Dissertations (Masters)-HSM-SOPAM

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Actors associated with utilization of immediate postpartum family planning services among post delivery mothers: A case of Chaguo la Maisha program in Ilala Dares salaam
(Mzumbe University, 2019) Ntambuto, Rose Marco
Introduction: Family Planning (FP) program is a key strategy for reducing maternal, infant and child morbidity. Effective Provision of PPFP prevents unplanned pregnancy during 12 months after delivery. Objective: The aim of this evaluation was to evaluate factors associated with utilization of IPPFP in Ilala Municipality. Methods: Descriptive Cross-sectional study design deployed both quantitative and qualitative methods for data collection and analysis. Selection of six Health Facilities used probability sampling strategies, with cluster sampling, non-probability sampling technique was used to select 395 who were selected conveniently and were given coded structured, translated to Kiswahili and pre-tested questionnaire to collect data. Quantitative observation checklist was used to quantify resources availability. Data were entered into the Microsoft excel sheet and imported into the STATA version 13 for data cleaning before analysis. Chi square test analysis was used to create the relationship between IPPFP services and the utilization of it. For Qualitative data, Purposive sampling methods were used to select health workers who had key information, and used in depth interview guide. Content analysis was used to analyze the data, transcription of the interview, formation of meaning units, condensation of the unit followed by codes formation then themes were created to produce report. Findings: The study findings show 79(20) % of clients were discharged with IPPFP. Aassociation was found between IPPFP use and counseling session (p-value 0.023), session clearly understood (p-value 0.030). Another finding which has no association was stock out of medical supplies and equipment for IPPFP, (p-value 0.360) and adequate room (p-value 0.332). Conclusion: There is low utilization of IPPFP use in Ilala Municipality. Reason for not using the service were; pain following delivery, not discussed with their husband, fear from side effect of methods and husband not approved to use IPPFP. Recommendation: Therefore, individual counseling, community and male involvement should be promoted to increase IPPFP utilization.
Assessment of energy efficient rocket stoves contribution on deforestation control in Tanzania: A case study of Chamwino District in Dodoma Region
(Mzumbe university, 2015) Annamaria Cornelius Gerome
Deforestation is undeniable fact that it is a worldwide environmental concern. This study assessed contribution of energy efficient rocket stoves technology in deforestation control at household level in Chamwino District whereby it specifically examined adoption and adaptive use of energy efficient rocket stoves technology. It also explored the impact of energy efficient rocket stoves technology in rate of deforestation and identified challenges in adoption and use of energy efficient rocket stoves technology in the study area. The study involved 114 respondents including randomly selected 100 households and 14 purposely selected key informants such as WEO, VEO, DEMO, FO and STT Officers. The data were collected using structured questionnaires, interviews, focus group discussions, participant observation and documentary review. Quantitative data were analysed using descriptive statistics while qualitative data were analysed through content analysis based on emerging themes. Moreover, forest cover change was assessed using ERDAS IMAGINE 2014, ArcGIS 10.2.2, Google Earth and Microsoft Office Excel. Findings showed that, even though the majority (60%) revealed the fact that rocket stoves are efficient in terms of firewood, adoption was only high initially due to promotion by STT project and perceived benefit, later as the project phased out, adoption decreased due to loss of hope and socioeconomic barriers. Even those who adopted the stoves, only few (27%) had adaptive use as the majority turned into use of traditional stoves because the majority (84%) faced challenges in use of the stoves. Among the challenges were easy breaking of the stove, costs of running the stove when broken and cutting of wood into small pieces. Moreover, it was revealed that the rate of deforestation is still increasing despite the introduced stoves. It was therefore concluded that rocket stoves have not helped in control of deforestation. Hence, it was recommended that, people should respond positively towards such projects so that forests are sustained for both present and future generations. Also, the implementers should continue to visit the areas and work on the existing challenges so as to ensure effective adoption as well as use of the stoves even after the phase is off.
Assessment of longterm contraceptive utilization among women of reproductive age : A case of Kibaha town council
(Mzumbe University, 2019) Yusuph, Phidman
Family planning is important in the community as it gives an opportunity for the individual to make decision on the number of children they wish to have, but also it prevent unintended pregnancy which lead to abortion especially unsafe abortion. For those women who are using family planning they have a chance to restore their health wellbeing. Economically it’s also benefiting the couple as they can make plans of their life depending with the number of children they have or they wish to have. The study approach was sequential mixed study which involved both quantitative and qualitative. The sample size quantitatively was determined by using Yamane formula and the sample size obtained was 396. On the other part of qualitative, the data were collected until saturation from key informants. Quantitative data were analysed by assistance of Stata and that the descriptive statistics finding were presented in percentage, charts and tables. Logistic regression used in analysis so as to give out inferential statistics findings, The qualitative data were analysed with the assistance of Atlas ti ,according to the views from the key informant’s especially health care providers and DRCHCO, they said education level and living in urban makes women to be aware on LARC services as also they proved that myths and misconceptions on the LARC, religious, availability of the services and husband decision on FP use have been obstacles for the women to use Long Acting Reversible Contraceptive methods. The study recommends efforts from different stakeholders and the Government to put much emphasis on ensuring that the health education on family planning especially LARC is reaching the community and male involvement it’s also a key Knowledge and awareness is the source of women and the community in large to change their behavior towards the use of long acting Contraceptive methods and avoid them from unwanted pregnancy which could lead to unsafe abortion and death. Key words: Long Term Contraceptive; Utilization; reproductive age; Kibaha
Assessment of medical waste management in health facilities: A case study of Makambako health centre
(2017) Mwakanyamale, Nuru
INTRODUCTION: Healthcare wastes pose health problems to the people and affect environment in general. Since the WHO set rules and principles of handling medical wastes but in health facilities health workers lack awareness and knowledge on how to handle those medical wastes whereby there are no training sessions and seminars to them. OBJECTIVES: The objectives of this study were to determine the practices of medical waste management at Makambako Health Centre, examining awareness to health workers and assessing the factors affecting adherence to the MWM at Makambako Health Centre (MHC) to avoid occurrence of health hazards to those interacted with those medical wastes including patients and environment around the area. METHODS: The researcher made use of both primary and secondary data. The study also employed the use of cross section method to describe the BWM since it involve 60 of Health workers included in the study from Health facility using purposive sampling technique. A semi structured questionnaire and observational check list were used to collect data. Data were entered and analyzed using SPSS. FINDINGS: The study has revealed the following key findings it indicates that generally level of awareness of health workers in government strategies to address medical waste was 65.4% and only 34.6% were not aware. Also 82.7% said the practices are satisfactory and 19.3% said the practices are not satisfactory since are encountering different challenges in the medical waste handling practices including getting injuries when handling wastes. RECOMMENDATIONS: From the research findings study recommend that there is a need of having regular training programs to all workers in order to help them to know the risks associated with poor management of medical wastes also the notification of quantity of wastes generated to enable the proper allocation of resources in medical waste management.
Assessment of outreach immunization services as a strategy to increase immunization coverage to reach Zanzibar national target of ninety Percent. A case study y - north “A” district of Unguja
(2015) Mize, Shah Abushir
Reaching the whole target population is one among the five essential components of the WHO/RED Strategy, and an operational approach to achieve immunization coverage. Different approaches for reaching target population enhance delivering of the health services to a large proportion of the population, that is Outreach (fixed site or mobile), Mass campaign and Village Health Day and Nutrition,The study was conducted to assess the outreach immunization service as a strategy to increase immunization coverage to reach Zanzibar national target of ninety percent. The study was carried out as quantitative and qualitative descriptive case study design involving 100 respondents including 80 community members from 5 selected Shehia in North “A “District of Unguja (Bandamaji, Kinyasini, Kandwi, Fukuchani and Kigongoni); 13 service providers from Chaani Kubwa, Kidoti and Pwani Mchangani health facilities and 7 supervisors from the District Health Management Teams. The information was obtained using guided interview questions, documentary review, and checklist/ observation. Data analysis was done by manual sorting, tallying, tabulation on master sheet through electronic software, and the results are presented in figures, tables and percentage (both qualitative and quantitative). The study findings revealed that the majority 46.15% of service providers interviewed were unskilled personnel (auxiliary worker) who execute outreach immunization services, with no reliable transport to track and follow up the outreach services, (23.75) % of the respondents agreed that outreach settings were not conducive to perform outreach services, and (16.25%) respondents were not satisfied with the services they received at the outreach setting. The study concluded that, factors limiting reaching unreached population include: weak supportive supervision (30%), weak male involvement (20%), and shortage of qualified staff (50%) to execute outreach immunization services and to reach all target population viii.Moreover, community suggested that to increase the number of resources, outreach services should be comprehensive and integrated as well as construction of health facility at every outreach setting to be put into consideration.The study recommended that the need to increase the demand for and supply of qualified staff so as to improve the utilization of health services and performance of the providers; to intensify community education on the use of the health services and to effectively provide supportive supervisions at regularly (at least monthly or quarterly) to improve staff performance.
Assessment of outreach immunization services as a strategy to increase immunization coverage to reach Zanzibar National target of ninety percent: A case study - North “A” District of Unguja
(Mzumbe university, 2015)
Reaching the whole target population is one among the five essential components of the WHO/RED Strategy, and an operational approach to achieve immunization coverage. Different approaches for reaching target population enhance delivering of the health services to a large proportion of the population, that is Outreach (fixed site or mobile), Mass campaign and Village Health Day and Nutrition, The study was conducted to assess the outreach immunization service as a strategy to increase immunization coverage to reach Zanzibar national target of ninety percent. The study was carried out as quantitative and qualitative descriptive case study design involving 100 respondents including 80 community members from 5 selected Shehia in North “A “District of Unguja (Bandamaji, Kinyasini, Kandwi, Fukuchani and Kigongoni); 13 service providers from Chaani Kubwa, Kidoti and Pwani Mchangani health facilities and; 7 supervisors from the District Health Management Teams. The information was obtained using guided interview questions, documentary review, and checklist/ observation. Data analysis was done by manual sorting, tallying, tabulation on master sheet through electronic software, and the results are presented in figures, tables and percentage (both qualitative and quantitative). The study findings revealed that the majority 46.15% of service providers interviewed were unskilled personnel (auxiliary worker) who execute outreach immunization services, with no reliable transport to track and follow up the outreach services, (23.75) % of the respondents agreed that outreach settings were not conducive to perform outreach services, and (16.25%) respondents were not satisfied with the services they received at the outreach setting. The study concluded that, factors limiting reaching unreached population include: weak supportive supervision (30%), weak male involvement (20%), and shortage of qualified staff (50%) to execute outreach immunization services and to reach all target population viii .Moreover, community suggested that to increase the number of resources, outreach services should be comprehensive and integrated as well as construction of health facility at every outreach setting to be put into consideration. The study recommended that the need to increase the demand for and supply of qualified staff so as to improve the utilization of health services and performance of the providers; to intensify community education on the use of the health services and to effectively provide supportive supervisions at regularly (at least monthly or quarterly) to improve staff performance
Defaulters tracing and retention of people living with HIV/AIDS (PLWHA), how far do peer performs this duty?: A case of Bunazi health centre in Missenyi District Council
(Mzumbe University, 2015) Rwazo Levitas Revelian
The study principally intended to assess the role of peer educators in defaulter tracing and retention of people living with HIV/AIDS at Bunazi Health Centre in Missenyi District. The study was motivated by defaulting trend of PLWHA already on ART. The general objective was to assess the performance of peer educators, government and partners in defaulter tracing and retention of People Living with HIV/AIDS (PLWHA) at Bunazi Health Centre. The specific objectives were; to establish the extent at which PLWHA lost to follow up ,to examine likely factors that cause PLWHA to default from their appointment dates ,to identify the ways used by peer educators, government and partners in tracing defaulters and emphasizing the use of ARVs and adherence to prescriptions and hence retention of PLWHA, to compare the trend of defaulters before and after introduction of peer educators program and to explore staff , community perception and support to PLWHA The study employed descriptive design, purposive and stratified sampling technique was applied to get representatives sample of respondents were involved in the study. Data were collected through interviews, questionnaire, observation and documentary review. Data was managed at highly standardized procedures to ensure quality results. Coding, recoding, cleaning, processing and finally analysis and outputting of the results were conducted depending on the available software standards. SPSS statistical programme was used for data entry and analysis of quantitative data. The qualitative data was presented according to the findings in logical and sequential way so that conclusion can be drawn from them. The data was presented according to research question and research objectives, tables are used to present data. The study showed that at Bunazi health centre PE reduces the rate of defaulting from 6.1% in 2011 to 4.5% 2014.The recommendations capitalize on the sustainability of peer educators’ programme and close follow up of PLWHA at the community level in collaboration with VHW and HBC providers.
Determinants of obesity among rural men aged 18 years and above: A case of Bagamoyo district hospital
(Mzumbe University, 2015) Lugendo, Pendo Eva
Introduction: In Tanzania, obesity is regarded as a town problem; but currently the problem is facing the rural community as well. However, the magnitude and determinants of this problem in rural areas are not well known. This study aimed to explore determinants of obesity among rural men aged 18 years and above in Bagamoyo district. Methodology: A cross sectional study design was employed; data were collected from selected health facilities in Bagamoyo district. A Hundred and twenty men patients aged 18 years and above who visited health facilities during the study period were recruited. A semi-structured questionnaire was used to collect primary data. Secondary data were obtained from reviewing patient’s registers and files from CTC and Diabetes clinics in Bagamoyo district hospital. Data were entered and analyzed using Microsoft Excel applications. Results: The findings showed that 41.5% and 31.7% of the obese men were of the age group 40 or above and between 29-39 years respectively. Majority of the obese men were married and cohabiting by 37% and 27% respectively. Over 70% of the obese men earned a monthly incomes ranging from TZS 201,000/= to TZS 300,000/=. Furthermore, 56% of the obese men reported to eat 3 times a day and 24% more than 3 times a day eat starch food like ugali and beans, rice and beans in as lunch and dinner while during morning they eat fried doughnuts or cassava. Beer and soda were highly preferred by obese men by 43.9% and 35% respectively while 34% had drinking habit after working hours. More than 70% of the obese men did not participate in physical activities, 56% reported that they did not have recreational places and 65.9% did not engage in any recreation clubs. In addition, the findings from CTC and Diabetes clinics revealed that overweight and obesity is an indicative of being at risk of co-morbidities. Recommendations: This study strongly recommends that education should be given on how to prevent and control obesity, for example education on eating balanced diet as well education on physical activities.
Effects of exemptions on cost sharing practices in government health facilities: A case study Chunya District Council
(Mzumbe University, 2015) Chengula, Veronica ,Andreas.
The study looks into the effects of exemptions on cost sharing practices at Chunya district hospital. The research objectives were to determine the awareness of health service providers on exemption mechanisms, how exemptions are implemented and satisfy the eligible groups, what are the effects of exemptions and identifying appropriate mechanisms of improving the implementation of exemptions. The study adopted a case study design by using questionnaires and interviews for primary data collection while secondary data were obtained from reviewed relate documents. The study was completed by 60 respondents working in different departments of Chunya district hospital including CHMT. Moreover, the sampling techniques were both non-probability and probability sampling, which include purposive sampling and simple random sampling. From the findings of the study, the majority 55 (91%) were aware with exemption Mechanisms in their work place. Moreover, on the satisfaction of the groups who are exempted 35 (58%) the system is satisfying with some challenges. Furthermore, on the effects of exemptions on cost sharing the result showed that 56 (93%) of respondents agreed that exemptions has effects of cost sharing due to lower revenue collections, workforce crisis and inadequate medicine and medical supplies. Tanzania should implement cost sharing and exemption mechanisms in situations that can maximize the revenue collection, compensate the revenue lost in exemption by using tax collected from natural resources i.e. gold mining, tourism, gas and mobilization of CHF.
Efficacy of Azadirachta indica plant leaves extract against “Bulinus globosus” snails under laboratory setting
(Mzumbe University, 2018) Badran, Issa S.
Niclosamide is the only chemical compound recommended for fresh- water snail control worldwide. Unfortunately, this compound has genotoxicity and carcinogenic effects. Besides, this compound is expensive and unaffordable to low income community members and developing countries like Tanzania. This study had the aim of testing the Azadirachta indica (neem) plant leaves extract against Bulinus globosus snails under laboratory setting so as to come up with alternative product to be used in the control of snails. The objectives of this study included determination of the lethal dose at LD50 and LD95 of grinded leaves of Azadirachta indica plant against field collected Bulinus globosus and determination of effectiveness of lethal time at LT50 and LT95 of grinded leaves of Azadirachta indica plant against field collected Bulinus globosus. Study population was snails and study design employed was experimental, which consists of two comparable groups which were an exposure and non-exposure groups containing 10 snails per batch with 266 total sample size for each group of hours. The study revealed that Azadirachta indica has a molluscicidal effect against Bulinus globosus although at all doses no LD50 and LD95 were recorded during the 6 hours exposure despite of recorded snail mortalities. The LD50 of 28.81g/L with a 95% Confidence Interval (CI) of 39.8-54.8 was recorded at 12 hours exposure where LD95 could not be recorded at this same time. The LD95 was recorded after 24 hours of snail exposure and this was 42.99g/L with a 95% Confidence Interval of 73.9-89.7. However, the Analysis of Variance (ANOVA) showed that no statistical significance different between the mortality exerted by the three groups for 6, 12 and 24 hours (P>0.05). On the hand, LT50 was recorded at the dosage of 28.81g/L and LT95 at the dosage of 42.99g/L. These findings therefore show that Azadirachta indica leaves extract has poison to kill Bulinus globosus snails because at laboratory setting experiment this was obvious. The important things noted are that to obtain high rate of mortality higher dose and longer time are needed. Furthermore, it is recommended to do the same vii experiment to these snail‟s species using other parts of the plant such as bark and seeds so as to make full utilization of the plant.
Evaluation of implementation process of Star Rating Assessment and quality improvement plans in primary healthcare facilities in Tanzania : A case of Kibaha Town and Rufiji District Councils.
(Mzumbe University, 2019) Justine, Chrisogone
The Government of Tanzania through Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) introduced the Star Rating Assessment (SRA) system as initiative under Big Results Now (BRN) to assess the quality of health services. The SRA system used standardized tools for assessing the quality of health services and the star level ranges from 0-5 stars depending on the quality of services provided. The SRA had a target of 80% of Primary Health Care (PHC) facilities be rated 3 stars and above by June 2018 but unfortunately only 20% of facilities attained this target countrywide. The study aimed at assessing the implementation process of SRA and Quality Improvement Plans (QIPs) as one of the initiatives in improving the quality of healthcare delivery in primary health facilities in Kibaha TC and Rufiji DC. I adopted a descriptive cross-sectional study design whereby qualitative technique was employed to gain the experiences of individual healthcare providers and groups of Quality Improvement Teams (QITs) on implementation of SRA. Data was collected through Focus Group Discussions (FGDs) in which 4 FGDs were conducted comprising between 4-7 participants for QITs and in-depth interviews (with 19 participants) for facility in-charges, CHMTs (DMO or District Health Secretary), Council and Regional QI Focal Person, and SRA coordinators at national level (MoHCDGEC and PO-RALG). Data were analyzed using qualitative content analysis, which offers the development of categories from the text data inductively in capturing experiences from the key informants. The study findings revealed mixed results regarding implementation of SRA and QIPs in PHC facilities. The results showed that the awareness on SRA system was low among healthcare providers, the QIT members were not aware of their roles in implementation of QIPs and the CHMTs were not including QIP follow up progress as part of their quarterly supportive supervision. Some of the reported challenges that were encountered during implementation of SRA and QIP included but not limited to shortage of staff, financial resources, inadequate training of staff on SRA system, and inadequate CHMTs support through supportive supervision. The implementation of SRA has shown some improvement in the delivery of quality healthcare in the study sites. However, enhancing the proper implementation of SRA especially QIP follow up and overcoming the barriers to implementation will improve the quality healthcare in Tanzania. MoHCDGEC, PO-RALG, R/CHMTs, Facility in Charges and QITs should play their roles for effective implementation of SRA system in Tanzania.
Evaluation of longterm methods family planning training to skilled health care provider to reach the national target: A case of Mufindi District.
(Mzumbe University, 2019) Balama, Elizabeth
Introduction; The government through its councils wants to put an emphasis on training health care providers on family planning in the implementation of family planning program. The main objective of this study is to assess the training on long term methods of family planning to skilled health care provider to reach the family planning National target. Methodology; The study included 10 health facilities (1 private hospital, 3 public Health Centers and 6 public Dispensaries). In-depth Interviews (IDIs) were conducted to all 10 RCH in charges from 10 facilities and 1 Focus Group Discussion were conducted to 6 members from Council Health Management Team (CHMT) who were DRCHCo, DHS, DHIS2 Coordinator, BRN coordinator DNO and CBHCo. A cross sectional design was used in evaluating this program using purposive sampling methods. Data was collected through Focus Group Discussions where by 6 members of CHMT were involved in FGD and in-depth interviews for Council Health Management Teams and RCH in charges. Phenomenological and narrative analysis was used to explore individual and group experience with the help of Atlas.ti software. Findings; The findings show that family planning is conducted as it planned and the family planning health care providers are trained on the provision of long term methods of family planning methods. But there are inadequate documentations for the training conducted on who have been trained, what methods were used, where the training was conducted and who funded it. Also training on long acting methods of family planning is offered through the MoHCDGEC and Boresha Afya with full package according to the family planning teaching module. Conclusion; The provision of long term methods of family planning training to skilled health care providers is of great impact on the process of reaching the National target. Follow up should be done to those who are trained and proper documentation should be made. Key words: Evaluation; long term; family planning; skilled health care providers
Evaluation of result based financing program at primary healthcare facilities ; Data quality improvement in health management information system: A case of Mafia District Council
(Mzumbe University, 2019) Nahoda, Hassan
The study evaluated result based financing program at primary healthcare facilities, Specifically, it intended to examine the RBF HMIS training on data quality improvement in HMIS at Primary healthcare facilities, examine the extent by which RBF data sharing meeting on data quality improvement in HMIS at Primary healthcare facilities, and evaluate the RBF supportive supervision on data quality improvement in HMIS at Primary healthcare facilities in Mafia DC A descriptive cross-sectional evaluation design was employed and a mixed method was used where simple random sampling techniques were used to select health care workers from RBF facilities. The self-administered questionnaire was employed and purposively technique was used to select key informants from RBF facilities to participate in an in-depth interview. Quality of health management information systems for managing patients and managerial issues was poor 38.4% in 2017 due to poor knowledge of health workers towards data collects, processing, analyzing and use for further improvement of health services provision. Obviously, this has a profound effect on service quality, customers’ satisfaction, health facilities’ performance and profitability, increasing morbidity, disability, and death, which also affects stability and economic activities of a country. The findings revealed that the majority of respondents attended training on HMIS data, it’s about 89.9% of them. When supportive supervision on HMIS data towards the quality of HMIS data was assessed, many showed to have contributed to data quality on HMIS data. Moreover, the researcher found data sharing meeting for health staff attended at least in on time which was noted to have great contribution to the improvement of the quality of HMIS data in their facility. The study noted that RBF program has increased health providers’ capacity to collects, analyze and use data in promote quality of health services provision. The health workers acquired knowledge and skills on collecting, analyzing, presenting, and using data. However, health care workers claimed that sometimes due to excessive workload they did not have enough time for data collecting and submitted timely to CHMT. The study concluded that RBF program has increased the improvement of data quality in health management information systems. The RBF program increased knowledge of healthcare workers in perspective of data collections, analysis and use at Primary healthcare facilities in Mafia DC. The study recommended that more initiatives should be carried out by the government and other stakeholders to advocate on improvement of data quality in HMIS to other districts and regions that are not implementing RBF program. This willpower progressively changes the outlook of health staff towards data collection, analysis, and use in decision making. Key words: Evaluation; Result-Based Financing; Data Quality Improvement.
Factors affecting continuity in attending antenatal care services among pregnant women in Chemba district
(Mzumbe University, 2019) Hamisi, Aziza
Background: Maternal mortality has remained to be the leading cause of death among women of reproductive age. In developing countries like Tanzania, the occurrence of maternal deaths has been linked with low level of attendance and utilization of skilled maternal health services like Antenatal Care (ANC) services. This is because some deaths among pregnant mothers could have been prevented if women early utilize skilled maternal health services especially ANC services. Objective: This study aimed to determine the factors affecting continuity in attending antenatal care services among pregnant women. Methodology: The study adopted a cross-sectional design. Data were collected from 384 conveniently selected respondents enrolled in 7 health facilities of Chemba. Questionnaire was used during data collection. SPSS version 17 was used for data analysis. Findings: The findings of this study indicated that description of ANC services from health care workers (HCW) (Harsh or irrelevant description of ANC by HCW to clients), awareness on the day to start ANC and awareness on the frequency in which a pregnant mother is supposed to attend ANC services are the client related hindrances for continuity of ANC attendance. Service providers related factors that hinder continuity of attendance to ANC include long waiting hours of ANC services, modality of counseling for HIV test and STI test, provision of ANC services by male health providers, provision of ANC services by younger health providers, and shortage of medicines and medical equipment. The socio-economic factors that hinder continuity of ANC attendance include low family monthly income, religion objections, lack of spouse’s escort to ANC, lack of spouse’s financial support, family responsibilities, existence of traditional birth attendants and long distance from ANC clinics. Conclusion: In respect to the findings of this study, planners and implementers should consider multiple factors such as client related factors, service providers’ related factors and socio-economic factors in order to enhance continuity of ANC attendance among pregnant mothers.
Factors contributing to teenage pregnancies in Tunduru District Council
(Mzumbe University, 2015) Malisa, Judith Nsimbo
This study was an attempt to assess the factors contributing to teenage pregnancy in Tunduru District Council. The objectives of the study were to determine whether poverty, awareness and low access to family planning services, peer pressure, and level of education contributed to the problem also to solicit for suggestions on how to curb them. Cross sectional research design was used to show and also help in investigating associations between risk factors and the outcome of interest. Purposive sampling technique was used because it enabled the researcher to include only the respondents that were needed for the study. The target population consisted of 183 respondents who satisfied the inclusion criteria. Primary data were collected from the respondents using self-administered questionnaires via the reproductive health service providers. Validity and reliability issues were considered in order to ensure consistency of the data. Both qualitative and quantitative methods of data analysis were used to analyze data in order to minimize the weakness of one another and thereafter SPSS program version 20 was used to code them. The results revealed that poverty, peer pressure, level of education, poor knowledge on the use of family planning contraceptives, reproductive health, little access of family planning methods, early marriages and low access to family services contributed much to the problem. Pregnancy prevention strategies were recommended based on the results. The strategies focused on improving female literacy rate, establishment of adolescent friendly clinics, revision of the current marriage law, encourage community based programmes for sensitization purposes, establishment of gender help desk specifically for youths in order to help them when in need and many others.
Human health effects of exposure to wastewater among residents nearby river Msimbazi in Kigogo ward, Dar es Salaam
(Mzumbe University, 2017) Mwalilei, Gladsone
Objective: This study was designed to investigate human health effects of exposure to wastewater among residents nearby river Msimbazi in Kigogo ward, Dar es Salaam, particularly on skin diseases, respiratory conditions and reproductive problems. Methodology: This case control study recruited 200 respondents, among them 100 were exposed in 500 metres from river Msimbazi and 100 were non exposed 2000 metres far from river Msimbazi. Data were collected using administered questionnaires and analysis was made by Statistical Package for Social Sciences (SPSS) version 21.0. Findings: The present study reports findings from 100 (50%) male and 100 (50%) female respondents. A minimum year of the respondents spent in occupation was 1 year and maximum was 22 years. Among of 200 respondents, 47 (23.5%) had history of skin diseases and 20 (10%) respiratory conditions while 37 (18.5%) reported to have reproductive problems. The skin diseases reported were skin itching and rashes 29 (14.5%), black spots on the skin 12 (6.0%) and scabies 6 (3.0%). The reported respiratory conditions included pneumonia 13 (6.5%), asthma 6 (3%) and wheezing 1 (0.5). The reproductive problems were miscarriage 27 (13.5%), low birth weight 5 (2.5%), preterm birth 3 (1.5%) and prolonged time to pregnancy 2 (1%). The factors that were associated with exposure status were existence of source of pollutants that pollutes river Msimbazi (p=0.010), number of years that respondents spent in occupation (p=0.016), ignorance of respondents on the use of personal protective equipments such that apron was (p=0.013), overall (p=0.043) and sunglasses (p=0.013). Variables such as age less than 35 years (p=0.034), distance less than 0.5 kms in proximity from river Msimbazi (p=0.005) were significantly associated with skin diseases. Female respondents (p=0.005), nature of respondents occupational for survival (p=0.048) were significantly associated with respiratory conditions while respondents education level (p=0.000), existence of source of pollutants that pollutes river Msimbazi (p=0.002) were significantly associated with reproductive problems. Conclusion: Exposure to wastewater was associated with skin diseases, respiratory conditions and reproductive problems more too exposed residents nearby river Msimbazi compared to non-exposed.
Implementation of subsidy ITNs vouchers scheme: The experience from Chunya District
(Mzumbe University, 2015) Lumuliko, Yohana N.
The study main objective was to explore the implementation of subsidy ITNs vouchers scheme, the experience from Chunya District, specific objectives was on examining malaria incidence, investigating subsidy insecticide treated nets (ITNs) vouchers coverage and identifying challenges faced by subsidy ITNs vouchers program actors and beneficiaries during the implementation. This study was descriptive cross-sectional, applied a triangulation of quantitative and qualitative methods. Information’s on malaria incidence and subsidy ITNs vouchers coverage was obtained from soft and hard copies archived records and reports by using checklist extracted from the District Medical Office. Information on challenges experienced during the implementation was obtained through an in-depth interview by involving three key participants, who were malaria focal person, community leader and selected woman rearing a child as program beneficiary were involved. Data analysis involved summarization and import in micro-soft excel for quantitative data for table and figure. For qualitative data atlas.ti was used for grounded theory and content analysis. Overall findings indicated the decline in malaria incidence as DMO‟s report depicted from 34% in 2012 to 9.2% for outpatient department (OPD) and 10% for in patient in the year 2013. Further findings revealed that, 9,380 pregnant women were identified in 2013, only 2,915 received subsidy ITNs vouchers equal to 31%. Also, findings revealed a total 5,163 of subsidy ITNs vouchers distributed to pregnant women in 2014, but a report was blank for the number of pregnant women received. Furthermore, majority of participants have knowledge about subsidy voucher. Also, findings observed that, some community members missed their share. Challenges identified were poor communication and coordination between actors. Subsidy ITNs vouchers scheme has shown to contribute in reducing malaria incidence despite some setbacks those emerged. It is necessary for the health sector management to rectify weaknesses observed for improvement during future intervention of the same nature.
Influence of religious beliefs on family planning and contraceptive utilization: A cross-sectional study of Morogoro Municipality
(Mzumbe University, 2018) Semwaiko, Jennifer Julius
The main objective of this study was to examine the influence of religion on FP and contraceptive utilization. This cross-sectional study was conducted in Morogoro Municipality, which employed questionnaires and interviews to collected data from 220 respondents. The study population included 200 respondents who are religious followers and 20 respondents were religious leaders. Qualitative data was analyzed using context analysis and quantitative data was analyzed by using SPSS version 21.0 to examine the influence of religion and other factors on family planning and contraceptive utilization in Morogoro Municipality. Findings of this study have shown that, family planning and contraceptive utilization differ across religions and denominations. For instance, it was revealed that 31.7% of Muslims used withdrawal method, 10% use condom, 6.7% use Standard Days Method, 5% use pills while 46.6% do not use any method, compared to Christians 25% of whom uses Standard Days Method, 18% uses pills, 18% uses condoms, 7% uses withdrawal method while the remaining 32% do not use any method of family planning. The findings indicated that religion has no significant influence on FP and contraceptive utilization as p-value was 0.070, above the alpha level of 0.05. Hence, in ranking, other factors has more influence than religion because they have shown statistical significance in influencing family planning and contraceptive utilization. In particular, these factors include sex (OR=5.0, 95% CI 2.053-12.427) with p-value=0.000, age (OR=0.3, 95% CI 0.111-1.080) with p-value=0.058, distance (OR=0.05, 95% CI 0.020-0.0127) with p-value=0.000, availability of FP commodities (OR=2.9, 95% CI 1.245-6.997) with p-value=0.011, friendliness of health providers (OR=3.0, 95% CI 1.344-6.734) with p-value=0.006 and side effects of contraceptives (OR=0.2, 95% CI 0.074-0.390) with p-value=0.000. However, in interpreting these findings, factors like sex, availability of family planning commodities and friendliness of health providers significantly increase the use of family planning and contraceptives, however, distance and side effects of contraceptives significantly decrease the use of family planning and contraceptives. In addition, as the age of people increase above 39 years old, the use of family planning and contraceptives fall.
Patients’ satisfaction under National Health Insurance Fund (NHIF): The case of Bugando Referral Hospital
(Mzumbe University, 2015) Mtwe, Joseph Nyamhanga
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.
People’s perception on mosquito net performance: A cross-sectional study in North-Western part of Lake Zone in Tanzania, Muleba District
(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 not having enough nets and bed nets being too old or in 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 wear and tear, 5 nets survived out of 10 nets after 3 years and 4 nets sustained field conditions 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 associate 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 differences, 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.