BackgroundThe Tabora Maternal and Newborn Health Initiative project was a multicomponent interven... more BackgroundThe Tabora Maternal and Newborn Health Initiative project was a multicomponent intervention to improve maternal and newborn health in the Tabora region of Tanzania. Components included training healthcare providers and community health workers, infrastructure upgrades, and improvements to health management. This study aimed to examine the impact of trainings on four key outcomes: skilled birth attendance, antenatal care, respectful maternity care and patient–provider communication.MethodsTrainings were delivered sequentially at four time points between 2018 and 2019 in eight districts (two districts at a time). Cross-sectional surveys were administered to a random sample of households in all districts at baseline and after each training wave. Due to practical necessities, the original stepped wedge cluster randomised design of the evaluation was altered mid-programme. Therefore, a difference-in-differences for multiple groups in multiple periods was adopted to compare outc...
Background: Child stunting is a global health concern. It has consequences on child survival, gro... more Background: Child stunting is a global health concern. It has consequences on child survival, growth, and development. The absolute level of stunting has been decreasing in Tanzania although the prevalence is still high (34%), varying across socioeconomic determinants with a larger burden among the disadvantaged group. Reduction of inequalities in stunting are very crucial as we aim to reduce stunting to 28% by 2021. Objectives: This study aimed to determine the trend, contributing factors and changes of inequalities in stunting among children aged 3 – 59 months from 2004 to 2016 Methodology: Data were drawn from the Tanzania Demographic and Health Surveys. The dependent variable was stunting. The concentration index was used to quantify the magnitude of inequalities in stunting for each year. In order to get the contribution of each determinant on the inequality in stunting, the concentration index was decomposed by using the Wagstaff and Watanabe decomposition methods of the conce...
Additional file 1. Weighted Frequencies and Proportions of Malaria services measuring Availabilit... more Additional file 1. Weighted Frequencies and Proportions of Malaria services measuring Availability and Readiness by Managing Authority.
Most malaria-endemic countries have struggled in the past decade to establish effective national-... more Most malaria-endemic countries have struggled in the past decade to establish effective national-scale continuous distribution mechanisms for long-lasting insecticidal nets (LLINs). Since the implementation of the Tanzania National Voucher Scheme in 2004 and mass-distribution campaigns in 2009–2011 and 2015–2016, Tanzania has been committed to finding new and innovative ways of achieving and maintaining universal bed net coverage. Planning for the School Net Programme (SNP) began in 2011 and in 2013, the country piloted a SNP in three regions. Nets were distributed annually to children attending schools in selected primary and secondary grades. Intra-family re-distribution was assumed, and hence the family as a whole, rather than just the children themselves, were the targeted beneficiaries. The programme has since expanded to 14 regions and has seen six rounds of annual distribution. In its fifth year, 3 million nets were distributed at a cost of USD 3.64 per net and USD 0.60 per p...
This is a project on evaluation of integrated nutrition interventions in Tanzania. It is a contro... more This is a project on evaluation of integrated nutrition interventions in Tanzania. It is a controlled before after evaluation implemented in Simiyu and Ruvuma regions, with Nzega, Uyui, Ruangwa and Lindi being the control areas. The project aims to test the hypothesis that targeted bundle of interventions spanning the 1,000 days period (increased knowledge, attitudes and practices for healthy pregnancy and infant feeding practices and treatment of severe acute malnutrition (SAM) cases) will reduce stunting in children under-two years. We are also exploring community norms contributing to poor maternal, child health and nutrition outcomes. To make it scalable, the study will assess quality of data collected and perform costs analysis
Background: The Affordable Medicines Facility- malaria (AMFm) is primarily an artemisinin combina... more Background: The Affordable Medicines Facility- malaria (AMFm) is primarily an artemisinin combination therapy (ACT) subsidy, aimed at increasing availability, affordability, market share and use of quality-assured ACTs (QAACTs). Mainland Tanzania was one of eight national scale programmes where AMFm was introduced in 2010. Here we present findings from outlet and household surveys before and after AMFm implementation to evaluate its impact from both the supply and demand side. Methods: Outlet surveys were conducted in 49 randomly selected wards throughout mainland Tanzania in 2010 and 2011, and data on outlet characteristics and stocking patterns were collected from outlets stocking antimalarials. Household surveys were conducted in 240 randomly selected enumeration areas in three regions in 2010 and 2012. Questions about treatment seeking for fever and drugs obtained were asked of individuals reporting fever in the previous two weeks. Results: The availability of QAACTs increased f...
Universal coverage with effective vector control remains the mainstay of malaria vector control i... more Universal coverage with effective vector control remains the mainstay of malaria vector control in sub-Saharan Africa Tanzania has utilized a number of mechanisms for the maintenance of long-lasting insecticidal net (LLIN) coverage over time. Schools have been identified as one potential channel for continuous distribution of LLIN. This research aims to evaluate an annual school based LLIN distribution programme in Tanzania which began in 2013, called the School Net Programme (SNP). Following each of the first four rounds of SNP distribution, a household survey was conducted in intervention and comparison districts in Southern and Lake zones of Tanzania (N = 5083 households). Measures of ownership, access, and use were compared between intervention and comparison districts. Determinants of reach were assessed in intervention districts. Population access to an LLIN increased from 63.1% (95% CI: 58.8, 67.5) to 76.5% (95% CI: 72.9, 80.0) in the intervention districts between the first ...
This is a project on evaluation of integrated nutrition interventions in Tanzania. It is a contro... more This is a project on evaluation of integrated nutrition interventions in Tanzania. It is a controlled before after evaluation implemented in Simiyu and Ruvuma regions, with Nzega, Uyui, Ruangwa and Lindi being the control areas. The project aims to test the hypothesis that targeted bundle of interventions spanning the 1,000 days period (increased knowledge, attitudes and practices for healthy pregnancy and infant feeding practices and treatment of severe acute malnutrition (SAM) cases) will reduce stunting in children under-two years. We are also exploring community norms contributing to poor maternal, child health and nutrition outcomes. To make it scalable, the study will assess quality of data collected and perform costs analysis.
Background: Although malnutrition particularly stunting is recognized as multi-causal, there has ... more Background: Although malnutrition particularly stunting is recognized as multi-causal, there has been limited integrated nutrition interventions to reduce its burden in children under-fives and those existing are not well evaluated. This study tested the effectiveness of provision of health and nutrition education and promotion of home gardening in child stunting.Methods: A quasi-experimental evaluation design with repeated cross-sectional surveys was used to assess changes in behaviors (uptake of Antenatal Care services and child feeding practices) and stunting among children under-five years. Household surveys were done at the baseline, and end-line in both controls (Tabora, Lindi and coast regions) and interventions (Simiyu and Ruvuma regions) sites. The sample size was calculated to detect a 10% percent absolute baseline-to-end-line change in stunting as a key indicator. A two-stage stratified sampling process was employed to select study participants. A total of 840 and 1,680 h...
Background As insecticide-treated nets (ITNs) wear out and are disposed, some household members a... more Background As insecticide-treated nets (ITNs) wear out and are disposed, some household members are prioritized to use remaining ITNs. This study assessed how nets are allocated within households to individuals of different age categories as ITNs are lost or damaged and as new ITNs are obtained. The study also explored how ITN allocation affects ITN durability. Methods A cross-sectional household survey and ITN durability study was conducted among 2,875 households across Tanzania to determine the proportion of nets that remain protective (serviceable) 22 months after net distribution aiming for universal coverage. Allocation of study nets within houses, and re-allocation of ITNs when new universal replacement campaign (URC) nets arrived in study households in Musoma District, was also assessed. Results Some 57.0% (95% CI 53.9–60.1%) of households had sufficient ITNs for every household member, while 84.4% (95% CI 82.4–86.4%) of the population had access to an ITN within their househ...
BackgroundThe Tabora Maternal and Newborn Health Initiative project was a multicomponent interven... more BackgroundThe Tabora Maternal and Newborn Health Initiative project was a multicomponent intervention to improve maternal and newborn health in the Tabora region of Tanzania. Components included training healthcare providers and community health workers, infrastructure upgrades, and improvements to health management. This study aimed to examine the impact of trainings on four key outcomes: skilled birth attendance, antenatal care, respectful maternity care and patient–provider communication.MethodsTrainings were delivered sequentially at four time points between 2018 and 2019 in eight districts (two districts at a time). Cross-sectional surveys were administered to a random sample of households in all districts at baseline and after each training wave. Due to practical necessities, the original stepped wedge cluster randomised design of the evaluation was altered mid-programme. Therefore, a difference-in-differences for multiple groups in multiple periods was adopted to compare outc...
Background: Child stunting is a global health concern. It has consequences on child survival, gro... more Background: Child stunting is a global health concern. It has consequences on child survival, growth, and development. The absolute level of stunting has been decreasing in Tanzania although the prevalence is still high (34%), varying across socioeconomic determinants with a larger burden among the disadvantaged group. Reduction of inequalities in stunting are very crucial as we aim to reduce stunting to 28% by 2021. Objectives: This study aimed to determine the trend, contributing factors and changes of inequalities in stunting among children aged 3 – 59 months from 2004 to 2016 Methodology: Data were drawn from the Tanzania Demographic and Health Surveys. The dependent variable was stunting. The concentration index was used to quantify the magnitude of inequalities in stunting for each year. In order to get the contribution of each determinant on the inequality in stunting, the concentration index was decomposed by using the Wagstaff and Watanabe decomposition methods of the conce...
Additional file 1. Weighted Frequencies and Proportions of Malaria services measuring Availabilit... more Additional file 1. Weighted Frequencies and Proportions of Malaria services measuring Availability and Readiness by Managing Authority.
Most malaria-endemic countries have struggled in the past decade to establish effective national-... more Most malaria-endemic countries have struggled in the past decade to establish effective national-scale continuous distribution mechanisms for long-lasting insecticidal nets (LLINs). Since the implementation of the Tanzania National Voucher Scheme in 2004 and mass-distribution campaigns in 2009–2011 and 2015–2016, Tanzania has been committed to finding new and innovative ways of achieving and maintaining universal bed net coverage. Planning for the School Net Programme (SNP) began in 2011 and in 2013, the country piloted a SNP in three regions. Nets were distributed annually to children attending schools in selected primary and secondary grades. Intra-family re-distribution was assumed, and hence the family as a whole, rather than just the children themselves, were the targeted beneficiaries. The programme has since expanded to 14 regions and has seen six rounds of annual distribution. In its fifth year, 3 million nets were distributed at a cost of USD 3.64 per net and USD 0.60 per p...
This is a project on evaluation of integrated nutrition interventions in Tanzania. It is a contro... more This is a project on evaluation of integrated nutrition interventions in Tanzania. It is a controlled before after evaluation implemented in Simiyu and Ruvuma regions, with Nzega, Uyui, Ruangwa and Lindi being the control areas. The project aims to test the hypothesis that targeted bundle of interventions spanning the 1,000 days period (increased knowledge, attitudes and practices for healthy pregnancy and infant feeding practices and treatment of severe acute malnutrition (SAM) cases) will reduce stunting in children under-two years. We are also exploring community norms contributing to poor maternal, child health and nutrition outcomes. To make it scalable, the study will assess quality of data collected and perform costs analysis
Background: The Affordable Medicines Facility- malaria (AMFm) is primarily an artemisinin combina... more Background: The Affordable Medicines Facility- malaria (AMFm) is primarily an artemisinin combination therapy (ACT) subsidy, aimed at increasing availability, affordability, market share and use of quality-assured ACTs (QAACTs). Mainland Tanzania was one of eight national scale programmes where AMFm was introduced in 2010. Here we present findings from outlet and household surveys before and after AMFm implementation to evaluate its impact from both the supply and demand side. Methods: Outlet surveys were conducted in 49 randomly selected wards throughout mainland Tanzania in 2010 and 2011, and data on outlet characteristics and stocking patterns were collected from outlets stocking antimalarials. Household surveys were conducted in 240 randomly selected enumeration areas in three regions in 2010 and 2012. Questions about treatment seeking for fever and drugs obtained were asked of individuals reporting fever in the previous two weeks. Results: The availability of QAACTs increased f...
Universal coverage with effective vector control remains the mainstay of malaria vector control i... more Universal coverage with effective vector control remains the mainstay of malaria vector control in sub-Saharan Africa Tanzania has utilized a number of mechanisms for the maintenance of long-lasting insecticidal net (LLIN) coverage over time. Schools have been identified as one potential channel for continuous distribution of LLIN. This research aims to evaluate an annual school based LLIN distribution programme in Tanzania which began in 2013, called the School Net Programme (SNP). Following each of the first four rounds of SNP distribution, a household survey was conducted in intervention and comparison districts in Southern and Lake zones of Tanzania (N = 5083 households). Measures of ownership, access, and use were compared between intervention and comparison districts. Determinants of reach were assessed in intervention districts. Population access to an LLIN increased from 63.1% (95% CI: 58.8, 67.5) to 76.5% (95% CI: 72.9, 80.0) in the intervention districts between the first ...
This is a project on evaluation of integrated nutrition interventions in Tanzania. It is a contro... more This is a project on evaluation of integrated nutrition interventions in Tanzania. It is a controlled before after evaluation implemented in Simiyu and Ruvuma regions, with Nzega, Uyui, Ruangwa and Lindi being the control areas. The project aims to test the hypothesis that targeted bundle of interventions spanning the 1,000 days period (increased knowledge, attitudes and practices for healthy pregnancy and infant feeding practices and treatment of severe acute malnutrition (SAM) cases) will reduce stunting in children under-two years. We are also exploring community norms contributing to poor maternal, child health and nutrition outcomes. To make it scalable, the study will assess quality of data collected and perform costs analysis.
Background: Although malnutrition particularly stunting is recognized as multi-causal, there has ... more Background: Although malnutrition particularly stunting is recognized as multi-causal, there has been limited integrated nutrition interventions to reduce its burden in children under-fives and those existing are not well evaluated. This study tested the effectiveness of provision of health and nutrition education and promotion of home gardening in child stunting.Methods: A quasi-experimental evaluation design with repeated cross-sectional surveys was used to assess changes in behaviors (uptake of Antenatal Care services and child feeding practices) and stunting among children under-five years. Household surveys were done at the baseline, and end-line in both controls (Tabora, Lindi and coast regions) and interventions (Simiyu and Ruvuma regions) sites. The sample size was calculated to detect a 10% percent absolute baseline-to-end-line change in stunting as a key indicator. A two-stage stratified sampling process was employed to select study participants. A total of 840 and 1,680 h...
Background As insecticide-treated nets (ITNs) wear out and are disposed, some household members a... more Background As insecticide-treated nets (ITNs) wear out and are disposed, some household members are prioritized to use remaining ITNs. This study assessed how nets are allocated within households to individuals of different age categories as ITNs are lost or damaged and as new ITNs are obtained. The study also explored how ITN allocation affects ITN durability. Methods A cross-sectional household survey and ITN durability study was conducted among 2,875 households across Tanzania to determine the proportion of nets that remain protective (serviceable) 22 months after net distribution aiming for universal coverage. Allocation of study nets within houses, and re-allocation of ITNs when new universal replacement campaign (URC) nets arrived in study households in Musoma District, was also assessed. Results Some 57.0% (95% CI 53.9–60.1%) of households had sufficient ITNs for every household member, while 84.4% (95% CI 82.4–86.4%) of the population had access to an ITN within their househ...
Uploads
Papers by Charles Festo