Master Dissertations

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Accuracy of clinical methods for the estimation of fetal weight in single tone pregnancy at term at Iringa regional referral hospital
(The University of Dodoma, 2019) Abdalla, Hassanat Mohammed
Background: Prediction of fetal weight accurately is an important parameter in planning proper managements of labor and delivery, so as to reduce the rate of complications associated with the delivery of macrosomic or low birth weight fetus especially in second stage of labor and during puerperium. Fetal weight can be estimated correctly by various clinical methods but require selection of the valid method. In the present study, an effort was done to find which formula is more accurate in estimating fetal weight as compared to actual birth weight. Objectives: This study aimed to assess the accuracy of clinical methods for the estimation of fetal weight in single tone pregnancy at term. Methods: This analytical cross section study with quantitative research approach was conducted on 401 single tone pregnant women by a convenient sampling technique in latent phase of labor or who were admitted for elective cesarean delivery with a gestational age of 37- 40 weeks. Structured questionnaire was used to collect social demographic characteristics, fetal weight was estimated clinically by Johnson’s, Insler’s and Dawn’s formula and actual birth weight was measured within 15 minutes after delivery. Analysis was done by SPSS vision25; frequency and percentage were used to present categorical variables. Wilcoxon signed-rank test was used to find the similarities and mean absolute error and mean absolute percentage error was used to find the accuray. P-value of< 0.05 was considered significant. Results: The mean weights obtained from three formulas under the study were compared with the mean of actual birth weight. Mean of Johnson’s formula (3.470kg) and Insler’s formula (3.412 kg) were almost similar to the mean actual birth weight (3.18), while Dawn’s formula had higher mean birth weight (4.574kg). Also correlation between three formulas and actual birth weight was done by Pearson’s correlation coefficient (r) which found to be 0.495, 0.508 and 0.479 for Johnson’s, Insler’s and Dawn’s respectively. Mean absolute error and mean absolute percentage error was used in order to find the accuracy of the formulas hence Johnson’s formula found to have less error in all birth weight categories followed by Insler’s except in underweight and Dawn’s being the least. Conclusion: In this study it was found that Johnson’s found to be more accurate than the other formulas in estimating fetal weight.
Adequacy of fluid resuscitation and outcome of emergency surgical patients, attended at Iringa regional referral hospital
(The University of Dodoma, 2020) Haule, Clemence Herman
Background: Fluid resuscitation is an extremely important part of patients management in clinical settings. Different common surgical conditions e.g. excessive vomiting and acute severe hemorrhage, can lead to an increased fluid loss and disturb the patients physiological status leading to worse outcomes. Proper fluid administration to a surgical patient, can lead to patients improvement from their illness, and hence reducing morbidity and mortality which are the main problems. Therefore, this study was assessing Adequacy of Fluid Resuscitation and Outcomes of Emergency Surgical Patients, Attended at Iringa Regional Referral Hospital. Methods: A hospital-based descriptive cross sectional study design of 162 emergency surgical patients was conducted at Iringa Regional Referral Hospital in Tanzania from February 2019 to April 2020 Results: Among the 162 study participants who were studied, majority 44 (27.2%) had intestinal obstruction while the least group had wet foot gangrene 2(1.2%). The rest were Peritonitis, Appendicitis/appendicular abscess, Chest injuries, Visceral injuries and multiple cut wounds (22.8%, 14.2%, 13.6%, 9.3%, 8.6%) respectively. Fluid resuscitation caused changes in pulse rate (96.16 ± 14.295 vs. 86.70 ± 22.441), respiratory rate (21.02 ± 2.796 vs. 18.96 ± 2.796), SBP (101.81± 20.727 mmHg vs. 106.70 ± 22.441 mmHg) and DBP (62.54 ± 13.648 mmHg vs. 65.12 ± 18.152 mmHg), MAP (75.254 ± 15.459 mmHg vs. 78.778 ± 21.4426 mmHg) and temperature 37.10± 1.159 vs.35.756±7.068 as from the time of admission and 24 hours post resuscitation. Conclusion: This study has shown a significant improvement of patients clinical conditions following fluid administration basing on vital signs, from time of admission up to 24hrs post resuscitation. Personalized fluid administration in patients requires clinicians to integrate abnormal physiological parameters into a clinical decision making. The physiological parameters include; vital signs, urine output and body weight recordings.
Aetiology and predictors of early surgical outcomes of pediatric hydrocephalus at Benjamin Mkapa hospital and Muhimbili orthopaedic institute
(The University of Dodoma, 2022) Rashidi, Salim
Ventriculoperitoneal shunt surgery is the mainstay treatment modality of pediatric hydrocephalus in low and middle-income countries. This treatment is effective, but it has complications. The aim was to determine the early surgical outcomes of Ventriculoperitoneal shunt surgery and the predictors of poor outcomes. This was a prospective, hospital-based study, that included pediatric hydrocephalus patients treated with Ventriculoperitoneal shunt at Benjamin Mkapa hospital and Muhimbili orthopaedic institute from October 2021 to June 2022. Early surgical outcomes and predictors of poor outcomes of Ventriculoperitoneal shunt surgery were analysed and presented in tabular and descriptive forms. A total of 138 patients were operated on with ventriculoperitoneal shunt with a median age of 5.5 months(interquartile range 2 to 11 months). The mean time from diagnosis to surgery was 31.9±4.5. The etiologies of hydrocephalus were post infectious(49.28%) non-postinfectious (23.91%), myelomeningocele(14.49%), and hydrocephalus of prematurity(1.45%). Early surgical outcomes were hunt infection (33.3%), mechanical shunt failure(10.9%), surgical site infection(11.05%), and mortality related to ventriculoperitoneal shunt surgery (6.5%). The independent predictors of poor surgical outcomes of Ventriculoperitoneal shunt surgery were post-infectious hydrocephalus, myelomeningocele, poor nutritional status, haemoglobin level below 9g/dl and delayed time from diagnosis to surgery. Shunt infection is the main complication of Ventriculoperitoneal shunt surgery. Poor early surgical outcomes are associated with post-infectious hydrocephalus, myelomeningocele, poor nutritional status, haemoglobin level below 9g/dl, and delayed time from diagnosis to surgery. Further studies are recommended to determine the predictors of Ventriculoperitoneal shunt infection which is the most common complication of Ventriculoperitoneal shunt surgery. Alternative surgical treatment for patients with myelomeningocele, post infectious hrocephalus, hemo
Anatomical pattern of placenta and umbilical cord in relation to fetal adverse outcome in Dodoma regional referral hospital.
(The University of Dodoma, 2020) Komba, Joseph M.
Background: Placenta and umbilical cord are highly specialized organs of pregnancy which support the normal growth and development of the fetus. Any alteration in gross anatomy of the placental appearance, location, number of cotyledons, weight, thickness and circumference and umbilical cord length, entanglement, nuchal cord, cord knots, thickness, insertion and number of umbilical blood vessel may result into adverse fetal outcome such as birth weight, Apgar score and fetal status. The gross anatomy of placenta and umbilical cord are routinely not examined. Objective: The study intended to determine anatomical pattern of placenta and umbilical cord in relation to fetal adverse outcome at Dodoma Regional Referral hospital. Methodology: It was a quantitative cross-sectional study involving pregnant women admitted in labor ward. It employed simple random sampling technique by lottery method to recruit sample size of 300 term single tone pregnant women without no comorbidities. A structured questionnaire and sonoscape E2 ultrasound machine with color Doppler system were used to collect data and SPSS program version 21 was used during data entry and analysis. Result: In this study majority of participants were aged between 21-30 years with the mean age of 25.46 and the median age of 23.00 ±7.017. BMI, cord length and cord entanglement were significantly associated with fetal status (P<0.05). Also it was found that BMI, placental appearance, cord entanglement and cord length were significantly associated with Apgar score (P<0.05).Furthermore BMI, parity, number of cotyledon, placental shape and placental circumference were significantly associated with birth weight (P<0.05). Conclusion and recommendations: A study revealed that, abnormalities of the gross anatomical pattern of placenta and umbilical cord are significant contributors to fetal outcomes. So efforts prior to and during pregnancy to prevent stillbirth, low Apgar score and abnormal birth weight will be most effective in conjunction with effective monitoring interventions in pregnancy.
Antenatal care services utilization and their associated factors among postnatal women in Dodoma city, a cross-sectional study
(The University of Dodoma, 2023) Kimario, Athanasia D.
Introduction: Antenatal care is an essential component of maternal and child health services, aimed at ensuring safe pregnancy and childbirth. In 2016, the World Health Organization (WHO) updated its antenatal care guidelines to improve the quality and effectiveness of antenatal care services. Thus, the aim of this research study was to assess the utilization of antenatal care services in line with the antenatal care guidelines among postnatal women. Methods: An analytical cross-sectional study design was employed. A face-to-face data collection approach using an interviewer-administered questionnaire and the abstraction of data from the ANC card was used to collect relevant data from 426 postnatal women. Data were collected using a researcher developed questionnaire based on information from the literature and the ANC guideline of 2018. Results: Most women received education about the use of bed nets to prevent malaria during pregnancy (92.9%, n = 247) and received the Tetanus Toxoid (TT) vaccination (86.8%, n = 231) during the first trimester. Nevertheless, in the second trimester, SP medication (90.8%, n = 387) and mebendazole medication to treat or prevent parasitic infections (90.1%, n = 384) were the most prominent services given to women during the second trimester. As for the third trimester, most of the women (> 85%) received the recommended intervention services for the third trimester. The majority of the postnatal women (63.2%, n = 266) initiated ANC visits during their first trimester of gestation (less than 12 weeks). Only 6.8% (n =29) of postnatal women were able to meet the minimum of 8 contacts as recommended by the WHO. Availability of an ANC support person was associated with early initiation of ANC services (AOR = 1.726, 95% CI = 1.055-2.822, p = 0.030), whereas living more than 5 km was associated with high frequency of ANC contacts (AOR = 3.890, 95% CI = 1.168, 12.958, p = 0.027). Conclusion: Adequate utilization of antenatal care services is vital to achieving good maternal and child health outcomes in developing countries such as Tanzania. By addressing the factors identified in this study, policymakers and healthcare providers can work together to enhance and ultimately improve maternal and child health outcomes.
Assesments of direct health facility financing programme on the determinants of healthcare workers motivation at primary health facilities in Kigoma region Retrospective pre- post design
(The University of Dodoma, 2021) Nyakunga, Rashda Zakaria
Globally, motivation of workers has variables based on high wages, financial reimbursements; non-monetary assistance, promotions, job training and development, and challenging tasks that are accountable for the overall motivation of employees. This dissertation aimed to assess the Direct Health Facility Financing programme on the determinants of healthcare workers’ motivation in the Kigoma Region. A retrospective pre-post design was used coupled with both qualitative and quantitative approaches. The study involved 188 healthcare workers from 43 primary health facilities. An interviewer-administered questionnaire was designed and conducted on 188 healthcare workers and in-depth interviews were done with 30 healthcare workers who had enough knowledge on the operations Direct Health Facility Financing. The determinants of motivation and Direct Health Facility Financing programme were measured through Likert scale ratings prior to and post Direct Health Facility Financing. Quantitative data analysis was done by using the Statistical Package for Social Sciences (SPSS) 26.0 version. Qualitative data were analyzed using the thematic analysis method whereby the recorded data were transcribed and coded to generate themes that helped to answer the research questions. A paired t-test and multiple linear regression model were performed. Healthcare workers in Kigoma are dominated by youth 31.4%, and a majority of them are females (60.6%). Further, a majority of healthcare workers are Certificate holders (61.7%) while Diploma holders are 35.1% of all healthcare workers. The analysis of the data obtained shows that the difference in commitment prior to and post the programme is statistically significant (p=< 0.001). Thus, there was improved overall job satisfaction post-Direct Health Facility Financing (P=0.004). The level of burnout has decreased post-Direct Health Facility Financing. The decrease is statistically significant (P = 0.0320). Health workers perceive decreased workload post Direct Health Facility Financing. Further generalized linear regression results indicated that demographic information and years in employment were not predictors for determinants of health care workers motivation in Kigoma region. Direct Health Facility Financing has positively affected job commitment, job satisfaction, and burnout of healthcare workers in the Kigoma Region.
Assessing factors for adherence to antiretroviral therapy among adolescents and young adults (aged 10-24) in Tanzania: retrospective cohort study (2016-2020)
(The University of Dodoma, 2022) Daud, Elia
Adherence to ART is vital for combating HIV pandemic and reducing incidence of the disease. Effective and sustainable adherence to ART is a viable mechanism for viral suppression and for subsequent benefits which include immune restoration, prolonged survival, reduced resistance, improved quality of life and prevention of further HIV infections. This study therefore, intends to examine factors for adherence to antiretroviral therapy among adolescent and young adults (aged 10-24) receiving care in Tanzania. The study employed retrospective cohort study design where as data for this study was extracted from the CTC2 database held by MOH under NACP. The total of 100624 clients involved in this study. The adherence level for adolescent and young adults was about 82%. The findings indicated significant association between demographic factors.Thus, female has better adherence to ART than male(aRR=1.42, P<0.001), Clients aged 15-19 and 20-24 are less adherent to ART than those aged 10-14 (aRR=0.92, p<0.001 and aRR=0.80, p=0.024 respectively). Clinical factors and frequency of service delivery also were significant associated with adherence to ART(P<0.05). In clinical actors, clients not initiated ART on Same day and those confirmed TB were less adherent to ART (aRR=0.78, p<0.001) and (aRR=0.35,p=0.001) respectively. The risk of adherence for clients initiated 3MMD (aRR=1.53, p<0.001) and those in 6MMD (aRR=1.42, p=0.001) were bether than their references category. The findings suggest lagging bellow 95% overall adherence to ART for adolescents and young adults and mostly influenced by demographic and clinical characteristics and frequency of service delivery. The findings evolved the need for in-depth understanding of adolescent and young adult’s challenges on adherence to ART. There is need to address adherence to ART in equitable manner among type of health care facilities and ownerships.
Assessing factors influencing mental healthcare seeking behavior using health belief model among caretakers of mentally ill patients in Zanzibar: an analytic cross-sectional study
(The University of Dodoma, 2021) Bakar, Said Shah
The statistics show that 450 million people around the globe are suffering from mental disorders. These victims require formal treatments from trained professionals in collaboration with patients caretakers. However, the literature demonstrates that caretakers are conflicted by traditions and modernity influences in managing mentally ill patients at home. Research is thus important to understand the factors which influence mental health seeking behaviour among community members. To use Health Belief Model to explain factors influencing mental health seeking behavior among caretakers of mentally ill patients in Zanzibar. A community based analytical cross-section study design was used to generate data from 246 randomly selected caretakers in Zanzibar. A 30 items semi-structured questionnaire was used for data collection while a statistical package for social sciences (SPSS v. 23) software was used for analysis. Bivariate and Multivariate Logistic regression was used to assess the factors influencing mental health seeking behaviour. A majority of caretakers, i.e. 145(58.9%), had inappropriate mental health seeking behavior. 157(63.8%), 139(56.5%), 198(80.5%) and 156(63.3%) of caretakers were aware of formal mental treatment, perceived formal mental treatment to be not beneficial, perceived barrier to access formal mental health treatment and perceived mental illness to have severe complications respectively. After adjusted for confounders, the factors which influenced mental health seeking behaviour were awareness on formal mental health treatment [Not aware (AOR = 0.907 at 95% CI: 0.406-10.009; p<0.004) compared to those who were aware and perceived severity (AOR = 4.635; p<0.01; 95%CI: 2.397, 9.021) compared to those who perceived mental illness to have no severe complications. Despite a majority of caretakers were aware on formal mental health treatment, still a majority of the respondents had inappropriate healthcare seeking behavior. Moreover, on the perceptions, a majority of the respondents perceived formal mental health treatment to be not beneficial, perceived barrier on accessing them and that mental illness had no severe complications. Of the health belief variables, only awareness and perceived severity significantly influenced mental health seeking behavior. The study recommends Health facilities to establish home basic care activities to the mentally ill patients in the community. This would help the caretakers to receive knowledge to the specialist on how to care psychiatric patients at home to avoid severe illness of the mental illness, to prevent relapse cases , to make life easy to the patient and community at large and to avoid complication and death.
Assessing patterns, facilitators, and barriers of electronic documentation among nurses in the postnatal ward at Dodoma regional referral hospital: A mixed methods study in Dodoma
(The University of Dodoma, 2023) Mrema, Margareth C.
Background: Electronic documentation, which involves computerized systems for managing patient information, is of global importance in healthcare, impacting the continuity of care, decision-making, and resource allocation. Despite its widespread adoption, nursing professionals face barriers, including limited knowledge, experience, resources, and motivation for system utilization. This study examines electronic documentation patterns, facilitators, and barriers among nurses at Dodoma Regional Referral Hospital in Tanzania. Objective: Assessing the pattern, facilitators, and barriers of electronic documentation on decision-making among nurses in the postnatal ward at Dodoma regional referral hospital. Methods: This mixed-methods study employed a concurrent triangulation design, utilizing both quantitative and qualitative data collection methods. Quantitative observation involved the use of a checklist, while qualitative insights were gathered through interviews using an interview guide. The data used was from January to June; eight electronic documentation items were assessed for each component. Quantitative data involved the collection of 400 secondary data points from the electronic health management system, analyzed using descriptive statistics (frequency, percentage), and presented in tables. Qualitative data was examined through thematic analysis based on interviews with eight nurses in the postnatal ward. Results: The study found that when assessing the implementation of electronic documentation, all seven components had high documentation rates for social demographic data related to postnatal women. However, other components had lower documentation rates, and some data was completely absent in electronic documentation. Nurses identified facilitators such as time-saving electronic health systems and easy access to patient data. Conversely, barriers included resource shortages, workload, lack of training, and technical issues. Notably, the highest observation rate was for social demographic data at 88.4; 4.7 (11.1,100), while labor records had lower observation rates across all components. Conclusion: This study highlights the use of electronic documentation in nursing, revealing that while completeness rates are high, satisfaction with electronic documentation falls short in other aspects. Facilitators include improved task efficiency, quick access to patient data, and data utilization for reports. However, barriers such as resource shortages, heavy workloads, and limited knowledge hinder electronic documentation adoption among nurses in postnatal wards.
Assessing self care practices, lifestyle behaviors, and cost evaluation among adults attending hypertension clinics in selected hospitals in Tanzania.
(The University of Dodoma, 2020) Shilole, Joseph Nyanda
Hypertension is a serious public health problem in Tanzania. Adherence of the recommended self-care practices is beneficial against poor health outcomes and health care expenditures among hypertensive patients. This study assessed the self-care practices, lifestyle behaviors and cost Evaluation among adults attending hypertension clinics in selected hospitals in Tanzania. A mixed approaches cross-sectional study involved 329 participants carried from June to September 2020. An interviewer questionnaire was conducted to 311 patients. The in-depth interviews with 18 informants were conveniently sampled in clinic visit at Dodoma and Amana Regional Referral Hospital. Self-care practices were assessed by H-SCALE endorsed by the Seventh Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7). The lifestyle behaviors and cost evaluations were assessed by WHO steps survey standard questionnaire. The SPSS, version 26 was used while the audio records were transcribed and coded depending on themes of the study. The mean age of hypertensive patients was 53.6 ± S.D 7.5 years. Females were 58.8%. Only 17.7% had good compliance with recommended lifestyle behaviors related to hypertension. Regular physical activities were 37.9% adhered and22.2% adhered the consumption of fruits and vegetables. The hypertensive patients 71.1% had adequate knowledge of self-care practices. Overall, 25.1% of the hypertensive patients had good self-care practices. The study revealed that patients with family history and adequate knowledge were more likely have good self-care practices (AOR=2.517, CI=95%, 1.255-5.045,p-value 0.009), (AOR=2.776, CI=95%, 0.818-5.399, p-value 0.003). Hypertensive patient’s catastrophic health expenditure was 8.4%. The total cost payments in the form of out of pocket were 183216Tsh (US$ 79.35) per year. Majority of hypertensive patients had poor self-care practices and low compliance with the recommended lifestyle behaviors. This finding shows a need for health promotion interventions and increases the health insurance coverage.
Assessing the factors associated with knowledge, attitude and skills on neonatal resuscitation among nurse midwives in Dodoma region: hospital-based analytical cross sectional study.
(The University of Dodoma, 2021) Mbinda, Mathias Anthony
The neonatal period is the most vulnerable time for a child’s survival because of the highest mortality and morbidity. Quarters of the global neonatal mortality is attributed to birth asphyxia due to failure of neonatal resuscitation; the highest burden of which is disproportionately concentrated in low and middle-income countries including Tanzania. Inadequate skills on neonatal resuscitation due to incompetent health care providers contributed significantly to this asphyxia-related mortality and morbidity. The study aimed at assessing the factors associated with knowledge, attitude and skills on neonatal resuscitation among nurse midwives in the Dodoma region, Tanzania. Hospital-based cross-sectional study design was employed among 340nurse/midwives selected by multistage sampling technique. A self-administered questionnaire and Observation checklist were used to collect data. Data were coded and entered into SPSS version 20 for analysis. Bivariate and multivariate logistic regression was used to assess factors associated with nurse/midwives' skills in neonatal resuscitation. Among 340 respondents (n=321, 94%) had adequate knowledge on neonatal resuscitation (n=290, 85%) had positive attitude on neonatal resuscitation while only (n=141, 41%) had adequate skills on neonatal resuscitation. After adjusted for confounders, factors associated with nurse/midwives knowledge was only the level of professional training, those with bachelor degree were 5 times to be knowledgeable (AOR=5.51, p<0.03) compared with those with certificate level of profession training. Factors associated with nurse/midwives’ positive attitudes were level of health facility [health centre (AOR=0.222, p<0.006), and Hospital (AOR=0.324, p<0.035)] compared to those working in dispensaries. Factors associated with adequate skills were; age of the midwives [20-34(AOR=O.082, p<0.008) and 35-49, (AOR=0.087, p<0.010)]; Being married (AOR=0.459, p=0.031); Working experience [worked 4-6] (AOR=2.905, p<0.003)and 10> years and above (AOR=12.825, p<0.000)]; working in District hospitals (AOR=1.544,p=0.032); Distance from place of residence [6-10km (AOR=0.090, p<0.001) and > 16km(AOR=0.049, p<0.001)]; Number of midwives per shift, ≥4(AOR=2.396, p=0.012) and Number of deliveries per day [6-10 (AOR=1.385, p<0.031), 11-20 (AOR=2.693, p<0.016)and >20 delivery per day (AOR=6.007, p<0.001) and knowledge on neonatal resuscitation [adequate knowledge were 3 times more likely to have adequate skills (AOR=3.87, p<0.041) compared to nurses with inadequate knowledge. The study had revealed that the majority of nurse midwives had adequate knowledge, positive attitude, and less than half of interviewed midwives had adequate skills on neonatal resuscitation. Moreover the study had shown that Nurse Midwives, who were young, married, with less than four years of working experience, working in dispensaries, living more than five kilometres from the working facility, fewer than four midwives per shift, and assist six deliveries per day were less likely to have good skills on neonatal resuscitation. The study recommends a deliberate effort to come up with a cost-effective strategy to empower these midwives on neonatal resuscitation in all aspects of knowledge, attitude and skills.
Assessment of administrative competencies among nurse managers in tertiary hospitals in the central and northern zones of Tanzania: a cross-sectional study
(The University of Dodoma, 2017) Ngowi, Fina Zacharia
Background: This study aims to determine the administrative competencies of nurse managers, working in Tertiary Hospitals of Tanzania. Method: this was cross sectional study design with quantitative research approach. Simple randomly sampling was employed to select two zones out of the five zones listed in Tanzania. Purposive sampling method was used to select three public tertiary hospitals and nurse (N=276). Standardized structured questionnaires were used as main data collection tool. Data were analyzed by using Statistical Package for the Social Sciences (SPSS) Version 20. Results: Study revealed that, majority of nurse managers lacked knowledge on administrative competencies. Out of (N=276) nurse managers, 54.3% (N=150) were observed to have poor knowledge on administrative competencies as compared those who had knowledge. Moreover most of nurse managers were observed to have good knowledge in coordinating 71.4% (n=194), followed by planning 22.1 %( n=61) and organizing being the last 17 %( n=48). Nurse manager aged 45+ years old were three times more likely to have a good knowledge on administrative competencies, (AOR=3.297, 95%CI=0.580-4.289, p=<0.05) as compared to other aged groups. Additionally nurse managers with Bachelor and above were four times more likely to have good knowledge on administrative competencies (AOR=3.681, 95% CI=0.045-5.896, p=0.05), as compared with other educational levels. Furthermore nurse manager had working experiences for 21+ years were three times more likely to have good knowledge on administrative competencies (AOR= 3.412,95%CI=1.482, p=0.05) higher than others. Conclusions: it was observed that age, working experience and education level of the nurse managers had positive influence on administrative competencies particularly knowledge. Keywords: Nurse Manager, Administrative competencies, Hospital Management, Planning, Organizing and coordination.
Assessment of commitment and capability of regions and councils to deliver nutrition services in the context of multisectoral nutrition governance in Tanzania: experience from the 2019-2020 budget cycle.
(The University of Dodoma, 2020) Ramadhani, Samsambia
The problem of malnutrition still persists in Tanzania mainland. Tanzania is not the only country suffering from the problem of malnutrition, at least one form of malnutrition if not many is identified in every country across the world. Millions of under-fives die every year from malnutrition and those who manage to survive fail to reach their full potential when reaching adulthood due to undernutrition. Good nutrition governance is an important component in fighting against malnutrition. Good nutrition governance embraces multisectoral collaboration but the challenge remains on the government to build adequate commitment, collaboration among actors for nutrition as well as setting up capabilities to work on these commitments. This study assessed the level of commitment and capability among regions and councils to deliver nutrition services in Tanzania mainland. A cross sectional study designed which involved a national survey where all councils and regions were involved was conducted in Tanzania mainland between June and July 2020. A total of 184 councils and 26 regions were invited to participate in a study and only 116 councils and 21 regions qualified to participate in this study. The same number of nutrition officers from these regions and councils responded to questions assessed nutrition officers. Quantitative data collection approach was used to collect quantitative data by the help of employed web based structured questionnaire. Result showed that, 38.1% of regions had very high level of commitment while 9.5% of council were regarded to have very high level of commitment in Tanzania mainland. 4.8% of region had the least level of commitment to deliver nutrition services while 4.3% of councils had the lowest commitment level in Tanzania mainland. Level of commitment were grouped from first group which was considered to have higher level to fourth group among regions and to seventh group among councils with very lower commitment levels. About 81% of regions had capabilities to provide nutrition services while 46.6% of council had capability. Only 38.1% of regions and 49.1% councils were identified that they offer nutrition services in Tanzania mainland while the rest offer inadequately. The study also found the relationship between the level of commitment and provision of nutrition services in Tanzania mainland with the significance of 0.001 p- value. The level of commitment of regions is seen to be very high compared to councils. Councils coming from rural area have low level of commitment to provide nutrition services than councils coming from urban area. Councils having low level of commitment provided less nutrition services compared to councils having higher level of commitment. Tanzania mainland still have inadequate capability to provide nutrition services to the people.
Assessment of competence on utilization of partograph among finalist nurse students within the selected nursing institutions in Tanzania: a cross sectional study
(The University of Dodoma, 2017) Mtaita, Stella Edward
Introduction: Partograph as a labour record chart that works as an important tool, when used correctly, could help to identify any abnormality when labour is no longer normal and immediate decision is made for action. Nevertheless, very little is known about the status of knowledge and utilization of partograph among finalist nurse students. Objectives: This study aimed to assess the competence on utilization of partograph among the finalist nurse students in Tanzania; this study was conducted in the United Republic of Tanzania Mainland. A cross-sectional study was conducted to 13 schools of nursing, with a total of 753 participants volunteered. Methodology: Sampling was done to obtain the zones and Institutions. Independent and dependent variables utilized. Semi-structured questionnaires were administered; collected data were analyzed by using SSPSS 20 version. Results: The study revealed that, 73.44 % had a good knowledge, while 26.56% had poor. However diploma program had a good knowledge 481 (85.69%) than undergraduate 122 (48.80%). A chi-square test revealed that, there was a statistically significant with p-value of <0.0001. Concerning skills, diploma program had higher skill 398 (79.13%) while undergraduate 161 (64.40%), with p-value of < 0.0001. Regarding factors; occupation (P=0.0032), availability of partograph forms (P =0.0028) and clinical supervision (P = 0.0223) were the affirmed predictors. Conclusion: Findings are sufficient to propose the drawn recommendation to improve competence on the utilization of partograph among student nurses,
An assessment of competencies of clinical instructors in teaching and guidance for nursing students in clinical areas: a cross-sectional study in Tanzania
(The University of Dodoma, 2017) Mligo, Rehema Cornery
Nursing student’s clinical competence including psychomotor skills, attitude, values, and beliefs of professional practices depend on the quality of clinical instruction given by their preceptors in clinical settings. The main objective was to assess the Tanzanian clinical instructors’ teaching abilities and attitude towards the clinical teaching and guidance of nurse students at clinical areas. It was a cross-sectional study design with quantitative approach. A total of 277 clinical instructors were sampled and voluntarily participated in this study. Data were obtained through semi-structured questionnaires. The analysis was carried out by the Statistical Product of Social Solution (SPSS) version 20. Findings indicated that none of the clinical instructors reported to pass through any short course of clinical teaching or use a clinical guideline for teaching nurse students at the clinical area (0.0%). Clinical instructors recruited as full-time who Employees could more likely develop appositive attitude towards clinical teaching and guidance of nurse students at clinical areas (AOR = 1.802, p<0.05, CI: 0.977, 3.323) as compared to part-time clinical instructors. Clinical teaching experience (p<0.01) and clinical instructors education level (p<0.01) were also observed to influence positive attitude towards clinical teaching and guidance of nurse students at clinical areas. Nevertheless, being employed as a full-time clinical instructor could enhance clinical teaching abilities (AOR = 2.348, P<0.01, CI: 0.420, 3.863). Moreover, the clinical experience could also influence clinical teaching abilities of clinical instructors (AOR = 1.948, P<0.05, CI: 1.420, 3.863). This can be concluded that full-time employment of clinical instructors is better than part-time in determining the attitude and clinical teaching abilities whereas, the more clinical instructors advance their education level and stay longer at work could predict positive attitude and good clinical teaching abilities of nurse students at the clinical area. There is a need to design, develop and implement clinical instructor courses as well as a clinical guideline which can help produce qualified clinical instructors and thus promote the quality of clinical teaching of nurse students at clinical areas.
Assessment of educational opportunities associated with job satisfaction and burnout among practicing nurses: A cross-sectional study in lake zone, Tanzania
(The University of Dodoma, 2018) Lunyilija, Mashaka Hirary
Introduction: Lack of nurses' job satisfaction and burnout in hospitals accelerate to low retention of workers. Unavailability of education opportunities is considered to be one of contributors of dissatisfaction and burnout among these nurses. Aim: This study intended to explore more on educational opportunities associated with job satisfaction and burnout among practicing nurses in Lake Zone. Methodology: Analytical quantitative cross-sectional study design was used. 416 Nurses were selected randomly and questionnaires were distributed for them in data collection with a response of 100%. Muller and McCloskey Satisfaction Scale (MMSS) (1990) was used for job satisfaction assessment. Prevalence of burnout inventory scale (Maslach, 1993) was also used. SPSS version 25 was used for data analysis. Results: Findings revealed that, 65.6 % of participants accepted that they have access to educational opportunities and 53% dissatisfied with their working health facilities followed by 47% who were satisfied. Likewise, on prevalence of burnout, indicated that 70.9% of respondents experienced lower level of emotional exhaustion. Moreover, results in personal accomplishment showed that, nurses were indicated higher level of burnout and lower level of depersonalization shown in practicing nurses in Lake Zone as well as a cardinal sign of burnout prevalence among them. Conclusion: Based on the study findings, it was concluded that lack of educational opportunities, job satisfaction and existance of burnout among practicing nurses in Lake Zone cause many problems. Study had shown that nurses in hospitals that investigated were not satisfied with their jobs as resulted into burnouts. However, study recommended that determinants of job dissatisfaction and burnout must be addressed for job retention and improvement by policymaker, hospital management and professional associations.
Assessment of essential newborn care competence and its associated factors among nurses/ midwives in Zanzibar: analytical cross-sectional study
(The University of Dodoma, 2021) Bakari, Salama Ame
Newborn health and well-being are important for growth and development of the infant. However, evidence indicates that nurses and midwives do not effectively practice and observe the WHO recommendations for essential newborn care. The aim of this study was to assess competence of Essential Newborn Care among nurses and midwives in Zanzibar. A hospital-based analytical cross-sectional study was conducted from January to February 2021 in Zanzibar by involving 246 nurses-midwives. One tertiary hospital and one regional hospital were involved in this study, whereas simple random sampling was used to select primary health facilities. Structured self-administered questionnaire was used to generate the data. The predictors of essential care competence were determined using Binary Logistic regression under multivariate analysis using SPSS version 23.0. The P<0.05 was considered to be significant. A total of 246 nurses/midwives participated in this study. Among them, 27% had inadequate essential newborn care practice and 36% had knowledge related to essential newborn care. Further analysis revealed that 40% of nurses/midwives had positive attitudes towards essential newborn care. The factors influencing ENC. Knowledge of nurses are professional qualification (AOR=8.83, 95% CI=2.00-38.96, p=0.004), present of guideline (AOR=3.52, 95%CI= 1.59-7.80, p=0.002). Attitude of nurses of essential newborn care are residence of participates (AOR=0.17, 95%CI= 0.07-0.38, p=<.0001), availability of equipment (AOR=0.24, 95%CI=0.10-0.55, p=), shortage of staffs (AOR=0.06, 95%CI= 0.02,0.25, p=<.0.001) and Practice of nurses are residence of participants (AOR=3.3, 95%CI= 1.16-9.09, p=0.0242), shortage of staff (AOR= 0.80, 95%CI = 0.02-0.32, p=0.0003) adequate knowledge (AOR=2.80, 95%CI = 1.15-6.84, p=0.0235) and positive attitudes (AOR=3.59, 95%CI=1.52-8.53, p=0.0037) were significantly associated with essential newborn care competence. The nurses and midwives participated in this study demonstrated had low competence of essential newborn care in Zanzibar. While there predictors of essential newborn care were profession qualification, lack of guidelines, area of residence, shortage of staff, inadequate knowledge and negative attitude.
Assessment of infant and young child feeding practices among the caregivers with children aged between 0 to 24 months in Njombe region of Tanzania
(The University of Dodoma, 2021) Jaffar, Suleiman Simai
Proper feeding practices during early childhood age including infancy are a foundation for ensuring optimum growth and development of the children. Despite the successful achievement in reduction of childhood diseases, malnutrition in young children has remained a challenge in Tanzania. Thus, this study assessed infants and young children’s feeding practices among caregivers with children aged 0 to 24 months in Njombe regions of Tanzania. Across-sectional study design involving 330households with mothers/caregivers of children aged between 0–24 months was conducted in Njombe Region from January to February 2021. Quantitative data were collected using semi-structured interviews and opportunistic observations among mothers/caregivers using the proPAN tool and analysed using the statistical product for service solution computer software version 20 (SPSS). Inferences were drawn at 95% confidence interval with a significant level of 5%. Three hundred and thirty (330) sampled caregivers who had infants and young children aged between 0 and 24 months were included in the study. This is a response rate of 97.6% of the intended sample. The overall proportion of the appropriate infant and young child feeding practices was 83%. The middle aged (AOR = 1.527; 95%CI (1.377,6.063)), adult aged (AOR=2.731; 95%CI (2.549,7.459)), secondary education (AOR = 2.059, 95%CI (1.478,5.561)), attendance of ANC care services for three times (AOR=3.313; 95%CI(2.074, 6.226)) caregivers who visited ANC care four times (AOR=2.019; 95%CI (1.398, 5.121)) and those caregivers who work at the office (AOR=3.371; 95%CI(1.130, 6.218)) were positively associated with the appropriate infant and young child feeding practices. A majority of caregivers with children aged between 0 to 24months practiced infant and young child feeding practices while very few caregivers practised exclusive breastfeeding, minimum acceptable diet, and consumed iron-rich foods. Therefore, there is a need to establish sensitization programmes and projects among mothers and caregivers to improve infant and young children feeding practices.
The assessment of interest, motivation level and perceived stress during clinical practice among nursing students in Tanzania: a cross-sectional study
(The University of Dodoma, 2017) Mtei, Goodluck Tumaini
Background: Nursing students faces number of challenges which are associated with interest conflict toward the profession, learning motivation and perceived stress during clinical practice Objectives: To assess the levels of interest, motivation and perceived stress during clinical practice among nursing students in Tanzania Methods: A cross-sectional analytical study design was used to assess levels of interest, motivation and perceived stress during clinical practice among nursing students. 1090 certificate, diploma and undergraduate nursing students attending clinical practice from selected nursing Schools and Universities were selected using convenient and simple random sampling. Results: About 49% of the respondents found to be interested to the nursing profession with 49.7% levels of clinical learning motivation, while the prevalence of perceived stress was 44.3%. Multivariate logistic regression has shown that, students from private institutions (AOR=0.542, p=0.0010) had significantly low stress. Female students were significantly affected by stress as compared to the male counterparts (AOR=1.335, p=0.0259). Undergraduate (AOR=1.940, p=0.0006) students were significantly associated with stress. Students who were not motivated to clinical practice had about 2 times higher odds of being stressed (AOR=1.785, p<0.0001). Conclusion and recommendation: This study has shown a relatively low level of interest to nursing profession and clinical learning motivation among student nurses with a low prevalence of stress during clinical practice.
Assessment of knowledge and skills on active management of third stage of labor among health care providers for prevention of post-partum haemorrhage in lake zone Tanzania
(The University of Dodoma, 2019) Muyanga, Daniel Lugwesa
Introduction: Globally, by 2015 the maternal mortality ratio is estimated to be 216 per 100,000 live births. In Tanzania was approximately 556 per 100,000 live births; the leading cause was PPH approximately 25% of maternal deaths and uterine atony contributes 70% of PPH. These show that there are some limitations of knowledge and skills level on AMTSL among health care providers for prevention of PPH as it prevented more than 60% of PPH. Objectives: Assessment of knowledge and skills on active management of third stage of labour among health care providers for prevention of PPH in Lake Zone Tanzania. Methods: The research design was descriptive cross- sectional study. The study involved 340 participants who were obtained by convenient sampling. Regional, District hospital and health centers were selected by simple random technique, consultant hospital was purposefully selected. Data were collected using questionnaires and observational checklist. Results: The study found that, of all 340 participants, 171 (50.3%) had adequate knowledge, while 153(45.0%) had adequate skills on AMTSL among health care providers. Health care providers aged 45 years and above are (AOR 9.350,P< 0.009) times more likely to have adequate knowledge compared with health care providers aged below 25 years. Health care providers who works at hospital level are (AOR 1.779,P< 0.014) times more likely to have adequate knowledge than health care providers who works at health centres. On skills, male health care providers were 1.962(P< 0.009) times more likely to have adequate skills than female health care providers. Enrolled nurses have 70.2 % (P< 0.008) less likely to have adequate skills than medical Doctors. Conclusion: the magnitude of adequate skills on AMTSL is low, thus there is a need of improving the level of skills by clinical mentorship visits and bed side training to health care providers working in labour ward .

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