Browsing by Author "Mbwambo, Jessie"

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    Generating trust: programmatic strategies to reach women who inject drugs with harm reduction services in Dar es Salaam, Tanzania
    (Elsevier, 2016) Zamudio-Haas, Sophia; Mahenge, Bathsheba; Saleem, Haneefa; Mbwambo, Jessie; Lambdin, Barrot H.
    Strong evidence supports the effectiveness of methadone-assisted therapy (MAT) to treat opioid dependence, reduce the risk of HIV transmission, and improve HIV related health outcomes among people who inject drugs (PWID). HIV prevalence reaches 71% in women who inject drugs (WWID) in Dar es Salaam, Tanzania; creating an urgent need for access to MAT. Despite the availability and potential benefits of treatment, few women have enrolled in services. This formative research sought to identify programmatic strategies to increase women's participation in outreach and their subsequent enrollment in MAT. We conducted twenty-five, in-depth interviews with patients and their providers at a MAT clinic. Open-ended interviews explored enrollment experiences, with a focus on contextual barriers and facilitators unique to women. Ethnographic observations of harm reduction education at outreach sites and the MAT clinic enriched interview data. Trust/mistrust emerged as an overarching theme cross cutting patient and provider accounts of the connective process to enroll PWID in the methadone program. We explore trust and mistrust in relationship to the interrelated themes of family loss, social isolation, vehement discrimination and motivation for treatment. Narratives delineated both the generation of mistrust against PWID and the generation of mistrust in PWID against outsiders and medical institutions. In order to enroll PWID in treatment, community base organizations engaged outreach strategies to overcome mistrust and connect eligible patients to care, which varied in their success at recruiting women and men. Greater discrimination against WWID pushed them into hiding, away from outreach teams that focus on outdoor areas where men who inject drugs congregate. Building trust through multiple encounters and making a personal connection facilitated entry into care for women. Only PWID were eligible for MAT, due to resource constraints and the higher risk associated with injection drug use. Many women smoke heroin, yet still face high risk of HIV, resulting from low condom use during sex work to fund drug use. Expanding outreach times and locations, by women peers, could increase women's enrollment in treatment. Allowing women who smoke heroin to enter the program could prevent onward transmission via sex work and reduce the chance of progressing from the lower risk smoking or sniffing to injection drug use.
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    Physical, sexual, emotional and economic intimate partner violence and controlling behaviors during pregnancy and postpartum among women in Dar es Salaam, Tanzania
    (Public Library of Science (PLoS), 2016) Mahenge, Bathsheba; Stockl, Heidi; Abubakari, Abdulai; Mbwambo, Jessie; Jahn, Albrecht
    Intimate partner violence (IPV) during pregnancy and postpartum is a serious global health problem affecting millions of women worldwide. This study sought to determine the prevalence of different forms of IPV during pregnancy and postpartum and associated factors among women in Dar es Salaam, Tanzania. We conducted a cross-sectional study among 500 women at one to nine months postpar tum in three health facilities in the three districts of Dar es Salaam: Temeke, Kinondoni and Ilala. Two trained research assistants administered the questionnaire, which aimed to examine sociodemographic characteristics and different forms of IPV. Of the 500 women who were interviewed, 18.8% experienced some physical and/or sexual violence during pregnancy. Forty-one women (9%) reported having experienced some physical and/or sexual violence at one to nine months postpartum. Physical and/or sexual IPV during pregnancy was associated with cohabiting (AOR 2.2, 95% CI 1.24–4.03) and having a partner who was 25 years old or younger (AOR 2.7, 95% CI 1.08–6.71). Postpar tum, physical and/or sexual IPV was associated with having a partner who was 25 years old or younger (AOR 4.4, 95% CI 1.24–15.6). We found that IPV is more prevalent during pregnancy than during the postpartum phase. There is also continuity and maintenance of IPV during and after pregnancy. These results call for policy and interventions to be tailored for pregnant and postpartum women.
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    The prevalence of mental health morbidity and its associated factors among women attending a prenatal clinic in Tanzania
    (Wiley-Blackwell, 2015) Mahenge, Bathsheba; Stöckl, Heidi; Likindikoki, Samuel; Kaaya, Sylvia; Mbwambo, Jessie
    To establish the prevalence of symptoms of anxiety, depression, and post-traumatic stress disorder (PTSD) among women attending prenatal care in Tanzania, and identify associated factors. A cross-sectional study was conducted of one in five physically well women attending a prenatal-care clinic in Muhimbili National Hospital, Dar es Salaam, between December 2011 and April 2012. Trained research assistants carried out face-to-face interviews using a structured questionnaire. The Hopkins Symptoms Checklist and the PTSD Diagnostic Scale were used to establish levels of depression and anxiety symptoms. Among the 1180 women interviewed, 905 (76.7%) had symptoms of anxiety, 923 (78.2%) had symptoms of depression, and 58 (4.9%) had moderate/severe PTSD symptoms. After adjustment for women’s sociodemographic characteristics, age of the woman and their partner, educational level of the woman and their partner, relationship duration, employment, and marital status were associated with symptoms of at least one of the three mental disorders (P < 0.05 for all). Many pregnant women had symptoms of mental health disorders. Screening of mental health disorders during prenatal care and training of healthcare providers are needed.