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Background: It is estimated 1.2 billion of world’s population are adolescents aged 10 - 19 years; 80% live in developing countries. Adolescents in developing countries especially Sub-Saharan Africa (SSA) face high burden of sexual and reproductive health problems. Sixteen million girls aged 15 to 19 years give birth every year of which 95% occur in low- and middle-income countries. Twenty five percent of unsafe abortions are in 15 - 19 years in Sub-Saharan Africa. Contraceptive use is low as approximately 10% of adolescents are current users. These problems can be averted if different ranges of Sexual and Reproductive Health Services for adolescent (SRHSA) are available and utilized by adolescents. In Tanzania, there is limited information addressing the availability, types and utilization pattern of sexual and reproductive health services by adolescents. This study investigates the availability, range and utilization of sexual and reproductive health services for adolescents (ASRHS) at Kinondoni Municipality, Tanzania. Method: A cross-sectional study was carried out in April to May 2013. A checklist was used to collect information on the availability and range of services offered at selected health facilities. In depth interviews conducted with in-charges of Reproductive and Child Health (RCH) clinics to explore barriers for provision of Sexual and Reproductive Health Services (SRHS) for adolescents. Adolescents were questioned using a questionnaire on utilization of SRHS and perceived barriers. Descriptive statistics were used to summarize quantitative data and content analysis for qualitative data. Results: On availability and range of adolescents’ sexual and reproductive health services, a total of 25 health facilities were surveyed. Forty four percent of the surveyed facilities did not have the adolescent sexual and reproductive health services (ASRHS). The Adolescents Sexual and Reproductive Health (ASRH) services offered differed greatly between facilities. On utilization of adolescents’ sexual and reproductive health services in total, 204 adolescents from the community were involved in this study. A third of adolescents reported to have ever used ASRH. The adolescents perceived barriers for underutilization of the services were fear of being seen at the clinics (23.3%), lack of money (18.3%), lack of privacy & confidentiality (14.2%) and unfriendly health care providers. Three barriers were perceived by health care providers in the provision of ASRHS: integration of SRHS, lack of training in relation to adolescents SRHS and attitudes of health care providers towards young people. Conclusion: About half of the health facilities did not have the SRH-services to adolescent (44%) and different ranges of services were not offered at the facilities as it was shown in the records. The results from this study show services were underutilized by adolescents. Training, attitudes of health care providers towards young people, & cost influenced ASRHS provision and utilization. Strategies to increase training in ASRHS for health providers including communication skills and scaling ASRH services to all primary care facilities may help to improve availability and access of services to adolescents.

Despite the availability of vaccines and antibiotics, pneumonia remains the leading cause of mortality among children under 5 years of age. The objective of this study was to identify modifiable risk factors for community-acquired pneumonia (CAP) in children under 5 years of age in a vaccinated population.A case-control study was conducted between January and December 2017. The cases included children aged 2-59 months with X-ray-confirmed pneumonia, whereas the controls were children from the community with no history of respiratory infection. A multivariable logistic regression model was used to determine the modifiable risk factors for CAP.A total of 113 children with X-ray-confirmed pneumonia and 350 healthy children were enrolled in this study. The median ages for the cases and controls were 13.7 (IQR = 7.2-25.3) and 13.4 (IQR = 6.0-24.8) months respectively. One (0.9%) child died after the enrolment. The independent predictors of CAP included a lack of exclusive breastfeeding for 6 months (aOR = 1.7, 95% CI = 1.0-2.9), underweight (aOR = 2.1, 95% CI = 1.0-4.5), unclean cooking fuel (aOR = 1.8, 95% CI = 1.0-3.3) and low income (aOR = 2.9, 95% CI = 1.6-5.4). No association was found between vaccination status and CAP.In addition to a lack of exclusive breastfeeding, children from families of low-economic status were at risk of contracting CAP. Since the risk factors are complex, the study results call for more concerted efforts by and collaboration among the health, agriculture and development sectors to address mortality caused by CAP.Malgré la disponibilité des vaccins et des antibiotiques, la pneumonie reste la principale cause de mortalité chez les enfants de moins de cinq ans. L'objectif de cette étude était d'identifier les facteurs de risque modifiables pour la pneumonie acquise en communauté (PAC) chez les enfants de moins de cinq ans dans une population vaccinée. MÉTHODES: Une étude cas-témoins a été menée entre janvier et décembre 2017. Les cas concernaient des enfants âgés de 2 à 59 mois atteints de pneumonie confirmée par la radiographie, alors que les témoins étaient des enfants de la communauté sans antécédents d'infection respiratoire. Un modèle de régression logistique multivariée a été utilisé pour déterminer les facteurs de risque modifiables pour la PAC. RÉSULTATS: Au total, 113 enfants atteints de pneumonie confirmée par la radiographie et 350 enfants en bonne santé ont été inclus dans cette étude. Les âges médians pour les cas et les témoins étaient respectivement de 13,7 (IQR = 7,2 - 25,3) et de 13,4 (IQR = 6,0 - 24,8) mois. Un enfant (0,9%) est décédé après l'inscription. Les prédicteurs indépendants de la PAC comprenaient une absence d'allaitement exclusif pendant six mois (aOR = 1,7; IC95%: 1,0 - 2,9), un poids insuffisant (aOR = 2,1; IC95%: 1,0 - 4,5), un combustible de cuisson non propre (aOR = 1,8; IC95%: 1,0 - 3,3) et un faible revenu (aOR = 2,9; IC95%: 1,6 - 5,4). Aucune association n'a été trouvée entre le statut de vaccination et la PAC.Outre l'absence d'allaitement maternel exclusif, les enfants issus de familles à faible statut économique étaient à risque de contracter la PAC. Les facteurs de risque étant complexes, les résultats de l’étude appellent à des efforts plus concertés et une collaboration accrue entre les secteurs de la santé, de l'agriculture et du développement afin de lutter contre la mortalité causée par la PAC.

Background Measuring and monitoring progress towards Millennium Development Goals (MDG) 4 and 5 required valid and reliable estimates of maternal and child mortality. In South Africa, there are conflicting reports on the estimates of maternal and neonatal mortality, derived from both direct and indirect estimation techniques. This study aimed to systematically review the estimates made of maternal and neonatal mortality in the period from 1990 to 2015 in South Africa and determine trends over this period. Methods Nationally-representative studies reporting on maternal and neonatal mortality in South Africa were included for synthesis. Literature search for eligible studies was conducted in five electronic databases: Medline, Africa-Wide Information, Scopus, Web of Science and CINAHL. Searches were restricted to articles written in English and presenting data covering the period between 1990 and 2015. Reference lists of retrieved articles were screened for additional publications, and grey literature was searched for relevant documents for the review. Three independent reviewers were involved in study selection, data extractions and achieving consensus. Results In total, 969 studies were retrieved and 670 screened for eligibility yielding 25 studies reporting data on maternal mortality and 14 studies on neonatal mortality. Most of the studies had a low risk of bias. Estimates from the institutional reporting differed from the international metrics with wide uncertainty/confidence intervals. Moreover, modelled estimates were widely divergent from estimates obtained through empirical methods. In the last two decades, both maternal and neonatal mortality appear to have increased up to 2009, followed by a decrease, more pronounced in the care of maternal mortality. Conclusion Estimates from both global metrics and institutional reporting, although widely divergent, indicate South Africa has not achieved MDG 4a and 5a goals but made a significant progress in reducing maternal and neonatal mortality. To obtain more accurate estimates, there is a need for applying additional estimation techniques which utilise available multiple data sources to correct for underreporting of these outcomes, perhaps the capture-recapture method. Systematic review registration PROSPERO CRD42016042769

Malaria is a life-threatening disease caused by female anopheles´ mosquitoes. In 2019, there were an estimated 229 million cases and 409,000 death of malaria worldwide. About 94% of malaria cases and deaths were from Africa, six African countries accounted for approximately half of all malaria deaths worldwide, including Tanzania (5%). The main complications of severe malaria are cerebral malaria, pulmonary edema, acute renal failure, severe anemia, bleeding, acidosis, hypoglycemia and rarely cerebral accident. Cerebral malaria is associated with neurological sequelae such as cortical blindness, ataxia, hemiparesis, tetraparesis, epilepsy, memory impairment, cognitive, language and behavioral problems. A 2 year old boy presented with convulsions, high grade fever, non-projectile vomiting, anaemia, left sided hemiplegia and right sided hemiparesis, the child was mRDT positive Blood smear showed hyperparasetimia, and the CT scan showed hypoperfusion on the right basal and thalamus regions, our patient also had history of incomplete antimalarial therapy. The child was treated with artesunate injections, intravenous antibiotics, paracetamol for the fevers, and sodium valproate which relieved the seizures, he was also kept on physiotherapy, improved after 10 days, and he regained full neurological functions and was discharged home.

Background Sexual and reproductive health (SRH) among young adults in developing countries is still a major public health concern. Early school-based sexuality education programs and sexual health information sharing between teachers, parents and young people have been considered protective against sexual health risks that young people are prone to. There is limited information on preferred choices of “where” and “how” young people like to get their SRH information. Here, we describe what young people prefer to learn with regard to sexual matters, where and who they prefer to learn from, and their experiences of parent-child sexuality communication. MethodsThis was a cross-sectional study, conducted from March 2019 to January 2020 among students aged 18-24 years attending Higher Learning Institutions (HLIs) within Mbeya. A self-administered questionnaire was used to collect information on SRH education, ability to discuss sexual matters with a parent/guardian, and SRH information gap during early sexual experience. ResultsOut of 504 students that were enrolled, 377 (74.8%) reported to be sexually active with mean age at sexual debut of 18.4 years. Six out of ten students found it difficult to discuss or did not discuss sexual matters with a parent/guardian while growing up at age 12-18 years. Majority learnt about SRH matters from peers (30%) and lessons at schools (23%). We found a gender-biased preference on sexual matters discussions, such that female and male participants preferred discussions with female adults and male adults, respectively. Peers (18%), Media (17%) and schools (13%) were preferred sources of SRH information. On recalling first sexual experience, participants felt they needed to know more about sexual feelings, emotions and relationships (26.9%), safer sex (13.8%), how to be able to say 'No' (10.5%) and how to use a condom correctly (10.2%). ConclusionYoung people have a gender-biased preference when it comes to learning about SRH matters from their parents; however, such conversations seldom occur. Community health IEC should incorporate the agenda on building skills of parents on parent-child communication on sexual matters so as to empower them to confidently initiate and convey appropriate and sufficient sexual health information. Comprehensive SRH education and skills building is needed in the current school SRH curriculum in order need to meet the demand and needs of students’ and teachers’.

Background. Breastfeeding is the best way to feed infants. It is a simple intervention to improve child health and development. Despite its advantages, there is a low global rate of exclusive breastfeeding (EBF) and, in Kilimanjaro region, Tanzania, EBF is rarely practiced. The aim of this paper is to explore social and cultural factors that might influence the practice of breastfeeding and exclusive breastfeeding in Kilimanjaro region.Methods. A qualitative design was used. Three districts in Kilimanjaro region, namely, Same, Moshi Municipal Council, and Rombo, were selected. In each district three focus group discussions (FGDs) were conducted with mothers with infants aged 0-12 months.Results. A total of 78 mothers participated in the focus group discussions. A majority of the mothers were positive towards breastfeeding. They believed that it prevents child sickness, creates happiness, and is good for family economy. Despite the positive attitudes, the mothers revealed many perceptions that interfered with breastfeeding and exclusive breastfeeding. These included the following: breast milk is very light and has bad odor, breastfeeding may affect mothers appearance,chango(abdominal pain) has to be treated, there is fear of the evil eye when breastfeeding in public places, breast milk may become unclean, and there is a need of pauses in breastfeeding after the child has burped on the breast.Conclusion. There are beliefs that promote the practice of breastfeeding in this setting; these local beliefs could be used to develop breastfeeding messages to improve breastfeeding practices. However, there is also a need to address beliefs that interfere with the practice of exclusive breastfeeding in this setting.

Background: Preterm birth is the leading cause of infant morbidity and mortality globally. Infants who are born preterm suffer long term health consequences. There only few studies done on risk factors for prematurity in Tanzania. This study aimed to determine the risk factors for preterm birth among women who delivered preterm babies at Bugando Medical Centre in Mwanza, Tanzania. Methods:A matched case-control study was conducted at the Bugando Medical Centre from May to June 2015. A total of 50 women with preterm birth (cases) were matched with 50 women who had term births (controls). Cases were matched with controls by date of delivery. We excluded mothers with multiple gestations and those who were sick and unsuitable for the interview. A structured questionnaire was used to collected relevant information from all participants. Data analysis was performed using SPSS version 20.0. Odds ratios with 95% confidence interval were estimated in a multivariate regression model to determine factors associated with preterm delivery.

Prevention of exposure to the COVID-19 virus in the general population is an essential strategy to slow community transmission. This paper shares the experiences and challenges of community engagement in COVID-19 prevention in the Kilimanjaro region, Northern Tanzania implemented by our team from the Institute of Public Health (IPH), Kilimanjaro Christian Medical University College (KCMUCo) in collaboration with the COVID-19 response team in the Moshi Municipality. We conducted an education session with the COVID-19 response team and together brainstormed transmission hotspots and which interventions would be most feasible in their settings. The first hotspot identified was crowded local market spaces. Suggested interventions included targeted and mass public health education through the engagement of market opinion leaders, public announcements, and radio shows. We conducted participatory rural appraisal techniques to enable market vendors and clients to visualize two-meter distances and provided a prototype hand-washing facility that was foot operated. We found mass public health educational campaigns essential to inform and update the public about COVID-19 pandemic and to address rumors and misinformation, which hampers compliance with public health interventions. Coordinated efforts among stakeholders in the country are necessary to develop context-specific prevention and case management strategies following the national and international guidelines. Local ownership of recommended interventions is necessary to ensure compliance.

Background Increasing knowledge on obstetric danger signs (DS) among pregnant women and their families is one of the interventions targeted to reduce maternal and newborn mortality. It is expected that knowledge in DS will lead to early care seeking once complications occur among women or newborns. Health care providers are required to educate women on DS of obstetric emergency during pregnancy, delivery and immediate-post-delivery. This study aimed to determine the level of knowledge on danger signs among rural women and its effect on antenatal care visits, birth preparedness and complication readiness (BPCR) and on use of skilled birth attendance (SBA) during childbirth.Methodology Community-based analytical cross-sectional study was conducted in July 2019 among women who delivered in the past 24 months in two wards at Babati Rural district, Tanzania. Questionnaire was used for data collection. Odds Ratio was used to assess association between knowledge on danger signs with use of services during pregnancy and childbirth.Results A total of 372 women were enrolled, with mean age of 28.5 years (S.D 7.2). All the women attended antenatal care at least once during pregnancy, 65.3% attended ANC 4 or more visits, 85.2% of women were assisted by SBA during childbirth, and 13.7% of the women had birth preparedness and complication readiness plan. Overall, 272 (73.1%) women reported that they were counseled about obstetric danger signs during antenatal clinic visits, but only 32% could mention three or more DS of obstetric and newborn emergency. Overall good knowledge of DS and knowledge of obstetric danger signs during pregnancy were significantly associated with 4 or more ANC visits and birth preparedness and complication readiness but not with SBA use during childbirth.Conclusion Majority of women were counseled on DS during pregnancy, however more than three quarters (68%) had low knowledge. Women who were knowledgeable on danger signs during pregnancy attended 4+ ANC visits and prepared for birth and its complications. There is a need of designing alternative models of engaging women during education/ counseling sessions so that they may have a higher retention of knowledge not only of danger signs but for other maternal and newborn health issues.

IntroductionDeath related to pregnancy complications and delivery remains a public health problem in developing countries including Tanzania where majority of women and newborns die each year due to preventable causes. Delivery with a skilled birth attendant (SBA) is an important intervention to avert maternal and newborn mortality. This study aimed to determine factors influencing skilled birth attendant’s use among postpartum women in Arusha city and Arumeru district in Arusha region.MethodsThis was a cross-sectional study which was conducted from April to July 2017. The study utilized secondary data from the parent study which was conducted in Arusha city and Arumeru district in Arusha region. The parent study aimed to assess knowledge of danger signs in obstetric complication, birth preparedness and utilization of skilled birth attendants among post-partum women in urban and rural Arusha region in Tanzania. Data analysis was performed using SPSS version 20. Chi square statistics was used to determine the association between a set of independent variables and utilization of skilled birth attendance in bivariate analysis. Odds ratios with 95% confidence interval for factors influencing skilled birth attendants’ use were estimated in a multivariable logistic regression models. A p-value of less than 0.05 was considered statistically significant.ResultsA total of 1218 post-partum women were studied. Their mean age was 26.2 (SD 5.9) years. Of these, 1020 used skilled birth attendants during delivery; this corresponds to prevalence of 83.7%. Mother’s education level, area of residence, distance from health facility, frequency of antenatal care and parity were significantly associated utilization of skilled birth attendants during delivery.ConclusionThe prevalence of skilled birth attendants’ use among postpartum women is high in the studied population compared to the national level. Strategies to create community awareness on important of skilled birth attendants’ use will increase its uptake and my help to reduce both mother and child mortality.

Objectives To determine the prevalence and predictors of gestational diabetes mellitus (GDM) as well as acceptability of returning for glucose tolerance testing among pregnant women in Moshi municipality, northern Tanzania. Methods Cross-sectional study from October 2015 to April 2016 among women with gestation age of 24-28 weeks of pregnancy attending at Kilimanjaro Christian Medical Centre (KCMC) referral hospital, Majengo and Pasua Health Centres. Women were interviewed and requested to return the next day (window within a month, depending on gestational age) for fasting plasma glucose (FPG) testing, followed immediately by a 75 g oral glucose tolerance test (OGTT). GDM was diagnosed using the 2013 WHO criteria. Logistic regression was conducted to reveal independent predictors for GDM. Results Of 433 interviewed women, 100 (23%) did not return for FPG and OGTT testing. The prevalence of GDM among the 333 screened women was 19.5%, and 3% had diabetes in pregnancy (DIP). GDM was significantly associated with age ≥35 years (adjusted OR 6.75), pre-pregnancy obesity (AOR 2.22) and history of abortion (AOR 2.36). Conclusion Prevalence of GDM is high in Moshi. We recommend introduction of routine screening for hyperglycaemia during pregnancy along with strategies for follow-up to prevent long-term effects of GDM and DIP in women and their children.

Background Measuring and monitoring progress towards Millennium Development Goals (MDG) 4 and 5 requires valid and reliable estimates of maternal and neonatal mortality. In South Africa, there are conflicting reports on the estimates of maternal and neonatal mortality, derived from both direct and indirect estimation techniques. This study aims to systematically review the estimates made of maternal and neonatal mortality in the period from 1990 to 2015 in South Africa and determine trends over this period. Methods For the purpose of this review, searches for eligible studies will be conducted in MEDLINE, Africa-Wide Information, African Index Medicus, African Journals Online, Scopus, Web of Science and CINAHL databases. Searches will be restricted to articles written in English and presenting data covering the period between 1990 and 2015. Reference lists of retrieved articles will also be screened for additional publications. Three independent reviewers will be involved in the study selection, data extractions and achieving consensus. Study quality and risk of bias will thereafter be assessed by two authors. The results will be presented as rates/ratio with their corresponding 95% confidence/uncertainty intervals. Discussion Identifying trends in maternal and neonatal mortality will help to track progress in MDGs 4 and 5 and will serve in evaluating interventions focusing on reducing maternal and child mortality in the country. This study will, in particular, provide the context for understanding inconsistencies in reported estimates of maternal and neonatal mortality by considering estimation methods, data sources and definitions used. Systematic review registration PROSPERO CRD42016042769

This study assessed the prevalence and risk factors associated with underweight, stunting and wasting among children aged 0–24 months in six districts of Kilimanjaro region, northern Tanzania. A cross-sectional population-based study using a multistage, proportionate to size sampling was conducted from June 2010 to March 2011. A structured questionnaire was used to collect sociodemographic, economic, feeding and child information. Anthropometric data were collected by trained field workers, and the data were used to assess child nutritional status. A total of 1870 children were enrolled in this study. The prevalence of children classified as underweight was 46.0%, stunting was 41.9%, and wasting was 24.7%. About 33% were both underweight and stunted, and 12% had all three conditions. In a multivariate logistic regression, child age, child being ill and birth weight were associated with all anthropometric indices. Child being breastfed was associated with being underweight and wasting. Mother’s education was associated with being underweight and stunting. Fathers aged 35+ years, and living in the Hai district was associated with stunting, and being female was associated with wasting. The prevalence of child undernutrition is high in this region. Strategies that target each risk factor for child undernutrition may help to reduce the problem in the region.

Introduction Human Immunodeficiency Virus (HIV) and hepatitis B virus are prevalent infections in sub-Saharan Africa, but information on the prevalence of co-infection is limited. This study aimed to determine seroprevalence and risk factors for hepatitis B virus infection among people living with HIV receiving care and treatment at Kilimanjaro Christian Medical Centre Referral Hospital in northern Tanzania. Methods This was a cross-sectional study conducted from March to June 2015 among people living with HIV (PLWHIV) aged 15 years and above attending the Care and Treatment Clinic for routine care at Kilimanjaro Christian Medical Centre. Systematic sampling was used to select the study participants. Information on socio-demographic data, sexual behaviour and medical history were collected using a questionnaire. Hepatitis B surface antigen was diagnosed using a rapid test. Descriptive statistics were used to summarize the data. Results A total of 300 PLWHIV consented to participate in this study, of whom 62% were female. Their ages ranged from 15-75 years, with a median age of 46 years (IQR of 39-53 years). The seroprevalence of hepatitis B surface antigen among people living with HIV was 2.3% (n=7/300). A history of blood transfusion was the only factor associated with hepatitis B surface antigen infection, while other socio-demographic and clinical factors showed no association. Conclusion Hepatitis B virus infection is infrequent among PLWHIV in this setting. Despite the prevalence, we recommend routine screening for hepatitis B surface antigen and other hepatitis B virus markers among PLWHIV in order to tailor antiretroviral regimens against hepatitis B virus.

Background Knowledge on infant feeding among pregnant women is essential when promoting optimal breastfeeding practices. This study aimed to assess the knowledge of women on optimal breastfeeding during pregnancy and associated factors as well as performance of the health system in reaching women with information on breastfeeding and infant feeding issues. Methods A cross-sectional study was conducted from October 2013 to April 2014 among pregnant women, in their third trimester, attending for routine care at two primary health care facilities in Moshi urban, northern Tanzania. Results A total of 536 women were enrolled, with mean age of 25.9 (SD 5.7) years. Only 51% (n = 274) reported to have received counselling on breastfeeding from their healthcare providers during the current pregnancy. More than seven out of ten pregnant women were knowledgeable about key issues regarding appropriate breastfeeding practices: importance of colostrum (95%), time of breastfeeding initiation (71%), exclusive breastfeeding (EBF) (81%), and time of introducing complementary feeding (83%). Receiving counselling on breastfeeding during the current pregnancy (Adjusted Odds Ratio [AOR] 3.7; 95% Confidence Interval [CI]: 2.4, 5.7), having two children (AOR 2.6; 95% CI: 1.5, 4.4), having three or more children (AOR 3.5; 95% CI: 1.8, 6.9) and intention to breastfeed the child exclusively (AOR 3.6; 95% CI: 2.0, 6.5) were significantly associated with appropriate breastfeeding knowledge. Conclusions The health system failed to reach the 49% of women who did not receive counselling on infant feeding. Pregnant women who had received counselling on optimal breastfeeding and women with more than one child were more likely to have knowledge of optimal breastfeeding practices.

Background Low birth weight (LBW) is an important indicator of newborn survival. It associated with higher risk of mortality, morbidity and long term health consequences later in life. Little has been explored in developing countries including Tanzania. This study aimed to determine the incidence and estimate recurrence risk of LBW among women who delivered at KCMC. Methods A prospective cohort study was conducted using maternally linked data from KCMC birth registry. A total of 39,073 women who delivered singleton live born babies between 2000 and 2014 were studied. Of these, 8,417 (21.5%) women had subsequent pregnancies. The recurrence risk of LBW was estimated using a multivariate log binomial model. A robust variance estimator was used to account for correlation between births of the same mother. Results The incidence of LBW was 7.7%. Women who delivered normal birth weight babies in the first pregnancy had a 6.0% risk of delivering a LBW baby in subsequent pregnancy compared to the absolute recurrence risk of 27.2% for women who had LBW in first pregnancy. This corresponded to a relative risk (RR) of 3.7-fold (95%CI: 3.87–5.25). Antenatal care visits ( Conclusion The incidence of LBW in our study was higher as compared to the national average. Previous history of LBW was associated with recurrent LBW in subsequent pregnancies. Maternal characteristics such as low number of antenatal care visits, preterm delivery, HIV status and preeclampsia in the previous pregnancy were important predictors for LBW recurrence. Early identification of women at risk of LBW and close clinical follow-up of these women may reduce the risk of recurrent LBW.

Background: Availability of emergency obstetric and newborn care (EmOC) is one of interventions to reduce maternal and newborn deaths. Maternal and newborn mortality is a public health problem in most developing countries including Tanzania. In these settings, coverage of EmOC is low especially in rural areas, with limited information on availability and use of EmOC services. Objectives: To assess the availability, utilization and quality of emergency obstetric care in Hai district, located at Kilimanjaro region, northern Tanzania. Methods: A cross-sectional survey of 12 health facilities (2 hospitals and 10 primary health care facilities) which provide delivery services in the district was conducted in May- June 2014. Modified AMDD data collection tool was used and it assessed availability of services, supplies and equipments, infrastructure and actual performance of EmOC within the past 3 months prior to the interview. Proportions were used to summarize the data. Results: The two comprehensive EmOC facilities (CEmOC) could provide all the nine required signal functions while none of the basic EmOC facilities (BEmOC) could provide the seven required signal functions. For a population of 214,454 in the district, the total number of health facilities designated to provide EmOC services exceeded the minimum required number which was 1 for CEmOC and 2 BEmOC. The proportion of births taking place in facilities was 65.3% and the met need for emergency obstetric complications was 94.5%. Population based caesarean section rate and the still birth rate were 7.4% and 1.3% respectively. Conclusion: BEmOC facilities, which are the first level of care for majority of women and newborns with complications, need to be strengthened to offer the required medical and surgical interventions to save lives. There is a need to scale-up training of health providers especially at the lower level (dispensaries and health centres) in EmOC as well as to strength supply chain system in order to contribute in attaining the national BEmOC coverage of 70% by December 2015.

Background Exclusive breastfeeding (EBF) for the first six months of infants' lives is a cost effective intervention in saving children's lives and can avert 13 - 15% of the 9 million deaths of children under 5 years old in resource poor settings. However, EBF rates have been shown to be low in resource poor settings, ranging between 20 and 40%. In Tanzania, the prevalence of EBF among infants under 6 months is 41%, with limited information on predictors of EBF. The aim of the study was to determine prevalence of EBF and its predictors in Kigoma Municipality, Western Tanzania. Methods A cross-sectional study was conducted in March to May 2010 among 402 consenting women, with infants aged 6 to 12 months, from randomly selected households. A questionnaire was used to collect information on demographic characteristics, knowledge of EBF, infant feeding practices, and on HIV status. Results The prevalence of EBF among women in Kigoma Municipality was 58%. Knowledge of EBF was relatively higher (86%) compared to the practice. In the multivariable analysis, women with adequate knowledge of EBF (AOR 5.4), women who delivered at health facilities (AOR 3.0) and women who had no problems related to breasts, like engorgement/cracked nipples (AOR 6.6) were more likely to exclusively breastfeed compared to others. Conclusions Prevalence of EBF in Kigoma municipality was slightly higher than the national figure of 41%, however it was way below the EBF prevalence of 90% recommended by the WHO. Strategies that target improving knowledge and skills for lactation management among women, as well as strategies to improve health facility delivery, may help to improve EBF in this setting.