Background The efficacy of the autodissemination of pyriproxyfen to control malaria vectors has been demonstrated under semi field environment in Tanzania. However, the information on how best communities should be engaged for its routine... more
Background The efficacy of the autodissemination of pyriproxyfen to control malaria vectors has been demonstrated under semi field environment in Tanzania. However, the information on how best communities should be engaged for its routine and large-scale adoption are lacking. This study assessed the community’s level of knowledge, perceptions, acceptability on the autodissemination approach, and the perceived risks and safety of pyriproxyfen on the environment. Methods This was a concurrent mixed methods study, comprised of a community-based survey of 400 household representatives and eight focus group discussions (FGDs). The study was conducted in two villages in Mlimba district in south-eastern Tanzania between June and August 2022. For the quantitative data, descriptive statistics were applied using R software, while inductive approach was used for qualitative data analysis, using Nvivo software. Results Knowledge on autodissemination approach was found to be relatively low among...
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The burden of noncommunicable diseases (NCDs) including hypertension, diabetes, and cancer, is rising in Sub-Saharan Africa countries like Tanzania and Malawi. This increase reflects complex interactions between diverse social,... more
The burden of noncommunicable diseases (NCDs) including hypertension, diabetes, and cancer, is rising in Sub-Saharan Africa countries like Tanzania and Malawi. This increase reflects complex interactions between diverse social, environmental, biological, and political factors. To intervene successfully, new approaches are therefore needed to understand how local knowledges and attitudes towards common NCDs influence health behaviours. This study compares the utility of using a novel arts-based participatory method and more traditional focus groups to generate new understandings of local knowledges, attitudes and behaviours towards NCDs and their risk factors. Single-gender arts-based participatory workshops and focus group discussions were conducted with local communities in Tanzania and Malawi. Thematic analysis compared workshop and focus group transcripts for depth of content and researcher-participant hierarchies. In addition, semiotic analysis examined the contribution of photo...
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Communities’ knowledge, attitudes and practices on malaria disease often remain unobserved during malaria control efforts. In Tanzania, many studies focus on increasing community knowledge and awareness on malaria prevention but the... more
Communities’ knowledge, attitudes and practices on malaria disease often remain unobserved during malaria control efforts. In Tanzania, many studies focus on increasing community knowledge and awareness on malaria prevention but the potential participation and contribution of schoolchildren towards knowledge, attitudes and practices on malaria has received little attention. We investigated the knowledge and understanding of primary school children on malaria transmission, recognition of symptoms, treatment seeking behaviour, preventive measures and practices in order to potentially include this group in Tanzania’s malaria control efforts. 125 children were recr uited fr om thr ee purposively selected primar y schools in Bagamoyo district, Tanzania. A semi-structured interview guide, including both closed and open-ended questions, was used to collect information from the participants to obtain their knowledge and understanding on malaria transmission, treatment and prevention. More t...
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Malaria is a life-threatening disease causing an estimated one million death annually. Major achievements have recently been noted in Tanzania, child mortality rates are declining. If prompt and effective treatment is initiated, malaria... more
Malaria is a life-threatening disease causing an estimated one million death annually. Major achievements have recently been noted in Tanzania, child mortality rates are declining. If prompt and effective treatment is initiated, malaria is a curable disease; however, in many places, people still lack access to prompt and effective malaria treatment. This thesis was carried out during the first phase of the ACCESS intervention program (2004-2008) which aimed at improving access to malaria treatment in the Kilombero Valley, Tanzania. The program had three main areas of interventions: 1) in the community, 2) the drug shops and 3) the health facilities. This thesis has grown out of the monitoring and evaluation component of the ACCESS program. It specifically focuses on two monitoring and evaluation activities: 1) treatment seeking surveys which assess interventions at community level and 2) mystery shopping studies at drug shop level. The studies on treatment seeking (Chapters 4-6) inv...
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Bed nets reduce malaria-related illness and deaths, by forming a protective barrier around people sleeping under them. When impregnated with long-lasting insecticide formulations they also repel or kill mosquitoes attempting to feed upon... more
Bed nets reduce malaria-related illness and deaths, by forming a protective barrier around people sleeping under them. When impregnated with long-lasting insecticide formulations they also repel or kill mosquitoes attempting to feed upon sleeping humans, and can even suppress entire populations of malaria vectors that feed predominantly upon humans. Nevertheless, an epidemiological study in 2012 demonstrated higher malaria prevalence among bed net users than non-users in urban Dar es Salaam, Tanzania. Focus group discussions were conducted with women from four selected wards of Dar es Salaam city, focusing on four major themes relating to bed net use behaviours: (1) reasons for bed net use, (2) reasons for not using bed nets, (3) stimuli or reminders for people to use a bed net (4) perceived reasons for catching malaria while using a bed net. An analytical method by framework grouping of relevant themes was used address key issues of relevance to the study objectives. Codes were rev...
Research Interests: Geography, Medical Microbiology, Environmental Health, Malaria, Tanzania, and 6 moreMedicine, Wa, Bed Nets, Qx, WC, and Mosquito net
Research Interests: Geography, Medical Microbiology, Environmental Health, Malaria, Medicine, and 15 moreHumans, Health and Social Care, Anopheles, Female, Male, Infant, Anopheles gambiae, Mosquito Control, Aged, Middle Aged, Adult, Environment, Community Health Promotion and Education, Child preschool, and Indoor residual spraying
Research Interests: Nursing, Health Care, Job Satisfaction, Qualitative Research, Health Services Research, and 15 moreHealth Administration, Medicine, Motivation, Pregnancy, Humans, Human Resources for Health, Health Services, Female, Personnel Management, Rural Health Services, Cross Sectional Studies, R, Health Personnel, Health facilities, and Residence Characteristics
Research Interests: Coping Strategies, Focus Groups, Environmental Health, Child, Health Services, and 15 moreFemale, Health Care Services, Focus Group, Data Collection, Cross Section, Antimalarials, Focus Group Discussion, Artemisinin, Cross sectional Study, Cross Sectional Studies, Health Facility, Child preschool, Health Services Accessibility, Family Characteristics, and Health Care Surveys
Global health experts use a health system perspective for research on social health protection. This article argues for a complementary actor perspective, informed by the social resilience framework. It presents a Saving4Health initiative... more
Global health experts use a health system perspective for research on social health protection. This article argues for a complementary actor perspective, informed by the social resilience framework. It presents a Saving4Health initiative with women groups in rural Tanzania. The participatory qualitative research design yielded new insights into the lived experience of social health protection. The study shows how participation in saving groups increased women’s collective and individual capacities to access, combine and transform five capitals. The groups offered a mechanism to save for the annual insurance premium and to obtain health loans for costs not covered by insurance (economic capital). The groups organized around aspirations of mutual support and protection, fostered social responsibility and widened women’s interaction arena to peers, government and NGO representatives (social capital). The groups expanded women’s horizon by exposing them to new ways of managing financia...
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What roles do accredited drug dispensing outlets in Tanzania play in facilitating access to antimicrobials? Results of a multi-method analysis (Article begins on next page) The Harvard community has made this article openly available.... more
What roles do accredited drug dispensing outlets in Tanzania play in facilitating access to antimicrobials? Results of a multi-method analysis (Article begins on next page) The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters.
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In October 2013, Tanzania adopted Option B+ under which HIV-positive pregnant women are initiated on antiretroviral therapy in reproductive and child health clinics at diagnosis. Studies have shown that adherence and retention to... more
In October 2013, Tanzania adopted Option B+ under which HIV-positive pregnant women are initiated on antiretroviral therapy in reproductive and child health clinics at diagnosis. Studies have shown that adherence and retention to antiretroviral treatment can be problematic. We implemented a group randomized controlled trial in 24 reproductive and child health clinics in eight districts in Mbeya region. The trial tested the impact of implementing paper-based appointment tracking and community outreach systems on the rate of missed appointments and number of days covered by dispensed antiretroviral medications among women previously established on antiretroviral therapy. We used interrupted time series analysis to assess study outcomes. Clinic staff and patients in intervention clinics were aware of the intervention because of change in clinic procedures; data collectors knew the study group assignment. Three months pre-intervention, we identified 1924 and 1226 patients established on...
Research Interests: Developmental Biology, Child health, Computational Biology, Family Medicine, Biotechnology, and 15 moreCancer, Cell Biology, Infectious Diseases, Medicine, Multidisciplinary, Antiretroviral Therapy, Humans, Reproductive health, Patient Compliance, PLoS one, Ci, Outreach, Adult, Randomized Controlled Trial, and Community health services
Research Interests: Pharmacology, Computational Biology, Family Medicine, Biotechnology, Cancer, and 15 moreAccreditation, Infectious Diseases, Medicine, Multidisciplinary, Humans, Facility, Health Care System, Medical Assistance, Mystery shoppers, ADDO, Health Facility, Health Services Accessibility, Family Characteristics, Delivery of Health Care, and Health facilities
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Research Interests: Medical Microbiology, Environmental Health, Malaria, Commerce, Humans, and 15 moreChild, Female, Male, Infant, Data Collection, Integrated Approach, Longitudinal Studies, Antimalarials, Cross Sectional Studies, Health Facility, Child preschool, Lumefantrine, Health Services Accessibility, Family Characteristics, and Drug combinations
Research Interests: Health Promotion, Poverty, Malaria, Quality of Mental Health Care, International Cooperation, and 15 moreTanzania, Medicine, Foundations, Livelihood, Rural Health, Humans, Child, Access to Health Care, Adult, Antimalarials, PLoS Med, Health Services Accessibility, Quality of health care, healthcare disparities, and Medical and Health Sciences
Research Interests: Health Promotion, Monitoring And Evaluation, Health Care, Medical Microbiology, Malaria, and 15 moreHealth Policy, Medicine, Pregnancy, Humans, Program Development, Health Services, Female, Male, Infant, Health System, Adult, Antimalarials, Pharmacies, Child preschool, and Health Services Accessibility
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Background Convulsions is one of the key signs of severe malaria among children under five years of age, potentially leading to serious complications or death. Several studies of care-seeking behaviour have revealed that local illness... more
Background Convulsions is one of the key signs of severe malaria among children under five years of age, potentially leading to serious complications or death. Several studies of care-seeking behaviour have revealed that local illness concepts linked to convulsions (referred to as degedege in Tanzanian Kiswahili) called for traditional treatment practices while modern treatment was preferred for common fevers. However, recent studies found that even children with convulsions were first brought to health facilities. This study integrated ethnographic and public health approaches in order to investigate this seemingly contradictory evidence. Carefully drawn random samples were used to maximize the representativity of the results. Methods The study used a cultural epidemiology approach and applied a locally adapted version of the Explanatory Model Interview Catalogue (EMIC), which ensures a comprehensive investigation of disease perception and treatment patterns. The tool was applied i...
Research Interests: Epidemiology, Family, Medical Microbiology, Culture, Malaria, and 15 moreMedicine, Humans, Female, Male, Cohort Study, Infant, Health System, Local adaptation, Fever, Cross Section, Antimalarials, Community Based Mental Health Services, Child preschool, Health Care Surveys, and Community health services
Research Interests: Biostatistics, Environmental Health, Health Education, Adolescent, Child, and 15 moreHealth Services, Female, Cost effectiveness, Case Management, Health System, Adult, Fever, Analysis of Variance, Control Strategy, Antimalarials, Cross Sectional Studies, Amodiaquine, Health Facility, Health Care Surveys, and Artemisinin based combination therapy
Research Interests: Biostatistics, Environmental Health, Malaria, Public Health, Medicine, and 15 moreLinear models, Commerce, Population, Humans, Child, Health Services, Case Management, Adult, Antimalarials, Private Sector, Educational Status, Artemisinin, Pharmacies, Logistic Models, and Artemisinin based combination therapy
Background Acceptability is a poorly conceptualized dimension of access to health care. Using a study on childhood convulsion in rural Tanzania, we examined social acceptability from a user perspective. The study design is based on the... more
Background Acceptability is a poorly conceptualized dimension of access to health care. Using a study on childhood convulsion in rural Tanzania, we examined social acceptability from a user perspective. The study design is based on the premise that a match between health providers’ and clients’ understanding of disease is an important dimension of social acceptability, especially in trans-cultural communication, for example if childhood convulsions are not linked with malaria and local treatment practices are mostly preferred. The study was linked to health interventions with the objective of bridging the gap between local and biomedical understanding of convulsions. Methods The study combined classical ethnography with the cultural epidemiology approach using EMIC (Explanatory Model Interview Catalogue) tool. EMIC interviews were conducted in a 2007/08 convulsion study (n = 88) and results were compared with those of an earlier 2004/06 convulsion study (n = 135). Earlier studies on...
Research Interests: Cultural Anthropology, Medicine, Library and Information Studies, Humans, Child, and 15 moreFemale, Animals, Male, Psychological Intervention, Emic and etic, Caregivers, Adult, Fever, Antimalarials, Culicidae, Convulsion, Health Services Accessibility, Interviews as topic, anthropology cultural, and Malaria Falciparum
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Background: Healthcare outcomes in child, adolescent and maternal in Tanzania are poor, and mostly characterised by fragmentary service provision. In order to address this weakness, digital technologies are sought to be integrated in the... more
Background: Healthcare outcomes in child, adolescent and maternal in Tanzania are poor, and mostly characterised by fragmentary service provision. In order to address this weakness, digital technologies are sought to be integrated in the milieu of health as they present vast opportunities especially in the ability to improve health information management and coordination. Prior to the design and implementation of the Afya-Tek digital intervention, formative research was carried out to ensure that the solution meets the needs of the users. The formative research aimed to examine: the burden of disease and related health seeking behaviour; workflow procedures and challenges experiencing healthcare actors; adolescent health and health seeking behaviour; and lastly examine technological literacy and perceptions on the use of digital technologies in healthcare delivery. This paper therefore, presents findings from the formative research. Methods: The study employed exploratory design gro...
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Background In low- and middle-income countries, too, public–private partnerships in health insurance schemes are crucial for improving access to health services. Problems in the public supply chain of medicines often lead to medicine... more
Background In low- and middle-income countries, too, public–private partnerships in health insurance schemes are crucial for improving access to health services. Problems in the public supply chain of medicines often lead to medicine stock-outs which then negatively influence enrolment in and satisfaction with health insurance schemes. To address this challenge, the government of Tanzania embarked on a redesign of the Community Health Fund (CHF) and established a Prime Vendor System (Jazia PVS). Informal and rural population groups, however, rely heavily on another public–private partnership, the Accredited Drug Dispensing Outlets (ADDOs). This study takes up this public demand and explores the potentials, pitfalls, and modalities for linking the improved CHF (iCHF) with ADDOs. Methods This was a qualitative exploratory study employing different methods of data collection: in-depth interviews, focus group discussions, and document reviews. Results Study participants saw a great pote...
In Tanzania, progress toward achieving the 2015 Millennium Development Goals for maternal and newborn health was slow. An intervention brought together community health workers, health facility staff, and accredited drug dispensing outlet... more
In Tanzania, progress toward achieving the 2015 Millennium Development Goals for maternal and newborn health was slow. An intervention brought together community health workers, health facility staff, and accredited drug dispensing outlet (ADDO) dispensers to improve maternal and newborn health through a mechanism of collaboration and referral. This study explored barriers, successes, and promising approaches to increasing timely access to care by linking the three levels of health care provision. The study was conducted in the Kibaha district, where we applied qualitative approaches with in-depth interviews and focus group discussions. In-depth interview participants included retail drug shop dispensers (36), community health workers (45), and health facility staff members (15). We conducted one focus group discussion with district officials and four with mothers of newborns and children under 5 years old. Relationships among the three levels of care improved after the linkage inte...
Research Interests: Focus Groups, Health Care, Community Health, Health Administration, Community Health Workers, and 15 moreLibrary and Information Studies, Intersectoral Collaboration, Humans, Female, Focus Group, Infant, Child Health Services, Health Facility, Health Personnel, Child preschool, attitude to health, Health Services Accessibility, Infant Health, Interviews as topic, and Community health services
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Publication View. 55423155. BMC Public Health BioMed Central (2002). John R Williams,; Piero Manfredi,; Alisa R Butler,; Marta Ciofi Degli Atti,; Stefania Salmaso,; Open Access,; Marta Ciofi Degli Atti,; Stefania Salmaso. Abstract. ...
Background Achieving universal health coverage will require robust private sector engagement; however, as many low- and middle-income countries launch prepayment schemes to achieve universal health coverage, few are covering products from... more
Background Achieving universal health coverage will require robust private sector engagement; however, as many low- and middle-income countries launch prepayment schemes to achieve universal health coverage, few are covering products from retail drug outlets (pharmacies and drug shops). This case study aims to characterize barriers and facilitators related to incorporating retail drug outlets into national prepayment schemes based on the experience of the Tanzanian National Health Insurance Fund’s (NHIF) certification of pharmacies and accredited drug dispensing outlets. Methods We reviewed government documents and interviewed 26 key informants including retail outlet owners and dispensers and central and district government authorities representing eight districts overall. Topics included awareness of NHIF in the community, access to medicines, claims processing, reimbursement prices, and how the NHIF/retail outlet linkage could be improved. Results Important enablers for NHIF/reta...
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IntroductionArts-based approaches to health promotion have been used widely across sub-Saharan Africa (SSA), particularly in public health responses to HIV/AIDS. Such approaches draw on deep-rooted historical traditions of indigenous... more
IntroductionArts-based approaches to health promotion have been used widely across sub-Saharan Africa (SSA), particularly in public health responses to HIV/AIDS. Such approaches draw on deep-rooted historical traditions of indigenous groups in combination with imported traditions which emerged from colonial engagement. To date, no review has sought to map the locations, health issues, art forms and methods documented by researchers using arts-based approaches in SSA.MethodsUsing scoping review methodology, 11 databases spanning biomedicine, arts and humanities and social sciences were searched. Researchers screened search results for papers using predefined criteria. Papers included in the review were read and summarised using a standardised proforma. Descriptive statistics were produced to characterise the location of the studies, art forms used or discussed, and the health issues addressed, and to determine how best to summarise the literature identified.ResultsSearches identified...