Browsing by Author "Ernest, Alex"

Now showing 1 - 7 of 7
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    Barriers to accessibility and utilization of HIV testing and counseling services in Tanzania: experience from Angaza Zaidi programme
    (The PAMJ, 2016) Meremo, Alfred; Mboya, Beati; Ngilangwa, David Paul; Dulle, Robert; Tarimo, Edith; Urassa, David; Michael, Emillian; Gibore, Nyasiro; Mpondo, Bonaventura; Mchonde, Gabriel; Ernest, Alex; Noronha, Rita; Ilako, Festus
    Introduction: While HIV testing and counseling (HTC) services remain to be amongst the effective strategies in slowing HIV transmission, its accessibility and uptake in Tanzania is low. In 2011, 50% of adults have been ever tested and received their results. We conducted this study to assess barriers to accessibility and utilization of HTC services in Tanzania. Methods: A mixed methods study was conducted using both quantitative and qualitative approaches. Data were collected in in 9 regions of Tanzania in 2012. Twelve (12) in-depth interviews, 8 Focus Group Discussions and 422 clients were approached for data collection. Quantitative data were entered and analysed using SPSS, proportions were compared using chi-square test. Qualitative data, content analysis approach was used. Results: Overall 422 exit clients were enrolled into the study, 4.9% clients reported spending >2 hours at the HTC centre before they were attended (p<0.0001). Of the 422 clients in our study 5.7 % received HIV testing before getting HIV counseling (p=0.0001). Of those clients who received counseling, 21.8% of reported counseling to be done in a group (p=0.0001). Majority of study participants reported that the counselling sessions were private, with sufficient information, and interactive (p<0.0001). Mobile services clinics, the Post Test Clubs and couple counselling and testing were effective approaches in stimulating demand for and use of HTC services. Conclusion: Findings show that coverage of HTC was high, however long waiting time and lack of confidentiality impeded its accessibility and utilization. We recommend increase of staff and adherence to counselling ethics to safeguard clients' privacy.
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    Gestational diabetes mellitus: challenges in diagnosis and management
    (Springer, 2015) Mpondo, Bonaventura C. T.; Ernest, Alex; Dee, Hannah E.
    Gestational diabetes mellitus (GDM) is a well-characterized disease affecting a significant population of pregnant women worldwide. It has been widely linked to undue weight gain associated with factors such as diet, obesity, family history, and ethnicity. Poorly controlled GDM results in maternal and fetal morbidity and mortality. Improved outcomes therefore rely on early diagnosis and tight glycaemic control. While straightforward protocols exist for screening and management of diabetes mellitus in the general population, management of GDM remains controversial with conflicting guidelines and treatment protocols. This review highlights the diagnostic and management options for GDM in light of recent advances in care.
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    Health facility service availability and readiness to provide basic emergency obstetric and newborn care in a low-resource setting: evidence from a Tanzania National survey
    (BMJ Publishing Group Ltd, 2019) Bintabara, Deogratius; Ernest, Alex; Mpondo, Bonaventura
    This study used a nationally representative sample from Tanzania as an example of low-resource setting with a high burden of maternal and newborn deaths, to assess the availability and readiness of health facilities to provide basic emergency obstetric and newborn care (BEmONC) and its associated factors. Design Health facility-based cross-sectional survey. Setting: We analyzed data for obstetric and newborn care services obtained from the 2014–2015 Tanzania Service Provision Assessment survey, using WHO-Service Availability and Readiness Assessment tool. Primary and secondary outcome measures Availability of seven signal functions was measured based on the provision of ‘parental administration of antibiotic’, ‘parental administration of oxytocic’, ‘parental administration of anticonvulsants’, ‘assisted vaginal delivery’, ‘manual removal of placenta’, ‘manual removal of retained products of conception’ and ‘neonatal resuscitation’. Readiness was a composite variable measured based on the availability of supportive items categorised into three domains: staff training, diagnostic equipment and basic medicines. Results: Out of 1188 facilities, 905 (76.2%) were reported to provide obstetric and newborn care services and therefore were included in the analysis of the current study. Overall availability of seven signal functions and average readiness score were consistently higher among hospitals than health centres and dispensaries (p<0.001). Furthermore, the type of facility, performing quality assurance, regular reviewing of maternal and newborn deaths, reviewing clients’ opinion and number of delivery beds per facility were significantly associated with readiness to provide BEmONC. Conclusion: The study findings show disparities in the availability and readiness to provide BEmONC among health facilities in Tanzania. The Tanzanian Ministry of Health should emphasise quality assurance efforts and systematic maternal and newborn death audits. Health leadership should fairly distribute clinical guidelines, essential medicines, equipment and refresher trainings to improve availability and quality BEmONC
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    Knowledge on birth preparedness and complication readiness among expecting couples in rural Tanzania: differences by sex cross-sectional study
    (PLOS, 2018) Moshi, Fabiola V.; Kibusi, Stephen M.; Ernest, Alex; Fabian, Flora
    Inadequate knowledge of birth preparedness and complication readiness (BPCR) among expecting couples delays timely access to maternal emergency services. The aim of this study was to assess knowledge on birth preparedness and complication readiness and how men and women differ" among expecting couples in a rural setting of Rukwa Region, Tanzania.A community-based cross-sectional study targeting pregnant women and their partners was performed from June 2017 to October 2017. A total of 546 couples were sampled using three-stage probability sampling techniques and then interviewed using a structured questionnaire. The mean score difference was sought using independent t-test. Multiple linear regressions were performed to determine the predictors of knowledge.There was a significant difference in mean knowledge scores between pregnant women (M = 5.58, SD = 4.591) and male partners (M = 4.37, SD = 4.285); t (1085) = -4.525; p<0.001. Among women, BPCR levels were positively influenced by age (β = 0.236; p<0.01), having ever heard about birth preparedness (β = 0.176;p<0.001), being of Mambwe ethnicity (β = 0.187; p<0.001), living near a health center rather than a dispensary (β = 0.101;p<0.05) and having had a prior preterm delivery (β = 0.086;p<0.05). Access to media through radio ownership negatively influenced BPCR levels among both women (β-.119; p<0.01) and men (β = -0.168; p<0.0001). Among men, the BPCR knowledge was only positively influenced by having ever heard about birth preparedness (β = 0.169;p<0.001), age at marriage (β = -0.103; p<0.05), and having completed either primary (β = 0.157;p<0.001) or secondary education (β = 0.131;p<0.01).Some important predictors of knowledge were revealed among women and men, but overall knowledge about birth preparedness and complication readiness was low. This study demonstrates inadequate knowledge and understanding at the community level about key elements of birth preparedness and complication readiness. In order to improve access to life-saving care for women and neonates, there is a pressing need for innovative community strategies to increase knowledge about birth preparedness and complication readiness. Such strategies are essential in order to reduce maternal and neonatal mortality in rural Tanzania.
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    Knowledge on prevention and management of preeclampsia and eclampsia among nurses in primary health settings: baseline findings from an interventional study in Dodoma Region, Tanzania
    (East African Health Research Commission, 2020) Mwampagatwa, Ipyana; Ernest, Alex; Angelina, Joho A.; Kibusi, Stephen M.
    Preeclampsia and eclampsia are conditions which increase maternal and foetal morbidity and mortality worldwide. These conditions are ranked as the second leading cause of maternal deaths. Nurses have a critical role in preventing and managing preeclampsia. However, their knowledge has not been evaluated particularly among those working in primary health facilities, where opportunities for continue education is limited. To assess knowledge on prevention and management of preeclampsia and eclampsia among nurses working in the primary health care settings. Analysis of baseline data from an intervention study which test the effectiveness of simulation-based training on obstetric and neonatal emergencies among nurses in managing maternal and newborn emergencies in primary health care settings. A total of 39 primary health centres within 7 districts in Dodoma Region were selected to take part in the interventional study. Individual participants were nurses working in maternity units were involved. 172 nurses were selected using a simple random method. Nurses’ knowledge on prevention and management of PEE and its predictors were assessed using a self-administered questionnaire. Descriptive statistics analysis was done to determine the distribution of the background characteristics of nurses and logistic regression analysis was performed to explore predictors of nurses’ knowledge Overall knowledge on preeclampsia and eclampsia was 88 (51.2%). Professional qualification was a predictor associated with a nurse’s knowledge about preeclampsia and eclampsia. Registered nurses were more knowledgeable compared to enrolled nurses (AOR3.311; CI, 1.62 to 6.768; P value =.001), years of working experience showed no association with knowledge on preeclampsia and eclampsia (AOR 0.98; CI: 0.39-2.47; P values = 0.970). This study showed there is a critical knowledge deficiency in the prevention and management of preeclampsia and eclampsia among nurses working in maternal units of primary health care setting. Effective regular training on prevention and man agement of preeclampsia and eclampsia for frontline nurses is required in order to improve maternal and neonatal survival.
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    Post-coital posterior fornix perforation with vaginal evisceration
    (BioMed Central Ltd, 2014) Ernest, Alex; Emmanuel, Mtui; Gregory, Knapp
    Cases of post-coital posterior fornix perforation with vaginal eviscerations are infrequently reported in literature and uncommon cause for laparotomy. We report the case of 28 year old nulliparous woman presented to the hospital with per vaginal bleeding and evisceration following penile-vaginal sexual intercourse. High degree of suspicion in these cases is important especially in sexually active women as delay in management often results in life threatening blood loss, peritonitis and intestinal obstruction. Physicians should be aware that initial patient history may be inaccurate or misleading if taken in the presence of family or partner given the sensitive nature of the injury.
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    Predictors of glycaemic control among adults attending a diabetic outpatient clinic in a tertiary hospital, Tanzania: a cross sectional study
    (Medical Association of Tanzania (MAT), 2016) Mweng’emeke, Msafiri; Bintabara, Deogratius; Ernest, Alex; Mpondo, Bonaventura C. T.
    The burden of diabetes mellitus is increasing worldwide and especially so in developing countries. Poor control of diabetes mellitus is associated with the development and progression of many chronic diseases. Proper glycaemic control is important to prevent the development and progression of these complications. In this study, we aimed at assessing the status of glycaemic control and identifying predictors of good glycaemic control among patients with diabetes mellitus type 2 attending an outpatient clinic in Kilombero district, Tanzania. This study was a prospective, clinic based, cross-sectional study conducted between August and October 2014 at the St. Francis Referral Hospital diabetic outpatient clinic in Ifakara. A systematic, random sample of 221 patients was enrolled for the study. Socio-demographic and clinical characteristics were collected using a structured questionnaire and a data-collecting tool was used to record the laboratory and clinical measurements. Fasting blood glucose was measured in all patients and the level of ≤7.2mmol/dl was considered good glycaemic control. Logistic regression was used to assess association between different variables and glycaemic control. Out of the 221 patients involved in the study, 65 (29.4%) had good glycaemic control. Factors associated with good glycaemic control included having received diabetes education (OR [95% CI] = 13.8 [5.95-31.9], p = < 0.001), engaging in regular physical exercise (OR [95% CI] = 5.26 [1.95-14.2], p=0.001), having health insurance (OR [95% CI] = 2.44 [1.08-5.49], P = 0.03) and the use of monotherapy (OR [95% CI] = 7.24 [1.70-30.8], p= 0.007). Duration of diabetes, age and BMI were not associated with glycaemic control in this study. The majority of patients had poor glycaemic control in this population. Health care resource allocation to diabetes and counseling patients to engage in physical activity are important to improve glycaemic control in type 2 diabetic patients.