Dissertations (Masters)-HME-SOPAM

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    Factors and challenges associated with loss of follow up visits among HIV/AIDS clients attending antiretroviral therapy in Ilala municipal council
    (Mzumbe University, 2015) Salema, Judith
    Background: The loss of follow up visits among HIV positive adults on antiretroviral therapy is a leading cause of morbidity and mortality in Tanzania. The loss of follow up visits brings a big challenge in Care and Treatment Centre (CTC) as many HIV clients are not attending clinics as scheduled. Broad Objective: To assess the factors and challenges associated with the loss of follow up visits among HIV positive adults attending CTC in Ilala Municipal Council. Methods: Cross sectional study design was conducted in Ilala Municipal Council involving HIV positive adults and health providers whereby data were extracted from CTC database and clients’ files. Data were obtained through structured questionnaires and were entered into Microsoft Excel and analyzed by using Stata version 13. Analysis for predictors was done using univariate and multivariate logistic regression where p value of <0.05 was considered as statistically significant. Results: 240 people were recruited in the study. 190 were patients, 50 were health workers, and most of the patients were females with the age ranging from 18-35 years amounting to 102 (54%). Lack of fare 72(60%), Stigma, shift from one clinic to another and use of traditional medicine found to be the factors contributing to the loss of follow up visits. However, lack of space (92%), shortage of health providers (94%), stigma and discrimination (90%), low motivation (94%) and work load (94%) were the challenges facing health providers during provision of services to HIV patients. Conclusion and Recommendations: The study found that the recording system of the patients’ information were poor, there were some clients who died, others were shifted to other clinics but the CTC term them as the loss of follow up visits therefore the data recording system should be strengthened.
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    Nutrition care and support services of people living with HIV/AIDS at care and treatment clinic: The case study of Kagera Region Referral Hospital
    (Mzumbe University, 2015) Tinkamwesigile, Nicolaus T
    Introduction: A process evaluation on nutrition assessment counseling and support services of PLWHA at CTC conducted at Bukoba Region Referral Hospital, Kagera region with the aim of ascertaining level of programme implementation. Methodology: Mixed methods were used to assess evaluation dimensions. The semi structure questionnaire, interview guide, observation checklists and documentary review were used to obtain information about programme context, implementation process, reach, fidelity, dose, adaptation and mechanisms of the impacts of the services provided to PLWHA. Evaluation findings: The evaluation findings revealed that programme was fairly implemented with overall 51% score of weighted factors. The evaluated factors show that implementation process was 42.8% and fidelity of the implementation is 43.5%. While dose and reach of the programme implementation show 38.64% and 79.64% respectively. Stakeholders were less engaging to the programme services as contextual limiting factors and integration of nutrition services to CTC services note as mediator of mechanisms of achieved reach. Using weight trend of PLWHA as nutrition status determination index seen as programme adaptation Conclusion: The CTC had inadequate implementation process that include limited number of staff to assist nutrition services, inadequate equipment, materials and supplies to better optimal programme implementation. Implementation components such as fidelity, dose and reach are imbalance implemented for optimal quality programme implementation. Recommendation: Hospital and regional health managements and ministry of health through TFNC and NACP with their nutrition stakeholders are urged to improve CTC capacity to better nutrition assessment, counseling and support services implementation for betterment of PLWHA.
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    Outcome evaluation of micro credit scheme saving and internal lending community intervention from people living with human immunodeficiency virus in Magu district
    (Mzumbe University, 2019) Iriya, Lucy C
    Background and rationale: HIV/AIDS has caused negative impacts on livelihoods including socio-economic problem, food insecurity and increased number of orphans in Sub-Saharan countries, including Tanzania. Following this, TAZAMA, the project operated under the Tanzania National Institute for Medical Research (NIMR) initiated the so called Microfinance schemes with the main objective to mitigate the negative impact of HIV/AIDS among People Living with Human Immunodeficiency Virus (PLHIV) and vulnerable populations in rural areas. Therefore the purpose of this study was to evaluate the contribution of microfinance Saving Internal Lending Community (SILC) intervention under TAZAMA project to the living standard of People Living with Human Immunodeficiency Virus (PLHIV) in Kisesa, Bujora and Bukandwe in Magu district within Mwanza city Tanzania Methods: Analytical cross-section study design was used which adapted mixed research methods; both quantitative and qualitative approaches were used. About 119 participants aged 18years old and above, PLHIV and beneficiaries of the SILC programme in Magu District suburb of Kisesa, Bujora and Bukandwe wards were enrolled for the study. Both self-administered questionnaires and interviews were used for data collection. STATA Statistical Software Package and ATLAS.ti V. 7 were used for data analysis. Inferential t-test and chi-squire test were used; also descriptive statistics such as frequency and percentage were presented in form of tables, figures and graphs. Results: The findings revealed that the majority of PLHIV had manage to save and receive credit through SILC groups, all beneficiaries of PLHIV manage to start entrepreneur activities after joining SILC groups such as horticulture, shops, transportation (bodaboda) and tailoring. Also, the findings show SILC members were able to increase meal intake and increased food stock. About success of SILC programme results shows PLHIV in improving their Living standard by owning assets and business. Statistically, there is significance difference on Ox-plough farm equipment before loan and after loan at P-value of 0.0095<0.05 which shows there is improvement in farming activities due to program intervention. Moreover, there is significance difference in type of wall materials used among the household of PLHIV before and after loan at P-value of 0.000<0.005. Conclusion: The scheme has been positively impacted to PLHIV through operational SILC groups by saving and receiving microcredit. It had improved lives of the PLHIV in the three wards in Magu district and therefore, the Government and other stakeholders should allocate resources to scale-up SILC initiatives to other areas of Magu District and beyond to cover unmet needs of PLHIV since the project did not cover the entire community of people who are living with HIV/AIDS.
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    Assessment of Health Management Information System (HMIS) perfomance in health facilities in Mbarali, Kyela, and Busokelo District Councils
    (Mzumbe University, 2015) Sanga, Jactany L.
    The purpose of this study was to assess the Health Management Information System (HMIS) Performance in health facilities in Mbarali, Kyela and Busokelo District Councils. The study adopted a mixed method design which enabled the study to triangulate the data and information. In this study, four methods of data collection were used, namely questionnaires, semi-structured interviews, focus group discussions and documentary review. The sample size was 49 respondents. PRISM DEAT was used in data analysis. The data analysis included the use of simple description of percentages, tables and graphs this was done using excel spreadsheet. The level of the HMIS performance was measured in terms of data quality and information use. The data accuracy at the facility level was observed using OPD Attendance, ANC and PMTCT MAT and observed to be higher than 95%. The use of information accounted to 65% of the health facilities stored meeting records and 100% of the reports requested were available at the facility and the district level, while 95.5% had a discussion at facility level on the HMIS, of these 83.3% made a decision after discussion, while 95.83% of health facilities referred their issue to higher levels for further assistance. The evaluation report recommend to improve HMIS skills specifically on data interpretation, use of information and problem solving, and the use of the performance improvement tools such as cause and effect analysis, flow chart, priority matrix, control chart, this may be achieved by developing a simplified HMIS training curriculum, conduct training of staff per facility and all health area management team members. The evaluation also recommends the promotion of a culture of information use, motivating health care providers and providing training on moral and ethical issues to improve information use for decision making.
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    Process evaluation on the implementation of Mwanzo bora nutrition program on the reduction of childhood stunting: A case of Kilolo district in Tanzania
    (Mzumbe University, 2018) Chisanga, Helen J
    Nutritional status of children is an important ending measure of their health status. Thus, child care and feeding practices has been recommended as a major solution to improve under-five survivals and promote healthy growth and development. This evaluation aimed to assess the implementation process of Mwanzo Bora Nutrition Program (MBNP) in reduction of childhood stunting at Kilolo district council in Iringa, Tanzania. The evaluation employed formative approach guided by a cross-sectional design. The evaluation enrolled a total sample size of 161 respondents. The sample included mothers of children/caregivers between 0-23 months enrolled in MBNP, community health workers and CHMT officials who were purposively and randomly selected. Data were obtained by using questionnaires, interviews and focus group discussions. Quantitative data were entered and analyzed by using SPSS software version 20 whilst simultaneously qualitative data were analyzed manually. Data were collected by using structured questionnaire, focus group discussion and in depth interview. Descriptive statistics were carried out, Chi – test was done to determine relationship between variables by using IBM SPSS version 20. The results revealed that 98% of mothers had knowledge about infant and young child feeding. There was no significance difference between knowledge of infant and young child feeding and practices especially on complementary food practice and breast feeding. However, significance difference was reported on the initiation of breastfeeding at (p≤0.05). Likewise, there was significance difference (p≤0.05) between knowledge of Mwanzo Bora Nutrition Program and its practices. Finally majority of the respondents (80%) had reported to have hand-washing equipments; and among them 51% reported to have started using the equipments after implementation of the program. The study concludes that use of hand-washing facilities improve hygienic condition and ultimately results on the reduction of childhood illness. Challenges associated with insufficient funds, shortage of human resources and poor community participation to some extent limited the implementation process.
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    Assessment of the quality of postnatal care services: A case study of Mbeya district council
    (Mzumbe University, 2015) Lotto, Theopista D.
    Postnatal care services consists of care given to the mother and her new born for the first six weeks following birth, which enable health care providers identify post-delivery problems and provide treatments promptly. This evaluation was conducted to assess the quality of postnatal care services following the unpublished report from Health Management Information System of the District which showed an increase in the number of maternal and infant death within six weeks post-delivery. Methods: The evaluation used descriptive cross sectional study design in which quantitative approach was employed to collect and analyze evaluation data. The study was also guided by Donabedian conceptual framework based on structural and process components. A total of 355 clients attending postnatal care services in five selected facilities participated in an exit interview. Observational checklist adopted from the WHO implementation guideline was used for assessing resource availability. Data was analyzed using STATA version 13.0. Results: The findings established that health facilities that were involved in the study had basic resources to render quality postnatal care, however, there were some deficiencies in both structure and process components for provision of Post Natal Care (PNC) services. None of the five facilities had separate PNC room equipped with facilities for provision of quality services. Discussion and policy implications: The evaluated health facilities scored below 90%, based on agreed standard as set by World Health Organization which implies PNC services offered was sub-standard. Mbalizi Hospital and Inyala Health Centre had the average score of 77%, Santilya dispensary scored the third (75%) followed by Ilembo Health Centre 70% and the last was Igoma dispensary which scored 68% which is equal to partial quality. There is a need for the management of Mbeya District Council to plan for improvement of health facility infrastructures by constructing separate rooms for PNC to be able to provide quality health services and reduce neonatal and maternal death and ensure privacy to patients and clients.
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    Assessment of quality of PMTCT service provided to HIV positive women and their HIV exposed infants in the Iringa District Council
    (Mzumbe University, 2015) Kisika Firma Ambrose
    This study was conducted to assess the quality of PMTCT services provided to HIV positive woman and their HIV exposed infants following the challenges of increasing dropouts. Specific objectives of the study were: to assess the input factors and their effects on the perceived quality to the satisfaction of the clients; and to assess the process factors and their effects on the perceived quality to the satisfaction of the clients. The study employed cross-sectional and descriptive designs in which data collection methods were questionnaire, in-depth interview, observation and documentary analysis. Data was analysed using Atlas it and SPSS version 16. The study findings revealed presence of some supplies and facilities requited for the provision of PMTCT services. However, it has been found that there are gaps/deficiencies in the structure, process and outcome that requited for providing PMTCT services. The study indicated that about half of the respondents had different views, both negative and positive, on the quality of PMTCT they received due to deficiencies in structural and process attributes that resulted in dissatisfaction. The study further showed deficiencies in structural attributes, in which majority of health care providers are not trained in PMTCT services, whereas it has been found that there is stock out of basic drugs for prevention of opportunistic infection. The study had opinions from CHMT concerning the problem of poor implementation at PMTCT services. The most and commonest problem is inadequate supervision. Further analysis indicated gaps in the process, where the majority of midwives demonstrated poor skills in counselling, whereas about half did not gather information. With regard to client provider interaction as they were not involved in the discussion. The study also revealed that none of the midwives used guidelines during provision of PMTCT services. In relation to history taking, it was observed that the majority of midwives did not obtain history and those few who attempted it came out with incomplete history. Almost all women and their HIV exposed infants were not examined. It is concluded that PMTCT services providers in Iringa District are poor quality.
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    Evaluation of USAID – Boresha afya program contributions among healthcare facilities in Lindi district council to improvement of the supply chain management of medical supplies.
    (Mzumbe University, 2019) Mwihava, Oswald
    This study evaluated the contributions of USAID Boresha Afya Progam to the medicine and medical equipment supply chain management system in Lindi District Council. The evaluation specifically focused on objectives: (i) to assess the use of data quality assessment (DQA) to supply chain management; (ii) to determine the efforts of USAID Boresha Afya Program to sharpen the skills on DQA among the health providers in the served facilities; and (iii) to establish the supervision of USAID Boresha Afya Program enhances supply chain management in healthcare facilities. The evaluation employed case study design with the qualitative approach. The sample size for the study was 33 participants purposively selected. Structured interviews were used to gather data from the participants who were 30 health workers in the selected health facilities and 3 officials of the Program. Because of qualitative nature of data, analysis of the findings employed the framework analysis that involved five stages of familiarization, thematic framework identification, indexing, charting and mapping and interpretation. The findings of the study revealed that the health facilities received Data Quality Assessment (DQA) for data cleaning and verification. It was found that DQA was effective for producing clean and verified data. The health personnel were well trained to handle and manage data for supply chain management of medicine and medical supply. The findings also showed that the health facilities needed supportive supervision from the Program officials. The Program officials offered the supervision but there was no auditing service of the Program. The evaluation reached a conclusion that Programs need clean and verified data to facilitate supply chain management without which it is impossible. Moreover, skills and knowledge are very important aspects in making the Program successful. Further, the most successful Program is that which is supportive supervision is in place. It was recommended that the Program management should establish auditing unit so as to avoid malicious behavior of some stakeholders in the Program.
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    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) Steven Kimambo Haika
    Background: Emergency obstetric care is one of the strategies for reducing maternal mortality, as pregnancy-related complications are unpredictable. However, maternal death due to problems related to unimproved comprehensive obstetric has been documented. Objectives: This evaluation aimed to assess the implementation process more specifically on the community awareness with regard 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 the provision of quality health services through the utilisation of EmONC services by the community of Uvinza District Council. Methods: The study was conducted in four villages of Uvinza district in the 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 on collecting 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. The 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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    Formative evaluation for births and deaths registration at the community, Kilosa District
    (MZUMBBE UNIVERSITY, 2016) Kimbute, Omari Abdallah
    Background: Registration of births and deaths is vital for the proper planning and development of the country but the global and local records show that there is more than 40 million births and deaths that goes unrecorded worldwide. Methodology: Formative evaluation using qualitative research methods was applied to try to establish why the registration is low in Tanzania, the country with centralized government structure and that enjoyed peace for most of the time. Eleven key informant interviews (n=11) and three focus group discussions (n=28) were conducted in three villages that were purposely sampled. Findings: People with birth certificates were very few regardless of being provided with notification and the reason for not having certificates ranged from low level of knowledge on importance, distance to the registration office and costs associated with registration. Death registration was found to be nonexistent at the community and few registered were those affiliated to legal/police issues and of deceased who left wealth. Overall accountability for the Village Executive Officers (VEO) to the Registration Insolvency Trusteeship Agency (RITA) office was totally missing as the evaluation villages had not registered any births or deaths for years and no one asked or made a follow up. Conclusion: The overall awareness on the importance of registration of births and deaths was low not only to the community but even to those assigned to conduct this work. The state agency (RITA) needs to conduct continuous sensitization especially at the communities and bring the services closer to people. The government and other stakeholders are missing important data for planning. vi vii