Health System Management Monitoring & Evaluation(HSME)

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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.
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.
Assessing factors influencing reporting of weekly diseases data from regions to ministry of health and social welfare in Tanzania Mainland
(Mzumbe University, 2015) Moshi, Solomon Frank
Background: Reporting weekly diseases data from regions to Ministry of Health and Social Welfare is one of method which is used to submit weekly diseases information from regions to the Ministry according to number of weeks in a year from 1st to 52 th week. This method is a paper based, that enables diseases information to be available at the national level on time to allow for quick and important public health action. This is an evaluation study designed to assess factors which tended to influence weekly diseases data from regions to Ministry of Health and Social Welfare, to determine technical challenges and determine measures to improving the reporting design. Methodology: The quantitative study design was conducted in Tanzania mainland which consist all regions. A primary data type was collected through structured closed questionnaire which was administered to a total of 25 respondents’ samples size that was 100% countrywide, since each region was represented by single reporter. Data was processed and analyzed by using Microsoft Excel 2010. Results: Findings showed that there was higher understanding of factors which influenced reporting. Findings indicate that 100% of the participants were Health officers, 68% were regional IDSR focal person who understood well the system of reporting weekly disease data. The evaluation also revealed technical challenges associated with reporting; whereas 88% of participants acknowledged to have incurred cost during reporting, 71% viewed that approving weekly diseases data contributed to untimely reporting. Finally, there were measures identified for improving reporting; these include feedback report, supportive supervision and availability of IDSR guidelines. Conclusions: The evaluation concludes that, the ineffectiveness of reporting weekly diseases data was due to several reasons which include weekly reporter having many responsibilities, approving and signing weekly diseases by RMO before submission, costs of reporting incurred by reporters and weak or no supportive supervision and feedback.. So the evaluation recommends that government through its ministry must take responsibilities of making sure that reporting forms are available. The Ministry and its development partners should take responsibilities to elevating the costs incurred by IDSR focal person. The study also recommends to the Ministry and RMHT to strategize on how to speed up reporting, and that weekly disease data should not be approved only by RMO but other RHMT members. Lastly, the study recommends that the Ministry set aside some fund and schedule a time table to enable them to conduct supportive supervision from National level to Regional levels
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.
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.
Assessment of factors influencing community health fund member’s satisfaction with treatment services offered through community health fund
(Mzumbe University, 2015) Swai, Denis F.
Background: In Tanzania, Community Health Fund (CHF) was initiated in 1996 with the aim of implementing a community Based Health Financing Scheme through volunteer membership contribution as additional income to improve access to quality health care service for marginalized rural community. The evaluation was conducted to assess factors that influencing Community Health Fund member‟s satisfaction with treatment services offered through Community Health Fund membership. Methods: A cross sectional study design was employed that involved 153 respondents for which allowed collection of data that provided a descriptive estimates of the population parameters. The study was guided by Donabedian conceptual framework where by questionnaires were designed to assess structures, process of service delivery and treatment outcome as attributes of satisfaction. A sample size of 153 respondents was calculated by statalcl 13 (64-bit) within the effect size of 0.7– 0.8 one sample (Alpha = CI=95%, α=0.05, two-sided). Two health facilities were involved in the exit interview where by respondents were selected and interviewed based on their inclusion criteria. Results: A bigger proportional of female 55(60%) and 40(60%) in Likombe and Mikindani compared to male 37(40%) and 21(34%). A big proportional of respondents revealed that structures of health facility include availability of adequate Health Care Providers (HCPs) and medicines influence their satisfaction (p=0.05). Most of respondents were happy with the quality of available medical supplies and it was statistically significant at satisfaction level (p=0.02). The process of service delivery indicate that CHF members spend more than one hour to receive treatment service in health facility from their first contact and there was significant association between time spent and satisfaction(p=0.02). However, significance association was found between happiness with treatment and overall satisfaction level with services (p=0.03) though members do not feel much difference from being a CHF member and other patients. Conclusions: All three attributes - Structure of the health facility, process and treatment outcomes significantly influence CHF members satisfaction of treatment services provided through CHF membership. However, the availability of medicines and qualified HCPs have great influence in the Satisfaction with structures, while there is a significant influence of time in satisfaction with process of services provision and treatment results have significant association with service provided.
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.
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.
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.
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.
Cost of dialysis in Tanzania: Evidence from the provider’s perspective
(Health Economics Review, 2015) Mushi, Lawrencia; Krohn, Markus; Flessa, Steffen
Background: Although End Stage Renal Disease (ESRD) is a disease of increasing epidemiological relevance very little is known about the cost of providing the respective dialysis services in Tanzania. This paper estimates the costs of dialysis for ESRD patients at Muhimbili National Hospital (MNH) in Tanzania in the year 2014. Methods: Cost calculations are based on the provider's perspective and include only the direct cost of dialysis treatment. The cost of drugs and consumables was obtained from the price list issued by the Medical Stores Department (MSD) in Tanzania. Additional data were collected through face-to-face interviews with experts at the dialysis unit. Results: MNH performs on average 442 hemodialysis per month (34 patients, with three sessions per week) with a personnel placement of 20 nurses, four nephrologists, eight registrars, one nutritionist, two biomedical engineers, four health attendants and nine dialysis machines. The respective average unit cost per hemodialysis is 176 US$. Consequently, an average patient requiring three dialyses per week (i.e. 156 dialyses per year) will incur annual costs of 27,440 US$. Conclusion: The cost of dialysis is enormous for a least-developed country like Tanzania where resources and technology are rather limited. Thus, from the economic point of view, it seems rational to allocate health care budgets towards curable diseases, which have a higher cost-effectiveness and cater for the majority of the population. However, before a final decision on allocation of budgets towards dialysis is made all efforts must be invested to improve technical efficiency by cutting the enormous unit cost.
Role of cultural orientation towards risk sexual behaviors among school children: A case of selected secondary schools in Morogoro Urban
(Mzumbe university, 2015) Goodluck Patrice Nombo
The study was conducted in Morogoro urban in Tanzania to explore the relationship between the cultural orientation and students risky sexual behaviors and examine whether and how modern intervention including modern contraception influence these behaviors to secondary and primary schools students. The main concern was to find out if traditional intervention through cultural orientation could be a proper strategy for risky sexual behaviors by determining the cultural orientation negative roles in students‟ sexual behaviors and also whether and how modern intervention programs for risky sexual behaviors had succeeded to reduce the problem. The study employed cross-sectional design: structured and unstructured questionnaires were used to collect both primary and secondary data. It involved 300 respondents from five secondary schools that were purposively selected while convenience sampling was used in choosing 1 education officer, 1 health officer and 3 indigenous aged people. Findings: 85% of students in secondary schools had sex before 19 years in which 68.33% of them did not use condoms completely as a result of cultural orientation factors; initiation ceremonies fostered the problem by 74.57% for males and 79.81% for females; having multiple sexual partners by 78.18% for males and 60.67% for females; Religion fostered the risky sexual behaviours by 61.42%; the orientation to use calendar or safe days method than modern contraceptives to females by 64.67%; social taboos caused 28% of males and 41.33% females not to use condoms. The parents‟ use of strokes to punish their children had led to the increase of risky behaviors among 19% of male students‟ while for females it decreased. Cultural orientation factors had impact on failure or success of the modern strategies including contraceptives on controlling risky sexual behaviours, thus there was a call for improvement of sexual health education via reviewing the cultural orientation factors in efforts to combat the
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.
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.
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.
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.
People's perception on mosquito net performance: A cross-sectional study in the north-western part of the Lake Zone in Tanzania
(Mzumbe University, 2015) Lukole, Eliud Andrea
The main aim of this study was to assess People’s Perception of Mosquito Net Performance in Muleba District in the North-Western Part of the Lake Zone of Tanzania. A cross-sectional survey and KAP survey were conducted a month apart. It was found that the sole reasons for not using bed nets in the study area were having not enough nets and bed nets being too old or poor condition. Half of the respondents continued to sleep under bed nets with poor conditions since they had no other alternatives. The attrition, survivorship and fabric integrity (LLIN with holes) rates were 36.85%, 57.76% and 60.15% respectively. Moreover, over 3 years more than 3 nets for every 10 nets distributed were lost because of wearing and tear, 5 nets survived out of 10 nets after 3 years and 4 nets sustained field condition for every net used. A proportionate hole index (pHI) was developed so that the integrity of net structure could be categorized. The pHI, IQR(Inter-quartile Range), median and standard deviation for HI were 3382.74, 2594.47, 3310.58 and 2551.50 respectively. There is wider dispersion of data on holes, and this is due to cluster geographical differences and differences in household composition between and within clusters. Based on study findings, mosquito nets are the main preventive measure against malaria used in Muleba. The population highly associates nets with malaria prevention. Nets with too many holes and more than three years old were perceived to be poorly performing in malaria prevention. Moreover,net attrition and survivorship and fabric integrity as elements of net durability showed significance difference between clusters because of geographical difference and the within cluster variation was due SES led by household composition. It is recommended that intensive and robust community-specific communication programmes should be devised by the government and/or other private institutions. Nets accessibility ought to be increased 3 years after free universal distribution through supply of subsidized nets in private shops so that families can at any time have access to them at lower costs. Pro- poor exemption policies can help the poorer group on equity bases.
Quality of cataract services in Zanzibar: A case of Mnazi Mmoja hospital
(Mzumbe University, 2015) Makame, Abass Taha
Inspite 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.
Assessing factors influencing reporting of weekly diseases data from regions to Ministry of Health and Social Welfare in Tanzania Mainland
(Mzumbe University, 2015) Moshi, Frank Solomon
Background: Reporting weekly diseases data from regions to Ministry of Health and Social Welfare is one of method which is used to submit weekly diseases information from regions to the Ministry according to number of weeks in a year from 1st to 52th week. This method is a paper based, that enables diseases information to be available at the national level on time to allow for quick and important public health action. This is an evaluation study designed to assess factors which tended to influence weekly diseases data from regions to Ministry of Health and Social Welfare, to determine technical challenges and determine measures to improving the reporting design. Methodology: The quantitative study design was conducted in Tanzania mainland which consist all regions. A primary data type was collected through structured closed questionnaire which was administered to a total of 25 respondents’ samples size that was 100% countrywide, since each region was represented by single reporter. Data was processed and analyzed by using Microsoft Excel 2010. Results: Findings showed that there was higher understanding of factors which influenced reporting. Findings indicate that 100% of the participants were Health officers, 68% were regional IDSR focal person who understood well the system of reporting weekly disease data. The evaluation also revealed technical challenges associated with reporting; whereas 88% of participants acknowledged to have incurred cost during reporting, 71% viewed that approving weekly diseases data contributed to untimely reporting. Finally, there were measures identified for improving reporting; these include feedback report, supportive supervision and availability of IDSR guidelines. Conclusions: The evaluation concludes that, the ineffectiveness of reporting weekly diseases data was due to several reasons which include weekly reporter having many responsibilities, approving and signing weekly diseases by RMO before submission, costs of reporting incurred by reporters and weak or no supportive supervision and feedback.. So the evaluation recommends that government through its ministry must take responsibilities of making sure that reporting forms are available. The Ministry and its development partners should take responsibilities to elevating the costs incurred by IDSR focal person.The study also recommends to the Ministry and RMHT to strategize on how to speed up reporting, and that weekly disease data should not be approved only by RMO but other RHMT members. Lastly, the study recommends that the Ministry set aside some fund and schedule a time table to enable them to conduct supportive supervision from National level to Regional levels.
The cost of dialysis in low and middle income countries: A systematic review
(BMC Health Services Research, 2015) Mushi, Lawrencia; Marschall, Paul; Fleßa, Steffen
Background: The cost of dialysis in low and middle-income countries has not been systematically reviewed. The objective of this article is to systematically review peer-reviewed articles on the cost of dialysis across low and middle-income countries. Methods: PubMed and Embase databases were searched for the years 1998 to March 2013, and additional studies were added from Google Scholar search. An article was included if two reviewers agreed that it had reported the cost of dialysis from low and middle-income countries. Results: The annual cost per patient for hemodialysis (HD) ranged from Int$ 3,424 to Int$ 42,785, and peritoneal dialysis (PD) ranged from Int$ 7,974 to Int$ 47,971. Direct medical costs especially drugs and consumables for HD and dialysis solutions and tubing for PD were the main cost drivers. Conclusion: The number of studies on the economics of dialysis in low and middle-income countries is limited. Few papers indicate that dialysis is an expensive form of treatment for the population of these countries and that the poorer countries have an over-proportional burden to finance dialysis services. Further research is needed to determine the cost of dialysis based on a standard methodology grounded on existing economic guidelines and to address the question of whether dialysis should be an element of the essential package of health in resource-poor countries. Used data should be as complete as possible. In case of missing data, proxies can be used. In the case of developing countries, expert interviews are often used for estimating missing information.