27 research outputs found
TBA Knowledge performance and Relation with the Formal Health System in Lindi Region and the role of Maternal Waiting Homes
No full textIn Lindi region 110 active trained TBAs (10 or more deliveries per year) and women who delivered with TBAs were interviewed about the role of these TBAs, their knowledge and practice and their relationship with the health facilities. In addition key information in the communities, the districts and the health care system were interviewed. The study that play a unique role in their respective communities as care giver for delivering mother and as principal advisor to families in all issues related to birth –giving. They are highly appreciated by their clients and the communities and often preferred to the health facilities, which are perceived as too expensive, hardly accessible and staff often not friendly to the clients. The training has increased the reputation of the TBAs in the community because they are perceived as comparable to the staff in the facility where they went for training. TBAs complained that I cases where the local government financed the training clients afterwards expect to get the service free of change because it was the community who paid for training. In addition communities are suspicious that the trained TBA gets money from the government. The TBAs do not play the expected role in referral because referral to the health facilities is perceived as a professional failure on the side of the TBA and as a shame on the part of the woman. The communication between health services and the TBAs is not satisfactory. There is no supervision and monitoring, no visits to the TBAs or any kind of meeting and supply of gloves or other equipment. Proper records are not available especially regarding problems during delivery (death of mother or the child). It is recommended that working relation between formal health system and TBAs has to be improved. Maternal waiting homes are not yet available in Lindi Region however a need is perceived by professionals and communities because many villages are too far from the nearest health facilities to make use of it for delivery. One church hospital offers a simple house for woman and their relatives where they can stay while waiting. However it does not yet meet the criteria defined by the Maternal Waiting Homes
HIV and infant feeding counselling: challenges faced by nurse-counsellors in northern Tanzania
No full textAbstract Background Infant feeding is a subject of worry in prevention of mother to child transmission (pMTCT) programmes in settings where breastfeeding is normative. Nurse-counsellors, expected to counsel HIV-positive women on safer infant feeding methods as defined in national/international guidelines, are faced with a number of challenges. This study aims to explore the experiences and situated concerns of nurses working as infant feeding counsellors to HIV-positive mothers enrolled in pMTCT programmes in the Kilimanjaro region, northern Tanzania. Methods A qualitative study was conducted using in-depth interviews and focus group discussions (FGDs) with 25 nurse-counsellors at four pMTCT sites. Interviews were handwritten and FGDs were tape-recorded and transcribed, and the programme Open Code assisted in sorting and structuring the data. Analysis was performed using 'content analysis.' Results The findings revealed a high level of stress and frustration among the nurse-counsellors. They found themselves unable to give qualified and relevant advice to HIV-positive women on how best to feed their infants. They were confused regarding the appropriateness of the feeding options they were expected to advise HIV-positive women to employ, and perceived both exclusive breastfeeding and exclusive replacement feeding as culturally and socially unsuitable. However, most counsellors believed that formula feeding was the right way for an HIV-positive woman to feed her infant. They expressed a lack of confidence in their own knowledge of HIV and infant feeding, as well as in their own skills in assessing a woman's possibilities of adhering to a particular method of feeding. Moreover, the nurses were in general not comfortable in their newly gained role as counsellors and felt that it undermined the authority and trust traditionally vested in nursing as a knowledgeable and caring profession. Conclusion The findings illuminate the immense burden placed on nurses in their role as infant feeding counsellors in pMTCT programmes and the urgent need to provide the training and support structure necessary to promote professional confidence and skills. The organisation of counselling services must to a larger extent take into account the local realities in which nurses construct their role as counsellors to HIV-positive childbearing women.</p
The Potential Role of Mother-in-Law in Prevention of Mother-to-Child Transmission of HIV: A Mixed Methods Study from the Kilimanjaro Region, Northern Tanzania.
No full textIn the Kilimanjaro region the mother-in-law has traditionally had an important role in matters related to reproduction and childcare. The aim of this study was to explore the role of the mothers-in-law in prevention of mother-to-child transmission (PMTCT) service utilization and adherence to infant feeding guidelines. The study was conducted during 2007-2008 in rural and urban areas of Moshi district in the Kilimanjaro region of Tanzania. Mixed methods were used and included focus group discussions with mothers-in-law, mothers and fathers; in-depth interviews with mothers-in-law, mothers, fathers and HIV-infected mothers, and a survey of 446 mothers bringing their four-week-old infants for immunisation at five reproductive and child health clinics. The study demonstrated that the mother-in-law saw herself as responsible for family health issues in general and child care in particular. However she received limited trust, and couples, in particular couples living in urban areas, tended to exclude her from decisions related to childbearing and infant feeding. Mothers-in-law expected their daughters-in-law to breastfeed in a customary manner and were generally negative towards the infant feeding methods recommended for HIV-infected mothers; exclusive replacement feeding and exclusive breastfeeding. Decreasing influence of the mother-in-law and increasing prominence of the conjugal couples in issues related to reproduction and child care, reinforce the importance of continued efforts to include male partners in the PMTCT programme. The potential for involving mothers-in-law in the infant feeding component, where she still has influence in some areas, should be further explored
Breastfeeding and HIV: Experiences from a Decade of Prevention of Postnatal HIV Transmission in Sub-Saharan Africa.
No full textInfant feeding by HIV-infected mothers has been a major global public health dilemma and a highly controversial matter. The controversy is reflected in the different sets of WHO infant feeding guidelines that have been issued over the last two decades. This thematic series, 'Infant feeding and HIV: lessons learnt and ways ahead' highlights the multiple challenges that HIV-infected women, infant feeding counsellors and health systems have encountered trying to translate and implement the shifting infant feeding recommendations in different local contexts in sub-Saharan Africa. As a background for the papers making up the series, this editorial reviews the changes in the guidelines in view of the roll out of prevention of mother to child transmission (PMTCT) programmes in sub-Saharan Africa between 2001 and 2010
Training Health Professionals in Tanzania: Effects of an Afrocentric Sexual Health Education Curriculum for Medical, Nursing and Midwifery Students (Randomized Controlled Trial Data)
No full textPARTICIPANTS.
Eligibility criteria for this study were: (a) Current student at MUHAS in midwifery, nursing, or medicine; (b) in their 3rd or 4th year (for medical students) or 2nd or 3rd year (nursing and midwifery students) so they would have sustained patient contact in the three months following the seminar and be on campus for the follow-up; (c) able to attend the full 4-day training during the first week of student vacation; (d) fluent in English (the language of instruction at MUHAS) and Kiswahili (the lingua franca in Tanzania); and (e) willing to volunteer and complete all evaluation procedures.
QUANTITATIVE SURVEY.
All participants were required to complete the online Qualtrics baseline survey on tablets at the study office. The survey took about 60 minutes to complete and covered demographic information, educational background, sexual health knowledge, and attitudes toward sexual health topics.
Immediately after the training, intervention arm participants completed a Qualtrics post-test survey that covered the same sexual health knowledge and attitudes toward sexual health topic items and asked participants to evaluate the sexual health training workshop (90 minutes).
Three to four months later, both intervention and control group participants completed an online follow-up survey that assessed their sexual health knowledge and attitudes toward sexual health topics (90 minutes).
Note, the waitlist control group also had the opportunity to participate in and evaluate the sexual health workshop after the completion of the randomized control trial.
All the survey data from baseline, post-test, and follow-up data collection were combined into one CSV file (Quantitative_Survey_Data; 597KB). Only the quantitative responses from the survey are included in this record.
STANDARDIZED PATIENT EXPERIENCE (SPE) SURVEYS.
After completing the baseline survey, participants completed two SP interviews. The interviews involved actors role-playing one of four sexual health-related patient scenarios developed by the team. Participants had 10 minutes per scenario to interview the patient and discuss a treatment plan. The four SP cases were: a) a woman who had been physically and sexually assaulted (Sexual Violence; SV), b) a heterosexually married man with situational erectile dysfunction and past homosexual experience (Erectile Dysfunction; ED), c) a 16-year-old girl who is worried she is pregnant from her older “sugar daddy” boyfriend (Adolescent Pregnancy; AP), and d) a young heterosexual man with penile discharge, groin pain, and a history of paying for sex (Penile Drip; PD). The participants were randomly assigned two of the four scenarios which they completed at baseline. Then they completed the remaining two scenarios at follow-up.
> Faculty Ratings. In their videotaped SP scenarios, participants were rated on their interpersonal communication (IC) skills and their ability to uncover a patient’s medical history (MH). Each of the SP scenarios was rated by one MUHAS faculty member who was part of the research team. Ratings were collected via an online Qualtrics survey.
> SP Ratings. Participants were also rated on their interpersonal communication (IC) skills and their ability to uncover a patient’s medical history (MH). by the SP actor that they interviewed. Ratings were collected via an online Qualtrics survey.
> Student Clinician (SC) Items. After each video interview, participants completed an online Qualtrics survey reflecting on how they performed as a student clinician (SC).
> Evaluation of the Standardized Patient Experience (ESPE) Items. At the end of follow-up data collection, participants completed an online Qualtrics survey evaluating the SPE.
All the survey responses and ratings for the SPE were combined across baseline and follow-up data collection but separated into four separate CSV files: faculty ratings (178KB), SP ratings (171KB), SC items (70KB), and ESPE items (11KB). The quantitative responses and ratings from the SPE are included in this record."Training for Health Professionals” was a randomized, controlled, single-blind, trial conducted at Muhimbili University of Health and Allied Sciences (MUHAS) in Dar es Salaam, Tanzania. As part of the study, 412 medical, nursing and midwifery students were stratified by discipline, completed baseline assessments, then randomized to attend a 4-day sexual health workshop (intervention, n=206) or to a waitlist control (n=206). The workshop curriculum covered sexual health across the lifespan, male and female sexual dysfunctions, key populations (LGBT), sexual violence, clinical skills building, ethics, policy writing, and cultural considerations. Primary outcomes were sexual health knowledge, attitudes, and clinical skills.
The primary outcomes of sexual health knowledge and attitudes were assessed at baseline, post-intervention (intervention group only), and 3-month follow-up via a quantitative survey. This survey also included demographic information, education background, and evaluation of the sexual health workshop.
The primary outcome of clinical skills was assessed at baseline and 3-month follow-up via videotaped standardized patient (SP) interviews. Each of the videos (2 at baseline, 2 at follow-up) was independently rated by an expert (a faculty member) and the patient (the SP actor). After each interview participants completed a survey reflecting on their performance as a student clinician. At the end of the follow-up videos, participants completed a survey evaluating the standardized patient experience (SPE).
In sum, this record includes an Excel file with the data codebook (also provided as six separate CSV files for accessibility) and five CSV data files covering the above outcomes. The responses were de-identified as described below in the README file.Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)National Institutes of Health (NIH, Grant number: 1 R01 HD092655)Rosser, B. R. Simon; Mkoka, Dickson A.; Leshabari, Sebalda; Kohli, Nidhi; Lukumay, Gift G.; Rohloff, Corissa T.; Trent, Maria; Mgopa, Lucy R.; Mkonyi, Ever; Ross, Michael W.; Mushy, Stella E.; Mohammed, Inari; Massae, Agnes F.; Zhang, Ziwei; Mwakawanga, Dorkasi L.. (2023). Training Health Professionals in Tanzania: Effects of an Afrocentric Sexual Health Education Curriculum for Medical, Nursing and Midwifery Students (Randomized Controlled Trial Data). Retrieved from the University Digital Conservancy, https://doi.org/10.13020/S565-YX03
A family-oriented antenatal education program to improve birth preparedness and maternal-infant birth outcomes: A cross sectional evaluation study
No full textBackground: In Tanzania, the information on Birth Preparedness and Complication Readiness is insufficiently provided to pregnant women and their families. The aim of this study was to evaluate the maternal and infant outcomes of a family-oriented antenatal group education program that promotes Birth Preparedness and Complication Readiness in rural Tanzania. Methods: Pregnant women and families were enrolled in a program about nutrition and exercise, danger signs, and birth preparedness. The cross sectional survey was conducted one year later to evaluate if the participants of the program (intervention group) were different from those who did not participate (control group) with respect to birth-preparedness and maternal and infant outcomes. Results: A total of 194 participants (intervention group, 50; control group, 144) were analyzed. For Birth Preparedness and Complication Readiness, the intervention group participants knew a health facility in case of emergency (OR: 3.11, 95% CI: 1.39–6.97); arranged accompaniment to go to a health facility for birth (OR: 2.56, 95% CI: 1.17–5.60); decided the birthplace with or by the pregnant women (OR: 3.11, 95% CI: 1.44–6.70); and attended antenatal clinic more than four times (OR: 2.39, 95% CI: 1.20–4.78). For birth outcomes, the intervention group had less bleeding or seizure during labour and birth (OR: 0.28, 95%CI: 0.13–0.58); fewer Caesarean sections (OR: 0.16, 95% CI: 0.07–0.36); and less neonatal complications (OR: 0.28, 95% CI: 0.13–0.60). Conclusions: The four variables were significantly better in the intervention group, i.e., identifying a health facility for emergencies, family accompaniment for facility birth, antenatal visits, and involvement of women in decision-making, which may be key factors for improving birth outcome variables. Having identified these key factors, male involvement and healthy pregnant lives should be emphasized in antenatal education to reduce pregnancy and childbirth complications
Rethinking Nursing Care: An Ethnographic Approach to Nurse-Patient Interaction in the Context of a HIV Prevention Programme in Rural Tanzania.
No full textWhile care has been described as the essence of nursing, it is generally agreed that care is a complex phenomenon that remains elusive. Literature reviews highlight the centrality of nurse-patient interactions in shaping care. In sub-Saharan Africa, where there is a critical shortage of health workers, nurses remain the core of the health workforce, but the quality of the patient care they provide has been questioned. OBJECTIVE: The study explored how care is shaped, expressed and experienced in nurses' everyday communication among HIV positive women in Tanzania. STUDY CONTEXT: Data were collected through a prevention of mother-to-child transmission of HIV programme with a comprehensive community component conducted by a church-run hospital in rural Tanzania. The population is largely agro-pastoral, the formal educational level is low and poverty is rampant. METHODS: An ethnographic approach was employed. Nurses and women enrolled in the prevention of mother-to-child transmission of HIV programme were followed closely over a period of nine months in order to explore their encounters and interactions. FINDINGS AND DISCUSSION: The way care is shaped, expressed and experienced is not globally uniform, and the expectations of what quality care involves differ between settings. In this study the expectations of nurses' instructions and authority, combined with nurses' personal engagement were experienced as caring interactions. The findings from this study demonstrate that the quality of nursing care needs to be explored within the specific historical, socio-cultural context in which it is practised
Evaluation of a family-oriented antenatal group educational program in rural Tanzania: a pre-test/post-test study
No full textAbstract Background To increase births attended by skilled birth attendants in Tanzania, studies have identified the need for involvement of the whole family in pregnancy and childbirth education. This study aimed to develop, implement, and evaluate a family-oriented antenatal group educational program to promote healthy pregnancy and family involvement in rural Tanzania. Methods This was a quasi-experimental 1 group pre-test/post-test study with antenatal education provided to pregnant women and their families in rural Tanzania. Before and after the educational program, the pre-test/post-test study was conducted using a 34-item Birth Preparedness Questionnaire. Acceptability of the educational program was qualitatively assessed. Results One-hundred and thirty-eight participants (42 pregnant women, 96 family members) attended the educational program, answered the questionnaire, and participated in the feasibility inquiry. The mean knowledge scores significantly increased between the pre-test and the post-test, 7.92 and 8.33, respectively (p = 0.001). For both pregnant women and family members, the educational program improved Family Support (p = 0.001 and p = 0.000) and Preparation of Money and Food (p = 0.000 and p = 0.000). For family members, the scores for Birth Preparedness (p = 0.006) and Avoidance of Medical Intervention (reversed item) (p = 0.002) significantly increased. Despite the educational program, the score for Home-based Value (reversed item) (p = 0.022) and References of SBA (p = 0.049) decreased in pregnant women. Through group discussions, favorable comments about the program and materials were received. The comments of the husbands reflected their better understanding and appreciation of their role in supporting their wives during the antenatal period. Conclusions The family-oriented antenatal group educational program has potential to increase knowledge, birth preparedness, and awareness of the need for family support among pregnant women and their families in rural Tanzania. As the contents of the program can be taught easily by reading the picture drama, lay personnel, such as community health workers or traditional birth attendants, can use it in villages. Further development of the Birth Preparedness Questionnaire is necessary to strengthen the involved factors. A larger scale study with a more robust Birth Preparedness Questionnaire and documentation of skilled care use is needed for the next step. Trial registration No.2013–273-NA-2013-101. Registered 12 August 2013
Translating Global Recommendations on HIV and Infant Feeding to the Local Context: The Development of Culturally Sensitive Counselling Tools in the Kilimanjaro Region, Tanzania.
No full textThis paper describes the process used to develop an integrated set of culturally sensitive, evidence-based counselling tools (job aids) by using qualitative participatory research. The aim of the intervention was to contribute to improving infant feeding counselling services for HIV positive women in the Kilimanjaro Region of Tanzania. Formative research using a combination of qualitative methods preceded the development of the intervention and mapped existing practices, perceptions and attitudes towards HIV and infant feeding (HIV/IF) among mothers, counsellors and community members. Intervention Mapping (IM) protocol guided the development of the overall intervention strategy. Theories of behaviour change, a review of the international HIV/IF guidelines and formative research findings contributed to the definition of performance and learning objectives. Key communication messages and colourful graphic illustrations related to infant feeding in the context of HIV were then developed and/or adapted from existing generic materials. Draft materials were field tested with intended audiences and subjected to stakeholder technical review. An integrated set of infant feeding counselling tools, referred to as 'job aids', was developed and included brochures on feeding methods that were found to be socially and culturally acceptable, a Question and Answer Guide for counsellors, a counselling card on the risk of transmission of HIV, and an infant feeding toolbox for demonstration. Each brochure describes the steps to ensure safer infant feeding using simple language and images based on local ideas and resources. The brochures are meant to serve as both a reference material during infant feeding counselling in the ongoing prevention of mother to child transmission (pMTCT) of HIV programme and as take home material for the mother. The study underscores the importance of formative research and a systematic theory based approach to developing an intervention aimed at improving counselling and changing customary feeding practices. The identification of perceived barriers and facilitators for change contributed to developing the key counselling messages and graphics, reflecting the socio-economic reality, cultural beliefs and norms of mothers and their significant others
