Dissertations (Masters)-HME-SOPAM

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    Evaluation of sanitation facilities in relation to communicable diseases in government primary schools in Mkinga District Council
    (Mzumbe University, 2018) Mosha, Irene V
    Background: Water, Sanitation and Hygiene related diseases remain one of the most significant child health problems worldwide. Infections such as cholera, malaria, trachoma, bilharzias and diarrhoea are on increase in our communities. The most affected ones are children. These diseases not only affect children‟s physical development but also school attendance and academic performance. The challenges of School Water, Sanitation and Hygiene (SWASH) are more pronounced in developing countries unlike the developed world. This study evaluated the Sanitation facilities in government Primary Schools in Mkinga district council. Methodology: The study used cross sectional study design, drawing a sample of 285 respondents. Purposive sampling was used to select Key informants. Simple random sampling was used to select Ward Development Committee (WDC), Village Government members, members of school committee, and teachers and snowball sampling was used to select Pupils, Parents/community and Private sector, Local artisans and construction companies. Primary data were collected through questionnaire and direct observation. Content analysis method was used to analyse the data from in-depth interviews. Questionnaire data were analysed using SPSS computer software where descriptive statistics such as frequencies and percentages were deployed. Results: A total number of 30% of Mkinga public primary school have sanitation facilities. Pupils whom practice hygiene are 30% but not all pupils are provided with protective gears. Community members agreed that the hygienity of water sources was poor are 36%. Conclusion: The sanitation facilities are insufficient in government primary schools. Pupils practice hygiene but not all pupils are provided with protective gears. The hygiene practice among community members is very poor due to the farming activities, which are conducted near the sources of water. Recommendations: The Government should ensure that, the district level guidance and support for compliance reflects the National regulatory framework. Use appropriate guidelines where standards do not exist.
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    Assessing the influence of health facility factors on utilisation of early infant diagnosis for HIV infection in Kilolo District Council
    (Mzumbe University, 2016) Wilfred William Rwechungura
    This study, which involved a sample of 200 respondents, was conducted in Kilolo District Council in Tanzania to assess the influence of health facility factors on utilizations of Early Infant Diagnosis of HIV infection (EID) services. The study problem was that there are HIV exposed infants who are enrolled in the EID programmed but they don’t access the intended services and hence the need for conducting the study. The specific objectives were (i) to evaluate availability of EID materials and its influence on utilizations of EID services in Kilolo health facilities; (ii) to assess availability of sample and results transportation system and its influence on utilizations of EID services in Kilolo health facilities; (iii) to assess the competence of healthcare workers and its influence on utilization of EID services at Kilolo health facilities; and (iv) to assess the satisfaction of mothers / guardians of HIV exposed infants on EID services provided in Kilolo health facilities. The study findings revealed that utilizations of EID service was indeed low (at 38%) as data suggested. Among contributing factors was inadequate EID materials at health facilities. Forty eight percent (48%) of the health worker respondents strongly disagree that there are adequate DBS materials at health facilities. On the same issue, when health workers were asked on whether they experienced stock outs of EID materials, fifty seven percent (57%) answered in the affirmative. The other finding was that health facility cares workers do not have sufficient skills for providing EID services. Forty three percent (43%) of the healthcare worker respondents reported that the sample and results transportation system is not reliable. The results showed that availability of EID materials and sample and results transportation system positively influence utilization of EID services at the health facilities whereas competence of healthcare workers influences negatively the utilization of EID services. This study recommends that the healthcare workers be trained in providing EID services and that arrangements be done for ensuring availability of EID materials, sample and results transportation system and availability of competent healthcare workers.
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    Assessment on implementation process of maternal health project on emergency obstetric care and neonatal services in rural settings: A case of Uvinza District Council-Kigoma
    (Mzumbe University, 2016) Kimambo Haika Steven
    Background: Emergency obstetric care is one of the strategies for reducing the maternal mortality as pregnancy related complications are unpredictable. However, maternal death due problems related to unimproved comprehensive obstetric has been documented. Objectives: The aim of this evaluation was to assess the implementation process more specifically on the community awareness with regards to emergency obstetric and neonatal care (EmONC).The goal of the project has been to improve maternal and child health age in a population by ensuring provision of quality health services by utilization of EmONC services by the community of Uvinza District Council. Methods: The study was conducted in four villages of Uvinza district in Kigoma region. A cross-sectional descriptive study was conducted involving 120 respondents. Semi structured questionnaire was used to capture information related to implementation process of World Lung Foundation. The focus was collected information on several issues such as assessing the level of community awareness in accessing EmONC services, identifying the roles of traditional birth attendants and challenges encounter by health care workers in facilities providing EmONC services. Evaluator randomly selected the participants to be included in the study. Results: The evaluation revealed institutional deliveries increased by 87.5% at CEmONC health centers, and 70% deliveries by caesarean section, the highest ever recorded. The level of community awareness in accessing EmONC services was high among the evaluation participants. Majority (87.5%) of the health care workers had received training supported by World lung foundation. The findings also revealed that traditional birth attendants have been undertaking early referrals of pregnant women to health facilities providing EmONC. vi Conclusion: The issue of 3 Ds (Delay in decisions making when to seek care, Decision of earlier referral and Decision on what time to start treatment) all these cut across as limitations to achieve millennium development goal number 5. Findings revealed that the maternal mortality rate (MMR) in all facilities decreased by 44% between January 2011 and June 2013(WLF report, 2013). Furthermore, there was a 70% increase in institutional deliveries in Project-supported facilities compared to a 30% decrease in non-Project-supported facilities; there were increased awareness of community in accessing care to health facilities providing EmONC services.
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    Assessing factors influencing reporting of weekly diseases data from regions to ministry of health and social welfare in Tanzania Mainland
    (Mzumbe University, 2015) Moshi, Solomon Frank
    Background: Reporting weekly diseases data from regions to Ministry of Health and Social Welfare is one of method which is used to submit weekly diseases information from regions to the Ministry according to number of weeks in a year from 1st to 52 th week. This method is a paper based, that enables diseases information to be available at the national level on time to allow for quick and important public health action. This is an evaluation study designed to assess factors which tended to influence weekly diseases data from regions to Ministry of Health and Social Welfare, to determine technical challenges and determine measures to improving the reporting design. Methodology: The quantitative study design was conducted in Tanzania mainland which consist all regions. A primary data type was collected through structured closed questionnaire which was administered to a total of 25 respondents’ samples size that was 100% countrywide, since each region was represented by single reporter. Data was processed and analyzed by using Microsoft Excel 2010. Results: Findings showed that there was higher understanding of factors which influenced reporting. Findings indicate that 100% of the participants were Health officers, 68% were regional IDSR focal person who understood well the system of reporting weekly disease data. The evaluation also revealed technical challenges associated with reporting; whereas 88% of participants acknowledged to have incurred cost during reporting, 71% viewed that approving weekly diseases data contributed to untimely reporting. Finally, there were measures identified for improving reporting; these include feedback report, supportive supervision and availability of IDSR guidelines. Conclusions: The evaluation concludes that, the ineffectiveness of reporting weekly diseases data was due to several reasons which include weekly reporter having many responsibilities, approving and signing weekly diseases by RMO before submission, costs of reporting incurred by reporters and weak or no supportive supervision and feedback.. So the evaluation recommends that government through its ministry must take responsibilities of making sure that reporting forms are available. The Ministry and its development partners should take responsibilities to elevating the costs incurred by IDSR focal person. The study also recommends to the Ministry and RMHT to strategize on how to speed up reporting, and that weekly disease data should not be approved only by RMO but other RHMT members. Lastly, the study recommends that the Ministry set aside some fund and schedule a time table to enable them to conduct supportive supervision from National level to Regional levels
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    Factors towards low contraceptive uptake: does providers’ capacity matter : A case in Morogoro District Council
    (Mzumbe University, 2015) Stephen J. Mduma
    The main objective of the study was to determine the role of providers’ capacity in enhancing contraceptive uptake. A descriptive cross sectional study design was used to a randomly selected 51 respondents of whom 26 were health providers and 25 were clients. The specific objectives were to determine magnitude of FP providers availability, to examine providers’ capacity in terms of training, skills, mentorship, experience, data generation and use for provision of FP services, to determine the magnitude of providers’ capacity for FP advocacy, to determine the degree of provider capacity in FP supply forecasting and to determine the level of provider capacity in meeting FP consumers’ choice. Findings revealed that, contraceptive uptake in Morogoro DC was 28% which was low compared to 37% of the region. Also, findings on availability of FP providers revealed that overall deficit of HCPs were 46.7% for dispensaries and 28.6% for health centers respectively. There was no statistically significant different between current contraceptive utilization and availability of health care providers with X2 Pr = 0.933>0.05 at 95% confident limit. Further findings on FP providers capacity revealed that lack of mentorship was at 66.6% for health centers and 100% for dispensaries and it was statistically significant with X2 Pr = 0.007 and correlation coefficient with P>|t| 0.006t 0.006 which is < 0.05 at 95% confident limit. Findings for FP/providers/clients decision making tool revealed that 92.31% of respondent reported that there was no tool available in their health facilities, statistically significant with X2 Pr 0.007 and correlation at P>t 0.006>0.05 at 95% confident limit. Conclusively: This research study had revealed that, consistent availability of contraceptives, health care providers, providers /clients’ decision-making tools and mentorship could enhance contraceptives uptake level in the community.
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    Assessment of factors influencing community health fund member’s satisfaction with treatment services offered through community health fund
    (Mzumbe University, 2015) Swai, Denis Francis.
    Background: In Tanzania, Community Health Fund (CHF) was initiated in 1996 with the aim of implementing a community Based Health Financing Scheme through volunteer membership contribution as additional income to improve access to quality health care service for marginalized rural community. The evaluation was conducted to assess factors that influencing Community Health Fund member‟s satisfaction with treatment services offered through Community Health Fund membership. Methods: A cross sectional study design was employed that involved 153 respondents for which allowed collection of data that provided a descriptive estimates of the population parameters. The study was guided by Donabedian conceptual framework where by questionnaires were designed to assess structures, process of service delivery and treatment outcome as attributes of satisfaction. A sample size of 153 respondents was calculated by statalcl 13 (64-bit) within the effect size of 0.7– 0.8 one sample (Alpha = CI=95%, α=0.05, two-sided). Two health facilities were involved in the exit interview where by respondents were selected and interviewed based on their inclusion criteria. Results: A bigger proportional of female 55(60%) and 40(60%) in Likombe and Mikindani compared to male 37(40%) and 21(34%). A big proportional of respondents revealed that structures of health facility include availability of adequate Health Care Providers (HCPs) and medicines influence their satisfaction (p=0.05). Most of respondents were happy with the quality of available medical supplies and it was statistically significant at satisfaction level (p=0.02). The process of service delivery indicate that CHF members spend more than one hour to receive treatment service in health facility from their first contact and there was significant association between time spent and satisfaction(p=0.02). However, significance association was found between happiness with treatment and overall satisfaction level with services (p=0.03) though members do not feel much difference from being a CHF member and other patients. viii Conclusions: All three attributes - Structure of the health facility, process and treatment outcomes significanly influence CHF members sutisfaction of treatment services provided through CHF membership.However, the availability of medicines ,.and qualified HCPs have great influence in the Satisfaction with structures, while there is a significant influence of time in satisfaction with process of services provision and treatment results have significant assoaciation with service provided
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    Effectiveness of result based financing programme on utilization of maternal health services in Urambo
    (Mzumbe University, 2018) Njopeka, Abdilahi Nassor.
    Background: Introduction of RBF to Africa resulted from increased maternal death and decreased national expenditure on health sector (Africa Progress Panel, 2010). In Tanzania, RBF was introduced in 2015, rolled-out to Urambo district in 2017. This study evaluated the worth of RBF on utilization of maternal health services through paying incentives, improving infrastructure and purchasing commodities to health facilities. Methodology: Quasi experimental evaluation study conducted in Urambo district where multistage sampling was used to select households from RBF facilities as intervention participants and non-RBF facilities as control participants. Baseline data was collected from DHIS 2, associations tested using Chi square (95%) and 0.05 P-value. Results: Institutional delivery cumulated 51% of incentives paid to health staff, implying that staff are motivated to perform duties with high incentives (20,720 Tshs/client) compared to the less paid of IPT 2 (1,240 Tshs/client) that demonstrated a drop of 11.7% after RBF implementation. The availability of 50% of medicines at maternity ward suggested the presence of other funds source. Changes from 0% to 61.3% state of building repair and an increase in availability of power and water sources by 82.9% and 50% respectively suggested improved facility infrastructures. Utilization of services increased for 43.3% in institutional delivery and 9.6% for prenatal visits >12wks were associated with incentives and infrastructure (P-values 0.006, 0.023; 0.001, 0.014). Conclusion and Recommendations: RBF was effective on utilization of maternal health services but limited to prenatal visits >12wks and institutional deliveries with effect size of 0.12 and 0.21 respectively. It is recommended that non-monetary form of incentive should be directed to clients in order to advocate the concept of RBF to the community, and the CHMT should provide technical support to health facility management team and make effort to community health education on the importance of completing four prenatal visits before delivery.
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    Evaluation of the implementation process of health system strengthening program towards improving emergency obstetric and newborn care services: A case of selected health facilities in Kisarawe District
    (Mzumbe University, 2018) Mwandiki, Martin F
    Background: In this 21st century with well advanced technology on medical treatment we still lose a number of women and childrenn during childbirth in Tanzania. Emergency obstetric care is one of the strategies for reducing death during childbirth. Objectives: The aim of this study was to evaluate the implementation process of health system strengthening program towards improving emergency obstetric and newborn care services specifically, ability of the health facilities on providing EmONC services after health system strengthening. The goal of the project has been to improve EmONC services by ensuring availability of funds for training of health staff, procurement of medical equipment and supplies to the health facilities of Kisarawe district. Methodology: A cross-sectional descriptive study was conducted to 15 health facilities in the period of 2015-2017. The methods of data collection employed were mixed methods of data collection whereby the data was collected through face to face questionnaires to coordinators of the program, structured questionnaire administered to health staff, observation checklist and documentary review of the facilities` records. Descriptive analyses such as bar charts, histograms, line charts and percentages were employed. Results: The amount of support was not adequate since the program managed to support just four facilities out of 35. Merely 19%-20% of staff were trained for EmONC services, and almost all were from the district hospital. There was a shortage of medical equipment by 39.1-56.5% and medical supplies by 40-65% for EmONC services to all selected health facilities except the district hospital.The dispensaries and health centers could provide EmONC services at rate of 22.2-44.4% except the district hospital which had 100 percent. Conclusions: The implementation process of health system strengthening towards improving EmONC services at selected health facilities is not implemented successfully. Recommendations: There is a need of more funds, and the district should see to it that the program is implemented more effectively to realise set objectives and the Government of Tanzania should also increase its stewardship.
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    People's perception on mosquito net performance: A cross-sectional study in the north-western part of the Lake Zone in Tanzania
    (Mzumbe University, 2015) Lukole, Eliud Andrea
    The main aim of this study was to assess People’s Perception of Mosquito Net Performance in Muleba District in the North-Western Part of the Lake Zone of Tanzania. A cross-sectional survey and KAP survey were conducted a month apart. It was found that the sole reasons for not using bed nets in the study area were having not enough nets and bed nets being too old or poor condition. Half of the respondents continued to sleep under bed nets with poor conditions since they had no other alternatives. The attrition, survivorship and fabric integrity (LLIN with holes) rates were 36.85%, 57.76% and 60.15% respectively. Moreover, over 3 years more than 3 nets for every 10 nets distributed were lost because of wearing and tear, 5 nets survived out of 10 nets after 3 years and 4 nets sustained field condition for every net used. A proportionate hole index (pHI) was developed so that the integrity of net structure could be categorized. The pHI, IQR(Inter-quartile Range), median and standard deviation for HI were 3382.74, 2594.47, 3310.58 and 2551.50 respectively. There is wider dispersion of data on holes, and this is due to cluster geographical differences and differences in household composition between and within clusters. Based on study findings, mosquito nets are the main preventive measure against malaria used in Muleba. The population highly associates nets with malaria prevention. Nets with too many holes and more than three years old were perceived to be poorly performing in malaria prevention. Moreover,net attrition and survivorship and fabric integrity as elements of net durability showed significance difference between clusters because of geographical difference and the within cluster variation was due SES led by household composition. It is recommended that intensive and robust community-specific communication programmes should be devised by the government and/or other private institutions. Nets accessibility ought to be increased 3 years after free universal distribution through supply of subsidized nets in private shops so that families can at any time have access to them at lower costs. Pro- poor exemption policies can help the poorer group on equity bases.
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    Patients’ satisfaction under National Health Insurance Fund (MHIF):The case of Bugando Referral Hospital
    (Mzumbe University, 2015) Mtwe, Joseph Nyamhanga
    Patients’ satisfaction under National Health Insurance Fund (NHIF):The case of Bugando Referral Hospital Introduction: The National Health Insurance Fund (NHIF), scheme was initiated in 2003 by the government, with the aim of making health care services accessible to the formal sector employees. Objective: The main objective of this study was to assess the patients’ level of satisfaction under NHIF and factors influencing their satisfaction. Methods: The study employed a cross sectional study design involving 82 NHIF outpatients. Qualitative and quantitative approaches were employed; the data collection methods used includes questionnaire administration, focus group discussions and documentary review. Results: It emerged from the study that, insured patients had good expectation towards health services as well as good attitude with health service at the OPD, except poor attitude was noted on patients’ comfort ability towards health service. 37 (52.9%) respondents expressed poor attitude. Also 38 (54.2%) respondents indicated dissatisfaction on accessibility of the health services, especially enough space and seats. Furthermore, up to 36(51.4 %) respondents were dissatisfied with too long consultation time; and 34 (48.6%) respondents were dissatisfied with the service area at OPD, being inconvenient for the provision of health care to the insured patients.. It however emerged from the study that respondents were moderately satisfied with the availability of health services at the OPD and were satisfied with the quality of health services at the OPD. Conclusion: The study recommends action to be taken by NHIF scheme together with the hospital administration on addressing patients’ concerns for the purpose of improving the provision of health services. They should also include patient satisfaction strategies in their strategic plan for monitoring and evaluation of patient satisfaction under NHIF