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Background: Globally, women and girls are subjected to various forms of sexual harassment while using public transport daily. Objective: To determine the prevalence of sexual harassment and identify different forms and associated risk factors among female university students who use public transport in Dar es Salaam, Tanzania. Methods: A cross-sectional study design using a questionnaire was employed to collect data. Data were collected from female first-year undergraduate students, who use public transport and are aged 18 years and above studying at the University of Dar es Salaam and Muhimbili University of Health and Allied Sciences. Results: The overall prevalence of sexual harassment on public transport was 88%. Study participants reported the highest levels of sexual harassment (91%). Verbal harassment was the most common form of sexual harassment (95%), and being called names such as baby, sweet, honey or love was reported by most students (78%). Factors associated with sexual harassment on public transport were: overcrowded vehicles (AOR=2.90, 95% CI: 0.09-4.50) and use of public transport as a form of transport (AOR=4.54, 95% CI: 0.40-8.90). Conclusion: The study findings highlight the need for the implementation of plausible interventions on the issue of sexual harassment through awareness campaigns and the implementation of modern surveillance and reporting systems in public spaces.

Background/Aims The low rate of exclusive breastfeeding among mothers living with human immunodeficiency virus (HIV) has been attributed to limited spousal support, and evidence shows that support from a male partner has a positive influence on HIV positive mothers' adherence to exclusive breastfeeding. There is a lack of research data on fathers' experiences of barriers to supporting their HIV-positive partners with exclusive breastfeeding for the first 6 months. This paper reports the results of a study that aimed to explore barriers to fathers' engagement in supporting exclusive breastfeeding by HIV-positive mothers in an urban setting in Tanzania. Methods A qualitative case study design was used in Temeke Municipal Council, at clinics for the prevention of mother to child transmission of HIV in four public health facilities. Purposive sampling was used to select 30 participants who took part in in-depth interviews. Data were digitally recorded, transcribed verbatim and translated from Kiswahili to English before being thematically analysed. Results Barriers to fathers' engagement in supporting exclusive breastfeeding included unstable income, inconvenient clinic hours, gender stereotypes, less emphasis on postpartum male involvement in prevention of mother-to-child transmission of HIV and stringent work regulations that provide very limited paternity leave. Conclusions This study has generated some insight into the main barriers to fathers' engagement in supporting exclusive breastfeeding among mothers with HIV. This knowledge can be applied to strengthen the role of fathers in prevention of mother-to-child transmission of HIV.

Emmanuel Balandya,1 Bruno Sunguya,2 Benson Kidenya,3 Tumaini Nyamhanga,4 Irene K Minja,5 Michael Mahande,6 Blandina T Mmbaga,7 Stephen E Mshana,8 Kien Mteta,9 John Bartlett,10 Eligius Lyamuya11 1Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania; 2Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania; 3Department of Biochemistry and Molecular Biology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 4Department of Development Studies, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania; 5Department of Restorative Dentistry, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania; 6Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania; 7Department of Pediatrics and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania; 8Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 9Department of Urology, Kilimanjaro Christian Medical University College, Moshi, Tanzania; 10Duke Global Health Institute, Duke University, Durham, NC, USA; 11Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, TanzaniaCorrespondence: Emmanuel Balandya, Department of Physiology, Muhimbili University of Health and Allied Sciences, P.O. Box. 65001, Dar-es-salaam, Tanzania, Tel +255-768-431600, Fax +255-22-2150465, Email ebalandya@muhas.ac.tzBackground: Mentorship is pivotal for sustainability of a successful research culture at higher learning institutions. Various models have been proposed for provision of research mentorship in health sciences but are challenged by utilizing predominantly hierarchical mentoring, as well as being centred on one discipline or one institution. This paper describes the approach and successes of an inclusive mentorship model employed in a resource-limited setting in sub-Saharan Africa.Methods: Through the NIH-funded Transforming Health Professions Education in Tanzania (THET) project, a consortium of three prominent health sciences higher learning institutions in Tanzania (MUHAS, CUHAS and KCMUCo) and two collaborating US institutions (UCSF and Duke University) was formed. Within THET, the Community of Young Research Peers (CYRP) was constituted, comprised two cohorts of undergraduate students and young faculty (fellows), and senior scientists. Besides mentorship and research training, fellows received funded research awards and in turn mentored undergraduate students.Results: By the first quarter of project year four, the number of fellows and mentored undergraduate students had increased from 12 to 24 and from 41 to 67, respectively. Fellows in the second cohort (junior fellows) included medical doctors, nurses, dentist, biomedical scientist, sociologist and education psychologist. In fostering peer-to-peer mentoring, the cross-institutional pairs of fellows from the first cohort (senior fellows) were assigned to reciprocal pairs of junior fellow mentees and took a leading role in research training. Furthermore, the senior fellows had made significant strides, including eight enrolled in PhD programmes, eight publications from mentored research projects, and six small to medium-size research grants won.Conclusion: The unifying model of research mentorship employed by the CYRP has been demonstrated as an effective model for joint research mentorship of the diverse group of young investigators from collaborating higher learning institutions in Tanzania. This model is recommended for scale-up, particularly in sub-Saharan Africa.Keywords: health research, cross-institutional, inter-disciplinary, young faculty, mentorship, undergraduate

Daudi Omari Simba,1 Deodatus Kakoko,2 Tumaini Nyamhanga,3 Zakayo Mrango,4 Phare Mujinja2 1Department of Community Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar-es Salaam, Tanzania; 2Department of Behavioural Sciences, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar-es Salaam, Tanzania; 3Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar-es Salaam, Tanzania; 4National Institute for Medical Research, Kilosa Station, Kilosa, Tanzania Purpose: Improving access to malaria treatment in rural remote areas remains a major challenge facing innovative strategies, such as Accredited Drug Dispensing Outlets (ADDOs) and Community Health Workers (CHWs) programs in Tanzania. This study tested the effectiveness of a financial benefit approach to motivate CHWs to improve prompt access to malaria treatment. Patients and methods: We applied a quasi-experimental study design in rural-remote areas in Kilosa district, Tanzania. Febrile children in selected intervention areas were provided access to malaria diagnostic and treatment at a minimal fee to CHWs and compared with non-intervention areas. We measured impact using difference in differences (DID) analysis. Results: At baseline, 870 children

BackgroundSustainability of research culture in Sub-Saharan Africa is threatened in part by the lack of a critical mass of young researchers with the requisite skills and interest to undertake research careers. This paper describes an intensive mentorship programme combining hierarchical (vertical) and peer-to-peer (horizontal) mentoring strategies among young researchers in a resource limited setting in Sub-Saharan Africa.MethodsA consortium of three partnering large Tanzanian health training institutions (MUHAS, CUHAS and KCMUCo) and two collaborating US institutions (UCSF and Duke University) was formed as part of the five-year Transforming Health Professions Education in Tanzania (THET) project, funded by the NIH through Health Professional Education Partnership Initiative (HEPI). Within THET, the Community of Young Research Peers (CYRP) was formed, comprising of inter-professional and cross-institutional team of 12 Master-level Young Research Peers and 10 co-opted fellows from the former MEPI-Junior Faculty (MEPI-JF) project. The Young Peers received mentorship from senior researchers from the consortium through mentored research awards and research training, and in turn provided reciprocal peer-to-peer mentorship as well as mentorship to undergraduate students.ResultsAt the end of the first 2 years of the project, all 12 Young Peers were proceeding well with mentored research awards, and some were at more advanced stages. For example, three articles were already published in peer reviewed journals and two other manuscripts were in final stages of preparation. All 12 Young Peers participated in CYRP-wide thematic training workshops on mentoring and secondary data analysis; 11 had undertaken at least three research training short courses in identified areas of need; 9 joined at least one other ongoing research project; 5 made at least one scientific presentation, and 5 participated in at least one submitted grant application. Half of the Young Peers have enrolled in PhD programmes. A collective total of 41 undergraduate students were actively mentored by the Young Peers in research.ConclusionThe CYRP has demonstrated to be an effective model for dual vertical and horizontal mentorship in research to young investigators in resource-limited settings. This model is recommended to educators working on developing research competence of early career researchers, particularly in Sub-Saharan Africa.

Background While the situation of married adolescent girls in Tanzania is increasingly documented, empirical evidence concerning the ways in which child marriage impacts girls’ and young women’s sexual lives is limited. Specifically, little is known about lived experiences on sexual violence among married adolescent girls in Tanzania. Methods This article reports on a qualitative study using a phenomenological approach to describe married girls’ experiences of sexual violence in the Shinyanga Region, an area with the highest prevalence (59%) of child marriage in Tanzania. Data were collected from 20 married girls aged 12–17 years. Results The study identified four analytical themes regarding the experience of sexual violence, namely: forced sex; rape; struggling against unpleasant and painful sex; and inculcation of the culture of tolerance of sexual violence. Conclusion The study highlights the voices of married adolescents on an important but a neglected topic of relevance to Tanzania’s public health. Findings from this study suggest that married adolescent girls suffer sexual coercion in silence. Plain English summary Child marriage is a major public health problem in sub-Saharan Africa in general and in Tanzania in particular. However, there is limited research on the ways in which it impacts sexual lives of married adolescent girls. In response to the inadequacy of information, married adolescent girls in Shinyanga Region of Tanzania were requested to voice out their experiences of sexual violence. Three themes were identified from the responses, namely: forced sex; rape, struggling against unpleasant and painful sex; and the inculcation of the culture of tolerance of sexual violence. In conclusion, this study has echoed voices of married adolescent girls on the sexual troubles they experience. Their main concern is that they suffer sexual coercion in silence, which increases their risk of acquiring sexually transmitted infections and/or unwanted pregnancies. Recommendations for sexual violence prevention strategies are discussed.

Background: In Tanzania, adolescent pregnancy results in a denial of the girl's fundamental right to education. School expulsion of pregnant adolescents is a common practice exercised by teachers in this country for decades. This study aimed to explore the perceptions and feelings of secondary school teachers towards this practice. Methods: The study used a qualitative approach comprising focus groups and individual semistructured interviews with a purposive sample of sixteen teachers and nine headmasters (n = 25) from nine secondary schools of the rural Igunga district, in Tabora region, Tanzania. Data was collected in March to June 2017 and submitted to thematic analysis. Results: Though most participants were not satisfied with the practice, their role on the expulsion of pregnant students was perceived as mandatory by law and regulations. Main argument in favor was its deterrent effect, yet the review of schools’ registries did not sustain that perception. Stigma and fear of contamination added a relevant contribution to its implementation. Conflicting feelings among teachers were also disclosed. Conclusion: This study was of most value to understand current perceptions and feelings of those who exercise the practice of banning pregnant adolescents from school in Tanzania, while having identified some of the cultural and social believes acting as influential factors in its pervasiveness. International and national human rights organizations should increase their efforts and campaigns in order to strength social awareness of the benefit of females’ education to society as a whole and of adopting policies and practices in support of their equal right to education. This study received financial support from FCT - Foundation for Science and Technology, Portugal

Background: Despite routine supportive supervision of health service delivery, maternal and newborn outcomes have remained poor in sub-Saharan Africa in general and in Tanzania in particular. There is limited research evidence on factors limiting the effectiveness of supportive supervision in improving the quality of maternal and newborn care. Objective: This study explored enablers of and barriers to supportive supervision in maternal and newborn care at the district and hospital levels in Shinyanga region in Tanzania. Methods: This study employed a qualitative case study design. A purposeful sampling approach was employed to recruit a stratified sample of health system actors: members of the council health management team (CHMT), members of health facility management teams (HMTs), heads of units in the maternity department and health workers. Results: This study identified several barriers to the effectiveness of supportive supervision. First, the lack of a clear policy on supportive supervision. Despite the general acknowledgement of supportive supervision as a managerial mechanism for quality improvement at the district and lower-level health facilities, there is no clear policy guiding it. Second, limitations in measurement of progress in quality improvement; although supportive supervision is routinely conducted to improve maternal and newborn outcomes, efforts to measure progress are limited due to shortfalls in the setting of goals and targets, as well as gaps in M&E. Third, resource constraints and low motivation; that is, the shortage of resources – CHMT supervisors, health staff and funds – results in irregular supervision and low motivation. Conclusion: Besides resource constraints, lack of clear policies and limitations related to progress measurement impair the effectiveness of supportive supervision in improving maternal and newborn outcomes. There is a need to reform supportive supervision so that it aids and measures progress not only at the district but also at the health facility level.

Background Studies on food insecurity in Tanzania have been quantitative in nature and have focused on specific population groups such as those of people living with HIV and women. However, there is very little, if any, qualitative research information in Tanzania on experiences of food insecurity among elderly with respect to its magnitude and associated circumstances.Methods Interview guide and focused group discussion guide were used to explore the magnitude of food insecurity among elderly and its associated circumstances. A total of 25 elderly and 3 district officials were involved in in-depth interview and another 25 elderly were involved in focused group discussion.Results The study found that elderly had limited access to food, eat less number of meals as well as insufficient amount. The circumstance associated with food insecurity were found to be limited strength to engage themselves in farm activities or working as casual laborers to earn some money to buy food, limited strength to prepare food, burden of taking care of grandchildren and inadequate food support from children.Conclusion In conclusion, this study has demonstrated that the elderly people experience food insecurity with respect to both quantity and quality. Therefore, it is high time that a strategy was developed to ensure that all elderly in Tanzania are food secure.

Background: Intimate partner violence is a major public health problem in Tanzania, yet little is known about the coping strategies among women living with HIV/AIDS who experiencing IPV. The objective of the study was to explore the coping strategies employed by women living with HIV/AIDS experiencing IPV who attended care and treatment services in the Singida region.Methods: A qualitative phenomenology study design was performed in which data were collected through in-depth interviews with 35 women living with HIV/AIDS who also experienced IPV. Content analysis was used to analyse the data.Results: We found that women living with HIV/AIDS experienced IPV used family members, such as their mothers, sisters, and brothers as a coping mechanism to express their pains. Spiritual leaders counselled them spiritually and psychologically and they were advised on how to live with their violent partners. Other coping mechanisms included reporting to the police and the legal system, and the use of support groups. Through support groups, they obtained relief from depression, loneliness, isolation, stigma and discrimination.Conclusions: This study concludes that coping mechanisms helped women living with HIV/AIDS to reduce the stress associated with HIV/AIDS and intimate partner violence. The government of Tanzania should strengthen policies related to IPV and HIV/AIDS among all women in Tanzania. Moreover, local government authorities should build safe homes for all survivors of intimate partner violence throughout the country.

Background: Intimate partner violence (IPV) is behaviour within intimate relationship that causes physical, sexual and psychological harm. Health care workers (HCW) have a big role to play for women living with HIV/AIDS (LWHA) who are experiencing IPV. The understanding and perception of IPV towards health care workers is very important in the provision of integrated holistic care.Methods: This was a qualitative study where data was collected through in-depth interviews and focus group discussions for 24 HCW, working at a care and treatment clinic and prevention of mother to child transmission of HIV/AIDS. Content analysis was used to analyse the data.Results: The study findings showed that HCW had their own meaning and understanding of IPV that was when a male partner does something wrong to his female partner which was associated with beating, use of abusive language and refusal to provide basic needs. HCW had various roles in caring and supporting women LWHA experiencing IPV. They provided emergency medical services, health education which helped them to cope with their HIV/AIDS disease, counselled on the importance of adhering to their antiretroviral treatment medications and referral services which helped them to address their IPV as women LWHA.Conclusions: The study concluded that HCW had a very important role to play in care and support of women LWHA. They needed more training on IPV so that they will be able to provide care and support to all women living with HIV/AIDS experiencing IPV and the community at large.

Although gender mainstreaming has been long recognized as a strategy for addressing gender inequalities and associated negative health outcomes; its implementation has remained a challenge, even in the area of prevention of mother to child transmission of HIV (PMTCT). Despite recognition of gender in Tanzania’s political arena and prioritization of PMTCT by the health sector, there is very little information on how well gender has been mainstreamed into National PMTCT guidelines and organizational practices at service delivery level. Using a case study methodology, we combined document review with key informant interviews to assess gender mainstreaming in PMTCT on paper and in practice in Tanzania. We reviewed PMTCT policy/strategy documents using the WHO’s Gender Responsive Assessment Scale (GRAS). The scale differentiates between level 1 (gender unequal), 2 (gender blind), 3 (gender sensitive), 4 (gender specific), and 5 (gender transformative). Key informant interviews were also conducted with 26 leaders purposively sampled from three government health facilities in Mwanza city to understand their practices. The gender responsiveness of PMTCT policy/strategy documents varies, with some being at GRAS level 3 (gender sensitive) and others at GRAS level 4 (gender specific). Those which are gender sensitive indicate gender awareness, but no remedial action is developed; while those which are gender specific go beyond indicating how gender may hinder PMTCT to highlighting remedial measures, such as the promotion of couple counselling and testing for HIV. In addition, interviews on organizational processes and practices suggested that there has been little attention to the holistic integration of gender in the delivery of PMTCT services. The study has revealed limited integration of gender concerns in PMTCT policy documents. Similarly, health facility leader responses indicate perspectives and practices that pay little attention to the holistic integration of gender in the delivery PMTCT services.

Although HIV is identified as a family disease, the overall response to the global HIV epidemic continues to predominantly focus on individuals. The aim of this qualitative study was to explore how the role of the family in HIV prevention is perceived by community-based stakeholders. Understanding the role of the family within the context of the HIV/AIDS is essential for community/public health nurses. In total, 34 stakeholders participated in the study. Three major categories were identified namely: fostering positive intra-familial relations, utilizing external resources, and barriers to family roles. The study findings have implications for community-based HIV family interventions.

Background Gender is often neglected in health systems, yet health systems are not gender neutral. Within health systems research, gender analysis seeks to understand how gender power relations create inequities in access to resources, the distribution of labour and roles, social norms and values, and decision-making. This paper synthesises findings from nine studies focusing on four health systems domains, namely human resources, service delivery, governance and financing. It provides examples of how a gendered and/or intersectional gender approach can be applied by researchers in a range of low- and middle-income settings (Cambodia, Zimbabwe, Uganda, India, China, Nigeria and Tanzania) to issues across the health system and demonstrates that these types of analysis can uncover new and novel ways of viewing seemingly intractable problems. Methods The research used a combination of mixed, quantitative, qualitative and participatory methods, demonstrating the applicability of diverse research methods for gender and intersectional analysis. Within each study, the researchers adapted and applied a variety of gender and intersectional tools to assist with data collection and analysis, including different gender frameworks. Some researchers used participatory tools, such as photovoice and life histories, to prompt deeper and more personal reflections on gender norms from respondents, whereas others used conventional qualitative methods (in-depth interviews, focus group discussion). Findings from across the studies were reviewed and key themes were extracted and summarised. Results Five core themes that cut across the different projects were identified and are reported in this paper as follows: the intersection of gender with other social stratifiers; the importance of male involvement; the influence of gendered social norms on health system structures and processes; reliance on (often female) unpaid carers within the health system; and the role of gender within policy and practice. These themes indicate the relevance of and need for gender analysis within health systems research. Conclusion The implications of the diverse examples of gender and health systems research highlighted indicate that policy-makers, health practitioners and others interested in enhancing health system research and delivery have solid grounds to advance their enquiry and that one-size-fits-all heath interventions that ignore gender and intersectionality dimensions require caution. It is essential that we build upon these insights in our efforts and commitment to move towards greater equity both locally and globally.

Interview guide for the interviews with District Health Managers (DHSS). This semi-structured interview guide (set of questions) was used for carrying the key informant interviews with the District Health Managers from the three districts. (DOC 34 kb)

Background Retention of Human Resources for Health (HRH), particularly doctors at district level is a big challenge facing the decentralized health systems in poorly resourced countries. Tanzania, with 75% of its population in rural areas, has only 26% of doctors serving in rural areas. We aimed to analyze the experiences regarding the retention of doctors at district level in Tanzania from doctors’ and district health managers’ perspectives. Methods A qualitative study was carried out in three districts from June to September 2013. We reviewed selected HRH documents and then conducted 15 key informant interviews with members of the District Health Management teams and medical doctors working at the district hospitals. In addition, we conducted three focus group discussions with Council Health Management Team members in the three districts. Incentive package plans, HRH establishment, and health sector development plans from the three districts were reviewed. Data analysis was performed using qualitative content analysis. Results None of the districts in this study has the number of doctors recommended. Retention of doctors in the districts faced the following challenges: unfavourable working conditions including poor working environment, lack of assurance of career progression, and a non-uniform financial incentive system across districts; unsupportive environment in the community, characterized by: difficulty in securing houses for rent, lack of opportunities to earn extra income, lack of appreciation from the community and poor social services. Health managers across districts endeavour to retain their doctors through different retention strategies, including: career development plans, minimum financial incentive packages and avenues for private practices in the district hospitals. However, managers face constrained financial resources, with many competing priorities at district level. Conclusions Retention of doctors at district level faces numerous challenges. Assurance of career growth, provision of uniform minimum financial incentives and ensuring availability of good social services and economic opportunities within the community are among important retention strategies. Electronic supplementary material The online version of this article (10.1186/s12913-018-3059-0) contains supplementary material, which is available to authorized users.

This chapter examines the socioeconomic, historical, and cultural context of the United Republic of Tanzania and how it has shaped the country’s family life and family life education throughout the precolonial, colonial, and postcolonial eras. The context includes social factors such as changes in family structures and functions, emergence of HIV/AIDS, sexuality and family life education programs, and related family and health policies. Utilizing the socio-ecological perspective, the article delineates family strengths, gaps, and opportunities available to key stakeholders to meet the contemporary family life education needs for the Tanzanian families.

Background There is limited information on the effect of expectant parents’ socio-cultural perceptions and practices on the use of skilled birth attendants (SBAs) in rural Tanzania. The purpose of this study was to explore the socio-cultural barriers to health facility birth and SBA among parents choosing home birth in rural Tanzania, specifically in the Rukwa Region. Methods This study used a descriptive exploratory methodology. Purposive sampling was used to recruit study participants for both in-depth interviews (IDIs) and focused group discussions (FGDs). Qualitative research methods, including FGDs and IDIs, were utilized in data collection. The respondents were men and women whose youngest child had been born at home within the prior 12 months. A thematic approach was used for data analysis. Results The main themes that emerged regarding barriers to the use of health facility were 1) limited decision-making by men on place of delivery; 2) low risk perception by men and its interference with health facility birth; 3) men’s limited resource mobilization for health facility birth and 4) females’ perceptions that pregnancy and childbirth are low-risk events. Conclusion This qualitative study demonstrates that apart from well-documented structural barriers to skilled birth attendance in rural Tanzania, the low risk perception among both men and women plays a substantial role. The low risk perception among both men and women affects the use of SBAs in two ways. First, women become negligent and take risk of delivering at home. Second, male partners do not seriously mobilize resources for health facility childbirth. These findings reinforce the urgent need to implement creative programs to increase genuine male participation in facilitation of health facility childbirth.

Background : There is a dearth of empirical research illuminating possible connections between gender imbalances and sexual violence among married women in Tanzania. There is a need to generate in-depth information on the connectivity between gender imbalances (asymmetrical resource ownership, sexual decision making, roles, and norms) and sexual violence plus associated HIV risky sexual behavior among married women. Design : This paper is based on a qualitative case study that involved use of focus group discussions (FGDs). A thematic analysis approach was used in analyzing the study findings. Results : The study findings are presented under the three structures of gender and power theory. On sexual division of labor , our study found that economic powerlessness exposes women to sexual violence . On sexual division of power, our study found that perception of the man as a more powerful partner in marriage is enhanced by the biased marriage arrangement and alcohol consumption. On cathexis, this study has revealed that because of societal norms and expectations regarding women’s sexual behavior characterized by their sexual and emotional attachments to men, women find it hard to leave sexually abusive marriages. That is, because of societal expectations of obedience and compelled tolerance many married women do suffer in silence. They find themselves trapped in marriages that increase their risk of acquiring HIV. Conclusions : This study suggests that married women experience a sexual risk of acquiring HIV that results from non-consensual sex. That non-consensual sex is a function of gender imbalances – ranging from women’s economic dependence on their husbands or partners to socioculturally rooted norms and expectations regarding women’s sexual behavior. The HIV risk is especially heightened because masculine sexual norms encourage men [husbands/partners] to engage in unprotected intra- and extramarital sex. It is recommended that the Tanzania Commission for AIDS (TACAIDS) should address the gender dimensions of sexual violence in marriage. Keywords : Gender; sexual violence; HIV; sexual risk; married women (Published: 5 December 2014) Citation : Glob Health Action 2014, 7 : 25346 - http://dx.doi.org/10.3402/gha.v7.25346

Background: It is almost two decades since various research works started documenting the debate surrounding the role of social capital on individual health outcomes in different contexts. However, in Tanzania there is a dearth of empirical evidence showing how social capital influences health outcomes. The objective of this study was to investigate the links between individual social capital and self-rated health by selected socio-demographic factors.Methods: We conducted a population-based cross-sectional study in Makete district in the south-western Tanzania. A semi-structured questionnaire was used to collect data using face to face interviews with the study participants. We collected information on individual structural social capita, which include memberships in organizations, giving social support, receiving social support and participation in voluntary activities. We also collected information on individual cognitive social capital including visiting neighbour, trusting neighbour, interaction with neighbour and ability to influence in decisions.Results: A total of 862 individuals from four villages participated in the study with the mean age of 31.3 years. Factor analysis (using principal components analysis) with varimax determined four domains of structural social capital: participation in collective activities, giving social support, membership in formal and informal organizations and receiving social support (factor loadings: 0.65 to 0.55). Four domains of cognitive social capital were also identified: visiting a sick neighbour, trusting a neighbour, and interacting with neighbour and ability to influence decisions (Factors loadings: 0.78 to 0.52). The multivariable logistic regression analysis shows that individuals with access to medium and high levels of structural social capital were almost 2 and 3 times more likely to report good health than individuals with low social capital [OR 2.3 (CI: 1.6-3.4)] and [OR 3.4 (CI: 2.3-5.1)], respectively.Conclusion: Our study findings support the argument that high level of structural social capital has positive health outcomes in rural Tanzania’ setting. Therefore, village leaders in particular and community members in general should promote social capital in their communities as one of the health interventions towards improving individual health.

This study examined the relationship between intimate partner violence and high-risk sexual behaviours (unprotected sex and partner promiscuity) among 392 married women. The findings show that about half (44.9%) of the respondents experienced physical violence. Furthermore, 47.5% of the respondents reported that they were made to have sex when they did not want to, without a condom. About two thirds (64.5%) of women were both physically hurt and made to have sex when they did not want to (P=0.03). Likewise, about half (42.8%) of women who reported to have experienced physical violence also admitted that their partners engaged in sexual intercourse outside their union (P=0.001). This study found a strong association between experience of physical violence and engagement in non-consensual sex without a condom and having an unprotected sex with an unfaithful husband.

Background: The role of parents in preventing child sexual abuse in the community in low-and-middle income countries has not been adequately emphasized. The objective of this study was to assess parents’ knowledge, attitudes and practices on child sexual abuse and its prevention in Shinyanga district, Tanzania in order to strengthen child protection. Methods: This was a cross-sectional study conducted during July 2015. Multistage cluster sampling technique was employed to obtain study participants from a list of sampling frame. Parents with children below 18 years old were randomly selected to form a study population. A quantitative technique using structured questions was used to assess parents’ knowledge, attitude and practices about preventing child sexual abuse.Results: A total of 384 respondents were included in the study. The majority (95.6%) of respondents had high knowledge regarding prevention of child sexual abuse. Majority (98.7%) of the respondents had positive attitudes on preventing child sexual abuse. However, only about a quarter (27.3%) of respondents had good practices on protection and prevention of child sexual abuse.Conclusion: Knowledge and attitudes of parents on child sexual abuse prevention was high in the study area. However, the practices of parents on child sexual abuse prevention were poor. Therefore, a public education programme is needed for parents, with the ultimate aim of protecting children from the preventable harm and trauma of sexual abuse in rural communities of Tanzania.

BACKGROUND In Tanzania, nurses play an important role in the management of patients with malaria. The study was conducted to identify the current status of the performance of nurses in the management of malaria patients, in order to provide the baseline data before the training intervention. METHODS The study was conducted at 19 government health facilities in four districts of Tanzania. In order to assess the performance of nurses, 60 procedures involved in the management of malaria patients were observed and evaluated. Additionally, exit interviews were conducted with 60 malaria patients or caretakers upon leaving the health facilities. RESULTS Of the 60 procedures observed, only 4 satisfied the standard established in the national guideline for treatment and diagnosis of malaria. The proportions of the interviewed patients who were able to correctly provide information were: 83.7-88% on home treatment topics; 6.1-33.3% on follow-up after treatment; and 48.3% on preventive measures on malaria. CONCLUSION The nurses do not satisfy the required standard in the management of malaria patients. The weak areas identified by the study are the quinine IV administration and health education provided to patients. Conducting a training programme for nurses and the provision of working aids, such as a dosage table and a wall chart, are recommended. Furthermore, in order to alleviate incorrect dosage in intravenous quinine administration associated with dosage calculation, the possibility of adopting treatment drugs that can be administered by other dosage routes could be explored.

Tanzania introduced the decentralisation of its health systems in the 1990s in order to provide opportunities for community participation in health planning. Health facility governing committees (HFGCs) were then established to provide room for communities to participate in the management of health service delivery. The objective of this study was to explore the challenges and benefits for the participation of HFGCs in health planning in a decentralised health system. Data were collected using semi-structured interviews and focus group discussions (FGDs). A total of 13 key informants were interviewed from the council and lower-level health facilities. Five FGDs were conducted from five health facilities in one district. Data generated were analysed for themes and patterns. The results of the study suggest that HFGCs are instrumental organs in health planning at the community level and there are several benefits resulting from their participation including an opportunity to address community needs and mobilisation of resources. However, there are some challenges associated with the participation of HFGCs in health planning including a low level of education among committee members and late approval of funds for running health facilities. In conclusion, HFGCs potentially play a significant role in health planning. However, their participation is ineffective due to their limited capacities and disabling environment.

The goal of this study was to identify the achievements and challenges of a resource allocation process in a decentralized health system in Tanzania as they are perceived by national and district level officers.This study was conducted between May 2011 and July 2012 in two districts of Dodoma region: Kongwa and Bahi. Data were collected from 25 key people involved in policy, planning and management aspects for the allocation of financial resources from the central government to local government districts. Thus, the recruitment of the study participants was purposive, as it took account of their positions and experience in health resource allocation and management. The data were collected through conversation in face-to-face in-depth interviews with the officers concerned. The data were analysed manually using qualitative content analysis.The study has identified the achievements and challenges of resource allocation in a decentralized health system of Tanzania. The achievements include: the design and use of a needs-based resource allocation formula; reduced resource allocation inequalities between rural and urban districts; and a wide discretion by the district council to mobilize and utilize health insurance funds and user fees. On the other hand, the challenges are: the disbursed funds fall far short of centrally determined budget ceilings, and the funds are sent late; Council Health Management Teams (CHMT) develop budgets but are restricted on the percentage they can allocate to different areas--so there is severe under-funding of disease prevention and health promotion initiatives at the community level.This study has identified achievements that should be further nurtured and challenges that should be worked on for the improvement of the decentralized health system. Thus, as a way forward, it is recommended that the equitable allocation of resources should go beyond the recurrent costs for the delivery of health services.

Background: Decentralised health systems in Tanzania depend largely on funding from the central government to run health services. Experience has shown that central funding in a decentralised system is not an appropriate approach to ensure the effective and efficient performance of local authorities due to several limitations. One of the limitations is that funds from the central government are not disbursed on a timely basis, which in turn, leads to the serious problem of shortage of financial resources for Council Health Management Teams (CHMT). This paper examines how dependency on central government funding in Tanzania affects health activities in Kongwa district council and the strategies used by the CHMT cope with the situation. Methods: The study adopted a qualitative approach and data were collected using semi-structured interviews and focus group discussions. One district in the central region of Tanzania was strategically selected. Ten key informants involved in the management of health service delivery at the district level were interviewed and one focus group discussion was held, which consisted of members of the council health management team. The data generated were analysed for themes and patterns. Results: The results showed that late disbursement of funds interrupts the implementation of health activities in the district health system. This situation delays the implementation of some activities, while a few activities may not be implemented at all. However, based on their prior knowledge of the anticipated delays in financial disbursements, the council health management team has adopted three main strategies to cope with this situation. These include obtaining supplies and other services on credit, borrowing money from other projects in the council, and using money generated from cost sharing. Conclusion: Local government authorities (LGAs) face delays in the disbursement of funds from the central government. This has necessitated introduction of informal coping strategies to deal with the situation. National-level policy and decision makers should minimise the bureaucracy involved in allocating funds to the district health systems to reduce delays.

Background : This article presents part of the findings from a larger study that sought to assess the role that gender relations play in influencing equity regarding access and adherence to antiretroviral therapy (ART). Review of the literature has indicated that, in Southern and Eastern Africa, fewer men than women have been accessing ART, and the former start using ART late, after HIV has already been allowed to advance. The main causes for this gender gap have not yet been fully explained. Objecti v e : To explore how masculinity norms limit men’s access to ART in Dar es Salaam. Design : This article is based on a qualitative study that involved the use of focus group discussions (FGDs). The study employed a stratified purposive sampling technique to recruit respondents. The study also employed a thematic analysis approach. Results : Overall, the study’s findings revealed that men’s hesitation to visit the care and treatment clinics signifies the superiority norm of masculinity that requires men to avoid displaying weakness. Since men are the heads of families and have higher social status, they reported feeling embarrassed at having to visit the care and treatment clinics. Specifically, male respondents indicated that going to a care and treatment clinic may raise suspicion about their status of living with HIV, which in turn may compromise their leadership position and cause family instability. Because of this tendency towards ‘hiding’, the few men who register at the public care and treatment clinics do so late, when HIV-related signs and symptoms are already far advanced. Conclusion : This study suggests that the superiority norm of masculinity affects men’s access to ART. Societal expectations of a ‘real man’ to be fearless, resilient, and emotionally stable are in direct conflict with expectations of the treatment programme that one has to demonstrate health-promoting behaviour, such as promptness in attending the care and treatment clinic, agreeing to take HIV tests, and disclosing one’s status of living with HIV to at least one’s spouse or partner. Hence, there is a need for HIV control agencies to design community-based programmes that will stimulate dialogue on the deconstruction of masculinity notions. Keywords : gender; masculinity; HIV; access; antiretro v iral therapy (ART) (Published: 22 October 2013) Citation : Glob Health Action 2013, 6 : 21812 - http://dx.doi.org/10.3402/gha.v6i0.21812

Background According to a WHO multi-country study, Tanzania is among the countries with a high prevalence of Intimate Partner Violence (IPV). The Demographic and Health Survey 2010 shows that there are several regions with high levels of IPV within the country, including Singida. There is an ongoing national effort to strengthen the police as well as the legal and health systems from the national to the community level to address IPV. The objective of this study was to describe the views and experiences of women living with HIV/AIDS of a government available system addressing IPV at the community level at Singida Regional Hospital in central Tanzania. Methods This was a qualitative study involving in-depth interviews (IDIs); content analysis was used to analyse the findings. Results The study suggests that there is a functional government system starting from the street chairperson, progressing through the police and legal systems up to the national level. IPV survivors were afraid to report their male partners to the police and legal system because of their fear of retaliation, loss of financial support, divorce and death, and their concern about who would care for their children. Also there were no psychosocial services at the community level. However, survivors of IPV end their IPV cases at the lower level of chairperson of the village. The findings suggest that there are no shelter services for IPV survivors in their community to provide for their basic needs. Discussion Our study showed that women living with HIV/AIDS report IPV to the chairperson of their village, in-laws and their parents rather than the police or legal officer due to fear of retaliation, lack of economic support, concern for their children, lack of support from family and friends, stigma and fear of losing custody of children associated with divorce, and the fear that their partners will kill them. Conclusions Our study concludes that the government of Tanzania needs to provide health education to communities about using the available government system to address IPV cases, to enhance community empowerment, especially for women living with HIV/AIDS, and to build safe homes for IPV survivors in the communities. We strongly recommend strict policies relating to men who inflict IPV on their female partners and strong action must be taken against them.

Little is known about what adolescents think about faithfulness and partner reduction for HIV prevention (the "B" in the ABC HIV prevention behavior change strategy), including how they understand its implementation within relationships. In addition, because adolescents face the twin threats of HIV and unintended pregnancy, it is important to understand how adolescents may integrate their thinking on pregnancy prevention if they are using faithfulness or partner reduction as their HIV prevention strategy. This study gathered evidence by conducting 20 focus group discussions (FGDs) with 158 adolescents, aged 14-20. The FGDs were stratified by sex, age, current school attendance, rural or urban residence, and marital status. Results showed that the vast majority of groups felt that "B" messages are important and relevant for unmarried (as well as married) youth to hear for HIV prevention, but the messages need to be explicit (e.g., "being faithful means having only one tested sexual partner at a time"). Faithful relationships are perceived as ideal in terms of romantic expectations and HIV prevention, but were considered unrealistic if the relationship had a power imbalance. Adolescents acknowledged the risks of multiple partners and a few recognized that concurrent partnerships are riskier than serial partnerships. Condoms were given as the primary method for pregnancy prevention among youth, yet faithfulness was usually seen as precluding condom use and many youth considered condom use as evidence of a lack of faithfulness. Overall, adolescents recognized that practicing fidelity is complex. Young people need life skills education for how to establish and maintain faithful relationships with one tested partner and how to integrate condom use for pregnancy prevention within that relationship. Programs also need to more explicitly address the issues of trust and repeat HIV testing within "faithful" relationships which is an uncomfortable but necessary reality for many adolescents.

Background: During the 1990s, the government of Tanzania introduced the decentralization by devolution (D by D) approach involving the transfer of functions, power and authority from the centre to the local government authorities (LGAs) to improve the delivery of public goods and services, including health services. Objective: This article examines and documents the experiences facing the implementation of decentralization of health services from the perspective of national and district officials. Design: The study adopted a qualitative approach, and data were collected using semi-structured interviews and were analysed for themes and patterns. Results: The results showed several benefits of decentralization, including increased autonomy in local resource mobilization and utilization, an enhanced bottom-up planning approach, increased health workers’ accountability and reduction of bureaucratic procedures in decision making. The findings also revealed several challenges which hinder the effective functioning of decentralization. These include inadequate funding, untimely disbursement of funds from the central government, insufficient and unqualified personnel, lack of community participation in planning and political interference. Conclusion: The article concludes that the central government needs to adhere to the principles that established the local authorities and grant more autonomy to them, offer special incentives to staff working in the rural areas and create the capacity for local key actors to participate effectively in the planning process. Keywords: challenges; decentralization; health services; Tanzania (Published: 29 August 2013) Citation: Glob Health Action 2013, 6 : 20983 - http://dx.doi.org/10.3402/gha.v6i0.20983