention, particularly in light of rising sugar consumption trends. The unique challenges facing Tanzania, including inadequate knowledge, limited infrastructure, and disparities in oral healthcare access, are analyzed within the broader context of sub‐Saharan Africa's health priorities. This article addresses the multifaceted challenges of oral health neglect in Tanzania, emphasizing the imperative need for a comprehensive and integrated approach. The discussion offers a detailed exploration of determinants contributing to oral health neglect, spanning socioeconomic, behavioral, and commercial factors, with a focus on their implications for Tanzanian communities. Recommendations are presented as a strategic roadmap, encompassing public health education, integrated healthcare services, government intervention, educational programs, community engagement, financial accessibility, and research initiatives. By synthesizing these recommendations into a cohesive framework, a proactive and collaborative approach to mitigate the consequences of oral health neglect in Tanzania, emphasizing the need for transformative policies and cultural sensitivity, is therefore envisioned.

Abstract The current Marburg virus (MARV) outbreak in Tanzania served as a stark reminder of the ongoing threat posed by emerging infectious diseases and the urgent need for global health security. The Tanzanian Ministry of Health (MoH) officially declared the outbreak on March 21, 2023. Eight cases in all, five of which included fatalities, have been reported in the country at present. The virus is a member of the Filoviridae family closely related to the widely known Ebola virus. Similar to other filoviruses, MARV causes acute and lethal hemorrhagic fever in both human and nonhuman primates with high case fatality rates ranging from 24% to 90%. The outbreak has highlighted the need for improved disease surveillance and response systems, as well as increased funding for research into emerging infectious diseases. The Tanzanian MoH has deployed a response team to investigate and monitor the transmission in the Kagera Region. The team works closely in collaboration with other organizations, such as the World Health Organization and the Africa Centre for Disease Control and Prevention, to ensure the effective control of the situation. Although there is no vaccine or treatment approved for Marburg virus disease (MVD), supportive management improves survival. Existing infection prevention and control protocols for Ebola and other viral hemorrhagic fevers such as isolation and use of appropriate personal protective equipment can be used to prevent transmission of MVD. The global community must work together to strengthen health systems, enhance research efforts, and build resilient and responsive health systems to prevent future outbreaks of this kind. In this article, we have analyzed the MVD outbreak in Tanzania, specifically in the Bukoba district of the Kagera Region, and provided recommendations for the management of the current outbreak and future outbreaks.

This article investigates the escalating occurrence of zoonotic diseases in Africa, attributing their spread to climate change and human activities. Africa’s unique combination of biodiversity, reliance on animal husbandry, and swift urbanization heightens its susceptibility. Climate change disrupts ecosystems and animal habitats, intensifying human-wildlife interactions. Urbanization, inadequate sanitation, and insufficient healthcare infrastructure further facilitate disease spread. Climate-induced displacement adds another layer of complexity. Mitigation strategies include improving surveillance systems, fostering early detection via point-of-care diagnostics and digital contact tracing, and investing in vaccines and therapeutics. Our purpose of this is to advocate for sustainable land use, robust community-level public health systems, international cooperation, and resource-sharing. We also emphasize the need for effective vector-control policies, dedicated research funding, and annual awareness, vaccination, and early detection campaigns in endemic regions.

Introduction: Adolescent girls and young women (AGYW) continue to experience a high incidence of HIV in southern and eastern Africa, even in the context of large-scale HIV prevention interventions. In Tanzania, AGYW account for the largest proportion of new infections and have a higher risk of HIV acquisition than males of comparable age., Methods: We used routinely collected data from the PEPFAR/USAID-funded Sauti Project, a large combination HIV prevention program, to examine the relationship between transactional sex and sex with older partners among AGYW in Tanzania (2015-2020). Out-of-school AGYW 15-24 years completed a vulnerability index and were tested for HIV. We estimated weighted prevalence ratios (PR) and 95% confidence intervals (CI) for the associations of transactional sex (sex exchanged for money/services/gifts outside of sex work) and sex with older partners (≥5-years older, ≥10-years older) with prevalent HIV. Age cutoffs of 5 and 10 years were used to align partner age differences with age-disparate and intergenerational sex, respectively. We assessed potential synergism between exposures, and subgroup analyses explored associations among girls 15-19., Results: Sixty seven thousand three hundred fifty seven AGYW completed the vulnerability index and 14,873 had captured HIV testing records. Median age was 20 years (IQR 18-22). Transactional sex and age-disparate sex were common (35% and 28%, respectively); 13% of AGYW reported both behaviors. HIV prevalence was associated with both transactional sex (PR: 1.28; 95% CI 1.00-1.63) and age-disparate sex (PR:1.26, 95% CI 0.99-1.60). In common referent analysis, transactional sex remained strongly associated with HIV, even in the absence of age-disparate sex (PR 1.41; 95% CI 1.02-1.94)., Discussion: Evidence of statistical synergism was not present, suggesting both transactional sex and age-disparate sex operate through similar pathways to increase HIV risk. Increased specificity within HIV prevention programs is needed to better meet the sexual and reproductive health needs of AGYW at high risk of HIV in Tanzania, including investment in tailored youth-friendly strategies for AGYW who have been marginalized from the current HIV response., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Rucinski, Mbita, Atkins, Majani, Komba, Casalini, Drake, Makyao, Galishi, Mlawa, Wamoyi, Schwartz, Baral and Curran.)

Background: Poverty and social inequality exacerbate HIV risk among adolescent girls and young women (AGYW) in sub-Saharan Africa. Cash transfers can influence the structural determinants of health, thereby reducing HIV risk., Objective: This study assessed the effectiveness of cash transfer delivered along with combination HIV prevention (CHP) interventions in reducing the risky sexual behavior of AGYW in Tanzania. The incidence of herpes simplex virus type 2 (HSV-2) infection was used as a proxy for sexual risk behavior., Methods: A cluster randomized controlled trial was conducted in 15 matched pairs of communities (1:1 intervention to control) across 3 strata (urban, rural high-risk, and rural low-risk populations) of the Shinyanga Region, Tanzania. The target population was out-of-school AGYW aged 15-23 years who had completed 10-hour sessions of social and behavior change communication. Eligible communities were randomly assigned to receive CHP along with cash transfer quarterly (intervention group) or solely CHP interventions (control group) with no masking. Study recruitment and baseline survey were conducted between October 30, 2017 and December 1, 2017. Participants completed an audio computer-assisted self-interview, HIV counselling and testing, and HSV-2 testing at baseline and during follow-up visits at 6, 12, and 18 months after the baseline survey. A Cox proportional hazards model with random effects specified at the level of clusters (shared frailty) adjusted for matching pairs and other baseline imbalances was fitted to assess the effects of cash transfer on the incidence of HSV-2 infection (primary outcome). Secondary outcomes included HIV prevalence at follow-up, self-reported intergenerational sex, and self-reported compensated sex. All secondary outcomes were measured at each study visit., Results: Of the 3026 AGYW enrolled in the trial (1482 in the intervention and 1544 in the control), 2720 AGYW (1373 in the intervention and 1347 in the control) were included in the final analysis. Overall, HSV-2 incidence was not significantly different at all follow-up points between the study arms in the adjusted analysis (hazard ratio 0.96, 95% CI 0.67-1.38; P=.83). However, HSV-2 incidence was significantly lower in the rural low-risk populations who received the cash transfer intervention (hazard ratio 0.45, 95% CI 0.29-0.71; P=.001), adjusted for potential confounders., Conclusions: Although this trial showed no significant impact of the cash transfer intervention on HSV-2 incidence among AGYW overall, the intervention significantly reduced HSV-2 incidence among AGYW in rural low-risk communities. Factors such as lesser poverty and more asset ownership in urban and rural high-risk communities may have undermined the impact of cash transfer., Trial Registration: ClinicalTrials.gov NCT03597243; https://clinicaltrials.gov/show/NCT03597243., (©Evodius Kuringe, Alice Christensen, Jacqueline Materu, Mary Drake, Esther Majani, Caterina Casalini, Deusdedit Mjungu, Gaspar Mbita, Esther Kalage, Albert Komba, Daniel Nyato, Soori Nnko, Amani Shao, John Changalucha, Mwita Wambura. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 19.09.2022.)

Adolescent girls and young women (AGYW) aged 15 to 24 years face disproportionately high risks of acquiring HIV and other sexually transmitted infections (STIs). A sexual health risk stratification tool can support the development and implementation of tailored HIV and STI prevention services for sub-groups of at-risk AGYW. Data were collected among sexually active AGYW aged 15 to 24 years in Tanzania between April 2015 and March 2017. Exploratory and confirmatory factor analyses were conducted to construct and assess the latent structure of a ten-item scale for rapid assessment of sexual health risks. Items with high factor loadings and minimal cross loadings were retained in the final scale. Scale performance was appraised against condomless sex (defined as unprotected vaginal or anal intercourse) reported by AGYW for construct validity. A three-factor structure of vulnerability to HIV among AGYW was supported with subscales for socioeconomic vulnerability; lack of adult support; and sexual behavioral risks. The chi-square goodness-of-fit test, root mean square error of approximation, comparative fit index, and Tucker-Lewis index indicated a strong goodness-of-fit of the three-factor scale. Cronbach alphas (0.55 for socioeconomic vulnerability, 0.55 for lack of support, and 0.48 for sexual risk) indicated sub-optimal internal consistency for all sub-scales. The factor-item and factor-factor correlations identified in these analyses were consistent with the conceptual framework of vulnerability of HIV infection in AGYW, suggesting good construct validity. The scale also demonstrated a statistically significant association with condomless sex and could be potentially used for sexual health risk stratification (OR = 1.17, 95% CI: 1.12, 1.23). The sexual health and HIV risk stratification scale demonstrated potential in identifying sexually active AGYW at high risk for HIV and other STIs. Ultimately, all AGYW in Tanzania are not at equal risk for HIV and this scale may support directing resources towards those at highest risk of HIV., Competing Interests: As stated above, we confirm that Jhpiego is not a commercial company and does not have any commercial interests of the study dataset or the findings. We adhere to all PLOS ONE policies on sharing data and materials.

Although cash transfers (CT) are hypothesized to reduce AGYW's HIV risk, little is known about the mechanisms through which CT empower AGYW. We explored the impact of a CT intervention on AGYW's sexual decision-making in order to describe the pathways through which the cash may influence risk behavior. The study employed qualitative methods involving: 20 longitudinal in-depth interviews (IDIs), 40 cross-sectional IDIs, 20 narrative IDIs, and two focus group discussions with AGYW ages 15-23 participating in a CT intervention. AGYW's conceptualized empowerment as: "independence", "hope and aspiration". Potential pathways through which CT empowered AGYW were: economic, hope and aspiration for a better future, and access to knowledge. As a result of this empowerment, AGYW reported reductions in transactional sex, experiences of intimate partner violence, and risky-sexual behaviour. A sense of responsibility developed through economic empowerment, enhanced participants' self-esteem and confidence in decision-making leading to changes in AGYW's sexual risk behaviors.

Cash transfers are theorised to reduce adolescent girls and young women's economic vulnerability and engagement in transactional sex; however, the processes involved remain unclear. We conducted longitudinal cross-sectional, and narrative timeline in-depth interviews with young women aged 15-23 years in northern Tanzania enrolled in a cash transfer intervention. We analysed data using a thematic approach guided by the transactional sex framework. We summarised data and compared findings to the domains of the framework. Participants reported relationships in the 'sex and material expression of love' domain characterised by emotional intimacy and loose ties between material support and sex, and the 'sex for basic needs' domain characterised by limited emotional intimacy, economic vulnerability, and a clear exchange between material support and sex. Some participants expressed that cash transfers provided business capital and savings which enabled them to decrease 'sex for basic needs'. Cash transfers influenced transactional sex engagement by altering partner selection criteria such as from an emphasis on what men could provide to a focus on relationship stability. Findings suggest that cash transfers have the potential to reduce young women's transactional relationships motivated by economic vulnerability.

Although cash transfers (CT) have been recommended as a strategy to address structural drivers of HIV, the evidence of the effects of CT on sexual risk and HIV outcomes is mixed. This could partly be due to CT implementation dynamics and beneficiary interpersonal factors. We conducted an assessment of CT component of the DREAMS programme in Tanzania. We explored how AGYW spent their CT over time, to whom they disclosed cash receipt, and where they sought advice on CT use. The study employed qualitative research methods including: 20 longitudinal in-depth interviews (IDIs) and 60 cross-sectional IDIs with AGYW in the CT programme. Data were analysed thematically. AGYW use of CT fell into five categories: business development, survival, self-care, helping family, and savings. The primary uses of CT funds were investment in businesses and livestock for savings. AGYW use of cash changed over instalments. AGYW consulted a variety of sources when deciding on how to use the cash, primarily mothers, programme personnel, and long-term partners/husbands. CT programmes that give cash directly to AGYW and have a strong entrepreneurial mentorship component could have implications for HIV prevention, SRH, and overall social and economic development.

Background: The HIV epidemic in Eastern and Southern Africa is characterized by a high incidence and prevalence of HIV infection among adolescent girls and young women (AGYW) aged 15-24 years. For instance, in some countries, HIV prevalence in AGYW aged 20-24 years exceeds that in AGYW aged 15-19 years by 2:1. Sauti (meaning voices), a project supported by the United States Agency for International Development, is providing HIV combination prevention interventions to AGYW in the Shinyanga region, Tanzania., Objective: The aim of this study is to determine the impact of cash transfer on risky sexual behavior among AGYW receiving cash transfer and HIV combination prevention interventions. This paper describes the research methods and general protocol of the study. Risky sexual behavior will be assessed by herpes simplex virus type 2 (HSV-2) incidence, compensated sex (defined as sexual encounters motivated by exchange for money, material support, or other benefits), and intergenerational sex (defined as a sexual partnership between AGYW and a man 10 or more years older). Through a qualitative study, the study seeks to understand how the intervention affects the structural and behavioral drivers of the HIV epidemic., Methods: The trial employs audio computer-assisted self-interviewing, participatory group discussions (PGDs), and case studies to collect data. A total of 30 matched villages (15 intervention and 15 control clusters) were randomized to either receive cash transfer delivered over 18 months in addition to other HIV interventions (intervention arm) or to receive other HIV interventions without cash transfer (control arm). Study participants are interviewed at baseline and 6, 12, and 18 months to collect data on demographics, factors related to HIV vulnerabilities, family planning, sexual risk behavior, gender-based violence, and HSV-2 and HIV infections. A total of 6 PGDs (3 intervention, 3 control) were conducted at baseline to describe perceptions and preferences of different intervention packages, whereas 20 case studies are used to monitor and unearth the dynamics involved in delivery and uptake of cash transfer., Results: The study was funded in June 2017; enrollment took place in December 2017. A total of two rounds of the follow-up survey are complete, and one round has yet to be conducted. The results are expected in December 2019 and will be disseminated through conferences and peer-reviewed publications., Conclusions: This study will document the synergetic impact of cash transfer in the presence of HIV combination prevention interventions on risky sexual behavior among out-of-school AGYW. The results will strengthen the evidence of cash transfer in the reduction of risky sexual behavior and provide feasible HIV prevention strategies for AGYW., Trial Registration: Clinicaltrials.gov NCT03597243; https://clinicaltrials.gov/ct2/show/NCT03597243., International Registered Report Identifier (irrid): DERR1-10.2196/14696., (©Mwita Wambura, Mary Drake, Evodius Kuringe, Esther Majani, Daniel Nyato, Caterina Casalini, Jacqueline Materu, Deusdedit Mjungu, Soori Nnko, Gaspar Mbita, Esther Kalage, Amani Shao, John Changalucha, Albert Komba. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 20.12.2019.)

Background: Little has been documented about partner violence among adolescent girls and young women (AGYW) who are out of school, a factor associated with HIV acquisition. To understand areas for prioritising HIV prevention intervention efforts, we explored the prevalence and correlates of partner violence among out of school AGYW in Shinyanga, Tanzania., Methods: A cross-sectional analysis of data from AGYW aged 15-23 years recruited in a cluster randomised trial conducted between October and December 2017 was used to examine correlates of partner violence. Data were collected through an Audio Computer-Assisted Self-interview. Multivariate logistic regression analysis was used to evaluate the association., Results: 2276 (75.5%) AGYW were sexually active. Of these, 816 (35.9%) reported having experienced violence from partners in the last six months. After adjusting for other covariates, being formerly married (AOR = 1.55, 95% CI:1.02, 2.37), having children (AOR = 1.79, 95% CI:1.47, 2.16), anxiety and depression symptoms (AOR = 3.27, 95%CI: 2.15, 4.96), having engaged in sex work in the past six months (AOR = 1.92, 95% CI: 1.45, 2.53) and economic deprivation (AOR = 1.61, 95% CI: 1.34,1.92) were significantly associated with partner violence., Conclusions: Almost one in three sexually active AGYW had experienced partner violence in the 6 months preceding the survey. The findings underscore the need for future research to focus on understanding the reasons and dynamics underlying high level of partner violence among AGYW. Furthermore, there is a need for implementing intervention programs that aim to reduce economic deprivation among AGYWs and address social norms and structures perpetuating violence against AGYW., Trial Registration: ClinicalTrials.gov-ID NCT03597243., Competing Interests: The authors have declared that no competing interests exist.

Background: In sub-Saharan Africa, adolescent girls and young women (AGYW) who are out of school are at higher risk of depressive and anxiety disorders compared to their school attending peers. However, little is known about the prevalence and risk factors for these conditions among out-of-school AGYW. This study examines the prevalence of depression and anxiety and associated factors in a community sample of out-of-school AGYW in Tanzania., Methods: A cross-sectional analysis of baseline data from an on-going cluster randomized controlled trial in North-West Tanzania was conducted. A total of 3013 out-of-school AGYW aged 15 to 23 years from 30 clusters were included. Anxiety and depression were assessed using the Patient Health Questionnaire (PHQ-4), a tool comprising of PHQ-2 and Generalized Anxiety Disorders (GAD-2) screeners. Data were collected using Audio Computer-Assisted Self-Interview (ACASI). A random-effects logistic regression was fitted for binary outcomes and an ordinal logistic regression model with robust variance was used to adjust for clustering at the village level. Logistic regression and ordinal logistic regression were used to explore the associations between mental disorders symptoms and other factors., Results: The prevalence of depressive (PHQ-2 ≥ 3) and anxiety (GAD-2 ≥ 3) symptoms among out-of-school AGYW were 36% (95% CI 33.8%-37.3%) and 31% (95% CI 29.0%-32.3%) respectively. Further, using the PHQ-4 tool, 33% (95% CI 30.8%-34.2%) had mild, 20% (95% CI 18.3%-21.1%) moderate and 6% (95% CI 5.5%-7.2%) had severe symptoms of anxiety and depression. After adjusting for other covariates, two factors most strongly associated with having anxiety symptoms were violence experience from sexual partners (AOR = 1.63, 95% CI: 1.36-1.96) and HIV positive status (AOR = 1.54, 95% CI: 1.03-2.31). Likewise, living alone, with younger siblings or others (AOR = 2.51, 95% CI: 1.47-4.29) and violence experience from sexual partners (AOR = 1.90, 95% CI: 1.59-2.27) were strongly associated with depression symptoms. Having savings (AOR = 0.81, 95% CI: 0.70-0.95) and emotional support (AOR = 0.82, 95% CI: 0.67-0.99) were protective against depression and anxiety, respectively., Conclusion: Depressive and anxiety symptoms are prevalent among out-of-school AGYW in Tanzania. The findings emphasize the need to strengthen preventive interventions and scale-up mental health disorder screening, referral for diagnosis and management., Competing Interests: The authors have declared that no competing interests exist.