Health Systems Management (HSM)
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Item Quality of cataract services in Zanzibar: A case of Mnazi Mmoja hospital(Mzumbe University, 2015) Makame, Abass TahaInspite of efforts taken to overcome the cataract related blindness, Zanzibar as one among sub-Saharan countries are far behind the WHO target for good visual outcome following cataract services. Zanzibar claimed to have 41% good visual outcome out of 95% WHO target while the reasons are not much clear, hence a quest to assess the quality of cataract services provided in Zanzibar in terms of: competency of human resource available, availability of medical requirement and level of staff compliance with the standard operation guidelines. To address the evaluation objectives a case study design was applied to assess the quality of cataract services in Zanzibar involving both qualitative and quantitative techniques. The evaluation had drawn its sample from cataract service providers, cataract patients and the heads of eye department in Mnazi Mmoja Hospital through convenient and purposive sampling procedures. Findings obtained from questionnaire, interview, observation and documentary review show that the case study hospital has only 39.1% of required skilled personnel. It has modern equipment and machines for quality cataract services. However, keratometer, B scan and YAG laser were not functioning while antibiotics for post operative and follow up care services were not adequately available to fulfil the requirements of all patients. About 75% cataract patients were not adequately received preliminary care as per guideline. 75.6% of patients received partial assessment for cataract surgical services while by 88.5% were fully assessed for critical events and anticipated variation as per standards. The evaluation conclude that the cataract services offered in the case study hospital was not as quality as expected since it had the following short comings: shortage of qualified human resources necessary for cataract services, shortage of medicines particularly antibiotics; lack of standard service guidelines, dysfunction of critical equipment and machines, and also inability of cataract service providers to adhere to standard guidelines.Item Process evaluation of result based financing program on improving maternal health in Kishapu district council, Shinyanga region(Mzumbe University, 2019) Ngwale, Tedson J.Shinyanga region is one among the regions of Tanzania mainland with high maternal mortality rate (MMR). In 2015, it was reported to have 60 MMR and ranked number one due to unsatisfactory health condition and poverty index. Result Based Financing (RBF) was introduced in Tanzania particularly in the regions with high burden of diseases with the aim of achieving Universal Health Coverage goal and to offset the long-term health sector challenges. RBF was implemented in Shinyanga from 2015. It was initially implemented in 157 health facilities where in Kishapu District Council (DC) is implemented to 55. Since the implementation of RBF in Shinyanga, there are limited studies conducted to evaluate its progress. Thus, the study aimed to conduct a process evaluation study on improvement made by RBF program on maternal health services in Kishapu District Council. Specifically, the study ascertain the extent to which maternal health have been improved at health facilities due to RBF implementation; to examine whether maternal health services delivery and support functions consistent with RBF system; also, to examine healthcare provider’s perceptions on bonus payment for RBF implementation towards improving maternal health services. The study employed a descriptive cross- sectional design with a mixed method approach. A semi-structured questionnaire was used to collect data from randomly selected 147 respondents from all 55 health facilities. Quantitative data was analysed by the use of SPSS V. 25.0 and descriptively presented by tables, figures, and measure of central tendency. Qualitative data was analysed with the help of ATLAS ti version 8.2.4 programs for content analysis. The results reveal that, (82.3%) of the health professionals provided appropriate healthcare to women with delay in labour as per national health guidelines, (80.3%) provided routine postnatal care to mothers and their new-borns, whereas all interviewed health professional (100%) provided care to women and new-borns as per standard precautions for preventing hospital-acquired infections. Nevertheless, (81.65%) of health professionals did not carry out an exit interview with their clients to gather important information about the quality of maternal health services.Item 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 CBackground and rationale: HIV/AIDS has caused negative impacts on livelihoods including socio-economic problem, food insecurity and increased number of orphans among 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 18 years 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 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.Item Provider fidelity in tuberculosis screening practices among adolescents and adults living with HIV in public health facilities in Tanzania(Frontiers Public Health, 2025-11-19) Shilugu,Lucas L.; Mushi, Lawrencia D.; Anasel, Mackfallen G.Tuberculosis (TB) remains the leading cause of morbidity and mortality among people living with HIV (PLHIV) in high-burden countries like Tanzania. Despite national and global guidelines recommending routine TB screening at every clinical encounter, missed and delayed TB case notifications persist, suggesting gaps in screening practices. This study evaluated the implementation fidelity of the TB screening algorithm and associated factors within routine HIV care in public health facilities in Geita, Tanzania. A facility-based cross-sectional study was conducted, involving the extraction of data from 423 client treatment records and observation of 423 screening sessions. Simple random and systematic sampling methods were employed to select the records and sessions, respectively. Descriptive and inferential analyses were performed using Excel and Stata. Modified Poisson regression with robust variance was used to estimate prevalence ratios (PRs) to determine factors associated with two binary outcomes: (1) consistent TB screening over 12-month period, and (2) correct utilization of the screening tool. TB screening was documented in 82.8% of clinical encounters. Overall, 70.7% of clients were screened at every encounter, and 75.4% screened at their most recent visit. Laboratory investigations were recorded in 94% of presumptive cases, with all confirmed TB cases initiated on treatment. Additionally, 80.6% of eligible clients were initiated on TB preventive therapy (TPT). The WHO Four-Symptom Screening (W4SS) was widely used (98.8%), and the tool was correctly administered in 62% of the sessions observed. Factors associated with inconsistent screening included age 40–49 years [Adjusted Prevalence Ratio (aPR) = 0.82; p = 0.046], age ≥50 years (aPR = 0.76; p = 0.025), suppressed viral load (aPR = 0.63; p < 0.001), monthly drug refill model (aPR = 0.55; p = 0.006), refill by treatment supporter (aPR = 0.09; p < 0.001), being traced back from a lost to follow up (aPR = 1.38; p = 0.019), and absence of prior TB (aPR = 0.81; p = 0.001). The correct use of the W4SS tool was less likely at PMTCT clinics (aPR = 0.55; p < 0.001). Although TB screening is widely integrated into HIV care, fidelity to the screening algorithm remains suboptimal in the initial stages of symptom screening. The completion of the algorithm cascade was well-implemented. Fidelity at earlier stages of the algorithm, such as the consistent and correct use of the W4SS, should be enhanced by strengthening provider capacity and routine monitoring to improve adherence to the protocol.Item Influence of religious beliefs on family planning and contraceptive utilization: A cross-sectional study of Morogoro Municipality(Mzumbe University, 2018) Semwaiko, Jennifer JuliusThe 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.Item Perception, practice and risk factors for self- medication among residents of Kakonko District council(Mzumbe University, 2017) Lusinge, Marcely S.This study was about perception, practice and risk factors for self-medication. Specific objectives of this study were; to determine the perception of Kakonko District residents towards self- medication, to identify risk factors that influence them to practice self-medication, to identify medicines which are commonly used for self- medication as well as to determine sources of medicines information among those who self- medicate. This study was carried out at Kakonko District council in which 6 wards were randomly selected from the available 11 wards in which in each ward 2 villages were selected. The study area was chosen due to limited health care and increased population as a result of influx of Burundian refugee which jeopardize health services delivery. This study covered 90 respondents with different backgrounds and experiences. Information from respondents were collected through questionnaires and interviews. Results show that out of 90 respondents, only 28% were aware of the concept of self-medication while 88% of all respondents practiced self-medication. Risk factors for self-medication mentioned were as; lack of basic education 64%, dishonorable behaviors of service providers 30%, limited health services 71%, low income 51%, long waiting hours at the facility 61%, knowledge of local medicines 33%, past experience 44% and lastly fear to seek medical care was mentioned by 14% of all respondents. On the other hand, common medicines used were found to be; 14 (25%) respondents said that they usually use ALU for self-medication, 13 (23%) respondents paracetamol, metakelfin was used by 10 (17%), local medicines by 6 (11%) respondents, ciprofloxacin by 3 (5%) respondents, amoxicillin by 7 (12%) while fragyl used by 4 (7%) respondents. Source of medicines information mentioned are individual themselves, friends, family members, parents and other relatives. Given the extent of the study findings, there is a need of concerted efforts to deliver basic factual information to the society on health and social-economic effects of self-medication.Item Assessment of medical waste management in health facilities: A case study of Makambako health centre(2017) Mwakanyamale, NuruINTRODUCTION: 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.Item 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 AbushirReaching 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.Item Determinants of obesity among rural men aged 18 years and above: A case of Bagamoyo district hospital(Mzumbe University, 2015) Lugendo, Pendo EvaIntroduction: 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.Item Human health effects of exposure to wastewater among residents nearby river Msimbazi in Kigogo ward, Dar es Salaam(Mzumbe University, 2017) Mwalilei, GladsoneObjective: 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.