Journals

Permanent URI for this collection

http://41.93.62.172:4000/handle/123456789/164

Browse

Now showing 1 - 20 of 145

Evaluating the implementation of the Pediatric Acute Care Education (PACE) program in northwestern Tanzania: a mixed-methods study guided by normalization process theory
(BMC health services research, 2024-09-13) Kalabamu,Florence S.
Background In low- and middle-income countries (LMICs), such as Tanzania, the competency of healthcare provid-ers critically influences the quality of pediatric care. To address this issue, we introduced Pediatric Acute Care Educa-tion (PACE), an adaptive learning program to enhance provider competency in Tanzania’s guidelines for managing seriously ill children. Adaptive learning is a promising alternative to current in-service education, yet optimal imple-mentation strategies in LMIC settings are unknown. Objectives (1) To evaluate the initial PACE implementation in Mwanza, Tanzania, using the construct of normalization process theory (NPT); (2) To provide insights into its feasibility, acceptability, and scalability potential. Methods Mixed-methods study involving healthcare providers at three facilities. Quantitative data was collectedusing the Normalization MeAsure Development (NoMAD) questionnaire, while qualitative data was gathered through in-depth interviews (IDIs) and focus groups discussions (FGDs). Results Eighty-two healthcare providers completed the NoMAD survey. Additionally, 24 senior providers participated in IDIs, and 79 junior providers participated in FGDs. Coherence and cognitive participation were high, demonstrat-ing that PACE is well understood and resonates with existing healthcare goals. Providers expressed a willingness to integrate PACE into their practices, distinguishing it from existing educational methods. However, challenges related to resources and infrastructure, particularly those affecting collective action, were noted. Early indicators point toward the potential for long-term sustainability of the PACE, but assessment of reflexive monitoring was limited due to the study’s focus on PACE’s initial implementation. Conclusion This study offers vital insights into the feasibility and acceptability of implementing PACE in a Tanza-nian context. While PACE aligns well with healthcare objectives, addressing resource and infrastructure challenges as well as conducting a longer-term study to assess reflexive monitoring is crucial for its successful implementation.
Outcomes of a Program to Reduce Birth- Related Mortality in Tanzania
(New England Journal of Medicine, 2025-02-26) Kabalamu,Florence S.
Birth-related mortality is a major contributor to the burden of deaths worldwide,especially in low-income countries. The Safer Births Bundle of Care program is a combination of interventions developed to improve the quality of care for mother and baby with the goal of reducing birth-related mortality. METHODS We performed a 3-year stepped-wedge cluster-randomized study of the Safer Births program at 30 high-burden facilities in five regions in Tanzania. The bundle of interventions in the program was aimed at continuous quality improvement through regular onsite simulation-based training, the collection and use of local clinical data, the assistance of trained local facilitators, and the use of innovative tools for perinatal care. The primary outcome was perinatal death, which included intrapartum stillbirth (suspected death during labor) and neonatal death within the first 24 hours after birth. RESULTS A total of 281,165 mothers and 277,734 babies were included in the final analysis. The estimated incidence of perinatal death decreased from 15.3 deaths per 1000 births in the baseline period of the program to 12.5 deaths per 1000 births after implementation (adjusted relative risk, 0.82; 95% confidence interval [CI], 0.73 to 0.92; P = 0.001), with substantial heterogeneity among regions. The incidence of intrapartum stillbirths was 8.6 deaths per 1000 births in the baseline period and 8.7 deaths per 1000 births after implementation (adjusted relative risk, 1.01; 95% CI,0.87 to 1.17), and the incidence of neonatal deaths within the first 24 hours after birth was 6.4 and 3.9 deaths per 1000 births, respectively (adjusted relative risk,0.61; 95% CI, 0.49 to 0.77). No serious adverse events were reported. CONCLUSIONS Implementation of the Safer Births Bundle of Care program showed the feasibility of integrating quality-improvement efforts targeting birth-related emergencies in resource-limited settings and was associated with a significant reduction in peri-natal mortality. (Funded by the Global Financing Facility; ISRCTN Registry number,ISRCTN30541755.)
Practice, Experiences, and Facilitators of Simulation-Based Training During One Year of Implementation in 30 Hospitals in Tanzania
(SAGE Open Nursing, 2025-01-03) Kalabamu,Florence S.
Introduction: Enhancing the proficiency of healthcare workers (HCWs) in handling birth-related complications is crucial for reducing maternal and newborn morbidity and mortality. To achieve this, the Safer Births Bundle of Care offers a compre- hensive set of innovative, simulation-based training interventions designed to strengthen the skills and competencies of HCWs working as skilled birth attendants. Objective: To describe the use of in-situ low-dose, high-frequency simulation-based training, and the experiences of this usage among HCWs and stakeholders at facilities in Tanzania. Methods: This mixed-methods study included quantitative and qualitative data collected between July 2021 and July 2022 across 30 health facilities in five regions of Tanzania. NeoNatalie Live (NNL) simulators were installed for independent skills and scenario training, and in-situ facilitator-led team simulations were introduced. The training frequency was analyzed using descriptive and analytical statistics, and mentorship and supervision reports were analyzed using qualitative content analysis. Results: A large and sustained number of in-situ NNL skill-training sessions (n = 35,101) and facilitator-led team simulations (n = 266) were conducted during the first year. Clinical burden per HCW did not affect the frequency of NNL skills training at the health facility level (r = −0.16, p = .40) nor facilitator-led team simulations. There was a positive but weak correlation between the frequency of facilitator-led team simulations and NNL skills training (r = 0.34, p = .05). Qualitative data showed a high degree of motivation and participation among all stakeholders, and active use of hospital data, both clinical indicators and training data, was perceived as a success factor. Conclusion: Facilitator-led in-situ simulation training was more likely to occur where individual skills-training sessions were recorded. Training sessions took place regardless of the increased workload.
Early childhood development status and associated factors among preschool children attending routine well clinics in Temeke Municipal, Dar es Salaam- Tanzania: a cross-sectional study
(Pan African Medical Journal, 2024-12-31) Kalabamu,Florence S. Fataki,Maulidi R. Malasa,Leonard J. Rutachunzibwa,F.
Introduction: Early Childhood Development (ECD) is a social and public health concern especially in low-and middle-income countries whereby around 43% of children living in these countries are at risk of developmental delays. This may negatively affect their potential including reduced productivity in adulthood. Data from the 2022 Tanzania Demographic and Health survey has shown that around 47.4% of children aged 24-59 months scored low in their early childhood scores. However, factors associated with low suboptimal ECD are not well understood. This study aimed to determine the magnitude and characteristics associated with low ECD scores among children aged 24-59 months attending RCH clinics in Temeke Municipal, Dar-es-salaam region. Methods: the study was a facility-based crosssection study design involving Children aged 24-59 months attending RCH clinics in Temeke District, Dar-es-salaam, Tanzania. An interviewerguided questionnaire was used to collect basic demographic information while ECD scores among participants were determined using a standardized ECD-I2030 tool. Data analysis was conducted using Statistical Package for Social Sciences (SPSS). The magnitude of children not on track was expressed in frequency and percentages. Factors associated with poor ECD were determined by using binary logistic regression analysis. The alpha level of 0.05 or less was considered statistically significant. Results: a total of 422 children were enrolled in the study. Among participants, only 144 (34.1%) were on track based on their childhood development scores while 278 (65.9%) were off track. Young age (AOR= 0.149(0.354-0.63); p-value= 0.001), nutritional status (AOR= 7.729 (2.234-26.735); p value= 0.010) and parents' employment status (AOR= 3.730 (1.937-7.184); p-value= 0.001) were independently associated ECD scores. Conclusion: most children enrolled in this study were off-track in their ECD scores which may limit the realization of their full potential. Young age, malnutrition and unemployed parents were significant factors associated with EDC delays. Therefore, targeted interventions aimed at ensuring food security and nutrition, economic empowerment of families through formal employment, and early positive parenting practices may improve ECDs among this age group.
Neonatal resuscitation skills acquisition among healthcare providers after Helping Babies Breathe simulation training using improved tools across two regions in Tanzania
(Advances in Simulation, 2025-03-01) Kalabamu,Florence S.
Introduction Neonatal mortality is high in middle- and low-income countries, including Tanzania. Most of these deaths are preventable and linked to suboptimal quality of care. In this study, we assessed neonatal resuscitation skills acquisition after a 1-day Helping Babies Breathe (HBB) simulation training using improved tools and associated factors among healthcare providers in 12 facilities in Tanzania. Methods A cross-sectional study was conducted among healthcare providers working in the labor wards in selected health facilities. The training was conducted in situ using the HBB second edition curriculum with improved simula- tion tools (Neonatalie Live simulator, NeoBeat heart rate meter, and Upright resuscitator). After training, skills acqui- sition was evaluated using Objectively Structured Clinical Evaluation. Participants who scored an average of 75% or above were considered passing. Descriptive statistics were used to determine the proportion of staff who passed the evaluation by different demographic categories. One-way analysis of variance was used to compare mean scores among demographic categories. Factors associated with neonatal resuscitation skills acquisition were analyzed using modified Poisson regression. Results A total of 481 participants were enrolled in the study. Among these, 420 (87.3%) passed the skills evaluation on the first attempt. The overall mean skills score was 92.4%. In bivariable analysis, health facility level, region, age, and experience working in the labor ward were associated with passing skills evaluation on the first attempt. How- ever, after controlling other variables in a multivariable model, none of the factors showed a statistically significant association. Conclusion In-situ, HBB simulation training using improved training tools effectively imparts neonatal resuscitation skills among healthcare providers. Participants learned skills similarly regardless of their different demographic charac- teristics, including level of education and working experience. Due to its potential to impart skills, frequent simulation training using improved tools may be considered for scaling up in other health facilities
Trends of measles in Tanzania: A 5-year review of case-based surveillance data, 2018-2022
(International Journal of Infectious Diseases, 2024-02) Kalabamu,Florence S.
Objectives: Tanzania observed a gradual increase in the number of measles cases since 2019 with a large outbreak recorded during 2022. This study describes the trend of measles in Tanzania over a 5-year pe- riod from 2018-2022. Methods: This was a descriptive study conducted using routine measles case-based surveillance system including 195 councils of the United Republic of Tanzania. Results: Between 2018 and 2022 there were 12,253 measles cases reported. Out of 10,691 (87.25%) sam- ples tested by enzyme-linked immunosorbent assay, 903 (8.4%) were measles immunoglobulin M posi- tive. The highest number of laboratory-confirmed measles cases was in 2022 (64.8%), followed by 2020 (13.8%), and 2019 (13.5%). Out of 1279 unvaccinated cases, 213 (16.7%) were laboratory-confirmed measles cases compared to 77/723 (10.6%) who were partially vaccinated and 71/1121 (6.3%) who were fully vac- cinated (P < 0.001). Children aged between 1-4 years constituted the most confirmed measles cases after laboratory testing, followed by those aged 5-9 years. There was a notable increase in the number of laboratory-confirmed measles cases in children <1 year and 10-14 years during 2022 compared to pre- vious years. The vaccination coverage of the first dose of measles-containing vaccine (MCV1) was main- tained >90% since 2013 while MCV2 increased gradually reaching 88% in 2022.
Practice, Experiences, and Facilitators of Simulation-Based Training During One Year of Implementation in 30 Hospitals in Tanzania
(Sage, 2025-01) Kalabamu, Florence S.
Introduction: Enhancing the proficiency of healthcare workers (HCWs) in handling birth-related complications is crucial for reducing maternal and newborn morbidity and mortality. To achieve this, the Safer Births Bundle of Care offers a comprehensive set of innovative, simulation-based training interventions designed to strengthen the skills and competencies of HCWs working as skilled birth attendants. Objective: To describe the use of in-situ low-dose, high-frequency simulation-based training, and the experiences of this usage among HCWs and stakeholders at facilities in Tanzania. Methods: This mixed-methods study included quantitative and qualitative data collected between July 2021 and July 2022 across 30 health facilities in five regions of Tanzania. NeoNatalie Live (NNL) simulators were installed for independent skills and scenario training, and in-situ facilitator-led team simulations were introduced. The training frequency was analyzed using descriptive and analytical statistics, and mentorship and supervision reports were analyzed using qualitative content analysis. Results: A large and sustained number of in-situ NNL skill-training sessions (n = 35,101) and facilitator-led team simulations (n = 266) were conducted during the first year. Clinical burden per HCW did not affect the frequency of NNL skills training at the health facility level (r = -0.16, p = .40) nor facilitator-led team simulations. There was a positive but weak correlation between the frequency of facilitator-led team simulations and NNL skills training (r = 0.34, p = .05). Qualitative data showed a high degree of motivation and participation among all stakeholders, and active use of hospital data, both clinical indicators and training data, was perceived as a success factor. Conclusion: Facilitator-led in-situ simulation training was more likely to occur where individual skills-training sessions were recorded. Training sessions took place regardless of the increased workload. Keywords: facilitator-led team simulations; high frequency; innovation; low dose; safer births; simulation-based training; skills training.
Asymptomatic hypoglycemia among pretermnewborns: A cross-sectional analysis
(Plos One, 2024-04-30) Kalabamu, Florence S.; Fataki, Maulidi R.
Background: Hypoglycemia is the commonest metabolic abnormality encountered in newborns. Besides, there is a growing body of evidence that links the causes of early neonatal mortality to neonatal hypoglycemia in Tanzania. However exact factors associated with asymptomatic hypoglycemia in preterm newborns are not known. Objective: Toassess factors associated with asymptomatic hypoglycemia among preterm newborns. Materials and methods Across sectional, analytical hospital- based study was carried out at Dar es salaam public regional referral hospitals. Preterm newborns with asymptomatic hypoglycemia were the target population. Data on demographic and clinical characteristics of preterm newborns andtheir mothers were collected and analyzed using Epi-Info™ software version 7.4. Main data analysis was done by applying a multivariable binary logistic regression model with neonatal random glycaemia coded in a binary fashion at a cut-off point of 2.6 mmol/L. An α level of 5% was used as a limit of type I error. Results: Werecruited and analysed 217 preterm newborns within 6–24 hours post-delivery. Male: Female =1.1:1 (females n = 105, 48.4%). Median glycemic level was 2.6 (IQR; 2.1–3.9) mmol/L. Median gestational age at delivery was 33 (IQR: 30–35) weeks. Breastfeeding within 1st hour post-delivery was a statistically significant factor against glycemic level associated with hypoglycemia (OR; 0.123, 95%-CI; 0.052–0.287) in a fitted multivariable logistic regression model. Conclusion: About half of all preterm newborns studied had glycemic values in a statistical range associated with hypoglycemia. Exclusive breast feeding within 1st hour post-delivery was associated with glycemic levels protective from risk of asymptomatic neonatal hypoglycemia. Recommendations: Exclusive breastfeeding practices within 1st hour post-delivery may need to be emphasized to all expectant mothers in order to avoid potential risk of asymptomatic hypoglycemia in preterm newborns.
Prevalence and factors associated with hypothermia among neonates in regional referral hospitals in Dar es Salaam, Tanzania
(Global Journal of Health Science, 2022-10-31) Malasa, Leonard J.; Kalabamu, Florence S.; Rutachunzibwa, Felician; Fataki, Maulidi R.; Mashalla, Yohana J.
Background: Neonatal hypothermia is a major cause of mortality. This study determined the prevalence and factors associated with neonatal hypothermia in two regional referral hospitals in Dar es Salaam, Tanzania. Methods: Cross-sectional study was carried out between March and May 2021 at the Mwananyamala and Temeke Regional Referral Hospitals. Simple random and stratified sampling procedures were used to select study sites and proportionate population samples from each hospital respectively. Body temperature was measured within 90 minutes post birth; knowledge of the WHO guidelines on thermal protection of new-borns was collected from the mothers and health care providers using questionnaires. Logistic regression was used to assess associations between variables. SPSS version 25 was used to analyse the data and p < 0.05 was considered significant. Results: Total of 296 mother-new-born pairs and 41 health care providers were enrolled in the study. 26 mothers did not consent for the study. 25.6% of the 270 studied neonates were hypothermic. Lack of skin-to-skin contact with the mother; early neonatal weighing and bathing increased likelihood of neonatal hypothermia. Knowledge of neonatal thermal protection among mothers and care-providers was inadequate. Conclusions: The prevalence of neonatal hypothermia among neonates in the referral hospitals is high. The findings suggest knowledge gaps of the WHO recommended guidelines on neonatal hypothermia are associated with neonatal hypothermia. Efforts to increase awareness of the WHO recommended thermal protection guidelines are needed.
Iron deficiency and iron deficiency anemia among children 3 to 59 months of age in Kinondoni municipal, Dar es Salaam: a facility-based cross-sectional study
(East Africa Science, 2023-05-23) Malasa, Leonard J.; Rutachunzibwa, Felician; Fataki, Maulidi R.; Kalabamu, Florence S.
Background: Iron deficiency with subsequent iron deficiency anemia is the most common micronutrient disorder in children below 5 years of age worldwide. The developing countries bear more weight on the problem as the result of multifactorial factors including but not limited to recurrent infections such as malaria, helminths infestation, and inadequate food security. However, its magnitude in children living in Kinondoni Municipal in Dar es salaam is not well understood. Therefore, the aim of this study was to determine the prevalence of anemia and how it is contributed by the presence of iron deficiency among children between 3-59months of age in the above-mentioned setting. Methods: A facility-based cross-section study was conducted among children 3-59months attending Reproductive and Child Health Services at Kairuki, Sinza Hospital, and Kambangwa dispensary. Children who met the criteria, their basic social demographic information, complete blood count and differentials as well as blood ferritin levels were collected to assess the level of anemia, erythrocytic indices, and iron deficiency. Data were analyzed using the Statistical Package of Social Sciences (SPSS version 22). The magnitude of anemia and iron deficiencies were presented in percentages, and the relationship between hemoglobin and blood ferritin was assessed using Spearman’s correlation test for two continuous variables. The p-value of less or equal to 0.05 was considered statistically significant. Results: A total of 350 children were recruited for the study, 255 Children (72.9%) were anemic. Children below 24 months of age were more anemic compared to the older age group (X2 = 50, p <0.001). Furthermore, anemia was significantly associated with low ferritin levels (X2 = 65, p <0.001). Iron deficiency was found in 156 (44.6%) participants while iron deficiency anemia (low MCV, low ferritin, and low hemoglobin) was found in 138 (39.4%) participants. However, among 255 participants with anemia, 147(65.3%) had iron deficiency. There was a significant positive correlation between hemoglobin and blood ferritin levels (Spearman’s correlation coefficient = 0.6; p<0.01. Conclusion: Prevalence of anemia was high among children and was highly associated with younger age and iron deficiency. To overcome this problem, appropriate interventions such as massive promotion of breastfeeding, appropriate complementary feeding, and ensuring food security are warranted.
Implementing adaptive e- learning for newborn care in Tanzania: an observational study of provider engagement and knowledge gains
(BMJ open, 2024-01-14) Kalabamu, Florence S.
Introduction:To improve healthcare provider knowledge of Tanzanian newborn care guidelines, we developed adaptive Essential and Sick Newborn Care (aESNC), an adaptive e- learning environment. The objectives of this study were to (1) assess implementation success with use of in- person support and nudging strategy and (2) describe baseline provider knowledge and metacognition. Methods 6- month observational study at one zonal hospital and three health centres in Mwanza, Tanzania. To assess implementation success, we used the Reach, Efficacy, Adoption, Implementation and Maintenance framework and to describe baseline provider knowledge and metacognition we used Howell’s conscious- competence model. Additionally, we explored provider characteristics associated with initial learning completion or persistent activity. Results: aESNC reached 85% (195/231) of providers: 75 medical, 53 nursing and 21 clinical officers; 110 (56%) were at the zonal hospital and 85 (44%) at health centres. Median clinical experience was 4 years (IQR 1–9) and 45 (23%) had previous in- service training for both newborn essential and sick newborn care. Efficacy was 42% (SD ±17%). Providers averaged 78% (SD ±31%) completion of initial learning and 7% (SD ±11%) of refresher assignments. 130 (67%) providers had ≥1 episode of inactivity >30 day, no episodes were due to lack of internet access. Baseline conscious- competence was 53% (IQR: 38%–63%), unconscious- incompetence 32% (IQR: 23%–42%), conscious- incompetence 7% (IQR: 2%–15%), and unconscious- competence 2% (IQR: 0%–3%). Higher baseline conscious- competence (OR 31.6 (95% CI 5.8 to 183.5)) and being a nursing officer (aOR: 5.6 (95% CI 1.8 to 18.1)), compared with medical officer, were associated with initial learning completion or persistent activity. Conclusion: aESNC reach was high in a population of frontline providers across diverse levels of care in Tanzania. Use of in- person support and nudging increased reach, initial learning and refresher assignment completion, but refresher assignment completion remains low. Providers were often unaware of knowledge gaps, and lower baseline knowledge may decrease initial learning completion or activity. Further study to identify barriers to adaptive e- learning normalisation is needed.
Improvements in obstetric and newborn health information documentation following the implementation of the safer births bundle of care at 30 facilities in Tanzania
(Healthcare, 2024-01-26) Kalabamu, Florence S.
Abstract: This paper examines changes in the completeness of documentation in clinical practice before and during the implementation of the Safer Births Bundle of Care (SBBC) project. This observational study enrolled parturient women with a gestation age of at least 28 weeks at the onset of labour. Data collectors extracted information from facility registers and then a central data manager summarised and reported weekly statistics. Variables of clinical significance for CQI were selected, and the proportion of non-documentation was analysed over time. A Pearson chi-square test was used to test for significant differences in non-documentation between the periods. Between 1 March 2021 and 31 July 2022, a total of 138,442 deliveries were recorded. Overall, 75% of all patient cases had at least one missing variable among the selected variables across both periods. A lack of variable documentation occurred more frequently at the district hospital level (81% of patient cases) and health centres (74%) than at regional referral hospitals (56%) (p < 0.001). Non-documentation decreased significantly from 79% to 70% after the introduction of the SBBC (p < 0.001). A tendency towards negative correlations was noted for most variables. We noted an increased attention to data quality and use which may have a positive impact on the completeness of documentation. However, halfway through the project’s implementation, the completeness of documentation was still low. Our Findings support the recommendation to establish short-spaced feedback loops of locally collected data using one data platform. Keywords: documentation; data missingness; data quality; Safer Births Bundle of Care; quality of care; mentorship; supervision
Acceptance of COVID-19 vaccination in children among adults attending selected health facilities in Kinondoni municipality; Dar es salaam, Tanzania: a cross sectional study
(Canadian Center of Science and Education, 2024-03-13) Malasa, Leonard J.; Fataki, Maulid R.; Rutachunzibwa, Felician; Kalabamu, Florence S.
Background: Safe and effective vaccines are crucial for controlling and containing COVID-19 pandemic. However, poor acceptance and hesitance to vaccinate limit effective utilization. In Tanzania, COVID-19 vaccines have been in use with adequate coverage in adults from 18-years old, however, the acceptability of their use in children is not well understood. This study was aimed at determining the acceptability of COVID-19 vaccination in children among adults in Dar es salaam, Tanzania. Methods: A cross section study was conducted among adults attending outpatient clinic in Dar es salaam and were having children below 18-years at home. A self-administered questionnaire was used to collect their demographic information and their opinions regarding COVID-19 vaccine use in their children. Data was analyzed using Statistical Package for Social Sciences (SPSS version 23). Level of acceptance and other categorical variables were calculated in frequency and percentages while factors associated with COVID-19 vaccination in children were determined using binary logistic regression analysis. A type II error of less or equal to 0.05 was considered statistically significant. Results: A total of 320 participants were recruited in the study. Among these, 289 (90.3%) were females. Out of all participants, 124 (38.57%) were willing for their children to receive COVID-19 vaccines upon availability and recommendation by respective authorities. Confidence in the safety of COVID-19 vaccines (Adjusted Odd Ratio= 0.03; 95% CI: 0.01-0.13; p=0.02, and perceived importance of COVID-19 vaccine use in children (AOR=0.29; 95% CI: 0.1-0.84; p=0.02) were independent factors associated with acceptance of COVID-19 vaccination in children. Conclusion: The level of acceptance of COVID-19 vaccination for children in this study was low (38.57%), with uncertainty around vaccine safety being the major concern. Therefore, to increase COVID-19 vaccines acceptance and uptake in children, effective public communication supported by data on safety and effectiveness of COVID19 vaccines should be emphasized. Keywords: Acceptance, COVID-19, children, Dar es Salaam, vaccines
Use of Haematological Changes as a Predictor of Dengue Infection among Suspected Cases at Kairuki Hospital in Dar Es Salaam, Tanzania: A Retrospective Cross Sectional Study
(East African Health Research Journal, 2021) Kalabamu, Florence S.
Background: Dengue is a viral disease transmitted by female Aedes mosquitoes which are commonly found in tropical and subtropical areas. There is a dramatic increase in annual incidence rate of dengue attributed to urbanisation, poor environmental management as well as increased people mobility. Outbreak of dengue have been reported in Tanzania in recent years with Dar es salaam being the most affected region. Dengue is associated with haematological derange- ments and itindicates the severity of the disease. These changes have not been well elucidated in Tanzanian patients. The aim of this study was to determine these derangements among dengue patients admitted at Kairuki hospital in Dar es salaam, and compare these changes with non- dengue febrile patients. Methods: A retrospective cross sectional study was conducted among patients who were suspected to have dengue; tested for dengue IgM and their Complete Blood Count were tested during the index illness. This information was ob- tained from Kairuki hospital laboratory database. Haematological parameters were compared between dengue and non-dengue patients using SPSS Version 20.0. Binary logistic regression analysis was used to determine haematological predictors of dengue positive results. Results: A total of 255 patients were enrolled, whereby 188(73.7%) were dengue positive and 67 (26.3%) were neg- ative. Dengue patients had relatively low mean total white blood cell counts compared to non-dengue patients (Student’s test= -2.7; p value=.007). Furthermore, Mean lymphocyte count was significantly low in dengue patients compared to non-dengue patients (Student’s (t) test=-5.1; p<.001). Other haematological parameters were not significantly different. Lymphopenia was a significant predictor for dengue positive results (Adjusted Odd Ration =5.26 (95% CI=2.28-12.2; P value <.001). Conclusion: Patients with dengue had significantly low total white blood cell and lymphocyte count compared to non-dengue febrile patients. Lymphopenia is a significant haematological predictor for dengue positive results. Case defining signs and symptoms combined with these haematological changes may be used by clinicians as a guide to order confirmatory test for suspected dengue cases.
Missed Opportunity for Vaccination among Children Under-five years of age: A Cross- Sectional Study at Mwananyamala Regional Hospital, Dar es Salaam, Tanzania
(TMJ Original research, 2021) Kalabamu, Florence S.
Background Immunization is among the most important public health interventions against common childhood diseases. However, a missed opportunity for vaccination (MOV), may hamper the progress made in reducing childhood illness through vaccination. Knowing the magnitude and contributing factors for MOV, is essential for planning and executing preventive measures; however, these factors are not well elucidated in the Tanzania context. Broad Objective To determine the magnitude and factors for MOV among children under five-years old admitted at Mwananyamala hospital. Methodology We conducted a hospital-based, cross-sectional descriptive study among children under-five year old who were admitted at Mwananyamala hospital and their respective care givers from October to November 2018. An interview-guided questionnaire was used to collect data from the caregivers. The childhood immunization history was obtained from the immunization cards. Data were analyzed using Statistical Package for Social Sciences (SPSS version 20). Results A total of 209 caretakers and their respective children were enrolled in the study. Thirty-eight (18.2%) had MOV, and among the missed vaccines, the second dose of measles and rubella was the most missed vaccine (45.5%). Identified factors for MOV were unavailability of the vaccine on the day of vaccination 12 (31.3%), the child being sick on the day of vaccination 10(26.3%), due date forgotten 8 (20.8%), not informed on when to return for vaccination 7(18.1%), and no money for transport to vaccination center 1 (2.7%). Conclusion and recommendation The magnitude of missed opportunity for vaccination is still high among hospital admitted children. Vaccine procurement and distribution as well as improved communication among caretakers and health personnel should be more strengthened to reduce the number of children who are missing vaccines.
Designing and Implementing Health System Strengthening Intervention Using Performance Score Card; the Effect on Health Service Delivery in Tanzania, a Study Protocol
(Science journal of public health, 2023-06-29) Kalabamu, Florence S.
Introduction: Sustainable development goals (SDGs) need to be achieved by Low and Middle Income countries in order to achieve the Universal Health Care (UHC). The strategies and interventions to achieve UHC need to be robust and effective for health system to work optimally. Simiyu Region (Health department) designed a health system strengthening (HSS) intervention which uses a continuous quality improvement (CQI) approach to address health system challenges. The designed HSS intervention had a major focus on improving health system performance using governance and leadership health system pillar as a lever. Methods: This is a prospective observational study implemented along with national essential health intervention packages. The governance priority areas included formulation of performance measurement/score card tool with 34 indicators and 87 operational standards comprised of structural, processes and outcome indicators. Governance domains are; supportive supervision, data quality assessment, monthly and quarterly data review meetings, star rating assessment, health facility governance committee meetings, medicine and drug audit and so forth. Performance measurement was done in all six councils quarterly to ensure intervention institutionalization and improved indicators performance. Data collection: Quantitative data; Data collection tools for the intervention will be developed according to the objectives, research questions and outcomes and outputs from this intervention. Routine data collection tools of Ministry of Health will be used to collect data outcome data of service delivery. Observational data of governance performance are collected using the generated performance measurement tool. Qualitative data. Will be collected using in-depth interviews and focus group discussions with regional and council management teams, health care staff, HMTs and council leaders. The interview will explore program acceptability, drivers and barriers towards its implementation of this intervention. Data analysis: Quantitative data will be analyzed using appropriate statistical software and data are presented in tables, charts and frequencies. Statistical significance test for association of independent and dependent variables will be performed accordingly. Qualitative data will be analysed by using Ground theory where the contents analysis will be performed after the data being transcribed verbatim. Discussion: Leadership and governance is critical cross-cutting pillar for HSS. Routine performance measurement using validated tool is important to monitor the strengths and weaknesses of governance structures and health system performance with end results of health system responsiveness and resilient. Conclusion: HSS interventions with CQI involving leadership and governance are indispensable in restricted resource countries for achieving large ends with restricted resources.
Feasibility of an adaptive e-learning environment to improve provider proficiency in essential and sick newborn care in Mwanza, Tanzania
(MedRxiv, 2023-07-13) Kalabamu, Florence S.
Introduction. To improve healthcare provider knowledge of Tanzanian newborn care guidelines, we developed adaptive Essential and Sick Newborn Care (aESNC), an adaptive e-learning environment (AEE). The objectives of this study were to 1) assess implementation success with use of in-person support and nudging strategy and 2) describe baseline provider knowledge and metacognition. Methods. 6-month observational study at 1 zonal hospital and 3 health centers in Mwanza, Tanzania. To assess implementation success, we used the RE-AIM framework and to describe baseline provider knowledge and metacognition we used Howell’s conscious-competence model. Additionally, we explored provider characteristics associated with initial learning completion or persistent activity. Results. aESNC reached 85% (195/231) of providers: 75 medical, 53 nursing, and 21 clinical officers; 110 (56%) were at the zonal hospital and 85 (44%) at health centers. Median clinical experience was 4 years [IQR 1,9] and 45 (23%) had previous in-service training for both newborn essential and sick newborn care. Efficacy was 42% (SD±17%). Providers averaged 78% (SD±31%) completion of initial learning and 7%(SD±11%) of refresher assignments. 130 (67%) providers had ≥1 episode of inactivity >30 day, no episodes were due to lack of internet access. Baseline conscious-competence was 53% [IQR:38-63%], unconscious-incompetence 32% [IQR:23-42%], conscious-incompetence 7% [IQR:2- 15%], and unconscious-competence 2% [IQR:0-3%]. Higher baseline conscious-competence (OR 31.6 [95%CI:5.8, 183.5) and being a nursing officer (aOR: 5.6 [95%CI:1.8, 18.1]), compared to medical officer) were associated with initial learning completion or persistent activity. Conclusion. aESNC reach was high in a population of frontline providers across diverse levels of care in Tanzania. Use of in-person support and nudging increased reach, initial learning, and refresher assignment completion, but refresher assignment completion remains low. Providers were often unaware of knowledge gaps, and lower baseline knowledge may decrease initial learning completion or activity. Further study to identify barriers to adaptive e-learning normalization is needed.
Dimethylarginines: endogenous inhibitors of nitric oxide synthesis in children with falciparum malaria
(The Journal of infectious diseases, 2014) Kalabamu, Florence S.
Background. Nitric oxide (NO) bioavailability is impaired in children and adults with severe falciparum malaria (SM). Asymmetric-dimethylarginine (ADMA) limits NO production by inhibiting NO synthase and is increased in adult SM. The role of ADMA in the pathogenesis of childhood SM is unknown. Methods. We studied Tanzanian children ages 4–8 years with malaria. Plasma levels of arginine, arginase, cell-free hemoglobin, ADMA, symmetric-dimethylarginine (SDMA), histidine-rich protein-2, and angiopoietin-2 were measured. Results. ADMA was low in children with SM relative to controls. Nevertheless, arginine and arginine:ADMA ratios were very low in SM. SDMA was high in children with SM. With treatment, arginine and the arginine:ADMA ratio normalized, but SDMA did not. Arginine:ADMA ratios, but not arginine, were significantly and independently inversely associated with lactate and angiopoietin-2. Plasma arginase was not elevated in those with malaria, and plasma free hemoglobin was elevated only in patients with cerebral malaria. Conclusions. In contrast to adults, plasma ADMA is reduced in SM in children, but hypoargininemia is more severe. Arginine bioavailability (reflected by low arginine:ADMA ratios) is therefore comparably low in SM in children as in adults. Therapies to increase NO bioavailability in malaria may be useful as adjunctive treatment of severe malaria in children.
Severity and morphological classification of anaemia among children aged 2- 59 months in dar es salaam, tanzania: a cross sectional study protocol
(MedRxiv, 2022-11-11) Kalabamu, Florence S.; Fataki, Maulidi R.
Background: Anaemia is a clinically significant secondary diagnosis in children under the age of five in most parts of developing world, including Tanzania. Studies that assess clinical conditions associated with prenatal and postnatal era are highly relevant to global health as they tend to reflect patterns of significant health challenges across the entire human lifespan. Objective: To assess for morphological characteristics and severity of anaemia among under-five population seen at Dar es Salaam regional referral facilities in Tanzania. Design & Methods: A cross-sectional hospital based study will be conducted at Temeke Regional Referral and Mbagala Rangi Tatu district hospitals in Dar es Salaam, Tanzania. All children aged 2-59 months will be eligible to participate in the study. All children aged 2 – 59 months with anaemia will be the target population. The study main tool will be a self-administered questionnaire with five distinct parts. Data analysis will commence with summarisation. Specifically, continuous data will be summarised using median (with inter-quartile range) and categorical data will be summarised using frequency (and proportion by %) Graphical tools will also be employed where by important correlations as well as +/- outliers will be assessed. Besides, univariate and bivariate statistics will be computed for all clinically relevant data. Main outcome measure will be severity and morphological classification of anaemia. Unless otherwise stated, an alpha-level of 5% will be used as a limit of type 1 error in findings. Written informed consent will be sought from the parent/guardian of each participant child prior to inclusion into the study. Keywords: Anaemia, children, Temeke, Dar es Salaam
Prevalence and factors associated with asymptomatic hypoglycemia among preterm newborns in dar es salaam regional referral hospitals, tanzania: a cross sectional analytical study protocol
(MedRxiv, 2022-10-30) Kalabamu, Florence S.; Fataki, Maulidi R.
Background: Hypoglycemia is the most common metabolic abnormality in newborns. It is still unclear whether the condition is truly pathological, especially if it occurs transiently during the 1st 24 hours of birth in an asymptomatic phase. Besides, there is hardly any data on the burden of asymptomatic neonatal hypoglycemia and its associated factors among preterm newborns in Africa. Aim: To assess the prevalence and associated factors of asymptomatic neonatal hypoglycemia among preterm newborns in a typical African settings. Design and Methods: We plan to conduct a quick, cross-sectional analytical hospital-based survey at all public regional referral hospitals in Dar es Salaam, Tanzania. We will consider all preterm newborns delivered in the specified settings between June 2022 and December 2022. Our study population will be all preterm newborns delivered at Dar es Salaam public regional referral hospitals. Our target population will be all preterm newborns with asymptomatic hypoglycemia. All newborns with clinically detected congenital anomalies and those who will be delivered at home but brought to the facilities for care will thus be excluded from the study. Our primary outcome measure will be neonatal RBG < 2.6 mmol/L without any symptoms associated with hypoglycemia. Maternal, fetal and early neonatal (> 6 hours but within 24 hours post-delivery) factors will be logistically regressed against the outcome variable after appropriate model validation. Unless otherwise stated, an α-level of 5% will be used as a limit of type I error in findings. Written informed consent will be obtained from mothers of each newborn prior to inclusion into the study. Main Outcome measure: Prevalence of asymptomatic hypoglycemia among preterm newborns in Dar es Salaam hospitals. Relevance of the findings to science, policy & practice: Current clinical practice does not provide evidence for routine glycaemic screening among preterm newborns asymptomatic for hypoglycemia. The study will have a potential to assess stata of preterm newborn with asymptomatic hypoglycemia

Browse

Recent Submissions