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Rune Nathaniel Philemon,1 Blandina T Mmbaga,1,2 John Bartlett,3 Jenny Renju,4,5 Tara B Mtuy,4,6 Innocent B Mboya,4,7,8 Sia E Msuya4,7,9 1Department of Pediatrics and Child Health, Kilimanjaro Christian Medical University College (KCMUCo) & Kilimanjaro Christian Medical Centre (KCMC), Moshi, Kilimanjaro, Tanzania; 2Department of Research, Kilimanjaro Clinical Research Institute (KCRI), Moshi, Kilimanjaro, Tanzania; 3Duke Global Health Institute, Duke University, Durham, NC, USA; 4Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania; 5Department of Population Studies, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK; 6Faculty of Public Health and Policy and the Department of Global Health and Development, London School of Hygiene & Tropical Medicine (LSHTM), London, UK; 7Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania; 8School of Mathematics, Statistics & Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa; 9Department of Community Health, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Kilimanjaro, TanzaniaCorrespondence: Rune Nathaniel Philemon, Department of Pediatrics and Child Health, Kilimanjaro Christian Medical University College (KCMUCo) & Kilimanjaro Christian Medical Centre (KCMC), P O Box 2240, Moshi, Kilimanjaro, Tanzania, Tel +255 754 389 049, Email rphilemon@yahoo.co.ukPurpose: We sought to assess how HIV-positive mothers enrolled in the PMTCT program adhere to breastfeeding recommendations concerning early initiation of breastfeeding (EIBF), ie, within one hour of birth, pre-lacteal feeds, exclusive breastfeeding until six months (EBF), and continued breastfeeding to one year of age. This study was designed to assess the practices in response to changing recommendations for breastfeeding in HIV, which have differed drastically over the years.Patients and Methods: We recruited 524 mother-child pairs from 37 PMTCT clinics across Kilimanjaro, Tanzania. The 5 clinics with the highest patient load in each of the 7 districts of Kilimanjaro were chosen, plus the zonal and municipal referral hospitals. The children were below two years of age and currently in the PMTCT program. We administered a questionnaire to assess the mother’s practices in feeding the child. We used multiple logistic regression models to determine factors associated with EIBF, EBF, and continued breastfeeding.Results: EIBF was achieved for 73.1% of babies. Cesarean delivery, low birth weight, and partner disclosure of HIV status were significant risk factors for not achieving EIBF. About 19% of children did not breastfeed exclusively. Of the 247 children ≥ 12 months old, 43.3% had stopped breastfeeding before 12 months. Counseling on ARV, having had > 2 pregnancies while HIV-positive and EBF were associated with breastfeeding until 12 months old. Using ART for more than two years decreased the odds of EBF and continued breastfeeding to 12 months of age.Conclusion: Adherence to breastfeeding recommendations for HIV-positive women is suboptimal, particularly in aspects of recent changes in recommendations such as continuing breastfeeding for one year. There is a missed opportunity for interventions such as counseling, which has shown to favor adherence. Health education and counseling are needed for providers and mothers to keep them abreast with the frequently changing recommendations.Keywords: early initiation, continued breastfeeding, exclusive breastfeeding, feeding recommendations

Mussa N Sweya,1 Sia E Msuya,2,3 Michael J Mahande,2 Rachel Manongi1,3 1Community Health Department, Kilimanjaro Christian Medical University College, 2Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University, 3Community Health Department, Kilimanjaro Christian Medical Centre, Moshi, Tanzania Background: Previous studies have shown that knowledge of contraceptives, especially among the youth in universities, remains limited, and the rate of premarital sexual activity, unwanted pregnancies, and illegal abortions remains higher among university students. This study aimed to assess contraceptive knowledge, sexual behavior, and factors associated with contraceptive use among female undergraduate university students in Kilimanjaro region in Tanzania. Methods: A cross-sectional analytical study was conducted from May to June 2015 among undergraduate female students in four universities in Kilimanjaro region. A self-administered questionnaire was given to the participants. Data analysis was performed using Statistical Package for Social Sciences. Descriptive statistics were used to summarize the data. An odds ratio with 95% confidence interval for factors associated with modern contraceptive use was computed using multiple logistic regression models. A P-value of 18 years of age. Hence, advocacy for adolescent reproductive health education to promote the use of the available contraceptive services among university students is needed. Keywords: knowledge, contraception, utilization, university students, Tanzania

This study examined the level of knowledge of sexually transmitted infections (STI) and HIV, knowledge of symptoms and potential sequelae of STI and perceived personal risks of infection among urban women in Zimbabwe. The women consented to being interviewed, examined, tested and treated for curable diagnosed STIs. Prevalence of both STI and HIV was high 11.4% and 54.5% among women aged 15-19 years, 28.5% and 62.4% among those 20-29 years and was highest among the age group >/=30 years 39.0% and 67.0% respectively. Women aged 15-19 years least perceived their risk of infection. Of the women with the highest rates of STI/HIV infection, less than 30% were aware of their vulnerability to such infections. Knowledge of specific STIs, their symptoms and sequelae was generally low. Women who did not know about syphilis, gonorrhoea, chancroid or warts were more likely to perceive themselves at no risk of infection. Condom use was very low (16.5%). There is an urgent need to improve current education programmes to raise awareness of STIs and the dangers of their long-term sequelae along with behavioural skills building interventions that include equipping women with negotiating skills, making female condoms available at affordable prices and motivating condom use. [ABSTRACT FROM AUTHOR]

Background: Mothers attending prevention of mother-to-child transmission (PMTCT) of HIV clinics seem to lack knowledge on many aspects of PMTCT, among which is breastfeeding. Breastfeeding recommendations in PMTCT have changed several times over the years leaving some confused and doubtful of what is currently recommended. One method shown to help improve their knowledge and acceptance of PMTCT recommendations is the use of peer educators. We sought to determine if mothers engage in discussions with other mothers during clinics and how these engagements influence trust in PMTCT recommendations., Methods: We interviewed 524 mothers with children under two years enrolled in PMTCT clinics in Kilimanjaro, Tanzania. We selected 5 clinics with the highest numbers of PMTCT enrolment from each district in the region. In each clinic, over a one-month period, we recruited all mothers attending the PMTCT clinic. We collected information on their engagement in discussions regarding PMTCT during clinics and how they perceived the information from their peers in relation to that from healthcare providers., Results: Fifty-five percent of the mothers reported engaging in peer discussions. Of the 90 (17%) mothers who reported noticing a change in PMTCT recommendations, 33 (36.7%) reported trusting previous recommendations more. A greater proportion (52.9%) of mothers who engaged in peer discussions reported trusting the information from peers more than that from healthcare workers., Conclusions: Peers have a great influence on mothers, which is concerning when their knowledge shared is outdated. Harnessing their influence and training them on current recommendations might be key to improving adherence to PMTCT recommendations., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Philemon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Limited data among miners in Tanzania suggests prevalence of silicosis, obstructive lung disease and restrictive lung disease to be around 1.6%, 1.9% and 8.8% respectively. Our study aimed to determine the prevalence and factors associated with silicosis and impaired lung function among tanzanite mining community in northern Tanzania. We conducted a cross-sectional study, involving 330 miners and 330 peri-mining community members in Mererani mines. Silicosis was defined based on study participants' history of exposure to mining dust and digital chest radiological findings with reference to the 2011 ILO classification of pneumoconiosis. Impaired lung function was determined by spirometry using American Thoracic Society/European Respiratory Society recommended system 3. Association between evidence of silicosis/impaired lung function and presumed risk factors were determined using binary logistic regression analyses. The study found that 99/330 (30.0%) of miners had silicosis. Total of 65 (9.8%) participants had impaired lung function, of whom 29 (4.4%) had Chronic Obstructive Pulmonary Disease, 32 (4.8%) had restrictive lung disease and 4 (0.6%) had both obstructive and restrictive lung diseases. Unexpectedly, miners who have worked for more than 10years and those worked for 6 to 10 years had 64% (aOR 0.34, CI = 0.17-0.67, p = 0.002) and 48% (aOR 0.52, CI = 0.30-0.89, p = 0.018) lower odds of having silicosis respectively compared those worked for up to 5 years. Participants with more than 10 years of work duration had more than 3-times higher odds of impaired lung function compared to those who had worked for up to 5 years (aOR 3.11, CI = 1.53-6.34, p<0.002). We found a concerningly high prevalence of silicosis despite short durations of exposure to occupational silica dust. Immediate dust control measures including deployment of wet drilling, wearing of personal protective equipment and regular monitoring of dust exposure need to be enforced by the Occupational Safety and Health Authority-Tanzania., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Mbuya et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Immune system and vaccine responses vary across geographical locations worldwide, not only between high and low-middle income countries (LMICs), but also between rural and urban populations within the same country. Lifestyle factors such as housing conditions, exposure to microorganisms and parasites and diet are associated with rural-and urban-living. However, the relationships between these lifestyle factors and immune profiles have not been mapped in detail. Here, we profiled the immune system of 100 healthy Tanzanians living across four rural/urban areas using mass cytometry. We developed a lifestyle score based on an individual's household assets, housing condition and recent dietary history and studied the association with cellular immune profiles. Seventeen out of 80 immune cell clusters were associated with living location or lifestyle score, with eight identifiable only using lifestyle score. Individuals with low lifestyle score, most of whom live in rural settings, showed higher frequencies of NK cells, plasmablasts, atypical memory B cells, T helper 2 cells, regulatory T cells and activated CD4 + T effector memory cells expressing CD38, HLA-DR and CTLA-4. In contrast, those with high lifestyle score, most of whom live in urban areas, showed a less activated state of the immune system illustrated by higher frequencies of naïve CD8 + T cells. Using an elastic net machine learning model, we identified cellular immune signatures most associated with lifestyle score. Assuming a link between these immune profiles and vaccine responses, these signatures may inform us on the cellular mechanisms underlying poor responses to vaccines, but also reduced autoimmunity and allergies in low- and middle-income countries., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Inc.)

COVID-19 vaccination effectively reduces disease severity, hospitalization, and mortality, particularly among individuals with chronic conditions who bear a disproportionate burden of disease complications. Vaccine confidence - belief in its safety, effectiveness, and importance - boosts uptake. However, limited data on vaccine confidence in this population hinders the development of targeted interventions. This study examined COVID-19 vaccine confidence and its impact on uptake among individuals with hypertension or diabetes mellitus in the Kilimanjaro region, Tanzania. A community-based cross-sectional study was conducted in March 2023 among 646 randomly selected adults aged ≥18 years with hypertension or diabetes mellitus in three districts of Kilimanjaro region, northern Tanzania. An interviewer-administered electronic questionnaire assessed confidence and uptake of COVID-19 vaccines in addition to related knowledge and demographic characteristics. Data analysis was done for 646 individuals who consented to participate. Multivariable logistic regression models determined the factors associated with COVID-19 vaccine confidence and its effect on vaccine uptake. The proportion of COVID-19 vaccine confidence among all 646 participants was 70% and was highest for perceived vaccine importance (80%), followed by perceived vaccine effectiveness (77%) and perceived vaccine safety (74%). Good knowledge of COVID-19 vaccines and living in the Mwanga municipal council (MC), a semi-urban district, was independently associated with confidence in the vaccines' importance, safety, effectiveness, and overall COVID-19 vaccine confidence. Confidence in COVID-19 vaccines increased the odds of vaccine uptake. Targeted interventions to boost vaccine confidence are therefore essential to enhance vaccine uptake in this high-risk population.

Background: Family interactions, which are always multi-faceted, are complicated further by family members with disabilities. In resource-poor settings, policies and programmes that address the needs of and challenges faced by families are often inaccessible or unavailable. Approximately 13% of the families in Tanzania have at least one member with a disability, yet family-centred research on caring for disabled children and adolescents is scarce in this context., Objective: The aim is to explore the needs and challenges faced by families that care for children and adolescents with physical disabilities in the Kilimanjaro Region of north-eastern Tanzania., Methods: This qualitative study had a constructivist grounded-theory design. In-depth interviews, using a semi-structured interview guide based on the social-capital framework, were conducted with 12 female participants aged between 24 and 80. A conceptual model of family needs, inspired by Maslow's hierarchy of needs, informed the analysis., Results: Challenging needs were grouped into five categories, which were linked to Maslow's hierarchy of needs and related to the central concept of 'adaptive adjustment': (1) 'barely surviving'; (2) 'safety needs in jeopardy'; (3) 'sociocultural protection'; (4) 'self-esteem far beyond reach', and (5) 'dreaming of self-actualisation'., Conclusion: Families caring for children and adolescents with physical disabilities in north-eastern Tanzania have needs that extend beyond the available and accessible resources. Families can adjust and adapt by avoiding certain situations, accepting the reality of their circumstances and exploring alternative ways of coping. A sustainable support system, including social networks, is essential for meeting basic needs and ensuring safety.

Introduction: Pneumococcal conjugate vaccines have reduced severe disease attributed to vaccine-type pneumococci in children. However, the effect is dependent on serotype distribution in the population and disease development may be influenced by co-occurrence of viral and bacterial pathogens in the nasopharynx., Methods: Following introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) in Tanzania we performed repeated cross-sectional surveys, including 775 children below 2 years of age attending primary healthcare centers. All children were sampled from nasopharynx and pneumococci were detected by single-target PCR. Pneumococcal serotypes/groups and presence of viruses and other bacteria were determined by two multiplex PCR assays., Results: The prevalence of PCV13 vaccine-type pneumococci decreased by 50%, but residual vaccine-types were still detected in 21% of the children 2 years after PCV13 introduction. An increase in the non-vaccine-type 15 BC was observed. Pneumococci were often co-occurring with Haemophilus influenzae , and detection of rhino/enterovirus was associated with higher pneumococcal load., Discussion: We conclude that presence of residual vaccine-type and emerging non-vaccine-type pneumococci in Tanzanian children demand continued pneumococcal surveillance. High co-occurrence of viral and bacterial pathogens may contribute to the disease burden and indicate the need of multiple public health interventions to improve child health in Tanzania., 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., (Copyright © 2024 Emgård, Andersson, Gonzales-Siles, Msuya, Nyombi, Nordén, Muro, Lindh, Andersson and Skovbjerg.)

Background: Tanzania is one of the countries with a high burden of HIV. It has an estimated 1.4 million people living with HIV in 2021. Adolescents living with HIV on antiretroviral therapy (ART) have worse treatment adherence, viral suppression, and mortality rates compared to adults. This study aim was to determine the trend of non-suppression among adolescents on ART in Tanzania from 2018 to 2021 and latest associated predictors., Methodology: The study utilized data of adolescents (10-19 years) receiving ART in Tanzania mainland for the period of 2018-2021 from the National Care and Treatment Centers database. The primary outcome of interest was non-suppression of viral load, defined as a VL above 1,000 copies/ml. The study employed multivariable logistic regression models to identify factors associated with non-suppression of VL. STATA 15 statistical software was used to analyze the data., Results: Records of 65,942 adolescents present in the CTC database Tanzania were analyzed. Approximately more than half were female 38,544 (58.5%). The proportion of non-suppression was 34.5%, 23.3%, 12.1%, and 9.7% for the years 2018-2021, respectively. After adjusting for other factors, adolescents with a history of poor adherence to ART in the last six months had higher odds of non-suppression (OR = 1.95, 95% CI = 1.64, 2.31). Adolescents on second or third line ART regimens were almost two times more likely to be non-suppressed compared to those on first-line regimens (OR = 2.85, 95% CI = 2.52, 3.23). Girls had lower odds of non-suppression compared to boys (OR = 0.91, 95% CI = 0.84, 0.98), and similarly, patients attending hospitals had lower odds compared to those attending dispensaries (OR = 0.79, 95% CI = 0.72, 0.87)., Conclusion: Being female, having good history of adherence over the last six months, and attending hospital level was significantly associated with lower levels of non-suppression, while being on second line ART or attending lower health facilities increased the odds of non-suppression. Efforts to enhance the quality and capacity of health services at lower-level facilities (dispensaries and health centers) should be prioritized, as well as promoting gender-sensitive approaches that take into account the unique needs and experiences of adolescent girls and boys are needed to improve VL suppression among this population., 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 Quaker, Shirima and Msuya.)

Background: Globally, the number of small-scale miners (SSM) is estimated to be more than 25 million, but it supports the livelihoods of around 100 million individuals. In Tanzania, the number of SSM has increased from an estimated 150,000 in 1987 to ~1.5 million in 2017. The miners are at a high risk of occupational-related health challenges. The study aimed to assess the concentrations of respirable crystalline silica (RCS) and radon among the tanzanite mining communities in Simanjiro District, Tanzania., Methods: We carried out a cross-sectional study involving the Mererani mines in Tanzania. These are underground mines comprised of informally employed miners, i.e. SSM. Concentrations of RCS and radon gas were measured in 44 study units, i.e. 22 mining pits and within 22 houses in the general community, e.g. shops in the peri-mining community. A total of 132 respirable personal dust exposure samples (PDS), 3 from each of the study units were taken, but only 66 PDS from the mining pits were analysed, as this was the main interest of this study. Radon concentration was measured by continuous monitoring throughout the working shift (and overnight for residences) using AlphaGuard monitor. The medians and comparison to the reference values, OSHA USA PEL and WHO/IARC references, were done for RCS and radon, respectively, using SPSS Ver. 27.0.0)., Results: The median time-weighted average (TWA) concentration of the RCS in the mining pits was 1.23 mg/m3. Of all 66 personal dust samples from the mining pits, 65 (98.5%) had concentrations of RCS above the Occupational Safety and Health Administration (OSHA) permissible exposure limit (PEL) of 0.05 mg/m3. Mining pits had a median radon concentration of 169.50 bq/m3, which is above the World Health Organization (WHO)/International Commission on Radiation Protection (ICRP) recommended reference of 100.00 bq/m3 but not above the upper reference of 300.00 bq/m3, while the community buildings had a median radon concentration of 88.00 bq/m3. Overall, 9 (20.5%) and 17 (38.6%) radon measurements were above 300.00 bq/m3 and between 100.00 and 300.00 bq/m3 references, respectively. Specifically, in the mining pits, 9 (40.9%) test results were above 300.00 bq/m3, while none of the test results in the community was above 300.00 bq/m3., Conclusion: The tanzanite SSM in Mererani we highly exposed to RCS, which increases the risk of pulmonary diseases, including silicosis, tuberculosis, and pulmonary malignancies. Immediate action by OSHA Tanzania should be enforcement of wearing respirators by all miners throughout the working hours. Health education programmes to the SSM must be strengthened and OSHA Tanzania should adopt the 0.05 mg/m3 PEL, and enforce other occupational health and safety measures, including regular use of dust suppression mechanisms (water spray and wet drilling) and monitoring of RCS exposures among SSM. Monitoring of radon exposure both in the mining pits and community buildings should be conducted, and mitigation measures should be implemented in areas that exceed the reference level of 100.00 bq/m3., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.)

Background: Human Papilloma Virus (HPV) vaccination is a key primary prevention method against cervical cancer which is given to young girls before onset of sexual activity. In Tanzania, cervical cancer is the most frequent occurring cancer among women and is the leading cause of cancer mortality. The HPV Vaccination programme was rolled-out in Tanzania in 2018 for adolescent girls aged 9-14 years to receive two doses at a six-months interval, with an annual vaccine uptake of 46.1%. In 2019, the uptake of the HPV vaccine was only 64%, whereas the national coverage target is 75%. This study aimed at assessing the determinants of HPV vaccination among adolescent girls in Hai district, Kilimanjaro region, northern Tanzania., Methodology: A cross-sectional study was conducted from July 2020 to August 2020 among 14-year-old adolescent girls in four selected secondary schools, including two government-owned and two private-owned, within Hai district. Close-ended questionnaire interviews were conducted with the adolescent girls in the study and data analysis was done using IBM SPSS Statistics for Windows version 20.0 (IBM Corp, Armonk, NY, USA). Odds ratio was used to assess the association between several factors and HPV vaccination., Results: A total of 301 adolescent girls aged 14 years consented to the study. HPV vaccination uptake was 65%. More than three-fifths (n=119, 60.7%) reported having received the two required doses. Knowledge of HPV (OR 5.68; 95% CI, 0.72 to 44.96; P=.01 ) and HPV vaccine (OR 20.11; 95% CI, 10.88 to 37.99); P =.01 ) contributed significantly to HPV vaccine uptake among the adolescent girls in the study. More than one-third (n=105, 34.9%,) of the participants, were not vaccinated, the main reasons adduced for not being vaccinated include lack of proper information about the HPV vaccine (60.0%), fear of side effects (14%) and parental refusal (11%)., Conclusion: HPV vaccination uptake was 65%. Lack of proper information to both the children and parents about the safety of the vaccine hinders its uptake. More effort should be made for clear and comprehensible dissemination of information especially to the community stakeholders mainly parents, community and religious leaders, about cervical cancer and HPV vaccine in order to considerably increase vaccination coverage among adolescent girls. Likewise, involvement of healthcare workers and policymakers in educating people about cervical cancer prevention measures can ensure successful implementation of HPV vaccination. There is need to conduct an indepth qualitative study to explore further people's perceptions and attitudes towards HPV., (© The East African Health Research Commission 2024.)

Background: Schistosomiasis is an acute and chronic tropical disease caused by trematodes of the genus Schistosoma. It is a disease of public health concern and mostly affects developing countries of the tropics. According to WHO burden of the disease is as high as 80-85%, principally in sub-Saharan Africa. Although the majority of the infection is often linked with morbidity, it also results in considerable death. The overall annual mortality rate might exceed 200,000 people in Africa due to different complications of urinary and intestinal Schistosomiasis. Children are at a greater risk of acquiring the infection as well as reinfection, and this might cause growth retardation, anemia and low school performance., Objective: The study aimed at determining the prevalence of Schistosoma mansoni, associated factors and evaluating the performance of Point of Care Circulating Cathodic Antigen comparison (POC-CCA) against a routine method (formal Ether) of detection methods among school aged children at Mwanga District Council, Kilimanjaro Tanzania., Methodology: This was a cross sectional study conducted from April - June 2019 in Mwanga District Council. A minimum of 288 primary school children in Mwanga District were enrolled. Random sampling technique was used to select the participants. Interviews were conducted with study participants followed by single stool and urine sample collection. formal-ether concentration technique, urine dipstick and Point of Care Circulating Cathodic Antigen (POC-CCA) were used for stool and urine analysis. Data were entered and cleaned by using SPSS Version 20. Descriptive statistics were summarised using frequency and proportion for categorical variables and mean and standard dispersion for continuous variables. Logistic regression was used to identify independent factors associated with schistosomiasis. Any association with P value <.05 was considered significant., Results: A total of 288 participants were enrolled. The mean age of participants was 9.8 (±2.4) years. The prevalence of Schistosoma mansoni among the 288 students was 7.3% by formal ether method and 80.4% by POC-CCA. Social demographic characteristics, and hygiene practice assessed were not associated with Schistosoma mansoni in this study. Water source was statistically significantly associated with the prevalence of Schistosoma mansoni ., Conclusion: The prevalence of Schistosoma mansoni among school aged children is low by using formal-ether concentration technique (routine method). The annual projects of deworming might have helped decrease the endemicity of the infection. This is due to regular deworming project as recommended by WHO. Despite various efforts which are done to deworm, school aged children are still at risk of acquiring infection, due to poor hygienic practice especially from water sources., (© The East African Health Research Commission 2024.)

COVID-19 is a major public health threat associated with increased disease burden, mortality, and economic loss to countries and communities. Safe and efficacious COVID-19 vaccines are key in halting and reversing the pandemic. Low confidence in vaccines has been one of the factors leading to hesitancy. We aimed to assess the COVID-19 vaccine confidence (safety and effectiveness), associated factors, and its effects on vaccine uptake among general community members in Tanzania. This was a community-based cross-sectional survey conducted from December 2021 to April 2022 in six regions of Tanzania mainland and two regions in Zanzibar. Participants were interviewed using an electronic questionnaire. Multiple logistic regression models estimated odds ratios (ORs) and 95% confidence interval (CI) for factors associated with vaccine confidence. All analyses were performed using SPSS version 25.0. The study enrolled 3470 general Tanzanian community members; their mean age was 40.3 (standard deviation ±14.9) years, and 34% were males. The proportion of COVID-19 vaccine confidence was 54.6%. Geographical region, residence area, COVID-19 disease risk perception, and good knowledge of COVID-19 vaccines were significantly associated with COVID-19 vaccine confidence. Confidence in COVID-19 vaccines was associated with over three times higher odds of vaccine uptake. Confidence in COVID-19 vaccines was low in Tanzania. Innovative community engagement strategies and region-specific interventions are needed to improve comprehensive knowledge and address community perceptions and attitudes toward COVID-19 vaccines.

Background: HIV Testing and Counseling is a critical entry-point for HIV care, treatment and prevention. Tanzania adopted the WHO recommendations of Provider-Initiated HIV Testing and Counseling (PITC) in 2007 with the aim of increasing early HIV diagnosis and timely access to treatment and support services. However, approximately 55% of men are still unaware of their HIV status. This study aimed to determine the level of PITC uptake and factors associated with PITC availability and uptake among men attending healthcare facilities in Moshi Municipality, Northern Tanzania., Method: A facility-based cross-sectional study was conducted in July 2019 in five selected healthcare facilities in Moshi Municipal, Kilimanjaro region. Exit interviews were conducted with men aged 18 years and above who attended for care in the selected facilities. Modified Poisson regression modelling with robust standard errors were used to determine factors independently associated with being offered and accepting the PITC offer., Results: A total of 562 men participated in this study. The median age of participants at enrollment was 37 (IQR: 26-59) years. Only 58% of participants reported to have been offered provider-initiated HIV counseling. Of these, 83% accepted the offer of HIV testing. Age between 35-59 years (aPR = 1.2; 95% Confidence Interval (CI): 1.0, 1.4; p = 0.033) and having primary education (aPR = 0.7; 95% CI: 0.6, 0.9; p = 0.010) were factors independently associated with being offered PITC. Age between 35-59 years (aPR = 0.8; 95% CI: 0.7, 0.9; p = 0.002); having been previously tested for HIV (aPR = 1.3; 95% CI: 1.1, 1.5; p = 0.011) and visiting a health facility twice or more in previous year (aPR = 1.3; 95% CI: 1.2, 1.5; p<0.001) were independently associated with uptake of HIV testing., Conclusion: Despite high PITC uptake, about 2 in 5 men attending healthcare facilities in Moshi municipality were not offered the service. Providers should target men aged ≤ 34 years, with primary education, visiting facilities for the first time and who have never been tested for HIV., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Kyilyosudu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The use of vaccines is one of the key tools in reversing the COVID-19 pandemic; however, various reports reported the low uptake of the vaccines. This study explored the barriers to the COVID-19 vaccine uptake among community members in Tanzania. A qualitative explorative study was conducted in December 2021 and April 2022 in eight regions of Tanzania. Focus group discussions (FGDs) and in-depth interviews (IDIs) were the methods of data collection. A total of 48 FGDs and 32 IDIs were conducted. Participants were aware of the COVID-19 disease and vaccines. The barriers to the COVID-19 vaccine non-uptake included receiving contradicting statements from top government leaders, vaccine preceded the education, myths towards vaccines, the presence of different types of vaccines, the process of getting the vaccine, the influence of social media and random people from the community, and vaccine conflicting religious beliefs. Despite being aware of the vaccine, the uptake of the COVID-19 vaccine is still low. Interventions that focus on increasing community knowledge about COVID-19 vaccines and addressing myths about the vaccines are needed.

Tuberculosis (TB) is among diseases of global health importance with Sub Saharan Africa (SSA) accounting for 25% of the global TB burden. TB prevalence among miners in SSA is estimated at 3,000-7,000/100,000, which is about 3 to 10-times higher than in the general population. The study's objective was to determine the prevalence of TB and associated risk factors among mining communities in Mererani, northern Tanzania. This was a cross-sectional study conducted from April 2019 to November 2021 involving current Small Scale Miners (SSM) and the General Community (GC). A total of 660 participants, 330 SSM and 330 GC were evaluated for the presence of TB. Data were analysed using Statistical Package for the Social Sciences (SPSS) database (IBM SPSS Statistics Version 27.0.0.0). Binary logistic regression (Generalized Linear Mixed Model) was used to determine the association between TB and independent predictors. Prevalence of TB was 7%, about 24-times higher than the national prevalence of 0.295%. Participants from the general community had higher prevalence of TB 7.9% than SSM (6.1%). Both for SSM and the GC, TB was found to be associated with: lower education level (aOR = 3.62, 95%CI = 1.16-11.28), previous lung disease (aOR = 4.30, 95%CI = 1.48-12.53) and having symptoms of TB (aOR = 3.24, 95%CI = 1.38-7.64). Specifically for the SSM, TB was found to be associated with Human Immunodeficiency Virus (HIV) infection (aOR = 8.28, 95%CI = 1.21-56.66). Though significant progress has been attained in the control of the TB epidemic in Tanzania, still hot spots with significantly high burden of TB exists, including miners. More importantly, populations surrounding the mining areas, are equally affected, and needs more engagement in the control of TB so as to realize the Global End TB targets of 2035., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Mbuya et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

COVID-19 is a major public health threat associated with the increased global burden of infectious diseases, mortality, and enormous economic loss to countries and communities. Safe and efficacious COVID-19 vaccines are crucial in halting the pandemic. We assessed the COVID-19 vaccine uptake and associated factors among community members from eight regions in Tanzania. The interviewer-administered questionnaire collected data. Multiple logistic regression models determined the factors associated with vaccine uptake. The median age of 3470 respondents was 37 years (interquartile range of 29-50 years) and 66% of them were females. Only 18% of them had received the COVID-19 vaccine, ranging from 8% in Dar es Salaam to 37% in Simiyu regions. A third (34%) of those vaccinated people did not know which vaccine they were given. Significantly higher rates of COVID-19 vaccine uptake were among the respondents aged 30+ years, males, and with a history of COVID-19 infection. Unfavorable perceptions about vaccine safety and efficacy lowered the rates of vaccine uptake. Setting-specific interventions and innovations are critical to improving vaccine uptake, given the observed differences between regions. Efforts are needed to increase vaccine uptake among women and younger people aged less than 30 years. Knowledge-based interventions should enhance the understanding of the available vaccines, benefits, target groups, and availability.

Background: Human papilloma virus (HPV) is a sexually transmitted infection causing more than 80% of cervical cancers. WHO recommends using of sensitive screening methods like HPV-testing to timely prevent future morbidity and mortality from cervical cancer. Pilot studies have shown that HPV-testing is feasible and can be scaled in developing country like Tanzania. However, there is limited information on women understanding, reactions and psychological challenges following diagnosis of high risk HPV (HR-HPV). This study explored the knowledge of women on HPV and their experience after HPV positive results in Kilimanjaro, Tanzania., Methods: The study was part of a larger study that assessed incidence and persistence of HR-HPV among women aged 18 years and above in Kilimanjaro. This was a cross sectional study conducted in Moshi municipal council among women who had HR-HPV positive results at enrollment. In-depth interviews were conducted with 13 randomly selected women who were attending for follow-up after enrollment. Interviews were conducted at the health facility and Atlas.ti.8 was used to analyze the data using thematic framework analysis., Results: Women had knowledge on HPV infection but they had different reactions following receiving positive HPV results. Reaction toward the positive HPV results had two extremes; some women had psychological effect (hopeless, death sentence, having cancer, being shocked, failure to disclose and psychosexual effects) while others women explained positive results is good as they are identified earlier, will be followed up and it has made them plan to continue with cervical cancer screening in future., Conclusion: Women had knowledge on HPV, but positive results lead to negative and positive experiences by women. Clinicians and programs need to develop interventions and good strategies to minimize the psychological and social burden of testing positive for HPV., (© 2023. The Author(s).)

Objectives: To describe the characteristics and disability-related needs of children and adolescents with physical disabilities in the Kilimanjaro region, North-Eastern Tanzania., Design: A cross-sectional community survey was conducted from November 2020 to June 2021. Trained research assistants interviewed primary children's carers using a questionnaire based on the International Classification of Functioning, Disability and Health-Children and Youth Framework. Data were analysed using IBM SPSS Statistics V.27. The Pearson χ 2 test was used to examine differences between age, gender and self-reported needs. The independent t-test assessed difference in needs according to age and gender., Setting: Kilimanjaro region, Tanzania., Participants: Children and adolescents, aged 2-18 years, with physical disabilities (n=212)., Results: Almost 40% had severe speech (n=84) and joint mobility (n=79) impairments, and more than half (n=124) had severe or complete difficulties walking. In aspects of self-care (caring for body parts, toileting, dressing, eating and drinking), most had severe and complete difficulties. Almost 70% (n=135) of households were located near health facilities without rehabilitation services. About one-quarter (n=51) had never received rehabilitation services. More than 90% (n=196) needed assistive devices, and therapeutic exercises (n=193). Over three-quarters needed nutritional supplements (n=162)., Conclusion: Children and adolescents with physical disabilities in North-Eastern Tanzania have impaired speech and joint mobility, and difficulties in communication, self-care and walking. Rehabilitation services essential for addressing these impairments and activity limitations are either scarce or inaccessible. Action is needed to facilitate urban and rural access to rehabilitation services in order to improve the well-being of children and adolescents with physical disabilities., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Adolescent's living with Human Immunodeficiency Virus (HIV) are widely reported to have poor adherence to antiretroviral therapy (ART) due to stigma and fear of discrimination. A "Teen club" is an adolescent centered intervention designed to reduce social stigma and improve adherence and retention in HIV care. In this study we determined how the availability of teen clubs within routine HIV care and treatment facilities affects adolescents' clinic attendance., Methods: We conducted a retrospective cohort study using secondary data from routine clinic records on adolescents (10-19 years) who started ART between 2010 and 2016, and had documented clinic visits between March 2017 and September 2017 at HIV care and treatment clinics (CTC) in northern and central Tanzania. Good clinic attendance was defined as attending at least four monthly clinic visits during the 7-month follow-up period. A Poisson model with robust standard errors was used to assess the relationship between presence of a teen club at health facilities and good clinic attendance adjusting for other factors including sex, age at ART initiation, duration on ART, WHO clinical stage and health facility level., Results: Of the 2839 adolescents, 73.1% had good clinic attendance. Good clinic attendance was independently associated with availability of a teen club at the health facility (aRR=1.16, 95%CI:1.09-1.21) and been on ART for >2 years (aRR=1.15, 95%C1.02-1.30). Adolescents aged 15-19 years during this study were less likely to have good clinic attendance (aRR= 0.93, 95%CI:0.88-0.98) than those aged <15 years. Sex and WHO clinical stage were not associated with good clinic attendance., Conclusion: Teen clubs improved visit adherence among adolescents in HIV care and treatment. Further qualitative research should be conducted to explore adolescents' perception of teen clubs as well as other enablers to clinic attendance., (© The East African Health Research Commission 2023.)

Background: Adolescent pregnancy increases the risk of maternal and child morbidity and mortality. We aimed to determine trends and factors associated with adolescent pregnancy in Tanzania from 2004 to 2016 using the Tanzania Demographic and Health surveys (TDHS)., Methods: We carried out an analytical cross-sectional study using the TDHS data for the years 2004 to 2005, 2010 and 2015 to 2016 among adolescent girls aged 15 to 19 years. Data analysis was performed using STATA version 15. Data analysis considered the complex survey design inherent in the demographic and health survey (DHS) data. The Poisson regression model was used to estimate Prevalence Ratios (PR) and 95% confidence intervals for factors associated with adolescent pregnancy., Results: We analysed data for a total of 10,972 adolescents for the three TDHS rounds. The proportion of adolescent pregnancy significantly decreased from 26% to 22.8% from the year 2004/05 to 2010 and then increased again to 26.7% in 2015/16. Adolescents who were aged 18 to 19 years (APR 1.52; 95% CI, 1.38 to 1.68) married or cohabiting with their partners (APR 2.15; 95% CI, 1.93 to 2.40; P<.001 ), widowed/divorced/separated (APR 2.32; 95% CI, 2.03 to 2.66; P<.001 ), and among those who started sexual activity before 15 years of age (APR 1.20; 95% CI, 1.11 to 1.31; P<.001 ) were more likely to become pregnant during adolescence. In contrast, adolescents with secondary school education level and above were the least likely to become pregnant (APR 0.62; 95% CI, 0.51 to 0.75; P<.001 ) compared to those with no formal education., Conclusion: One in four adolescent girls aged 15 to 19 in Tanzania have already started childbearing and despite fluctuation, high rate of adolescent pregnancy persists. Preventive interventions should focus on adolescents with low education level, married/cohabiting with their partners, and who have started sex before 15 years of age. We advocate for the increase of school attendance until high school level to reduce the risk of early pregnancy in adolescents. Furthermore, qualitative studies are crucial to explore reasons for the rising trend of adolescent pregnancy in most zones of Tanzania, particularly between 2010 and 2015/16., (© The East African Health Research Commission 2023.)

Background: Low uptake of modern contraceptives among adolescents remains a serious public health concern with over 20 million adolescents in need of modern contraceptives are not using any. In Tanzania where the adolescent fertility rate is 112 per 1000, only 15.2% of adolescents are using modern contraceptives. Contraceptive use stands out to be one of the key interventions to reduce the burden of adolescent pregnancy which is high in the country at 22%. There is little information on factors associated with modern contraceptive use among out of school adolescents, who are at an increased risk of adolescent pregnancies., Objective: To determine the prevalence and factors associated with modern contraceptive use among out of school adolescent girls in Moshi municipality, Kilimanjaro region., Methodology: This was a population based cross-sectional study, conducted in Moshi municipality in Kilimanjaro region 2 wards; Majengo and Njoro. The wards were randomly selected out of the 21 wards in the region. Household survey was conducted in the wards and adolescents aged 10 to 19 years who were out of school and consented and or assented to participate in the study were recruited. Data was collected using Kobo Collect TM on an Android device. Data was analysed using SPSS version 20. To determine the factors associated with modern contraceptive use, crude and adjusted analysis using logistic regression analysis was done., Results: A total of 298 out-of-school adolescents were enrolled, with a median age of 19 (IQR 17-19) years. The prevalence of ever use of modern contraceptives among 154 sexually active adolescents was 51%, and 35% were current users of the methods. Two of common methods ever used were; injectables (27.3%) and male condoms (3.2%) respectively. Factors independently associated with ever use of modern contraceptives were; being married or cohabiting (aOR: 5.7) and having 2 or more sexual partners in the past 12 months (aOR: 5.9)., Conclusion: Ever and current use of modern contraceptives among out-of-school adolescents were reported at 51% and 35% respectively. Respondent's marital status and number of sexual partners was associated with ever use of modern methods. Strengthening of adolescent-friendly SRH services outside facility setting is needed given very few are currently using a modern method. Further, through inter-sectoral collaboration interventions to keep adolescent girls at school should be strengthened., (© The East African Health Research Commission 2023.)

Background: Sexually transmitted infections (STIs) are common among young people in low- and middle-income countries and are associated with negative reproductive and pregnancy outcomes. Most of the studies have assessed HIV among adolescents and young adults, with limited information on occurrence of other STIs in this population. This study aimed to describe the prevalence of and risk factors associated with Herpes Simplex Virus-type 2 (HSV-2), Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Syphilis and HIV infection among young adults attending Higher Learning Institutions (HLIs) in Mbeya, Tanzania., Methods: We conducted a cross-sectional study among students aged 18-24years attending HLIs in Mbeya-Tanzania, randomly selected using a computerized random number. Participants were tested for HSV-2, CT, NG, Syphilis and HIV infection. We used a self-administered questionnaire to collect information on sexual activity and risk factors to the tested STIs., Results: We enrolled 504 students from 5 HLIs, with mean age of 21.5 years (SD 1.7). 17% of the students had at least one STI; prevalence was higher among females than males (21.1% versus 14.1%). CT (11%) and HSV-2 (6.1%) were the most common STIs, while NG (1.1%) and HIV (0.7%) infection had the least occurrence. None of the participants was diagnosed with Syphilis. In univariate analysis, predictors for STIs were Sex, inconsistent condom use in the past 4weeks, report of oral sex, sexual orientation (bisexual/homosexual) and having a sexual partner with an age-difference of at least 5years (either older or younger); while in the multivariate analysis, Sex, inconsistent condom use in the past 4weeks and sexual orientation (bisexual/homosexual) remained significant., Conclusion: STIs such as Chlamydia and HSV-2 which are commonly asymptomatic are of concern among young adults attending HLIs. The latter is an important group that needs attention and recognition that is pivotal in transmission of STIs considering their risk. Information, Education and Communication (IEC) campaigns targeting young adults, especially those at HLIs, need to focus on exposure-risk minimization. Funding institutions that have invested heavily on HIV prevention campaigns should consider giving similar recognition to other STIs for a streamlined outcome., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Healthy dietary habits prevent childhood overweight and obesity and the risk of non-communicable diseases (NCDs) later in life. We examined dietary patterns and their association with adiposity among primary school children in northern Tanzania., Methods: Dietary data was collected by 24-h recall and food frequency questionnaire (FFQ) for 1170 primary school children aged 9 - 11 years from 20 primary schools in the Kilimanjaro region. Factor analysis and FFQ data were used to identify dietary patterns. Children were categorized into terciles of their adherence to each dietary pattern. Multilevel logistic regression was used to evaluate the association of dietary pattern terciles with adiposity indicators: body mass index z-scores (BMI z scores), body fat percentage by bioelectrical impedance, triceps, subscapular skinfold thicknesses, and waist circumference., Results: Fifteen percent of children had BMI Z > 1.0, indicating overweight or obesity. Two dietary patterns were identified by factor analysis: a healthy pattern characterized by frequent consumption of fruits and vegetables; and a mixed dietary pattern characterized by intake of fatty snacks, sweets and sugar snacks, sugary beverages, meat and alternatives, milk, and milk products. After adjusting for potential confounders, for both models: model 1 (age and sex), and model 2 (age, sex, school type, time spent walking to school, district [urban/ rural], availability of television and electronic gadgets at home and neighbourhood playground); we found no significant associations between dietary patterns and adiposity measures., Conclusion: Dietary patterns were not associated with adiposity in Tanzanian primary school children, possibly because of limitations of the FFQ, which did not record information on portion sizes. Future research should focus on understanding the key foods / snacks consumed by school children, portion sizes and their long-term effects on adiposity in children., (© 2022. The Author(s).)

This study aimed to examine associations of dietary quality and diversity among reproductive-aged women with overweight and obesity. We conducted a cross-sectional study in the Health and Demographic Surveillance System of the Dar es Salaam Urban Cohort Study (DUCS) in Tanzania. A random sample of 1004 non-pregnant women was selected from the DUCS population database and interviewed about dietary information using the FFQ. Women were aged 30.2 (±8.1) years; 27.8% were overweight and 22.6% were obese. All 1004 women in the study consumed starchy staple foods. Of all the women studied, 10.5%, 1.7% and 3.8% consumed vitamin A rich dark green vegetables, nuts and seeds, and beans and peas, respectively. Compared with women in the lowest quintile of Prime Dietary Quality Score (PDQS), those who were in the highest quintile were significantly less likely to be overweight or obese (Adjusted Prevalence Ratio (APR) = 0.76, 95%CI: 0.62, 0.89) (F for trend = 0.029). Dietary diversity score (DDS) was not significantly associated with overweight and obesity. Risk factors included the highest consumption of animal foods (APR = 2.81, 95% CI: 1.51-3.51) and fast food (APR = 2.57, 95% CI: 1.24-4.34). Consumption of legumes and whole grains was associated with lower risk (APR = 0.59; 95% CI: 0.38-0.2). Dietary quality is an important predictor of overweight and obesity among women of reproductive age. Nutrition interventions may be warranted to support women of reproductive age to enter pregnancy with healthier weight to prevent adverse pregnancy outcomes and future risk of chronic diseases., Competing Interests: The authors have declared that no competing interests exist.

Background: Placental parasitic infections continue to be a public health problem despite numerous interventions put in place. Placental parasitic infections reported are Toxoplasma, Trypanosome, Borrelia, Schistosoma, Hookworm and Plasmodia. The infections persist to cause poor pregnancy outcomes such as maternal anaemia, low birth weight and stillbirth. This study aimed to determine the prevalence and pregnancy outcomes associated with placental parasitic infections at a tertiary hospital in northern Tanzania., Methods: A cross sectional study was conducted at Kilimanjaro Christian Medical Centre between June and July 2016. Pregnant women were interviewed before delivery and additional information obtained from their medical files. Blood samples as well as placental material were collected from each mother. Malaria was tested using a malaria rapid diagnostic test (mRDT). A total of 80 placental slide sections were made following histological protocols. After staining, slide sections were examined for the presence of parasites microscopically. Pearson's Chi-square and Fisher's exact tests were used to test for differences between groups., Results: Placental malaria parasites were found on histological examination of 8(10%) mothers' placental sections, none of whom had a positive mRDT. Education status was significantly associated with placental malaria ( p =0.035). Stillbirth, maternal anaemia and pre-eclampsia were significantly associated with placenta malaria ( p <0.05)., Conclusion: Placental malaria was found to be prevalent in the studied population and was associated with stillbirth, maternal anaemia and pre-eclampsia. Efforts for developing malaria tests that will detect subclinical infections are needed in order to identify infections early and offer prompt treatment to prevent poor pregnant outcomes., (© The East African Health Research Commission 2022.)

Objective . To identify the bacterial isolates and their antibiotics susceptibility pattern among patients with lower limb ulcers admitted at a tertiary hospital in northern Tanzania. Methodology. A cross-sectional study was conducted between April and July 2018 at the Kilimanjaro Christian Medical Centre. Questionnaire was used to obtain the demographics and clinical information of participants. Wound samples were collected and culture method used to identify the bacteria and their susceptibility patterns. Results. Out of 65 participants, 55 (84.6%) had positive aerobic bacterial growth. Twelve (18 %) participants had more than one bacterium. Fifty-nine (88.1%) were gram-negative bacteria. Proteus vulgaris (13, 19.9%), Pseudomonas spp (10, 14.8%), and Staphylococcus aureus (8, 11.7%) were the common isolates. Out of 59 gram-negative bacterial, 47 (78%) were sensitive to amikacin. Staph were sensitive to oxacillin (75%; n = 8) and vancomycin (50%; n = 8). Gram-negative were common isolates and were resistant to amoxicillin/clavulanic acid but sensitive to amikacin. Conclusion . The observed resistance to antibiotics calls for continuous monitoring of the resistance pattern to guide the empirical management of patients with leg ulcer.

Extended-Spectrum Beta-Lactamase (ESBL) producing Enterobacteriaceae (EPE) is increasing worldwide, though less documented in low-income settings. Here we determined the prevalence of EPE infection and carriage, and patient factors associated with EPE-carriage among pediatric patients in three health care levels in Tanzania. Between January and April 2016, 350 febrile children (median age 21 months) seeking care at a university or a regional referral hospital, or a health centre in Moshi municipality, Tanzania, were included. Socio-demographic characteristics were collected using a questionnaire. Rectal swabs and blood cultures were collected from all children (n = 350) and urinary samples from 259 children at admission. ESBL-phenotype and antimicrobial susceptibility were determined for Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E. coli) isolates. Only one EPE case (E. coli) in blood and four in urine (one E. coli and three K. pneumoniae) were found, whereas (n = 90, 26%) of the children were colonized in feces (ESBL-E. coli; n = 76, ESBL-K. pneumoniae, n = 14). High resistance rates were seen in fecal ESBL-E. coli (n = 76) against trimethoprim-sulfamethoxazole (n = 69, 91%), gentamicin (n = 51, 67%), ciprofloxacin (n = 39, 51%) and chloramphenicol (n = 27, 35%) whereas most isolates were sensitive to amikacin (n = 71, 93%). Similar rates were seen for fecal ESBL-K. pneumoniae. Resistance to first line antibiotics were also very high in fecal E. coli not producing ESBL. No sociodemographic factor was associated with EPE-carriage. Children colonized with EPE were younger than 12 months (n = 43, 48%) and often treated with antibiotics (n = 40, 44%) in the previous two months. After adjustment for age children admitted to the intensive care unit had higher odds of EPE fecal carriage compared with those in the general wards (OR = 3.9, 95%CI = 1.4-10.4). Despite comparatively high rates of fecal EPE-carriage and previous antibiotic treatment, clinical EPE cases were rare in the febrile children. The very high resistant rates for the EPE and the non-ESBL producing E. coli to commonly used antibiotics are worrying and demand implementation of antibiotic stewardship programs in all levels of health care in Tanzania., (© 2021. The Author(s).)

Introduction: a repeated pregnancy represents a failure of health and social systems to educate and provide the necessary services and skills to ensure adolescent girls do not experience any further unwanted pregnancies during this young age. We aimed to determine trends and factors associated with repeated adolescent pregnancies in Tanzania 2004-2016., Methods: an analytical cross-sectional study was conducted using secondary data from Tanzania demographic and health surveys of the years 2004-2005, 2010 and 2015-2016 among adolescent mothers aged 15 to 19 years. Data analysis was performed using STATA version 15 and considered the complex survey design. The Poisson regression model was used to estimate prevalence ratios (PR) and 95% confidence intervals for factors associated with repeated adolescent pregnancy., Results: the proportion of repeated adolescent pregnancies increased from 15.8% in 2004/2005 to 18.6% in 2010, then to 18.8% in 2015/2016. Adolescents who delivered their first pregnancy at home (APR: 1.36, 95% CI: 1.03, 1.78) and who started sexual activity before 15 years of age (APR: 1.80, 95% CI: 1.40, 2.31) were likely repeated adolescent pregnancy. In contrast, adolescents who used contraception (APR: 0.52, 95% CI: 0.34, 0.81) had a lower prevalence of repeated adolescent pregnancies., Conclusion: the prevalence of repeated adolescent pregnancies has increased and remains unacceptably high. Adolescents who had low education delivered their first pregnancy at home and were non-contraceptive users need to be targeted in policies and programs for the prevention of repeated adolescent pregnancies., Competing Interests: The authors declare no competing interest., (Copyright: Octavian Aron Ngoda et al.)

Background High-risk sexual behaviors(HRSBs) among young adults are key risk for Sexually Transmitted Infections(STIs), HIV and unplanned pregnancies. WHO has identified the 15-24years age-group as high-risk for STIs. Students at Higher Learning Institutions(HLIs) may be at higher risk because they are free of immediate parental-supervision, are a transient migratory population, probably at peak-years of sexual activity.  In Tanzania, information is limited on sexual and preventive behaviours among young adults in HLIs. We describe risky sexual behaviours and preventive practices among young adults attending HLIs in Mbeya-Tanzania. Methods We conducted a cross-sectional study from March2019 to January2020 among randomly selected students aged 18-24years enrolled in HLIs within Mbeya.  Probability proportional to size was used to determine total student number from each HLI. We used a self-administered questionnaire to collect information on sexual health education, activity, behaviour and STI knowledge. Results Total of 504students were enrolled with mean age of 21.5(SD 1.74)years. Total of 446(88.5%) students reported ever having had sex. Mean-age at first sex was 18.4years and 9.9% reported sexual debut <15years. A higher proportion of male students(57%) reported sexual debut with non-steady partners than females(37.9%). Lack of condom use at sexual debut was reported by 52% of the participants. Consistent condom use during past 4-weeks was reported at 33% and 16.5% among males and females, respectively. About 1 in 10 students reported forced sex by someone they were dating. Sex under the influence of alcohol was reported by 24% of the students.  Nearly 8 in 10 (78.7%) students have heard of STIs, but only 16% were aware STIs can be asymptomatic.  Conclusion STI prevention programs need to recognize young adults in HLIs as at-risk population; and advocate targeted messages to minimize risk to acquiring STIs, counseling and support for those experiencing sexual violence, promote condom use and safer-sex negotiation skills., Competing Interests: No competing interests were disclosed., (Copyright: © 2021 Mcharo RD et al.)

Background: Exclusive breastfeeding (EBF) up to six months is sub-optimal globally. Tanzania has surpassed the World Health Assembly (WHA) target of increasing the rate of exclusive breastfeeding among children below six months to at least 50% by the year 2025 the median age of cessation of EBF is only three months., Objective: To determine the time to cessation of exclusive breastfeeding and its associated factors among women with children aged 6-24 months in Kilimanjaro region, Northern Tanzania., Methods: This was a secondary analysis of data from a community-based cross-sectional study conducted between April 2016 and April 2017 in Kilimanjaro region, northern Tanzania. In the parent study, a multistage sampling technique was used to select study participants and interviewed using a questionnaire. Data for 1291 mother-child pairs were analyzed using STATA version 15. Kaplan-Meier method with the log-rank test estimated and compared the survivor functions across covariate levels. Cox regression proportional hazards models estimated the hazard ratios (HR) and their 95% confidence intervals (CI) for factors associated with time to cessation of exclusive breastfeeding., Results: The prevalence of cessation of exclusive breastfeeding before six months was 68.7%, with a median age of cessation of four months (95% CI: 3, 4). In comparison to women living in Siha district, women living in Moshi Municipal (HR = 1.61; 95% CI = 1.24, 2.09), Same (HR = 1.32; 95% CI = 1.06, 1.65) and Mwanga (HR = 1.53; 95% CI = 1.20, 1.96) districts, had higher hazards of cessation of exclusive breastfeeding before six months. Women who received breastfeeding counselling at antenatal care had a lower hazard to cease EBF (HR = 0.76, 95% CI 0.65, 087) compared to those who did not receive breastfeeding counselling., Conclusion: The median age of cessation of EBF is unsatisfactory but at least higher (four months) than the national level estimate of three months. District specific interventions and breastfeeding counselling at antenatal care are essential for improving time to cessation of exclusive breastfeeding. Promotion of adequate ANC visits remains one of the critical interventions to improve BF practices and other reproductive health outcomes., Competing Interests: No authors have competing interests.

Background: Sexual and reproductive health (SRH) among young adults in low- and middle-income countries (LMIC) is still a major public health challenge. Early school-based sexuality education programs and sexual health information sharing between teachers, parents and young people have been considered protective against the sexual health risks to which young people are exposed. There is, however, limited information on the preferred choices of "where", "how" and "from whom" young people would like to receive SRH information. We aimed to describe the experience and preferences of young people regarding their SRH education and learning and in particular communication with their parents/guardians., Methods: We conducted a cross-sectional study among randomly selected students aged 18-24y attending Higher Learning Institutions (HLIs) in Mbeya, Tanzania. We used a self-administered questionnaire to collect information on SRH education received, ability to discuss SRH matters with a parent/guardian and SRH information gaps encountered during their early sexual experience., Results: We enrolled 504 students from 5 HLIs, of whom 446 (88.5%) reported to be sexually active, with mean age at sexual debut of 18.4y (SD 2.2). About 61% (307/504) of the participants found it difficult to discuss or did not discuss SRH matters with their parent/guardian while growing up. Learning about SRH matters was reported from peers (30.2%) and teacher-led school curriculum (22.7%). There was a strong gender-biased preference on SRH matters' discussions, female and male participants preferred discussions with adults of their respective sex. Peers (18.2%), media (16.2%) and schools (14.2%) were described as the preferred sources of SRH information. On recalling their first sexual experience, sexually-initiated participants felt they needed to know more about sexual feelings, emotions and relationships (28.8%), safer sex (13.5%), how to be able to say 'No' (10.7%) and how to use a condom correctly (10.2%)., Conclusion: Young people have a gender preference when it comes to learning about SRH matters from their parents; however, such conversations seldom occur. Community health education should focus on building skills of parents on parent-child communication on SRH matters so as to empower them to confidently initiate and convey accurate SRH information. Comprehensive SRH education and skills building need to be strengthened in the current school SRH curriculum in order to meet the demand and needs of students and increase the competence of teachers., (© 2021. The Author(s).)

Background: Overweight and obesity have increased considerably in low- and middle-income countries over the past few decades, particularly among women of reproductive age. This study assessed the role of physical activity, nutrient intake and risk factors for overweight and obesity among women in Dar es Salaam, Tanzania., Methods: We conducted a cross-sectional survey among 1004 women aged 15-49 years in the Dar es Salaam Urban Cohort Study (DUCS) from September 2018 to January 2019. Dietary intake was assessed using a food frequency questionnaire (FFQ). Physical activity was assessed using the Global Physical Activity Questionnaire (GPAQ) using metabolic equivalent tasks (MET). Modified poison regression models were used to evaluate associations between physical activity and nutrient intake with overweight/obesity in women, controlling for energy and other factors., Results: The mean (±SD) age of study women was 30.2 (±8.1) years. Prevalence of overweight and obesity was high (50.4%), and underweight was 8.6%. The risk of overweight/obesity was higher among older women (35-49 vs 15-24 years: PR 1.59; 95% CI: 1.30-1.95); women of higher wealth status (PR 1.24; 95% CI: 1.07-1.43); and informally employed and married women. Attaining moderate to high physical activity (≥600 MET) was inversely associated with overweight/obesity (PR 0.79; 95% CI: 0.63-0.99). Dietary sugar intake (PR 1.27; 95% CI: 1.03-1.58) was associated with increased risk, and fish and poultry consumption (PR 0.78; 95% CI: 0.61-0.99) with lower risk of overweight/obesity., Conclusion: Lifestyle (low physical activity and high sugar intake), age, wealth status, informal employment and marital status were associated with increased risk of overweight/obesity, while consumption of fish and poultry protein was associated with lower risk. The study findings underscore the need to design feasible and high-impact interventions to address physical activity and healthy diets among women in Tanzania., (© 2021. The Author(s).)

Introduction: Adequate sexual and reproductive health information is vital to women of reproductive age (WRA) 15 to 49 years, for making informed choices on their reproductive health including family planning (FP). However, many women who interact with the health system continue to miss out this vital service. The study aimed to identify the extent of provision of FP counselling at service delivery points and associated behavioral factors among women of reproductive age in two districts of Arusha region. It also determined the association between receipt of FP counselling and contraceptive usage., Methods: Data were drawn from a cross-sectional survey of 5,208 WRA residing in two districts of Arusha region in Tanzania; conducted between January and May 2018. Multistage sampling technique was employed to select the WRA for the face-to-face interviews. FP counseling was defined as receipt of FP information by a woman during any visit at the health facility for antenatal care (ANC), or for post-natal care (PNC). Analyses on receipt of FP counseling were done on 3,116 WRA, aged 16-44 years who were in contact with health facilities in the past two years. A modified Poisson regression model was used to determine the Prevalence Ratio (PR) as a measure of association between receipt of any FP counseling and current use of modern contraception, controlling for potential confounders., Results: Among the women that visited the health facility for any health-related visit in the past two years, 1,256 (40%) reported that they received FP counselling. Among the women who had had births in the last 30 months; 1,389 and 1,409 women had contact with the service delivery points for ANC and PNC visits respectively. Of these 31% and 26% had a missed FP counseling at ANC and PNC visit respectively. Women who were not formally employed were more likely to receive FP counselling during facility visit than others. WRA who received any FP counseling at PNC were significantly more likely to report current use of modern contraception than those who did not (adjusted PR [adj. PR] = 1.28; 95% Confidence Interval [CI]: 1.09, 1.49)., Conclusion: Overall, only 40% women reported that they received any form of FP counseling when they interfaced with the healthcare system in the past two years. Informally employed women were more likely to receive FP counselling, and women who received FP counselling during PNC visits were significantly more likely to use contraceptive in comparison to the women who did not receive FP counselling. This presents a missed opportunity for prevention of unintended pregnancies and suggests a need for further integration of FP counseling into the ANC and PNC visits., Competing Interests: None of the research costs or authors’ salaries were funded, in whole or in part, by a tobacco company. The identity of the donor is irrelevant to editors or reviewers’ assessment of the validity of the work. The authors are not aware of any competing interests.

Background: Information on how well Isoniazid Preventive Therapy (IPT) works on reducing TB incidence among people living with HIV (PLHIV) in routine settings using robust statistical methods to establish causality in observational studies is scarce., Objectives: To evaluate the effectiveness of IPT in routine clinical settings by comparing TB incidence between IPT and non-IPT groups., Methods: We used data from PLHIV enrolled in 315 HIV care and treatment clinic from January 2012 to December 2016. We used Inverse Probability of Treatment Weighting to adjust for the probability of receiving IPT; balancing the baseline covariates between IPT and non-IPT groups. The effectiveness of IPT on TB incidence was estimated using Cox regression using the weighted sample., Results: Of 171,743 PLHIV enrolled in the clinics over the five years, 10,326 (6.01%) were excluded leaving 161,417 available for the analysis. Of the 24,800 who received IPT, 1.00% developed TB disease whereas of the 136,617 who never received IPT 6,085 (4.98%) developed TB disease. In 278,545.90 person-years of follow up, a total 7,052 new TB cases were diagnosed. Using the weighted sample, the overall TB incidence was 11.57 (95% CI: 11.09-12.07) per 1,000 person-years. The TB incidence among PLHIV who received IPT was 10.49 (95% CI: 9.11-12.15) per 1,000 person-years and 12.00 (95% CI: 11.69-12.33) per 1,000 person-years in those who never received IPT. After adjusting for other covariates there was 52% lower risk of developing TB disease among those who received IPT compared to those who never received IPT: aHR = 0.48 (95% CI: 0.40-0.58, P<0.001)., Conclusion: IPT reduced TB incidence by 52% in PLHIV attending routine CTC in Tanzania. IPTW adjusted the groups for imbalances in the covariates associated with receiving IPT to achieve comparable groups of IPT and non-IPT. This study has added evidence on the effectiveness of IPT in routine clinical settings and on the use of IPTW to determine impact of interventions in observational studies., Competing Interests: This study was funded through the SEARCH Project under Bill and Melinda Gates Foundation. Routine HIV data is managed by the Government of the Republic of Tanzania in collaboration with the Government of the United STates of America through President’s EMergency Plan for AIDS Relief (PEPFAR).

Background: Antibiotic resistance is a threat to global child health. Primary healthcare workers play a key role in antibiotic stewardship in the community, but few studies in low-income countries have described their experiences of initiating antibiotic treatment in children. Thus, the present study aimed to describe primary healthcare workers' experiences of antibiotic prescription for children under 5 years of age and their conceptions of antibiotic resistance in Northern Tanzania., Methods: A qualitative study involving individual in-depth interviews with 20 prescribing primary healthcare workers in Moshi urban and rural districts, Northern Tanzania, was performed in 2019. Interviews were transcribed verbatim, translated from Kiswahili into English and analysed according to the phenomenographic approach., Findings: Four conceptual themes emerged during the analysis; conceptions in relation to the prescriber, the mother and child, other healthcare actors and in relation to outcome. The healthcare workers relied mainly on clinical examination and medical history provided by the mother to determine the need for antibiotics. Confidence in giving advice concerning non-antibiotic treatment varied among the participants and expectations of antibiotic treatment were perceived to be common among the mothers. Antibiotic resistance was mainly perceived as a problem for the individual patient who was misusing the antibiotics., Conclusions: To increase rational antibiotic prescription, an awareness needs to be raised among Tanzanian primary healthcare workers of the threat of antibiotic resistance, not only to a few individuals, but to public health. Guidelines on childhood illnesses should be updated with advice concerning symptomatic treatment when antibiotics are not necessary, to support rational prescribing practices and promote trust in the clinician and mother relationship.

Introduction: Prevention of mother-to-child transmission (PMTCT) remains a cornerstone of HIV prevention and control efforts. It is vital that the beneficiaries of PMTCT programs understand PMTCT recommendations, especially since their adherence to recommendations is key to successful PMTCT. There have been several major changes in PMTCT recommendations, and many women have encountered different recommendations. It is plausible that confusion has arisen as to what is currently recommended for successful PMTCT. This confusion can affect adherence to recommendations and hinder PMTCT efforts. However, little is known about how women enrolled in PMTCT understand the recommendations in the context of these frequent changes., Aim: In this paper, we present our findings regarding how HIV-positive women enrolled in PMTCT in Kilimanjaro understand PMTCT recommendations pertinent to them., Methods: From August 2019 to April 2020, we surveyed 521 mothers enrolled in PMTCT in seven districts in the Kilimanjaro region, Northern Tanzania. A pretested questionnaire was administered to consenting mothers. The questionnaire collected information on mothers' demographic characteristics, previous encounters with PMTCT, and knowledge of various PMTCT program elements, including medication duration, breastfeeding recommendations and infant HIV testing schedule. A logistic regression model was used to determine factors associated with good PMTCT knowledge among mothers., Results: A total of 521 women were enrolled, the median score for the 19 items used to assess knowledge was 57.9%, and 64.9% scored above the median. Counselling on ART (OR=2.17, 95% CI 1.08-4.36) and counselling on breastfeeding during the ANC visits (OR=2.38, 95% CI 1.38-4.11) were the only factors that we found to be significantly associated with higher odds of good knowledge of PMTCT., Conclusion: Even amongst mothers enrolled in PMTCT, poor understanding regarding key PMTCT recommendations prevails. There is a need to reassess the training modalities and look at ways to reinforce PMTCT messages to mothers., Competing Interests: Dr Rune Philemon reports grants from THRiVe, grants from MEPI, during the conduct of the study. The author reports no other conflicts of interest in this work., (© 2021 Philemon et al.)

Background : Self-reports are commonly used to assess physical activity in children. Existing self-reports for physical activity have not been validated for primary school children in Tanzania. To understand if primary school children can accurately report their physical activity, we examined the validity of self-reported physical activity against accelerometer measured physical activity. Methods : A community-based cross-sectional study was conducted from May to July 2018. We conveniently selected four primary schools in Moshi municipal and Moshi rural districts in Kilimanjaro, Tanzania. From these districts, 51 children aged 9 - 11 years were randomly selected. A self-reported questionnaire was used to collect physical activity-related variables. Children wore accelerometers for seven consecutive days to capture physical activity movements. Spearman's rank test and Bland Altman plots were used for assessing validity and agreement between self-reports and accelerometer moderate to vigorous physical activity (MVPA). Results : The study participants' mean age was 10 (SD=0.8) years, and 32 (63%) were girls. A significant positive correlation was found between self-reports and accelerometer MVPA (rho=0.36, p=0.009). The mean total of weekday minutes in MVPA from accelerometers was higher than from self-reports, 408 (SD = 66) versus 261 (SD = 179). Conclusions : This study found a significant positive correlation between self-reports and accelerometers. Self-reports are prone to errors due to recall bias, which interferes with their validity. More research is needed to develop better self-reported measures with specific activities that children can easily remember. Also, researchers should carefully consider the inherent limitations in the validity of self-reports., Competing Interests: No competing interests were disclosed., (Copyright: © 2021 Mosha MV et al.)

Introduction: Childhood undernutrition is a major public health problem especially in low and middle-income countries (LMIC). The prevalence of early introduction of complementary feeding, low meal frequency, and low dietary diversity are frequent in LMICs. The effect of inappropriate complementary feeding practices on the nutritional status of children is not well documented in East African countries including Tanzania. Therefore, this study aimed at determining the effect of inappropriate complementary feeding practices on the nutritional status of children aged 6-24 months in urban Moshi, Tanzania., Methodology: A retrospective cohort study was done using the Pasua and Majengo cohorts of mother-child pairs in urban Moshi who were enrolled from 2002 to 2017. About 3355 mother-child pairs were included in the analysis. Appropriate complementary feeding practices were assessed using WHO IYFP indicators such as age at introduction of solid, semi-solid, or soft foods, minimum dietary diversity, and minimum meal frequency. Nutritional status (stunting, wasting, and underweight) was determined. Multilevel modeling was applied to obtain the effect of inappropriate complementary feeding practices on the nutritional status of children and to account for the clustering effect of mothers and children and the correlation of repeated measures within each child., Results: Majority of the children (91.2%) were given soft/semi-solid/solid foods before six months of age, 40.3percent had low meal frequency, and 74percent had low dietary diversity. Early introduction of complementary food at age 0-1 month was statistically significantly associated with higher risks of wasting and underweight (ARR 2.9, 95%CI 1.3-6.3; and ARR 2.6, 95% CI 1.3-5.1 respectively). Children with low minimum meal frequency had higher risks of stunting, wasting, and underweight (ARR 2.9, 95%CI 2.3-3.6; ARR 1.9, 95%CI 1.5-2.5 and ARR 1.9, 95%CI 1.5-2.4 respectively). Children with low minimum dietary diversity were more likely to be stunted than is the case with their peers who received the minimum dietary diversity (ARR 1.3, 95% CI 1.01-1.6)., Conclusion: There were a high proportion of children, which were fed inappropriately; Inappropriate complementary feeding practices predisposed children to undernutrition. Our study supports the introduction of complementary feeding, providing minimum dietary diversity, and minimum feeding frequency at six months of age as important in improving the nutritional status of the children., Competing Interests: The authors have declared that no competing interests exist.

Background: Postpartum contraceptive discontinuation refers to cessation of use following initiation after delivery within 1 year postpartum. Discontinuation of use has been associated with an increased unmet need for family planning that leads to high numbers of unwanted pregnancies, unsafe abortion or mistimed births. There is scant information about contraceptive discontinuation and its predictors among postpartum women in Tanzania. This study aimed to determine predictors of contraception discontinuation at 3, 6, 12 months postpartum among women of reproductive age in Arusha city and Meru district, Tanzania., Methods: This was an analytical cross-sectional study which was conducted in two district of Arusha region (Arusha city and Meru district respectively). A multistage sampling technique was used to select 13 streets of the 3 wards in Arusha City and 2 wards in Meru District. A total of 474 women of reproductive age (WRAs) aged 16-44 years residing in the study areas were included in this analysis. Data analysis was performed using STATA version 15. Odds ratios (ORs) with 95% confidence interval (CI) for the factors associated with contraceptives discontinuation (at 3, 6 and 12 moths) were estimated in a multivariable logistic regression model., Results: Overall, discontinuation rate for all methods at 3, 6, and 12 months postpartum was 11, 19 and 29% respectively. It was higher at 12 months for Lactational amenorrhea, male condoms and injectables (76, 50.5 and 36%, respectively). Women aged 40-44 years had lower odds of contraceptive discontinuation at 3 months as compare to those aged 16 to 19 years. Implants and pills users had also lower odds of contraceptive discontinuation compared to injectable users at 3, 6 and 12 months respectively., Conclusion: Lactational amenorrhea, male condoms and injectables users had the highest rates of discontinuation. Women's age and type of method discontinued were independently associated with postpartum contraceptive discontinuation. Addressing barriers to continue contraceptive use amongst younger women and knowledge on method attributes, including possible side-effects and how to manage complications is warranted.

Background: Prevalence of childhood overweight and obesity in low- and middle-income countries is on the rise. We focused on multiple factors which could influence body mass index., Methods: A cross sectional school-based study was conducted in Moshi, Tanzania. Primary school children aged 9-11 years were recruited from 20 schools through a multistage sampling technique. Questionnaires were used to collect information on physical activity and diet by food frequency questionnaire. Height and weight measurements were taken and body mass index z scores for age and sex (BMIZ) calculated using the WHO AnthroPlus. Children were considered thin if BMIZ was <-2 standard deviations and overweight or obese if BMIZ was >1 SD. Information on school policies and environment was obtained from headteachers. Correlates of overweight and obesity were examined using a multinomial multilevel logistic regression., Results: A total of 1170 primary school children, of whom 636 (54%) were girls, were recruited from 20 schools. The prevalence of overweight and obesity was 15% overall (overweight 9% and obesity 6%) and most prevalent in urban areas (23%) and in private schools (24%). Moreover, thinness was found to be (10%) overall, most prevalent in rural areas (13%) and in government schools (14%). At school level, residing in urban (adjusted relative risk ratio [aRRR] 3.76; 95% confidence interval [CI] 2.49,5.68) and being in private school (aRRR 4.08; 95% CI 2.66,6.25) were associated with a higher risk of overweight and obesity while availability of playgrounds in schools (aRRR 0.68; 95% CI 0.47, 0.97) was associated with a lower risk of overweight and obesity. At home level, availability of sugary drinks (aRRR 1.52; 95% CI 1.01,2.28) was associated with a higher risk of overweight and obesity., Conclusion: Overweight and obesity are common in private schools and in urban settings. Efforts should be taken to ensure availability of playgrounds in schools and encouraging children to engage in physical activities., Competing Interests: The authors have declared no competing interests exist.

Introduction: Human papillomavirus (HPV) is the causative agent of precancerous lesions and cervical cancer, cervical cancer being the leading cause of deaths in Tanzanian women. Early detection and treatment of precancerous lesions are important in the prevention of cervical cancer cases., Material and Methods: We conducted a cross-sectional study among 3390 Tanzanian women aged 25-60 years. Information on lifestyle habits was collected, and women underwent gynecological examination with collection of cervical cells for conventional cytological and HPV testing. Blood samples were tested for HIV. The association between cervical high-grade cytology (HGC) and potential risk factors was examined using multivariable logistic regression adjusting for age and high-risk HPV (HR-HPV)., Results: The prevalence of HGC was 3.6% and of low-grade cytology was 8.3%. In women who were both HR-HPV-positive and HIV-positive, the prevalence of HGC was 28.3%. It increased by age and was 47% among women aged 50-60 years. Women, who had their sexual debut at age 9-15 years and 16-18 years, respectively, had 2.5 and 2.4 times increased odds of HGC compared with women whose sexual debut was at age 21 years and older. HIV-positive women had increased odds of HGC in comparison with HIV-negative women after adjustment for age (odds ratio [OR] 2.95, 95% CI 1.92-4.54). HR-HPV-positive women had nearly 100-fold increased odds of HGC compared with HR-HPV-negative women (OR 96.6, 95% CI 48.0-194), and this estimate was higher among HIV-positive women (OR 152.2, 95% CI 36.1-642.0)., Conclusions: Increasing age, early age at first intercourse, HR-HPV, and HIV infections were associated with a substantially increased risk of HGC., (© 2021 Nordic Federation of Societies of Obstetrics and Gynecology.)

Background: Postpartum contraceptive use is vital to improve maternal and child survival. It helps to have optimal child spacing, prevent unplanned pregnancies and associated adverse birth outcomes. However, postpartum contraceptive use in Tanzania remains low. Short median interval for resumption to sex after birth among African women has been associated with adverse maternal and child health wellbeing. This study aimed to assess optimal time to contraceptive use and predictors of time to contraceptive use after birth among women of reproductive age in Tanzania., Methods: A cross section study using the TDHS 2015-16 data was used. A total of 3775 postpartum women were analyzed. Information on pregnancy, births and contraceptive use were recorded over the previous 5 years with the focus on most recent birth from the contraceptive calendar. Data analysis was performed using Stata 14.0. Analysis accounted for complex survey design. Time to modern contraceptive use after birth was computed using Kaplan Meier estimate. Adjusted time ratios with 95% CI were estimated using Weibull accelerated failure time models., Results: A total weighted sample of 3775 women was analyzed. The median time to contraceptive use after birth was 7(IQR: 4-13) months, while for resumption to sex afterbirth was 2(IQR: 1-5) months. Factors such as never been married (TR: 1.63; 95%CI: 1.26-2.11) and breastfeeding (TR: 5.50; 95%CI: 4.12-7.35) were associated with longer time to postpartum contraceptive use. Belonging to richest wealth quintile (TR: 0.73; 95%CI: 0.54-0.99) and adopting long acting methods (TR: 0.70; 95%CI: 0.60-0.82) increased women's likelihood of having shorter time to postpartum contraceptive use., Conclusion: There was a time lag of five months from resumption of sex and initiation of postpartum contraception use. The interceptive measures to facilitate timely availing methods of women's choice and promotion of utilization of maternal health care services may reduce delays in postpartum contraceptive use., Competing Interests: The authors have declared that no competing interests exist.

Background: Child stunting is a global health concern. Stunting leads to several consequences on child survival, growth, and development. The absolute level of stunting has been decreasing in Tanzania from from 50% in 1991/92 to 34% in 2016 although the prevalence is still high (34%)Stunting varyies across socioeconomic determinants with a larger burden among the socioeconomic disadvantaged group. The reduction of inequalities in stunting is very crucial as we aim to reduce stunting to 28% by 2021 and hence attain zero malnutrition by 2030 under Sustainable Development Goal 2.2.This study aimed at determining the trend, contributing factors and changes of inequalities in stunting among children aged 3-59 months from 2004 to 2016., Methods: Data were drawn from the Tanzania Demographic and Health Surveys. The concentration index (CIX) was used to quantify the magnitude of inequalities in stunting. The pooled Poisson regression model was used to determine the factors for stunting, decision criterion for significant determinants was at 5% level of significance. The CIX was decomposed using the Wagstaff and Watanabe decomposition methods., the percentage contribution of each factor to the toal concentration index was used to rank the factors for socioeconomic inequalities in stutning., Results: Inequalities in stunting were significantly concentrated among the poor; evidenced by CIX = - 0.019 (p < 0.001) in 2004, - 0.018 (p < 0.001) in 2010 and - 0.0096 (p < 0.001) in 2015. There was insignificant decline in inequalities in stunting; the difference in CIX from 2004 to 2010 was 0.0015 (p = 0.7658), from 2010 to 2015/6 was - 0.0081 (p = 0.1145). The overall change in CIX from 2004 to 2015/6 was 0.00965 (p = 0.0538). Disparities in the distribution of wealth index (mean contribution > 84.7%) and maternal years of schooling (mean contribution > 22.4%) had positive impacts on the levels of inequalities in stunting for all surveyed years. Rural-urban differences reduced inequalities in stunting although the contribution changed over time., Conclusion: Inequalities in stunting declined, differentials in wealth index and maternal education had increased contribution to the levels of inequalities in stunting. Reducing stunting among the disadvantaged groups requires initiatives which should be embarked on the distribution of social services including maternal and reproductive education among women of reproductive age, water and health infrastructures in remote areas.