10 research outputs found
Providing anti-retroviral therapy in the context of self-perceived stigma: a mixed methods study from Tanzania
No full textAdherence to anti-retroviral treatment (ART) has been a significant step towards improving quality of life among people living with HIV. However, stigma has been described to influence adherence to ART. A cross-sectional mixed methods study was conducted to explore factors related to stigma and perceived influence of stigma on adherence to treatment amongst ART-prescribed patients and health care providers, respectively in Tanzania. Stigma was assessed through interviewer administered survey among 295 patients. The results from patients showed that 279/295 (95%) were satisfied with the services provided at the Care and Treatment Centres (CTCs). The set up of CTCs 107/295 (36%), and queuing at the CTCs 88/295 (30%) were associated with stigma (P<0.001). The perceived influence of stigma on adherence to ART was assessed using focus group discussions (FGDs) of 33 health care providers (HCPs). Through FGDs, HCPs perceived the set up of CTCs as friendly yet violated confidentiality. The HCPs reported that ART-prescribed patients hide identifiable cards to avoid being recognised by other people. Some patients were reported to rush to avoid familiar faces, and due to the rush they picked wrong medicines. Also some patients were reported to throw away manufacturers’ box with dosage instructions written on the box, resulting in use of doses contrary to the prescriptions. We conclude that despite the fact that most patients were satisfied with the services provided at the CTCs, it is important that HCPs provide dosage instructions on another piece of paper or use disposable bags. A common dispensing window for all patients regardless of the diagnosis may be useful to minimize stigma. Also HCPs may introduce appointment system to avoid long queue at the CTCs.
Life threatening arrhythmias: Knowledge and skills among nurses working in critical care settings at Muhimbili National Hospital, Dar es Salaam, Tanzania
No full textIntroduction: A life threatening arrhythmia is a medical condition that requires immediate intervention, or it can cost a patient’s life. However, there is limited understanding of nurses’ knowledge and skills in identification and care provided to patients with life threatening arrhythmias in Tanzania. The objective of this study was to assess knowledge and skills of nurses in identifying life threatening arrhythmias and the required patient care.Methods: A descriptive cross-sectional study was conducted to assess the knowledge and skill level of nurses in identification of life threatening arrhythmias and the required patient care, as well as exploring the barriers in acquiring and implementing particular knowledge and skills. A convenient sample of 141 nurses working in critical care areas at Muhimbili National Hospital, were recruited.Results: The majority (44%) of the participants were 31-40 years old and more than three quarters were females. The majority (60%) scored highly when tested about their knowledge of life threatening arrhythmia identification. However, the majority of nurses (84.4%) scored poorly when being observed on their skills. A total of 116 (82.3%) nurses were able to identify asystole on an electrocardiogram strip, and demonstrated a high level of knowledge (95%) in the nursing care of patients in asystole. Although they demonstrated poor skills in general, nurses were competent (97.9%) in electrode placement on the patient’s chest before connecting the patient to the cardiac monitor. The overwhelming workload was identified by many (68.8%) as the major barrier in acquiring and implementing knowledge and skills.Conclusion: Although the majority of the participants scored highly in their level of knowledge regarding life threatening arrhythmias, they scored poorly in most of the observed skills when identifying and treating this patient group. It is important that hospital administration take into consideration the identified areas of deficiency and work to improve the skills among nurses and enhance optimal care of patients
A cross-sectional study on knowledge and implementation of the nursing process among nurses at Muhimbili National Hospital-Tanzania
No full textBackground: The nursing process involves a series of actions that begin with assessing the patient, identifying problems, setting goals with expected outcomes, implementing care to achieve those goals, and finally evaluating the effectiveness of the care given. Utilization of the nursing process to guide nursing care enhances the quality of patient care and outcomes for both the patient and family members. The purpose of this study was to assess the knowledge and implementation of the nursing process among nurses working at Muhimbili National Hospital, Dar es Salaam, Tanzania.
Methods: We conducted a descriptive cross-sectional study design. A convenient sample of 102 registered nurses (RN) completed a self-administered questionnaire in April 2016. Descriptive statistics and non-parametric tests were used to assess the significance levels of associated variables.
Results: Of 102 respondents, only 16 (15.7%) had high knowledge of the nursing process. Similarly, a few (11, 10.8%) respondents had a high level of practice. The majority of RN (94, 92.2%) were aware of the role of the nurses in providing care to admitted patients. However, only a few (32, 31.4%) were aware of the purpose of the nursing process. Respondents were more likely to have high knowledge in the nursing process if they had a diploma in nursing education (95% CI 0.000-0.029, p < 0.01). The small number of nurses in the ward and inadequate motivational strategies were reported to deprive the implementation of the nursing process.
Conclusion: Overall, low knowledge of the nursing process, understaffing and workload have contributed to the ineffective implementation of the nursing process. On-the-job refresher courses are a short-term strategy that may improve the nurses’ knowledge and motivation to implement the nursing process. This study underscores the need for policymakers to advocate for the employment of a sufficient number of nurses to enable implementation of the nursing process to all admitted patients
Key considerations in scaling up male circumcision in Tanzania: views of the urban residents in Tanzania
No full textMale circumcision (MC) reduces the risk of sexually transmitted
infections (STI) including HIV. The WHO and UNAIDS recommend male
circumcision as an additional intervention to prevent HIV infection.
Tanzania is embarking on activities to scale up safe male circumcision
for HIV prevention and other related health benefits. In line with
this, it is crucial to assess views of the population using specific
groups. This paper describes perceptions on male circumcision and
strategies of enhancing uptake of male circumcision in urban Tanzania
using members of the police force. This cross sectional survey was
conducted among members of the police force in Dar es Salaam Tanzania
from January 2010 to July 2010. The police officer serves as a source
of the clinical trial participants in on-going phase I/II HIV vaccine
trials. Three hundred and thirteen (313) police officers responded to a
self-administered questionnaire that comprised of socio-demographic
characteristics, reasons for not circumcising, perceptions regarding
circumcision, methods of enhancing male circumcision, communication
means and barriers to promote circumcision. This was followed by a
physical examination to determine male circumcision status. The
prevalence of circumcision was 96%. Most (69%) reported to have been
circumcised in the hospital. The reported barriers to male circumcision
among adults and children were: anticipation of pain, cost, fear to
lose body parts, and lack of advice for adult’s circumcision.
Sensitization of parents who take children to the reproductive and
child health services was recommended by most respondents as the
appropriate strategy to promote male circumcision. The least
recommended strategy was for the women to sensitize men. Use of radio
programs and including male circumcision issues in school curricula as
means of enhancing community sensitization regarding male circumcision
were also highly recommended. Other recommendations include use of
public media, seminars at work and issuance of circumcision regulations
by health authorities. In conclusion, the present study reveals male
circumcision was common in a selected urban population. There are
various barriers and channels of communication regarding male
circumcision. In view of scaling male circumcision in Tanzania, use of
radio messages, inclusion of male circumcision in the school curricula
and sensitization at the reproductive and child health clinics are
likely to promote early medical male circumcision
Key considerations in scaling up male circumcision in Tanzania: views of the urban residents in Tanzania
No full textMale circumcision (MC) reduces the risk of sexually transmitted
infections (STI) including HIV. The WHO and UNAIDS recommend male
circumcision as an additional intervention to prevent HIV infection.
Tanzania is embarking on activities to scale up safe male circumcision
for HIV prevention and other related health benefits. In line with
this, it is crucial to assess views of the population using specific
groups. This paper describes perceptions on male circumcision and
strategies of enhancing uptake of male circumcision in urban Tanzania
using members of the police force. This cross sectional survey was
conducted among members of the police force in Dar es Salaam Tanzania
from January 2010 to July 2010. The police officer serves as a source
of the clinical trial participants in on-going phase I/II HIV vaccine
trials. Three hundred and thirteen (313) police officers responded to a
self-administered questionnaire that comprised of socio-demographic
characteristics, reasons for not circumcising, perceptions regarding
circumcision, methods of enhancing male circumcision, communication
means and barriers to promote circumcision. This was followed by a
physical examination to determine male circumcision status. The
prevalence of circumcision was 96%. Most (69%) reported to have been
circumcised in the hospital. The reported barriers to male circumcision
among adults and children were: anticipation of pain, cost, fear to
lose body parts, and lack of advice for adult’s circumcision.
Sensitization of parents who take children to the reproductive and
child health services was recommended by most respondents as the
appropriate strategy to promote male circumcision. The least
recommended strategy was for the women to sensitize men. Use of radio
programs and including male circumcision issues in school curricula as
means of enhancing community sensitization regarding male circumcision
were also highly recommended. Other recommendations include use of
public media, seminars at work and issuance of circumcision regulations
by health authorities. In conclusion, the present study reveals male
circumcision was common in a selected urban population. There are
various barriers and channels of communication regarding male
circumcision. In view of scaling male circumcision in Tanzania, use of
radio messages, inclusion of male circumcision in the school curricula
and sensitization at the reproductive and child health clinics are
likely to promote early medical male circumcision
Perceptions About Repeat HIV Testing in an Incidence Study: A Qualitative Study among a Potential Cohort for HIV Vaccine Trials in Dar es Salaam, Tanzania
No full textInformation regarding repeat HIV testing is useful in the conduct of HIV vaccine trials as potential trial participants are required to undergo repeat HIV testing. In an incidence study conducted in 2008 among 1042 Police Officers 30% of them did not participate in a repeat HIV test. This study was therefore conducted to explore perceptions on repeat HIV testing among members of the incidence study cohort that also served as a source of volunteers for subsequent HIV vaccine trials. This qualitative cross-sectional study was conducted in Dar es Salaam. The study included male and female Police Officers who were eligible to participate in the HIV incidence study. Participants were selected purposefully from eight Police stations out of the 32 stations. Data was collected using in-depth interviews and analysed qualitatively using the content analysis approach. A majority of participants were willing to undergo a repeat HIV test and stated that it was important to repeat an HIV test to confirm their health status, and hence continue protecting themselves. Participants who participated in a repeat HIV test as a part of incidence study reported that the repeat HIV testing process was acceptable because counselling was provided, testing was voluntary, there was trust in the health care providers and a freedom to choose where to test. Participants who did not repeat the HIV test held that repeat a HIV test was not necessary since they believed that the initial test was adequate. Others said that communication breakdown was the main cause as they weren't aware of the importance of a repeat HIV test. Fear of the test results was also mentioned as one of the reasons. The participants were eager to gain more knowledge about the importance of a repeat HIV test. In order to facilitate repeat HIV testing in potential cohorts for HIV vaccine trials, more information and education regarding the repeat HIV test is needed. It is also important to make sure that researchers are well informed on what study participants are supposed to know.\u
How do Tanzanian nursing students experience an elective exchange programme – A qualitative study
No full textBackground: Experiences from the Peace Corps and President's Emergency Plan for AIDS Relief programs show that exchange of nurses can strengthen the breadth and quality of nursing care delivery in places with shortages of health professionals. The objective of this study was to capture the perspectives and experiences of Tanzanian students participating in an international elective in a Scandinavian country. With a phenomenological hermeneutical approach, qualitative interviews were conducted with 16 student nurses from Tanzania. The interviews were guided by a qualitative thematic interview guide. The international placement in Scandinavia had significance to all students. Most students underlined that it had changed their professional and private life to the better, providing them with new competences, new awareness, and job opportunities.</p
A Global Mapping System for Bambara Groundnut Production
No full textThis is the first study that estimates the potential production for any underutilised
crop on a global basis. Our long-term aim is to demonstrate how this approach,
initially for bambara groundnut, can be used to assess the potential productivity
of many underutilised food crops at locations beyond their current distribution.
The most significant contributions from this study are the integration of a
weather simulator and a crop simulation model into a Geographical Information
System (GIS) to predict potential production of bambara groundnut over
the globe. The integration came through a coincidence of interests. FAO needed
to improve the knowledge and better use of underutilised crops that can contribute
to the food security of the world s poorest people. For the University of
Nottingham it was an opportunity to provide a geographic basis for their existing
crop model that had been refined by the third author so that predictions of
bambara groundnut potential could be extended to new sites.
Integration of the weather generator and model into a GIS was based on the
experiences gained by the second author in using fish growth models to estimate
potential for fish farming in Africa (FAO, 1998, available at www.fao.org/docrep/
W8522e/W8522E00.htm)
"I have the vaccine in my body": perceptions of female sex workers after enrolling in a phase IIb HIV vaccine and pre-exposure prophylaxis trial in urban Tanzania.
No full textBACKGROUND: HIV continues to be a significant global public health problem in low and middle-income countries. Efforts to search for an effective and affordable preventative HIV vaccine are on-going. We investigated the understanding of perceived risk for acquiring HIV and the experience of female sex workers (FSW) in Tanzania, before and after enrolling in an HIV vaccine and Pre-Exposure Prophylaxis Trial. METHODS: This was a descriptive qualitative study design nested in a multicentre Phase IIb three-arm, two-stage HIV prophylactic vaccine trial with a second randomization to compare two pre-exposure prophylaxes (PrEPVacc trial) regimens. We present findings from Dar es Salaam site in Tanzania. Fifteen in-depth interviews and four focus group discussions were conducted among FSW who participated in the HIV vaccine and Pre-Exposure Prophylaxis Trial between 2021 and 2023. Data analysis was done manually using the Framework and thematic content analysis approaches. RESULTS: Two themes emerged from the findings: `Apparent risk' of acquiring HIV infection before enrolling in the HIV vaccine trial and `Balancing perceived risk' of acquiring HIV infection and preventive measures after enrolling in the HIV Vaccine and Pre-Exposure Prophylaxis Trial. Before enrolling in the trial, the participants perceived themselves at high risk of acquiring HIV infection. They reported inconsistent condom use in multiple relationships with clients whose HIV status was unknown. After enrolling in the trial, the participants reported improved knowledge of HIV prevention, particularly the use of pre-exposure prophylaxis and compliance with preventive measures. However, some participants perceived that the experimental vaccine was an established HIV preventive measure. In addition, condomless sex was still practiced, mainly to get higher payments from the clients. CONCLUSION AND RECOMMENDATIONS: The knowledge gained on HIV preventive measures by FSW after participation in the trial was valued. However, continued engagement in risky sexual practices and poor compliance with HIV preventive measures highlights the need for continued risk-reduction interventions while searching for an effective HIV vaccine
Prevention of mother-to-child transmission of HIV-1 by antiretroviral treatment and the impact on maternal health in Dar es Salaam, Tanzania
No full textThis thesis describes the results of the Mitra Plus study, including the outcome of antiretroviral therapy (ART) for preventing mother-to-child transmission (PMTCT) of HIV-1 in breastfeeding women and improving HIV-free survival (Paper I), treatment outcome of women initiated on ART for life (Paper II) and reasons for poor drug adherence (Paper III) in Dar es Salaam, Tanzania. Another study (qualitative in nature) explored women’s preferred treatment option for the prevention of breast milk transmission of HIV (Paper IV).In the Mitra Plus study, 501 HIV-1 infected pregnant women were treated with Zidovudine + Lamivudine + Nevirapine/Nelfinavir from 34 weeks of gestation. Treatment of mothers was stopped at six months post-delivery except for those who needed ART for their own health (CD4 cell count = 200/µL or WHO stage III or IV). Mothers were advised to exclusively breastfeed and to wean abruptly when the infant was between five and six months. The cumulative HIV-1 rates determined by Kaplan Meier survival analysis of transmission of 441 infants were 4.1% (95% confidence intervals (CI) 2.2-6.0%) at six weeks, 5.0% (95% CI 2.9-7.1%) at six months and 6.0% (95% CI 3.7-8.3%) at 18 months post-delivery. The cumulative risk of HIV transmission between six weeks and six months was 1.0% and between six months and 18 months was 1.1%. The cumulative HIV infection or death rate was 13.6% (95% CI 10.3-16.9%) at 18 months after delivery. Thus extended maternal prophylaxis with ART resulted in low HIV-1 transmission during breastfeeding and a high HIV-free child survival at 18 months.Follow-up of the Mitra Plus women on ART for life revealed that, following an initial treatment success at three and six months, virologic and immunologic failure were common at 12 and 24 months postpartum. A high proportion of viremic mothers also had drug resistance mutations. The mortality rate was fairly low, 5.9% (95% CI 2.5-13.7%). The probability of virologic and immunologic failure was associated with reported non-perfect adherence to ART at month 24 postpartum. In-depth interviews revealed that women’s main motivation for ART adherence was to protect the infant from HIV infection. HIV-related stigma, poverty and overwhelming daily demands were other important barriers to ART adherence.Among the currently recommended WHO Options for preventing breast milk transmission (Ainfant prophylaxis, B-maternal prophylaxis and B+-maternal treatment for life) women preferred Option B as they thought it was better than Option A because of less risk for HIVassociated stigma, less drug side effects for the child and better logistics for postnatal adherence. Women were not in favour of Option B+ as they anticipated loss of motivation after protecting the child, fearing drug side effects and many did not feel ready to embark on lifelong medication when asymptomatic regardless of CD4 count.In conclusion, women should be counselled about the possibility to “opt-out” of ART after cessation of breastfeeding. Drug adherence counselling, drug safety and benefits, economic concerns and available resources for laboratory monitoring and evaluation should be addressed during B+ implementation to enhance long-term feasibility and effectiveness.List of scientific papersI. Charles Kilewo, Katarina Karlsson, Matilda Ngarina, Augustine Massawe, Eligius Lyamuya, Andrew Swai, Rosina Lipyoga, Fred Mhalu, Gunnel Biberfeld. Prevention of Mother to Child Transmission of HIV-1 through Breastfeeding by Treating Mothers with triple Antiretroviral Therapy in Dar es Salaam, Tanzania: The Mitra Plus study. Journal of Acquired Immune Deficiency Syndromes. 2009, 53: 406-41. https://doi.org/10.1097/QAI.0b013e3181b323ff II. Matilda Ngarina, Charles Kilewo, Katarina Karlsson, Said Aboud, Annika Karlsson, Gaetano Marrone, Anna Mia Ekström, Gunnel Bibberfeld. Virologic and immunologic responses to antiretroviral therapy, drug resistance and mortality during the first 24 months postpartum in a cohort of HIV-1 infected mothers in Dar es Salaam, Tanzania. [Manuscript]III. Matilda Ngarina, Rebecca Popenoe, Charles Kilewo, Gunnel Biberfeld, Anna Mia Ekström. Reasons for poor adherence to antiretroviral therapy postnatally in HIV-1 infected women treated for their own health: experiences from the Mitra Plus study in Tanzania. BMC Public Health. 2013, 13:450. https://doi.org/10.1186/1471-2458-13-450 IV. Matilda Ngarina, Edith A.M Tarimo, Helga Naburi, Charles Kilewo, Mary Mwanyika-Sando, Guerino Chalamilla, Gunnel Biberfeld, Anna Mia Ekström. Women’s preferences between infant or maternal antiretroviral prophylaxis for prevention of mother-to-child transmission of HIV during breastfeeding and their views on Option B+ in Dar es Salaam, Tanzania. PLoS One. 2014 9(1):e85310. https://doi.org/10.1371/journal.pone.0085310 </p
