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The transition from rural to urban spurred by population growth and housing densification has implications for the planning of service provisions, not least domestic water supplies. The objective of this paper is to document the status of domestic water access and examine existing options for domestic water provision along the rural–urban transition. The study employs a combination of research methods in both data collection and analysis. Given the dual character (rural–urban) of the emerging urban centres, there is limited distinction in the domestic water services provided since they tend to be in between the two, in a state of transition. [ABSTRACT FROM AUTHOR]

Private rental markets accommodate a significant share of Africa's rapidly growing urban populations. The vast majority of tenants are accommodated in rental housing supplied by private landlords. Few studies offer insights on the dynamics and logics shaping the supply and production of private rental housing in the context of African cities. This paper contributes to fill this remarkable knowledge gap with a study of the supply and production of private rental housing by self-builder households in Dar es Salaam and Mwanza, two of the largest and fastest growing cities in Tanzania. This paper examines the motivations and aspirations of self-builder landlords, the type and quality of rental housing they supply and the logics shaping their investments in housing quality and tenants' access to services. The paper argues that housing policies should acknowledge the significance of private rental housing in accommodating growing urban populations and the contribution of small landlords, such as the self-builders in Dar es Salaam and Mwanza, in the supply and production of private rental housing. Furthermore, any policies seeking to increase the availability and quality of affordable rental housing should be informed by in-depth understanding of the perspectives of such landlords. While concerns regarding lack of protection of tenants' rights and sub-standard accommodation are often justified, great care is needed, as policies promoting tenants' rights or enforcing minimum standards could undermine the supply of new rental housing or make rents wholly unaffordable for the poorest tenants. [ABSTRACT FROM AUTHOR]

• This is an attention to domestic investors of tree planting in Tanzania. • Investors are urbanites, villagers, rural-urbanites, institutions, local leaders. • Employed mechanisms of land access are capital, social identity, and authority. • Land investments for tree planting significantly increase the pressure on land. Processes involved in making land-based investments in the global South are more complex than the literature on land-grabbing shows. This study diverges in its focus from foreign-led investments to South- South investments dominated by domestic investors. Recent studies have suggested that the scale of domestic investments may exceed those of foreign investors. However, our knowledge about these domestic investors - who they are and how they access land - is limited. This study reviews literature on land-based investments in Africa and analyses empirical research into acquisitions of land for timber investments in the Southern Highlands of Tanzania. The paper serves a dual purpose, developing a typology of domestic investors involved in tree planting in the Southern Highlands, and improving our understanding of the diversity of private domestic land-based investments in Africa. The study identifies five major types of such investors: urban-based investors without local ties, urban-based investors originating in the area in which the investments are taking place, resident villagers, government and religious institutions and local leaders. In the main each category uses one of three different access mechanisms, namely capital, social identity, and authority. In general, access to land for non industrial private forest investors in Tanzania's Southern Highlands is facilitated by the state to a lesser extent and with less use of force. By unpacking the diversity of domestic investors, the paper suggests that the impacts of these investors on local livelihoods differ at the local level. However, more research is needed on the scale and impact of each type of domestic investor. [ABSTRACT FROM AUTHOR]

Leisure and popular culture have long played an important role in all aspects of life throughout the African continent. It has been recognised that the analysis of leisure and popular culture can put social practices, as well as political issues into relief. For instance, in colonial Brazzaville, Gold Coast and urban Zanzibar, dress and fashion not only symbolised change, but they were also tools for affirming and 'crystallising' new generational, gender, status and ethnic identities (Martin 1991, 1995; Akyeampong 1998; Fair 1998, 2001). This paper argues that this was also the case in urban colonial Tanganyika. For instance, young city dwellers - both men and women, Christians and Muslims, elite and non-elite - creatively 'appropriated' Western clothes in order to express new identities and aspirations, foster social changes, and sometimes bring about political transformations. In order to perceive such broader dynamics, this paper makes use of local debates on the changing fashions which took place in the Swahili-language press. This paper demonstrates that educated Africans used letters to the editor and mashairi (poems) - as a forum mainly to make comments and complain about 'new' clothing styles. Chiefly based on evidence found in the monthly magazine Mambo Leo, and partly in archival documents and oral testimonies (as well as photographic support) collected during my Ph.D. fieldwork carried out in Tanzania between 2004 and 2005, this paper aims to illustrate the ways in which new personal and collective identities were constructed (and contested) through clothing practices in everyday life. To a lesser extent, this paper also focuses on the interactions between local fashions and global elements. The focus on dress contributes to grasp local strategies of resiliency and broader processes through which the so-called 'common' people forged their notions of the 'modern' and produced 'translocal' connections. [ABSTRACT FROM AUTHOR]

How are health inequalities articulated across urban and rural spaces in Tanzania? This research paper explores the variations, differences, and inequalities, in Tanzania's health outcomes-to question both the idea of an urban advantage in health and the extent of urban-rural inequalities in health. The three research objectives aim to understand: what are the health differences (morbidity and mortality) between Tanzania's urban and rural areas; how are health inequalities articulated within Tanzania's urban and rural areas; and how are health inequalities articulated across age groups for rural-urban Tanzania? By analyzing four national datasets of Tanzania (National Census, Household Budget Survey, Demographic Health Survey, and Health Demographic Surveillance System), this paper reflects on the outcomes of key health indicators across these spaces. The datasets include national surveys conducted from 2009 to 2012. The results presented showcase health outcomes in rural and urban areas vary, and are unequal. The risk of disease, life expectancy, and unhealthy behaviors are not the same for urban and rural areas, and across income groups. Urban areas show a disadvantage in life expectancy, HIV prevalence, maternal mortality, children's morbidity, and women's BMI. Although a greater level of access to health facilities and medicine is reported, we raise a general concern of quality and availability in health services; what data sources are being used to make decisions on urban-rural services, and the wider determinants of urban health outcomes. The results call for a better understanding of the sociopolitical and economic factors contributing to these inequalities. The urban, and rural, populations are diverse; therefore, we need to look at service quality, and use, in light of inequality: what services are being accessed; by whom; for what reasons? [ABSTRACT FROM AUTHOR]

Societal factors influencing adolescent alcohol initiation and use are not well documented in Tanzania. The goal of this qualitative study was to explore the structural and environmental factors influencing adolescent alcohol uptake and use in urban Tanzania. 177 adolescents aged 15–19 from varying socioeconomic backgrounds participated in 16 participatory groups (separated by sex and in-school/out-of-school status) at sites in four different locations in Dar es Salaam, Tanzania. Participatory methods were used, including listing and ranking activities, and photovoice, exploring adolescent's perceptions around youth alcohol use, and recommendations for structural interventions to prevent or reduce adolescent alcohol uptake and use. Themes included: (1) "idle time" shapes adolescent alcohol use in urban Tanzania; (2) societal influences shape the locations where adolescents consume or purchase alcohol; and, (3) adolescents' recommendations about structural approaches for reducing their idle time and vulnerability to alcohol use. Our findings highlight the need for programs and policies aimed at reducing youth idle time as an approach to reducing alcohol use, such as increasing opportunities for employment, extracurricular activities, and entertainment, particularly for adolescent boys in urban Tanzania, given their increased vulnerability to the uptake and use of alcohol. [ABSTRACT FROM AUTHOR]

The human gut microbiota is increasingly recognized as an important factor in modulating innate and adaptive immunity through release of ligands and metabolites that translocate into circulation. Urbanizing African populations harbor large intestinal diversity due to a range of lifestyles, providing the necessary variation to gauge immunomodulatory factors. Here, we uncover a gradient of intestinal microbial compositions from rural through urban Tanzanian, towards European samples, manifested both in relative abundance and genomic variation observed in stool metagenomics. The rural population shows increased Bacteroidetes, led by Prevotella copri, but also presence of fungi. Measured ex vivo cytokine responses were significantly associated with 34 immunomodulatory microbes, which have a larger impact on circulating metabolites than non-significant microbes. Pathway effects on cytokines, notably TNF-α and IFN-γ, differential metabolome analysis and enzyme copy number enrichment converge on histidine and arginine metabolism as potential immunomodulatory pathways mediated by Bifidobacterium longum and Akkermansia muciniphila. The authors profile stool metagenomics and plasma metabolomics in Tanzanian individuals and uncover a gradient of gut microbial profiles, from rural through urban Tanzania towards Western populations. Integration with ex vivo blood microbial stimulations reveals immune responses associated with histidine and arginine pathways, mediated by Bifidobacterium longum and Akkermansia muciniphila. [ABSTRACT FROM AUTHOR]

Background: Globally, there is increased advocacy for community-based health insurance (CBHI) schemes. Like other low and middle-income countries (LMICs), Tanzania officially established the Community Health Fund (CHF) in 2001 for rural areas; and Tiba Kwa Kadi (TIKA) for urban population since 2009. This study investigated the implementation of TIKA scheme in urban districts of Tanzania.Methods: A descriptive qualitative case study was conducted in four urban districts in Tanzania in 2019. Data were collected using semi-structured interviews, focus group discussions and review of documents. A thematic approach was used to analyse the data.Results: While TIKA scheme was important in increasing access to health services for the poor and other disadvantaged groups, it faced many challenges which hindered its performance. The challenges included frequent stock-out of drugs and medical supplies, which frustrated TIKA members and hence contributed to non-renewal of membership. In addition, the scheme was affected by poor collections and management of the revenue collected from TIKA members, limited benefit packages and low awareness of the community.Conclusions: Similar to rural-based Community Health Fund, the TIKA scheme faced structural and operational challenges which subsequently resulted into low uptake of the schemes. In order to achieve universal health coverage, the government should consider integrating or merging Community-Based Health Insurance schemes into a single national pool with decentralised arms to win national support while also maintaining local accountability. [ABSTRACT FROM AUTHOR]

Background: Dyslipidemia is a leading risk factor for atherosclerotic cardiovascular disease. There are few published epidemiological data regarding dyslipidemia in Africa. We determined full lipid and apolipoprotein profiles and investigated factors associated with lipid levels in urban and rural populations of north-western Tanzania and southern Uganda. Methods: We conducted a cross-sectional survey of randomly-selected, community-dwelling adults (≥18yrs) including five strata per country: one municipality, two district towns and two rural areas. Participants were interviewed and examined using the World Health Organization STEPwise survey questionnaire. Serum levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, and apolipoproteins were measured. Factors associated with mean lipid levels were assessed by multivariable linear regression. Framingham 10-year cardiovascular risk scores were calculated with and without lipids. Results: One-third of adults in the study population had dyslipidemia. Low high-density lipoprotein cholesterol affected 32–45% of rural adults. High total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B were found in <15% of adult population in all strata, but were more common in urban adults. Factors independently associated with higher mean low-density lipoprotein cholesterol and apolipoprotein B were female gender, older age, higher education, higher income, obesity, and hypertension. Framingham cardiovascular risk scores with and without lipids yielded similar results and 90% of study subjects in all strata were classified as "low risk". Among older adults (>55 years), 30% were classified as "high" or "very high" risk. Conclusions: Dyslipidemias are common among adults in north-western Tanzania and southern Uganda affecting one third of adult population. Overall, cardiovascular risk scores are low but high risk scores are common with older adults. Health services designed and equipped to diagnose and treat dyslipidemia are urgently needed. [ABSTRACT FROM AUTHOR]

There is a known high disparity in access to perinatal care services between urban and rural areas in Tanzania. This study analysed repeated cross-sectional (RCS) data from Tanzania to explore the relationship between antenatal care (ANC) visits, facility-based delivery and the reasons for home births in women who had made ANC visits. We used data from RCS Demographic and Health Surveys spanning 20 years and a cluster sample of 30 830 women from ∼52 districts of Tanzania. The relationship between the number of ANC visits (up to four) and facility delivery in the latest pregnancy was explored. Regional changes in facility delivery and related variables over time in urban and rural areas were analysed using linear mixed models. To explore the disconnect between ANC visits and facility deliveries, reasons for home delivery were analysed. In the analytic model with other regional-level covariates, a higher proportion of ANC (>2-4 visits) and exposure to media related to an increased facility delivery rate in urban areas. For rural women, there was no significant relationship between the number of visits and facility delivery rate. According to the fifth wave result (2009-10), the most frequent reason for home delivery was 'physical distance to facility', and a significantly higher proportion of rural women reported that they were 'not allowed to deliver in facility'. The disconnect between ANC visits and facility delivery in rural areas may be attributable to physical, cultural or familial barriers, and quality of care in health facilities. This suggests that improving access to ANC may not be enough to motivate facility-based delivery, especially in rural areas. [ABSTRACT FROM AUTHOR]

Objective: This study explored the risk factors for infant hospitalization in urban and peri-urban/rural Tanzania.Methods: We conducted a prospective cohort study examining predictors of hospitalization during the first year of life among infants enrolled at birth in a large randomized controlled trial of neonatal vitamin A supplementation conducted in urban Dar es Salaam (n = 11,895) and peri-urban/rural Morogoro region (n = 20,104) in Tanzania. Demographic, socioeconomic, environmental and birth outcome predictors of hospitalization were assessed using proportional hazard models.Results: The rate of hospitalization was highest during the neonatal period in both Dar es Salaam (102/10,000 neonatal-months) and Morogoro region (78/10,000 neonatal-months). Hospitalization declined with increased age and was lowest for infants 6-12 months of age in both Dar es Salaam (11/10,000 infant-months) and Morogoro region (16/10,000 infant-months). In both Dar es Salaam and Morogoro region, older maternal age, male sex, low birth weight and being small for gestational age were significant predictors of higher risk of hospitalization (p < 0.05). Increased wealth and having a flush toilet were significantly associated with an increased risk of hospitalization in Morogoro region only (p < 0.05).Conclusions: This study determined high rates of neonatal hospitalization in Tanzania. Interventions to increase birth size may decrease risk of hospitalization. Equity in access to hospitals for poor rural families in Tanzania requires attention. [ABSTRACT FROM AUTHOR]

The young urban population of Tanzania is growing rapidly, primarily due to rural-urban migration. More information is needed on the challenges facing young adult urban women and men in using family planning (FP). The purpose of this study is to identify perceptions, interpersonal and familial attitudes, and sociocultural norms regarding FP among young adults (18–25 years) in Dar es Salaam, Tanzania, comparing responses by sex, marital status and migration status. We conducted 12 focus groups with young adult men and women (n= 74) in Dar es Salaam in December 2009. Participants knew of modern contraceptive methods, but had serious concerns about side effects. Single men and women preferred condoms. Female migrants stated that traditional methods were ineffective, yet commonly used in rural areas. Men's desires for more children frequently led female migrants not to use FP, while many married long-term residents used FP discreetly. Single women sometimes received the support of their parents/boyfriends to access and use contraception. Findings highlight differences in experiences among young adult men and women based on their migrant and marital status at the individual, interpersonal and normative levels. Future efforts to promote FP should engage existing social support systems and cultivate new ones in response to barriers. [ABSTRACT FROM AUTHOR]

Enormous gaps between HIV burden and health care availability in low-income countries raise severe ethical problems. This article analyzes four HIV-priority dilemmas with interest across contexts and health systems. We explore principled distributive conflicts and use the Atkinson index to make explicit trade-offs between health maximization and equality in health. We find that societies need a relatively low aversion to inequality to favor treatment for children, even with large weights assigned to extending the lives of adults: higher inequality aversion is needed to share resources equally between high-cost and low-cost treatment; higher inequality aversion is needed to favor treatment rather than prevention, and the highest inequality aversion is needed to favor sharing treatment between urban and rural regions rather than urban provision of treatment. This type of ethical sensitivity analysis may clarify the ethics of health policy choice. [ABSTRACT FROM PUBLISHER]

Background: As a result of poor economic opportunities and an increasing shortage of affordable housing, much of the spatial growth in many of the world's fastest-growing cities is a result of the expansion of informal settlements where residents live without security of tenure and with limited access to basic infrastructure. Although inadequate water and sanitation facilities, crowding and other poor living conditions can have a significant impact on the spread of infectious diseases, analyses relating these diseases to ongoing global urbanization, especially at the neighborhood and household level in informal settlements, have been infrequent. To begin to address this deficiency, we analyzed urban environmental data and the burden of cholera in Dar es Salaam, Tanzania. Methodology/Principal Findings: Cholera incidence was examined in relation to the percentage of a ward's residents who were informal, the percentage of a ward's informal residents without an improved water source, the percentage of a ward's informal residents without improved sanitation, distance to the nearest cholera treatment facility, population density, median asset index score in informal areas, and presence or absence of major roads. We found that cholera incidence was most closely associated with informal housing, population density, and the income level of informal residents. Using data available in this study, our model would suggest nearly a one percent increase in cholera incidence for every percentage point increase in informal residents, approximately a two percent increase in cholera incidence for every increase in population density of 1000 people per km2 in Dar es Salaam in 2006, and close to a fifty percent decrease in cholera incidence in wards where informal residents had minimally improved income levels, as measured by ownership of a radio or CD player on average, in comparison to wards where informal residents did not own any items about which they were asked. In this study, the range of access to improved sanitation and improved water sources was quite narrow at the ward level, limiting our ability to discern relationships between these variables and cholera incidence. Analysis at the individual household level for these variables would be of interest. Conclusions/Significance: Our results suggest that ongoing global urbanization coupled with urban poverty will be associated with increased risks for certain infectious diseases, such as cholera, underscoring the need for improved infrastructure and planning as the world's urban population continues to expand. [ABSTRACT FROM AUTHOR]

Background: Host preference is a critical determinant of human exposure to vector-borne infections and the impact of vector control interventions. Widespread use of long-lasting insecticide-treated nets (LLINs) and indoor residual spraying (IRS) across sub-Saharan Africa, which protect humans against mosquitoes, may select for altered host preference traits of malaria vectors over the long term. Here, the host preferences of Anopheles arabiensis and Anopheles gambiae sensu stricto (s.s.) were experimentally assessed in the field, using direct host-preference assays in two distinct ecological settings in Tanzania. Methods: Eight Ifakara Tent Trap (ITT), four baited with humans and four with bovine calves, were simultaneously used to catch malaria vectors in open field sites in urban and rural Tanzania. The numbers of mosquitoes collected in human-baited traps versus calf-baited traps were used to estimate human feeding preference for each site's vector species. Results: The estimated proportion [95% confidence interval (CI)] of mosquitoes attacking humans rather than cattle was 0.60 [0.40, 0.77] for An. arabiensis in the rural setting and 0.61 [0.32, 0.85] for An. gambiae s.s. in the urban setting, indicating no preference for either host in both cases (P = 0.32 and 0.46, respectively) and no difference in preference between the two (Odds Ratio (OR) [95%] = 0.95 [0.30, 3.01], P = 0.924). However, only a quarter of An. arabiensis in the urban setting attacked humans (0.25 [0.09, 0.53]), indicating a preference for cattle that approached significance (P = 0.08). Indeed, urban An. arabiensis were less likely to attack humans rather than cattle when compared to the same species in the rural setting (OR [95%] = 0.21 [0.05, 0.91], P = 0.037). Conclusion: Urban An. arabiensis had a stronger preference for cattle than the rural population and urban An. gambiae s.s. showed no clear preference for either humans or cattle. In the urban setting, both species exhibited stronger tendencies to attack cattle than previous studies of the same species in rural contexts. Cattle keeping may, therefore, particularly limit the impact of human-targeted vector control interventions in Dar es Salaam and perhaps in other African towns and cities. [ABSTRACT FROM AUTHOR]