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Awareness And Decision Making On Health Seeking And Utilization Behaviors Among Substance Abuse Youths, Ezekiel Henry Mbao, Tumbwene Mwansisya, Achilles Kiwanuka, Hossea Rwegoshora

School of Nursing & Midwifery, East Africa

Substance abuse has continued to increase in Tanzania particularly among youth with minority of them seeking the available health services. This study sought to determine the relationship between awareness and decision making on health seeking and utilization behaviors among youth involved in substance abuse in Kinondoni municipality, Dar es Salaam. Concurrent mixed methodology was used. Data were collected among youth with substance abuse problems through face-to-face interviews (n=300) using a structured survey questionnaire. In addition, in-depth interviews (n=23), and focus group discussions (n=5) were conducted. The quantitative data were analyzed using SPSS version 23. Content analysis was used for analyzing …

Cost Analysis Of Large-Scale Implementation Of The ‘Helping Babies Breathe’ Newborn Resuscitation-Training Program In Tanzania, Sumona Chaudhury, Lauren Arlington, Shelby Brenan, Allan Kaijunga Kairuki, Amunga Robson Meda, Kahabi Isangula, Victor Mponzi, Dunstan Bishanga, Erica Thomas, Georgina Msemo, Mary Azayo, Alice Molinier, Brett D. Nelson

School of Nursing & Midwifery, East Africa

Background: Helping Babies Breathe (HBB) has become the gold standard globally for training birth-attendants in neonatal resuscitation in low-resource settings in efforts to reduce early newborn asphyxia and mortality. The purpose of this study was to do a first-ever activity-based cost-analysis of at-scale HBB program implementation and initial follow-up in a large region of Tanzania and evaluate costs of national scale-up as one component of a multi-method external evaluation of the implementation of HBB at scale in Tanzania.

Methods: We used activity-based costing to examine budget expense data during the two-month implementation and follow-up of HBB in one of the …

Blood, Donors And Dollars: Rethinking Financial Sustainability Of Safe Blood Services In Tanzania, Kahabi Isangula, Sharon Brownie, Abela Mahimbo, Solomon Kibona, Abdu Juma, Deus Mogela

School of Nursing & Midwifery, East Africa

Introduction: Collection, processing and distribution of safe blood in Tanzania occurs within a free-for-service context, that is, a collection from non-remunerated blood donors and distributing freely to the needy people through health facilities. The safe blood services in the country appear to be crippled with many challenges and cannot meet the demand for blood and its products. As such, a need for rethinking collection methods, financial models and possible mechanisms for donor remuneration is evident.

Methods: In this paper, we venture on multi-stakeholder meetings and ongoing discussions regarding the internal mechanisms of safe blood transfusion financing. The intent is to …

Fear, Blame And Transparency: Obstetric Caregivers' Rationales For High Caesarean Section Rates In A Low-Resource Setting, Helena Litorp, Andrew Mgaya, Columba Mbekenga, Hussein L. Kidanto, Sara Johnsdotter, Birgitta Essén

School of Nursing & Midwifery, East Africa

In recent decades, there has been growing attention to the overuse of caesarean section (CS) globally. In light of a high CS rate at a university hospital in Tanzania, we aimed to explore obstetric caregivers' rationales for their hospital's CS rate to identify factors that might cause CS overuse. After participant observations, we performed 22 semi-structured individual in-depth interviews and 2 focus group discussions with 5–6 caregivers in each. Respondents were consultants, specialists, residents, and midwives. The study relied on a framework of naturalistic inquiry and we analyzed data using thematic analysis. As a conceptual framework, we situated our findings …

Women’S Perceptions Of Antenatal, Delivery, And Postpartum Services In Rural Tanzania, Gladys Reuben Mahit, Dickson Ally Mkoka, Angwara Dennis Kiwara, Columba Mbekenga, Anna-Karin Hurtig, Isabel Goicolea

School of Nursing & Midwifery, East Africa

Background: Maternal health care provision remains a major challenge in developing countries. There is agreement that the provision of quality clinical services is essential if high rates of maternal death are to be reduced. However, despite efforts to improve access to these services, a high number of women in Tanzania do not access them. The aim of this study is to explore women’s views about the maternal health services (pregnancy, delivery, and postpartum period) that they received at health facilities in order to identify gaps in service provision that may lead to low-quality maternal care and increased risks associated with …

Global Collaboration Between Tanzania And Japan To Advance Midwifery Profession: A Case Report Of A Partnership Model, Yoko Shimpuku, Shigeko Horiuchi, Sebalda C. Leshabari, Dickson Mkoka, Yasuko Nagamatsu, Miwako Matsutani, Hiromi Eto, Michiko Oguro, Yukari Yaju, Mariko Iida, Columba Mbekenga, Lilian Mselle, Agnes Mtawa

School of Nursing & Midwifery, East Africa

The global health agenda to reduce maternal mortality is delayed in Sub-Saharan Africa. The shortage of skilled birth attendants in Tanzania hinders the improvement of midwifery care to prevent maternal mortality and morbidity. It is urgently neccesary to develop midwifery leaders capable of working as educators, researchers, administrators, and advanced practitioners, contributing to the improvement of midwifery care and maternal child health in their own country. This report describes the process of establishing the first midwifery master’s program in Tanzania through the efforts of two academic institutions, one in Tanzania and one in Japan. The collaboration developed a sustainable partnership …

“We Have Been Working Overnight Without Sleeping”: Traditional Birth Attendants’ Practices And Perceptions Of Post-Partum Care Services In Rural Tanzania, Gladys R. Mahiti, Angwara D. Kiwara, Columba Mbekenga, Anna-Karin Hurtig, Isabel Goicolea

School of Nursing & Midwifery, East Africa

Background: In many low-income countries, formal post-partum care utilization is much lower than that of skilled delivery and antenatal care. While Traditional Birth Attendants (TBAs) might play a role in post-partum care, research exploring their attitudes and practices during this period is scarce. Therefore, the aim of this study was to explore TBAs’ practices and perceptions in post-partum care in rural Tanzania.

Methods: Qualitative in-depth interview data were collected from eight untrained and three trained TBAs. Additionally, five multiparous women who were clients of untrained TBAs were also interviewed. Interviews were conducted in February 2013. Data were digitally recorded and …

Psychobiobehavioral Model For Preterm Birth In Pregnant Women In Low- And Middle-Income Countries, Shahirose S. Premji, Ilona S. Yim, Aliyah Dosani (Mawji), Zeenatkhanu Kanji, Salima Sulaiman, Wangira Musana, Pauline Samia, Kiran Shaikh, Nicole Letourneau

School of Nursing & Midwifery, East Africa

Preterm birth (PTB) is a final common outcome resulting from many interrelated etiological pathways; of particular interest is antenatal psychosocial distress (i.e., stress, anxiety, and depression). In LMI countries, both exposure to severe life stressors and rate of PTB are on average greater when compared with high-income countries. In LMI countries women are exposed to some of the most extreme psychosocial stress worldwide (e.g., absolute poverty, limited social resources). High prevalence of antenatal stress and depression have been observed in some studies from LMI countries. We propose a psychosocial, biological, and behavioral model for investigating the complex multisystem interactions in …

Birth Preparedness And Complication Readiness – A Qualitative Study Among Community Members In Rural Tanzania, Furaha August, Andrea B. Pembe, Edmund Kayombo, Columba Mbekenga, Pia Axemo, Elisabeth Darj

School of Nursing & Midwifery, East Africa

Background: Birth preparedness and complication readiness (BP/CR) strategies are aimed at reducing delays in seeking, reaching, and receiving care. Counselling on birth preparedness is provided during antenatal care visits. However, it is not clear why birth preparedness messages do not translate to utilisation of facility delivery. This study explores the perceptions, experiences, and challenges the community faces on BP/CR.

Design: A qualitative study design using Focused Group Discussions was conducted. Twelve focus group discussions were held with four separate groups: young men and women and older men and women in a rural community in Tanzania. Qualitative content analysis was used …

The Leaking Pocket: The Implicit Struggle For Skilled Health Workers Between Private Not-For-Profit And Public Sector In Tanzania, Kahabi Isangula, Sharon Brownie

School of Nursing & Midwifery, East Africa

Public health services in sub-Sahara Africa countries face severe health workforce shortages exacerbated by both outward migration and internal public to private sector migration—Tanzania is no exception. This review was conducted to characterize the extent of health workforce shortages in Tanzania, and the factors impacting on the shortage. The authors reviewed publicly available data to assess the extent of health workforce shortages within Tanzania and the range of ‘pull’ and ‘push’ factors contributing to the shortages. Findings highlight significant health workforce shortages in Tanzania. Pull factors, the advantages offered that 'pull' workers towards the new jobs and well as Push …

Interprofessional Curriculum On Environmental And Social Determinants Of Health In Rural Kenya: Aga Khan University East Africa University Of California San Francisco Integrated Primary Health Care Program, M. R. Mahoney, K. Baltzell, Esther Nderitu, R. Dhanani, S. Macfarlane

School of Nursing & Midwifery, East Africa

The Aga Khan University East Africa (AKU)-University of California San Francisco (UCSF) Integrated Primary Health Care Program (IPHC) is a public–private partnership with community and government to strengthen the primary health care (PHC) system in Kenya. IPHC provides opportunities for health professions students to work and learn together in the rural and underserved district of Kaloleni.

Prolonged Sexual Abstinence After Childbirth: Gendered Norms And Perceived Family Health Risks. Focus Group Discussions In A Tanzanian Suburb, Columba Mbekenga, Andrea B. Pembe, Elisabeth Darj, Kyllike Christensson, Pia Olsson

School of Nursing & Midwifery, East Africa

Background: Prolonged sexual abstinence after childbirth is a socio-cultural practice with health implications, and is described in several African countries, including Tanzania. This study explored discourses on prolonged postpartum sexual abstinence in relation to family health after childbirth in low-income suburbs of Dar es Salaam, Tanzania.

Methods: Data for the discourse analysis were collected through focus group discussions with first-time mothers and fathers and their support people in Ilala, Dar es Salaam, Tanzania.

Results: In this setting, prolonged sexual abstinence intended at promoting child health was the dominant discourse in the period after childbirth. Sexual relations after childbirth involved the …

Informal Support To First-Parents After Childbirth: A Qualitative Study In Low-Income Suburbs Of Dar Es Salaam, Tanzania, Columba Mbekenga, Andrea B. Pembe, Kyllike Christensson, Elisabeth Darj, Pia Olsson

School of Nursing & Midwifery, East Africa

Background: In Tanzania, and many sub-Saharan African countries, postpartum health programs have received less attention compared to other maternity care programs and therefore new parents rely on informal support. Knowledge on how informal support is understood by its stakeholders to be able to improve the health in families after childbirth is required. This study aimed to explore discourses on health related informal support to first-time parents after childbirth in low-income suburbs of Dar es Salaam, Tanzania.

Methods: Thirteen focus group discussions with first-time parents and female and male informal supporters were analysed by discourse analysis.

Results: The dominant discourse was …

Tanzanian Nurses Understanding And Practice Of Spiritual Care, Khairunnisa Aziz Dhamani, Pauline Paul, Joanne Kaye Olson

School of Nursing & Midwifery, East Africa

Spirituality, as a basic characteristic of humans and a contributor to human health, is regarded as part of nursing practice. The purpose of this study was to examine how Tanzanian nurses understand spirituality and spiritual care. Using the qualitative method of interpretive description, fifteen registered nurses engaged in clinical practice in a Tanzanian hospital were recruited to participate in this study. In-depth interviews using open-ended questions were carried out, tape-recorded, and transcribed verbatim. Data collection and inductive analysis occurred concurrently. In this paper, key findings are grouped under the following headings: meaning of spiritual care, recognition of spiritual needs, and …