23 research outputs found
Primacy of effective communication and its influence on adherence to artemether-lumefantrine treatment for children under five years of age: a qualitative study.
No full textPrompt access to artemesinin-combination therapy (ACT) is not adequate unless the drug is taken according to treatment guidelines. Adherence to the treatment schedule is important to preserve efficacy of the drug. Although some community based studies have reported fairly high levels of adherence, data on factors influencing adherence to artemether-lumefantrine (AL) treatment schedule remain inadequate. This study was carried-out to explore the provider's instructions to caretakers, caretakers' understanding of the instructions and how that understanding was likely to influence their practice with regard to adhering to AL treatment schedule. A qualitative study was conducted in five villages in Kilosa district, Tanzania. In-depth interviews were held with providers that included prescribers and dispensers; and caretakers whose children had just received AL treatment. Information was collected on providers' instructions to caretakers regarding dose timing and how to administer AL; and caretakers' understanding of providers' instructions. Mismatch was found on providers' instructions as regards to dose timing. Some providers' (dogmatists) instructions were based on strict hourly schedule (conventional) which was likely to lead to administering some doses in awkward hours and completing treatment several hours before the scheduled time. Other providers (pragmatists) based their instruction on the existing circumstances (contextual) which was likely to lead to delays in administering the initial dose with serious treatment outcomes. Findings suggest that, the national treatment guidelines do not provide explicit information on how to address the various scenarios found in the field. A communication gap was also noted in which some important instructions on how to administer the doses were sometimes not provided or were given with false reasons. There is need for a review of the national malaria treatment guidelines to address local context. In the review, emphasis should be put on on-the-job training to address practical problems faced by providers in the course of their work. Further research is needed to determine the implication of completing AL treatment prior to scheduled time
Managing malaria in under-fives : prompt access, adherence to treatment and referral in rural Tanzania
No full textBackground: Nearly a million people die of malaria each year, the majority are children in rural African settings. These deaths could be reduced if children had prompt access to artemisinin-based combination therapy (ACTs), demonstrated adherence to treatment and to referral advice for severe malaria. However, health systems are weak to deliver the interventions. Although many African countries, including Tanzania, changed malaria treatment policy to ACTs in the last decade, few children reportedly get prompt access to ACTs.Main aim: To determine factors influencing prompt access to effective antimalarials; adherence to treatment schedules and to referral advice among children under five, in rural settings.Methods: Community-based studies were conducted in rural villages in Kilosa (I,II) and Mtwara rural (II,IV) districts, in Tanzania. Study I and II were prospective designed while study III and IV were nested in a community-based rectal-artesunate deployment intervention study. In study I, a total of 1,235 children from 12 randomly selected villages were followed up for six months. Caretakers of children reported to have fever were interviewed at home about the type and source of treatment using a questionnaire. In study II, all children (3918) in five selected villages were followed-up for 12 months, to determine adherence to treatment when they had malaria, diagnosed using Rapid Diagnostic Test (RDT) and treated with artemether-lumefantrine (ALu). In study III, 587 children who received pre-referral rectal artesunate during the deployment study were traced home and caretakers interviewed on a number of factors likely to influence adherence to referral advice, using a questionnaire. Study IV was qualitative, 12 focus group discussions were conducted in three purposively selected villages to explore reasons for non-adherence to referral advice.Results: Only one-third (37.6%) of febrile children had prompt access to ALu, the recommended ACTs in Tanzania, mainland (I). Lack of prompt access was mostly (>80 percent) attributed to receiving non-recommended drugs. Less than half of the febrile children were taken to government facilities, where they were 17-times more likely to have prompt access compared to those who went elsewhere. Less than 10% (41/607) of febrile children had access to ALu (I) from faith-based organisation facilities and accredited drug dispensing outlets, despite having subsidized ALu. Reported adherence to treatment schedules was high (>80 percent) and non-adherence was attributed mainly to untimely dosing, rather than taking a fewer number of doses (II). While social economic status influenced prompt access to ALu and adherence to treatment, basic education did not (I, II). Caretakers of children with altered consciousness and convulsion were almost 4-times more likely to adhere to referral advice than those whose children had less severe symptoms (III). They seemed to weigh child condition against obstacles to accessing care at health facilities, if the condition was less severe prior to or improved after rectal artesunate dose, caretakers were likely to be deterred from adhering to referral advice (IV). Detailed understanding of provider’s advice was likely to lead to adherence to the treatment schedule (II) and to referral advice (III, IV).Conclusion: This thesis has shown that once a child had access to ALu, caretakers were likely to adhere to treatment schedule; and to referral advice, if child had severe symptoms or not improved after pre-referral treatment. More efforts should therefore be directed towards increasing access to ALu by strengthening the public health sector to reach rural remote areas. A wide coverage in prompt access to ALu will also reduce the need for the rectal artesunate strategy.List of scientific papersI. Simba, D., Warsame, M., Kakoko, D., Mrango, Z., Tomson, G., Premji, Z. & Petzold, M. (2010) Who Gets Prompt Access to Artemisinin-Based Combination Therapy? A Prospective Community-Based Study in Children from Rural Kilosa, Tanzania. PLoS ONE. 5, e12104. https://doi.org/10.1371/journal.pone.0012104 II. Simba, D., Kakoko, D., Tomson, G., Premji, P., Petzold, M., Mahindi, M & Gustafsson, L. High Adherence to Artemether-lumefantrine Treatment in Children Under Real-life Situation in Rural Tanzania. [Submitted]III. Simba, D., Warsame, W., Kimbute, O., Kakoko, D., Petzold, M., Tomson, G., Premji, Z. & Gomes, M. (2009) Factors Influencing Adherence to Referral Advice Following Pre-Referral Treatment with Artesunate Suppositories in Children in Rural Tanzania. Tropical Medicine and International Health. 14;775-783. https://doi.org/10.1111/j.1365-3156.2009.02299.x IV. Simba, D., Kakoko, D., Warsame, M., Premji, Z., Gomes, M., Tomson, G. & Johansson, E. (2010). Understanding Caretakers' Dilemma in Deciding Whether or not to Adhere with Referral Advice after Pre-referral Treatment with Rectal Artesunate. Malaria Journal. 9,123; 775-783. https://doi.org/10.1186/1475-2875-9-123 </p
Application of ICT in Strengthening Health Information Systems in Developing Countries in the Wake of Globalisation.
No full textInformation Communication Technology (ICT) revolution brought opportunities and challenges to developing countries in their efforts to strengthen the Health Management Information Systems (HMIS). In the wake of globalisation, developing countries have no choice but to take advantage of the opportunities and face the challenges. The last decades saw developing countries taking action to strengthen and modernise their HMIS using the existing ICT. Due to poor economic and communication infrastructure, the process has been limited to national and provincial/region levels leaving behind majority of health workers living in remote/rural areas. Even those with access do not get maximum benefit from ICT advancements due to inadequacies in data quality and lack of data utilisation. Therefore, developing countries need to make deliberate efforts to address constraints threatening to increase technology gap between urban minority and rural majority by setting up favourable policies and appropriate strategies. Concurrently, strategies to improve data quality and utilisation should be instituted to ensure that HMIS has positive impact on people's health. Potential strength from private sector and opportunities for sharing experiences among developing countries should be utilised. Short of this, advancement in ICT will continue to marginalise health workers in developing countries especially those living in remote areas
FACTORS INFLUENCING QUALITY of HEALTH MANAGEMENT INFORMATION SYSTEM (HMIS) DATA: THE CASE OF KINONDONI DISTRICT IN DAR ES SALAAM REGION, TANZANIA
No full textObjective: A study was done in Kinondoni Municipality, Tanzania, to
assess quality of data collected through the HMIS and explore possible
associated factors. Method: Using a structured questionnaire, health
facility in-charges were interviewed. Attributes of data quality were
recorded from health facility data using an observation schedule. A
total of 69 health facilities were involved in the study including all
(21) public health facilities and 25% (41/164) private facilities.
Completion rate of health facility data was used as a proxy for
measuring quality of data. Results: Although knowledge on HMIS basic
concept was found to be associated with improved quality of data,
training in HMIS did not seem to correspond with improved quality of
data. Regardless of duration, supervision had no relationship with
quality of data thus raising serious doubts on its quality. Presence of
a focal person, responsible for day to day HMIS activities, had a
positive influence on the quality of data where facilities with a focal
person had a higher data completion rate (69.9%) compared to those
without (44.7%). Accountability as measured by queries reportedly made
by Municipal authorities on data inaccuracies was associated with
better quality of data. However, queries on delay in sending report had
no influence in quality of data. Conclusion: The study concludes that
training, followed by supervision in HMIS, did not result into a
significant improvement of the quality of HMIS. There is need to
re-examine the current approaches used in training and supervision to
focus on actual needs of health workers. As a long- term goal, creation
of demand for processed data will serve to enhance ownership of the
system by health workers, hence improve data qualit
Le bénévolat chez les éducateurs de pairs qui ne fréquentent plus l’école et qui sont chargés de la santé de reproduction : Est-ce une stratégie durable dans les pays ayant des ressources limitées?
No full textOut-of-school peer educators [PE] are resourceful in transmitting
reproductive health information but their retention remains a
contentious issue. This study aimed to assess motivation and
sustainability of out-of-school PEs in disseminating reproductive
health information among adolescents. A structured questionnaire was
used to interview 406 PEs in Mbeya region, Tanzania. Focus Group
Discussions [FGDs] were also conducted with the PEs and other relevant
stakeholders. Most PEs had hopes for future employment and allowances
through continuous training. The fact that majority of PEs had primary
level education [89%] and were either peasants or self employed [92%]
posed a serious question as to whether voluntary work is for the less
educated, peasants and self-employed. Sustenance of PEs needs to be a
continuous activity aimed at increasing the number of trained
adolescents from their own social and economic groups. Otherwise,
provision of transport and compensation for time spent should be
considered (Afr J Reprod Health 2009; 13[3]:99-110).Les éducateurs de pairs qui ne fréquentent plus
l’école (EPs) sont ingénieux en matière de la
transmission de l’information concernant la santé de
reproduction, mais le problème reste de savoir si l’on doit
les retenir ou non. C’est-a-dire, il faut évaluer la
motivation et la viabilité des EPs qui ne fréquentent plus
l’école par rapport à la dissemination de
l’information sur la santé de reproduction chez les
adolescents. Nous avons interviewé 406 EPs dans la région de
Mbeya en Tanzanie à l’aide d’un questionnaire
structuré. Il y a eu aussi des discussions à groupe cible
(DGC) avec les EPs et les autres intéressés appropriés.
Le fait que la majorité des EPs avaient reçu
l’éducation primaire (89%) et qu’ils étaient soit
des paysans soit des auto-employés (92%) a soulevé une
question importante de savoir si le bénévolat est
destiné au gens moins scolarisés, aux paysans et aux
auto-employés. Il faut que le maintien des besoins des EPs soit
régulier pour les rendre une activité qui visent à
l’augmentation de nombre des adolescents formés à
partir de leurs groupes sociaux et économiques. Sinon, il faut
tenir en compte l’assurance du transport et de la recompensation
pour le temps qu’on a passé (Afr J Reprod Health 2009;
13[3]:99-110)
Adherence to artemether/lumefantrine treatment in children under real-life situations in rural Tanzania.
No full textA follow-up study was conducted to determine the magnitude of and factors related to adherence to artemether/lumefantrine (ALu) treatment in rural settings in Tanzania. Children in five villages of Kilosa District treated at health facilities were followed-up at their homes on Day 7 after the first dose of ALu. For those found to be positive using a rapid diagnostic test for malaria and treated with ALu, their caretakers were interviewed on drug administration habits. In addition, capillary blood samples were collected on Day 7 to determine lumefantrine concentrations. The majority of children (392/444; 88.3%) were reported to have received all doses, in time. Non-adherence was due to untimeliness rather than missing doses and was highest for the last two doses. No significant difference was found between blood lumefantrine concentrations among adherent (median 286 nmol/l) and non-adherent [median 261 nmol/l; range 25 nmol/l (limit of quantification) to 9318 nmol/l]. Children from less poor households were more likely to adhere to therapy than the poor [odds ratio (OR)=2.45, 95% CI 1.35-4.45; adjusted OR=2.23, 95% CI 1.20-4.13]. The high reported rate of adherence to ALu in rural areas is encouraging and needs to be preserved to reduce the risk of emergence of resistant strains. The age-based dosage schedule and lack of adherence to ALu treatment guidelines by health facility staff may explain both the huge variability in observed lumefantrine concentrations and the lack of difference in concentrations between the two groups
Le bénévolat chez les éducateurs de pairs qui ne fréquentent plus l’école et qui sont chargés de la santé de reproduction : Est-ce une stratégie durable dans les pays ayant des ressources limitées?
No full textOut-of-school peer educators [PE] are resourceful in transmitting
reproductive health information but their retention remains a
contentious issue. This study aimed to assess motivation and
sustainability of out-of-school PEs in disseminating reproductive
health information among adolescents. A structured questionnaire was
used to interview 406 PEs in Mbeya region, Tanzania. Focus Group
Discussions [FGDs] were also conducted with the PEs and other relevant
stakeholders. Most PEs had hopes for future employment and allowances
through continuous training. The fact that majority of PEs had primary
level education [89%] and were either peasants or self employed [92%]
posed a serious question as to whether voluntary work is for the less
educated, peasants and self-employed. Sustenance of PEs needs to be a
continuous activity aimed at increasing the number of trained
adolescents from their own social and economic groups. Otherwise,
provision of transport and compensation for time spent should be
considered (Afr J Reprod Health 2009; 13[3]:99-110).Les éducateurs de pairs qui ne fréquentent plus
l’école (EPs) sont ingénieux en matière de la
transmission de l’information concernant la santé de
reproduction, mais le problème reste de savoir si l’on doit
les retenir ou non. C’est-a-dire, il faut évaluer la
motivation et la viabilité des EPs qui ne fréquentent plus
l’école par rapport à la dissemination de
l’information sur la santé de reproduction chez les
adolescents. Nous avons interviewé 406 EPs dans la région de
Mbeya en Tanzanie à l’aide d’un questionnaire
structuré. Il y a eu aussi des discussions à groupe cible
(DGC) avec les EPs et les autres intéressés appropriés.
Le fait que la majorité des EPs avaient reçu
l’éducation primaire (89%) et qu’ils étaient soit
des paysans soit des auto-employés (92%) a soulevé une
question importante de savoir si le bénévolat est
destiné au gens moins scolarisés, aux paysans et aux
auto-employés. Il faut que le maintien des besoins des EPs soit
régulier pour les rendre une activité qui visent à
l’augmentation de nombre des adolescents formés à
partir de leurs groupes sociaux et économiques. Sinon, il faut
tenir en compte l’assurance du transport et de la recompensation
pour le temps qu’on a passé (Afr J Reprod Health 2009;
13[3]:99-110)
Factors influencing quality of health management information system (HMIS) data: The case of Kinondoni district in Dar es Salaam region, Tanzania
No full textObjective: A study was done in Kinondoni Municipality, Tanzania, to
assess quality of data collected through the HMIS and explore possible
associated factors. Method: Using a structured questionnaire, health
facility in-charges were interviewed. Attributes of data quality were
recorded from health facility data using an observation schedule. A
total of 69 health facilities were involved in the study including all
(21) public health facilities and 25% (41/164) private facilities.
Completion rate of health facility data was used as a proxy for
measuring quality of data. Results: Although knowledge on HMIS basic
concept was found to be associated with improved quality of data,
training in HMIS did not seem to correspond with improved quality of
data. Regardless of duration, supervision had no relationship with
quality of data thus raising serious doubts on its quality. Presence of
a focal person, responsible for day to day HMIS activities, had a
positive influence on the quality of data where facilities with a focal
person had a higher data completion rate (69.9%) compared to those
without (44.7%). Accountability as measured by queries reportedly made
by Municipal authorities on data inaccuracies was associated with
better quality of data. However, queries on delay in sending report had
no influence in quality of data. Conclusion: The study concludes that
training, followed by supervision in HMIS, did not result into a
significant improvement of the quality of HMIS. There is need to
re-examine the current approaches used in training and supervision to
focus on actual needs of health workers. As a long- term goal, creation
of demand for processed data will serve to enhance ownership of the
system by health workers, hence improve data qualit
Who Gets Prompt Access to Artemisinin-based Combination Therapy? A Prospective Community-Based Study in Children from Rural Kilosa, Tanzania.
No full textEffective and timely case management remains one of the fundamental pillars for control of malaria. Tanzania introduced artemisinin-combination therapy [ACT] for uncomplicated malaria; however, the policy change is challenged by limited availability of ACTs due to high cost. This study aimed to determine factors influencing prompt access to ACTs among febrile children in rural Kilosa, Tanzania. In a community-based study, 1,235 randomly selected children under five were followed up weekly for six months, in 2008. Using a structured questionnaire, children's caretakers were asked about the child's febrile history in the last seven days, and treatment actions including timing, medicines used and source of care. Caretakers' knowledge about malaria and socioeconomic and demographic data were also obtained. About half of followed-up children had at least one episode of fever. Less than half (44.8%) of febrile children were taken to government facilities. Almost one-third (37.6%; 95% CI 33.1-42.1) of febrile children had prompt access to ACT. Care-seeking from a government facility was the overriding factor, increasing the likelihood of prompt access to an ACT 18 times (OR 17.7; 95% CI 10.55-29.54; adjusted OR 16.9; 95% CI 10.06-28.28). Caretakers from the better-off household (3rd-5th quintiles) were more likely to seek care from government facilities (OR 3.66; 95% CI 2.56-5.24; adjusted OR 1.80; 95% CI 1.18-2.76). The majority of antimalarials accessed by the poor were ineffective [86.0%; 295/343], however, they paid more for them (median Tsh 500) compared to the better-offs (median Tsh 0). Prompt access to ACT among febrile children was unacceptably low, due mainly to limited availability of subsidised ACT at the location where most caretakers sought care. There is urgent need to accelerate implementation of strategies that will ensure availability of ACT at an affordable price in remote rural areas, where the burden of malaria is highest
The repertoire of Kayamba Africa: contemporary reworking of traditional musics in Nairobi
No full textIncludes bibliographical references.This research focuses on Kayamba Africa's repertoire of reworked traditional songs in Nairobi, where they are based. The study involved extensive literature and field research through library and online research, participant observation, interviews, data analysis and transcriptions. Three live performances of Kayamba Africa were analysed: a wedding reception and state function and an edited DVD recording. An analysis of Kayamba Africa's three recordings, namely 'Omutun', 'Wakarirũ' and 'Ngulũ', from the album Kayamba Africa was conducted. This analysis observed and compared different interpretations and translations of the songs' texts sourced from different research consultants, as well as Kayamba Africa's musical structure and recordings of Boniface Mganga's choral arrangement of Ngulũ and Hugh Tracey's recording of 'Rũimbo rwa ngũ'
