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The use of reliable and valid tools to evaluate theory-based health interventions is widely accepted as critical to the behavioral sciences. However, quite often the psychometric properties of survey instruments used to evaluate behavioral interventions are not published, limiting our understanding of how the theory works. The purpose of this study was to present the results of psychometric analyses on measures used to evaluate an HIV/AIDS prevention program for youth in Tanzania. We first began by pilot-testing a self-administered questionnaire with sixth and seventh-grade students in nine schools in 11 villages throughout the Kahe ward of Tanzania (n = 524). Theory-based scales tapped into intrapersonal, social and attitudinal factors. Reliability was evaluated by examining internal consistency, while validity was determined by examining content, construct and discriminant validities. The results indicate that the scales constructed are reasonably reliable and valid measures. Use of these measures should be considered when designing, implementing, and analyzing interventions targeting youth in sub-Saharan Africa.

Adherence to medical protocol (quality) is low in most developing countries. We show that, although the differences in knowledge of protocol among doctors in Arusha region of Tanzania are explained by years of training, the differences in actual adherence to protocol and the gap between knowledge and actual adherence are best understood by examining the types of organizations in which these doctors work. These results suggest that some organizations are better at getting doctors to perform at capacity and that understanding the link between organizational structure and protocol adherence is important in any attempt to increase the quality of care. (Contains 3 tables, 1 figure and 6 footnotes.)

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2006.06.003 Byline: Kenneth Leonard (a), Melkiory C. Masatu (b) Keywords: Tanzania; Hawthorne effect; Out patient department quality evaluation; Audit and feedback Abstract: We examine the evidence that the behavior of clinicians is impacted by the fact that they are being observed by a research team. Data on the quality of care provided by clinicians in Arusha region of Tanzania show a marked fall in quality over time as new patients are consulted. By conducting detailed interviews with patients who consulted both before and after our research team arrived we are able to show strong evidence of the Hawthorne effect. Patient-reported quality is steady before we arrive, rises significantly (by 13 percentage points) at the moment we arrive and then falls steadily thereafter. We show that quality after we arrive begins to look similar to quality before we arrived between the 10th and 15th consultations. Implications for quality measurement and policy are discussed. Author Affiliation: (a) Department of Agricultural Economics, University of Maryland, 2200 Symons Hall, College Park, MD 20742, USA (b) Centre for Educational Development in Health, Arusha, Tanzania

This paper reports the results of a comparison between two different methods of examining quality in outpatient services in a developing country. Data from rural and urban Tanzania are used to compare the measures of quality collected by direct clinician observation (DCO) (where clinicians are observed in the course of their normal consultations) and vignettes (unblind case studies with an actor). The vignettes are shown to exhibit a strong connection between the inputs provided during consultation (rational history taking, physical examination and health education) and the ability of the clinician to properly diagnose the presented illness. However, the inputs provided in vignettes are not well correlated with the inputs provided in DCO, suggesting that the inputs provided in the vignette are not well correlated with the inputs that would be provided in an actual consultation. We conclude that since vignettes do not appear to be measuring what would be provided in an actual consultation they are not a good measure of quality. Instead, we suggest that vignettes and DCO be used simultaneously. We show how the scores obtained using vignettes in conjunction with DCO can be used to improve the reliability of DCO and therefore our estimates of actual clinician quality. Keywords: Direct clinician observation; Vignettes; Health services quality; Tanzania

Abstract Background Sexual activities are increasingly changing from the cultural point of view what they used to be. Knowledge of these practices among adolescents may be a basis to create awareness among adolescents on practices that involve risks. This study aims to assess sexual practices among unmarried adolescents in Tanzania. Methods A cross-sectional survey was conducted among in-school and out-of-school but unmarried adolescents aged 10 to 19 in five locations in Tanzania. A questionnaire was used to collect information and to characterize sexual practices among these adolescents. Results About 32% of adolescents reported being sexually active; a higher proportion being males than females. The only inquired and reported sexual practices include vaginal sex, masturbation, oral and anal sex. About 15% of sexually active adolescents reported having multiple sexual partners. Significantly more males reported having multiple partners than females. Nearly 42% of sexually active adolescents reported having used a condom during most recent sexual act. Females reported older partners at first sexual act. Conclusion Adolescents experience several sexual practices that include penetrative and non-penetrative. More males reported being sexually active than females. Despite adolescents reporting having multiple sexual partners, reported condom use during the most recent sexual act was low. We advocate for a more enhanced approach of reproductive health education that includes safer sex to adolescents without forgetting those in-schools.

Objective: To determine the magnitude of perceived AIDS risk among out-of-school adolescents in Moshi rural district of Kilimanjaro region, northern Tanzania., Methods: A cross-sectional study involving face-to-face interviews with out-of-school adolescents in eleven rural villages in Moshi district, northern Tanzania., Results: We found that of the 668 adolescents (10-19 years of age) surveyed, 45.4% were sexually active and significantly more men than women reported being sexually active (55.85 versus 23.0%, OR = 0.24, 95% CI = 0.16 to 0.34). Adolescents who had travelled to Moshi town or out of Tanzania were significantly more likely to be sexually active compared with those who have never travelled. Despite perception of AIDS risk, a large majority (70.5%) of sexually active adolescents reported having multiple sexual partners. Adolescents who perceived being at AIDS risk were less likely to report having multiple sexual partners and were more likely to report having used a condom at the last sexual intercourse., Conclusion: These findings indicate that adolescents in this rural population are still practising high risk sexual behaviours suggesting the need for youth-targeted intervention programmes in rural Tanzania.

Purpose: To determine the prevalence of substance use among primary school pupils and out-of-school adolescents in Moshi rural district, northern Tanzania., Methods: A school-based cross-sectional study focusing on primary school adolescents in standards 6 and 7 in Kahe rural community. We also conducted a population-based cross-sectional study among out-of-school adolescents in the same rural villages. A self-administered questionnaire was used to collect data from the school-based survey while for the out-of-school survey the questionnaire was administered in the households using trained interviewers., Results: A total of 545 in-school and 668 out-of-school adolescents participated in the study. Of the 545 school adolescents, 45.4% were males and 56.6% females while for the out-of-school adolescents, 68.1% were males and 31.9% females. Of the school adolescents, more males than females reported being alcohol drinkers (16.7% versus 9.2%; odds ratio (OR) = 1.9, 95% CI, 1.17 - 3.29). The prevalence proportions of cigarette smoking were 26.2% for men and 15.5% for women while prevalence proportions of marijuana smoking were 4.1% for men and 3.0% for women. As for the out-of-school adolescents, the prevalence proportions of alcohol use were 26.2% for men and 15.5% for women. The prevalence proportions of cigarette smoking were 14.3% for men and 1.9% for women while the prevalence proportions of marijuana smoking were 1.5% for men and 1.4% for women., Conclusions: Substance use among adolescents is very high suggesting the need for interventions in this rural population of Tanzania.