Master Dissertations

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Prevalence and factors associated with cholelithiasis in children with sickle cell disease attending clinic at Dodoma regional refferal hospital
(The University of Dodoma, 2023) Mfugale, Zipora
Background: Cholelithiasis also known as Gallstones are a common consequence of chronic hemolysis in Sickle Cell Disease (SCD) and its variants. In our settings majority of children comes with cholecystitis which is one of the complication of cholelithiasis, but the real burden of cholelithiasis is not well. The purpose of this study was to determine the prevalence of cholelithiasis and associated factors in children with SCD in Dodoma. Methods: This was a hospital based cross-sectional study of 180 children aged 2 to 17years, from January 2023 to June 2023 (a period of 6 months) at Dodoma Regional Referral Hospital. Socio-demographic, clinical and laboratory data were collected using a semi structured questionnaire. Cholelithiasis was defined as curvilinear echogenic structures casting acoustic shadow in the liver which moved with a change in scan position by using a Phillips HD3 general purpose ultrasound scanner. Data analysis was done using SPSS version 25 and statistical significance was assumed for factors with p-value<0.05. Results: A total of 180 children were enrolled. Most of the enrolled children were males 112(62.22%). The mean age was 6.89±3.8 years ranging from 2 to 17 years. The prevalence of cholelithiasis was 12.22% (22 children) and age range between 10-17 years (AOR=6.831, CI [1.360, 34.326], p-value =0.0197), female sex AOR= 9.471, CI [2.271, 39. 507], p-value =0.0197), blood transfusion more than once in the past one year (AOR=5.959, CI [1.689, 21.023], p-value 0.0055), family history of gallstones (AOR=15.244, CI [1.565, 148.487], p-value 0.0190) and hepatomegaly (AOR=16.778, CI [3.140,89.655],p-value 0.0010) were factors independently associated with Cholelithiasis. Conclusion: Cholelithiasis is a common complication warranting regular screening among children with SCD attending clinic in Dodoma. Female sex, children aged between 10-17 years, blood transfusion more than once in a year, those with family history of gallstones and presence of hepatomegaly were more likely to have cholelithiasis.
Spontaneous bacterial peritonitis: prevalence, predictors and diagnostic performance of leukocyte esterase dipstick among patients with liver cirrhosis in tertiary hospitals, Dodoma, Tanzania
(The University of Dodoma, 2023) Mwinyi, Salum Ali
Introduction: Spontaneous bacterial peritonitis (SBP) is one of the important complications of liver cirrhosis. It associated with significant morbidity and mortality. This study aimed to determine the prevalence and predictors of SBP, and to evaluate the diagnostic performance of leukocyte esterase dipstick in diagnosing SBP among cirrhotic patients in tertiary hospitals, Dodoma, Tanzania. Methods: A cross-sectional analytical study was conducted from November 2022 to June 2023. The study enrolled 224 individuals who had cirrhotic ascites, aged 18 years or older, and met the specified inclusion criteria. At baseline, social demographic, cirrhosis risks factors, clinical characteristics and laboratory findings were acquired. Ascitic fluid with PMN ≥ 250 cells/mm3 was considered positive for SBP, and +1 to +3 scale of CYBOWTM series dipstick test, were used as cut off levels for a positive result for SBP. Results: Among study participants 135 (60.27%) were male. The study population mean age was 46.17 ±10.31 years. The prevalence of SBP was 18.75%. Patients with SBP were more likely to have fever (AOR = 9.181[2.351 – 35.847]), and Child Pugh score C (AOR = 6.915[2.130 – 22.449]). At +2 cut-off of grade CYBOWTM series urine reagent strip had a sensitivity of 82.14%, specificity of 99.39%, PPV of 95.83% and NPV of 96.79%, with AUC of 0.9074. Conclusion: SBP is frequently observed in individuals with cirrhosis who are admitted to tertiary hospitals in Dodoma. Fever and a high Child Pugh score have been identified as significant predictors of SBP. Additionally, urinary reagent strips have demonstrated substantial diagnostic capability and can serve as a rapid screening tool for SBP detection.
Electronic medical records system data use in decision-making and associated factors among health facility managers at public primary health facilities, Dodoma region
(The University of Dodoma, 2023) Kessy, Eusebi C.
Tanzania has shown some improvements in the adoption of electronic medical records systems in public health facilities; however, the rate of utilization of data generated by EMRs among health managers is not well documented. This study aims to assess the use of electronic medical records system data use in decision-making among health managers at public primary health facilities in the Dodoma region, Central Tanzania. A facility-based quantitative cross-sectional analytical study was conducted among 308 randomly selected health managers. A self-administered questionnaire supplemented with documentary review was used. Descriptive summary statistics and bivariable and multivariable logistic regression analyses (crude and adjusted odds ratios) were used. A P value of <0.05 was used to declare statistically significant association. Overall, more than a third 174(40.6%) of health managers reported using data generated by EMR system in decision-making. One third (33.4%) of health managers were adequately using data generated by EMRs in which 39.3% used data to support continuous quality improvement initiatives. Among facilities visited only 9(30%) had good documented EMRs data use. Access to computers (AOR=4.72, 95% CI: 1.65, 13.48, p=0.004) and discussions on EMR during meetings (AOR=2.77, 95% CI: 1.01, 7.58, p=0.047) were independent predictors of EMR system data use. Those who reported having EMR systems in all working areas were seven times more likely to use EMR system data (AOR=7.23, 95% CI: 3.15, 16.59, p=0.001). Respondents with good perceived EMR system information quality were three times more likely to use EMR system data (AOR=2.84, 95% CI: 1.50, 5.39, p=0.001) than those with poor perception. Health managers who had excellent knowledge on computer and data use had higher odds of using EMR system data (AOR=1.84, 95% CI: 3.38, 10.13, p=0.001) compared to their counterparts. The findings of this study indicate that utilization of EMR system data in decision-making among health managers was sub-optimal. Since it was found that training in itself is insufficient to improve use of EMR points to more organizational aspects of work routine as a challenge. Thus, a comprehensive approach that addresses these factors is essential for maximizing EMRs data use in decision-making.
Prevalence, pattern and early treatment outcomes predictors of patients with fournier’s gangrene at University of Dodoma affiliated teaching hospitals
(The University of Dodoma, 2023) Lesso, Mwinyimkuu Rajabu
Background information: Fournier’s Gangrene is a rare disease worldwide, which has a significant mortality. The incidence is progressively becoming common in general surgical wards. While this disease is uncommon in Western countries, it is more prevalent in resource limited settings, but there hasn't been sufficient information on its prevalence, pattern and early treatment outcomes predictors. This study highlight the local prevalence of the disease, pattern and predictors of mortality and hence awareness of clinicians about the disease in resource limited settings. Objective: The aim of this study was to assess the prevalence, pattern and early treatment outcomes predictors among patients admitted with Fournier’s gangrene at the University of Dodoma Affiliated Teaching Hospitals. Methodology: This was a hospital based prospective analytical study, involving 67 patients with Fournier’s gangrene. The study was conducted from January 2021 to July 2023, where a convenient sampling technique was employed to recruit study participants. Data was managed and analysed using IBM SPSS version number 25, where continuous variables were presented using mean and standard deviation, whereas, categorical variables presented using frequency and percentage. Univariate and multivariate logistic regression were employed to assess association between independent and predictors variables. P value of less than 0.05 was considered statistically significant. Results: Out of 6655 patients admitted in surgical ward during the study period, 67 patients had Fournier’s gangrene giving a prevalence of 1%. The median age were 44 years with majority having age above 45 years (49.2%). Whereby, male were predominantly by 64(95.5%). About two-third of the patient (65.7%) had no formal education and 33.3% had comorbidities. The most common source of infection was urogenital system (44.8%), followed by anorectal infections (14.9%). The commonest pattern of wounds were scrotal 48 (67.2%), penoscrotal 32 (47.8%) and perineum 25 (37.3%). All patients underwent surgical debridement with IV fluids and IV broad spectrum antibiotics. An infection originating from anorectal region {p<0.01, (OR 17.7 (95% CI 1.99- 157)} , presence commodities {p<0.025, (OR 9.5(95% CI 1.32-67.74)} , less than 2 frequency of serial surgical debridement {p<0.009, (OR 17.63(95% CI 2.03-153.8)} and wound pattern extending to abdominal wall {p<0.006, (OR 16.2 (95% CI 2.19- 119.15)} were significant predictors of mortality. Conclusion: The prevalence of Fourniers gangrene in this study was 1%. The pattern of wounds was scrotal 45(67.2%), penoscrotal 32(47.8%) and perineum 25(37.3%). The median length of hospital stay was 24 days and mortality rate of 11 (16%). Presence of comorbidies, the infection originate from anorectal region, less than 2 surgical debridement and pattern of wound extending to anterior abdominal wall were the independence predictors of mortality with p value <0.05.
The lived experiences of postnatal mothers receiving birth companionship care in Katavi region: a qualitative study
(The University of Dodoma, 2023) Linja, Caroline
Background Even though there is a great effort to improve maternal health, 243:100000 per live births of maternal deaths occur every year. This overwhelming rate of maternal deaths occurs amid several global preventive strategies, including the sustainable development goal number 3 which targets a reduction of maternal deaths to 70 maternal deaths per 100,000 live births by 2030. Other strategies, includes birth companionship which is one of the most recent aspects in improving maternal and perinatal outcome during intrapartum care. Global trend shows an increase in the number of countries that continue to implement the birth companionship policy as per World Health Organisation guidelines. Tanzania is among the Eastern African countries that have piloted the policy. Therefore, this study explored the lived experience of postnatal women receiving birth companionship in the Katavi region. Methods The study applied a phenomenological study design where eleven (11) postnatal mothers were recruited conveniently from seven health facilities in the Katavi region to ensure the study dug deep into participant's lived experiences. Data were collected using in-depth interviews and analysed by an inductive thematic approach. Results It was found that six themes and nineteen (19) subthemes merged in this study. The main themes were 1) women’s choice of birth companions, 2) Mixed feelings of postnatal women on the presence of BC during the intrapartum period, 3) Different types of services offered to postnatal women by BC, 4) Availability of BC during intrapartum period 5) Different between formal and non-formal BC services, 6) Challenges faced by postnatal women as a result of having BC. The results indicate that women chose their family members and traditional birth attendants to be their birth companions. Birth companions were reported to be beneficial in providing Conclusion In this study, postnatal women reported having positive experiences when they had a companion during childbirth, regardless of the presence of healthcare providers. The women had diverse ways of selecting their BC and reported mixed feelings about having a BC during labor and delivery. The BC had different tasks in providing care including emotional support, instrumental support, nutritional support, physical support, giving information, and laundry support.
Determining the uptake of early infant HIV diagnosis, its associated factors, and the readiness of higher-level health care facilities to provide the service in Dodoma region, Tanzania
(The University of Dodoma, 2023) Kihurugo, Esther G.
Background: Early infant HIV diagnosis is crucial for preventing the transmission of the virus from mother to child and initiating timely treatment. However, the uptake of this essential service remains a global challenge. This study investigated the uptake of early infant HIV diagnosis, its associated factors, and the readiness of higher-level healthcare facilities to provide the service to inform strategies for improving paediatric HIV care. Methodology: A cross-sectional study was conducted in Dodoma Region between May 29, and July 28, 2023 involving 147 caregivers of HIV-exposed infants. Data was collected through a self-administered structured questionnaire, a documentary review, and an observation. Data were analyses using SPSS, descriptive statistics and logistic regression model were used and significant results were declared at p value of less than 0.05. Results: The proportion of the uptake of early infant HIV diagnosis among caregivers in Dodoma Region found to be 111 (76%), and the overall readiness was 125 (85%). The major factors strongly associated with the uptake of early infant HIV diagnosis are as follows: caregivers residing in the district council (AOR=5.568; p-value 0.0078), married caregivers (AOR=4.266; p-value 0.0168), income between Tsh 100000 and Tsh 300000 (AOR=3.649; p-value 0.0330), and caregivers with adequate knowledge on EID (AOR=1.628; p-value 0.0374). However, positive attitude was more likely to be uptake compared to negative attitude, though not statistically significant after controlling for other variables. Conclusion: It was observed that the proportion of early infant HIV diagnosis uptake was high, indicating that most infants received an early HIV diagnosis within six weeks of age. This is a positive development to ensure early initiation of ARV and prevent infant morbidity and mortality from HIV. The availability of DBS kits in health facilities and trained healthcare providers contributed to this proportion. Moreover, the readiness of higher-level healthcare facilities was 85%, which is high. However, 56.5% have no national PMTCT and DBS sample collection guidelines, which are used as references to provide standardized procedures.
Routine health data use for decision making and its associated factors among primary healthcare managers in Dodoma region
(The University of Dodoma, 2023) Yusuph, Fatuma
Background: Data demand and use culture have a tremendous impact on the proper allocation of scarce resources and evidence-based decision making. However, primary healthcare managers in the majority of Sub-Saharan African countries continue to struggle with using routine health data for decision-making. Purpose/objective: This study aimed to assess routine health data use for decision making and its associated factors among primary healthcare managers in Dodoma region. Methods: Cross-sectional study design involved 188 primary healthcare managers from Dodoma City council, Kondoa Town council and Bahi Distric council was conducted. A self-administered questionnaire adapted from the Performance of Routine Information System Management (PRISM) tools was used to collect the data. Data was analysed by using SPSS program. Principal Component Analysis was used to find the level of routine health data use, Chi-square and binary logistic regression analysis were used to determine factors associated with routine health data use for decision making among primary healthcare managers. The study was conducted from May to June, 2022. Results: The level of adequate routine health data use for decision making among healthcare managers was 63.30%. Factors associated with adequate routine health data use for decision making among healthcare managers were; respondents characteristics: level of health facility (A0R=2.680, C1= [1.926, 6.147], p=0.0062), and district surveyed (AOR=4.426, CI= [1.137, 17.237] p=0.0320). Individual factors: comparing data with strategic objectives (AOR=4.905, CI= [1.352-17.796], p=0.0156), decision based on health needs (AOR=9.440, CI= [1.290-69.076], p=0.0271). Technical factors: ability to plot information by month (AOR=9.532, CI= [1.839, 49.398], p=0.0072). Conclusion and Recommendation: The level of routine health data use for decision making was found to be modest. The level of data demand and use culture may increase more quickly if capacity building is strengthened and issues that de-motivate primary health care managers from using data are addressed. This will help address the underlying causes of health problems.
Testing the efficacy of integrated conversational and journaling reflective learning strategies on perceived self-directed learning and clinical reasoning among nursing students Tanzania: a quasi-experimental study
(The University of Dodoma, 2023) Nyaki, Flora S.
Background: Self-directed learning positively influences clinical reasoning by equipping nurses with the knowledge that can be applied in data interpretation and evidence-based practice and enabling nursing students to attain professional competencies. Thus, high-quality nursing education is crucial for preparing competent nurses to provide safe, effective care in the future. Objective: The purpose of this study was to compare the three teaching and learning methods (conversational, journaling and integrated conversational and journaling reflective learning strategy to determine its effect on perceived self-directed learning and clinical reasoning in nursing education. Methods: Uncontrolled quasi - experimental study design using a quantitative approach was employed. The study recruited 143 nursing students from the University of Dodoma. The study had three timeline including developmental procedures of training materials, implementation and evaluation phases. Baseline and end line assessment was done in all groups that were intervened. Descriptive analysis and inferential statistics such as DID model were used for data analysis. Results: There was a statistically significant mean change on perceived self-directed learning and clinical reasoning. Conversational group, the mean change in perceived SDL ranged from 2.00 ±0.51 to 2.50± 0.68; journaling group, it ranged from 2.02± 0.56 to 2.52 ±0.56; and the mean change in the integrated conversational and journaling group ranged from 3.06± 0.08 to 4.43± 0.50. The mean score of perceived clinical reasoning for the conversational group ranges 2.60 ±0.89 to 2.98 ±1.06, journaling 2.60 0.89 to 3.00 1.03 and 2.98± 0.94 to 4.43± 0.50 for those exposed to integrated conversational and journaling. Conclusion: The findings revealed that integrated conversational and journaling reflective learning strategy has the significant academic potential of empowering the nursing student’s perception of self-directed learning ability and clinical reasoning skills. Thus, a combined reflective learning strategy can be used as a clinical teaching and learning strategy in nursing education.
The potential for integrating perinatal mental health care into reproductive health services in Tanzania: a mixed method approach
(The University of Dodoma, 2023) Hoya, Magdalena l.
Background: Perinatal mental health is a challenging concern worldwide especially in poor-resourced countries like Tanzania as it is associated with substantial psychiatric morbidity, and relapse of mental illness including depression and anxiety secondary to pregnancy and the related complications. Impaired mental health affects perinatal mental health and the well-being of their babies, family, community, and the Nation at large. In Tanzania, perinatal mental health services traditionally have been underdeveloped, inadequately resourced and stigmatized due to the lack of policies and guidelines that would demand the provision of both mental health and reproductive health services at the same destination. Objective: This study aimed to assess the potential of integrating perinatal mental health care into reproductive health services in Tanzania. Methods: The study used a convergent parallel mixed method approach from April to July 2023. The study included a total of 384 perinatal mothers, 181 healthcare providers, 30 health facilities and 8 key informants (stakeholders). A simple random sampling and a purposive sampling technique were used to obtain study participants. Data were collected using a semi-structured questionnaire and an interview guide by the two standard researcher-administered tools and an adopted self-administered questionnaire. The quantitative data were analyzed using a descriptive analysis by frequency, table and Chi-square test to compare respondents’ demographic characteristics and the outcome variable. Furthermore, the thematic analysis was employed for qualitative data. Results: The majority of perinatal mothers had (55.2% at 95% CI=50.1%-60.3%) perinatal depressive symptoms and (59.9% at 95% CI=54.8%-64.8%) perinatal anxiety symptoms. Among 181 healthcare providers assessed 99 (55%) had adequate knowledge of identifying perinatal mothers with mental symptoms. Also, of them, 122(67%) had a positive perception towards integration, and of 30 facilities assessed only 8 (24%) were ready to integrate the services. However, Qualitative narratives indicate that stakeholders had a positive perception toward the integration of perinatal mental health care into reproductive and maternal health services. Conclusion: Integrating perinatal mental health care into reproductive and maternal health services has significant potential to improve the mental well-being of women during the perinatal period. The findings from this study provide important insights into the prevalence of common mental health disorders among perinatal mothers, healthcare providers' knowledge, perception and the perspectives of key stakeholders support the significance of this integration and underline the need for collaboration between various stakeholders to ensure successful implementation.
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.
The effectiveness of a simulated hybrid video-based pedagogy in improving knowledge, attitude, and practice towards catheterization among junior nursing students in Tanzania: a cluster randomized controlled trial
(The University of Dodoma, 2023) Mugo, Miriam W.
Background: Traditional teaching methods used in nursing education such as lectures and demonstrations, may not effectively engage students or provide them with sufficient practical experience. In Tanzania, the effectiveness of teaching catheterization skills using innovative approaches, such as Simulated Hybrid video-based pedagogy remained largely unexplored. Objectives: The aim was to investigate the effectiveness of a simulated hybrid video-based pedagogy in improving knowledge, attitude, and practice toward catheterization skills among junior nursing students in Tanzania Methods: The study used a Cluster Randomized Controlled Trial design to determine the effectiveness of the intervention. The process of randomization involved assigning the selected 7 nursing schools to either the intervention group or the control group by using the method of sequentially numbered, opaque sealed envelopes (SNOSE) for allocation concealment. The simple random sampling method was used to select a total of 320 study participants. Data were analyzed using a Statistical Package for Social Science (SPSS) version 26. The independent t-test was used to test the effectiveness of the intervention. The effects of additional confounding variables were controlled using a linear mixed model. A p-value of <0.05 was used to determine the statistical significance. Results: There was a significant increase in the mean scores for knowledge (5.94±1.32, p<0.0001), attitude (4.20±0.61, P<0.0001) and practice (7.99±0.16, P<0.0001) in the intervention group compared to knowledge (5.07±1.40), attitude (4.04±1.09) and practice (0.11±0.56) in the control group. The intervention was a significant predictor for change in mean scores in both knowledge (ß=1.0259, P<0.0001) and attitude (ß=0.0337, P=0.0012). Predictors for adequate practice of catheterization were knowledge (AOR=3.457 at 95% CI=2.370-5.044, P<0.0001), attitude (AOR=3.971 at 95% CI=2.218-7.111, P<0.0001) and previous opportunity to practice (AOR=1.567 at 95% CI=1.066-2.304, P=0.0225). Conclusion: This study demonstrated the positive effectiveness of simulated hybrid video-based pedagogy for teaching catheterization on nursing students’ knowledge, attitude, and practice in Tanzania. The findings suggest that the use of videos as a supplementary teaching method can significantly enhance students’ understanding and improve their performance on catheterization. Trial Registration: The trial was registered at Pan African Clinical Trial Registry number PACTR202306791237048 in June, 2023.
Upright birth position implementation and its hindering factors among nurses and midwives working in maternity departments of public hospitals in Dar es salaam-Tanzania, analytical cross-sectional study
(The University of Dodoma, 2023) Mkangi, Sospeter K.
Introduction: Despite the recommendations of the WHO that women should be delivered upright due to their physiological advantages; the majority of women are still delivered in the horizontal birth position. This not only deprives women and their foetuses and newborn of advantages related to the upright birth position but also subjects them to adverse effects attributed to the horizontal birth position. This study aimed to assess the upright birth position implementation and its hindering factors among nurses and midwives working in maternity departments in Dar es Salaam Tanzania. Methodology: This was a hospital-based analytical cross-sectional study design using a quantitative approach that was conducted in maternity department of public hospitals in Dar es Salaam. The study involved 283 nurses and midwives who were randomly selected. Self-administered structured questionnaires and observation checklists were used to collect data and descriptive and inferential statistics were used in the analysis whereby logistic models were employed. Results: The study revealed that upright birth position implementation was significantly low; only 13.4% (38) out of 283 participants reported having ever implemented upright birth position at least once. The identified hindering factors were; low level of education (AOD 1.799; P=0.001; 95%CI: 0.846, 4.681), short duration of work in the labour ward (AOD 1.354; P=0.019; 95%CI:1.473,7.129), lack of knowledge (AOR 7.090; P=0.005; 95% CI: 2.829, 16.483), low self-efficacy (AOR 1.731; P=0.003; 95% CI: 0.685, 4.718), discomfort (AOR 2.498; P=0.018; 95% CI: 1.167, 5.347), inconvenience (AOR 1.302; P=0.001; 95% CI: 0.884, 3.693) and maternal medical conditions (AOR 2.396; P=0.022; 95% CI: 1.174, 7.495). Conclusion: This study revealed that the upright birth position implementation is hindered by lack of knowledge, low self-efficacy, discomfort, and inconvenience and maternal related condition particularly maternal medical condition. Therefore, in order to scale up the upright birth position nurses and midwives should be trained on upright birth position and deliver women by considering evidence-based implementation. Moreover, labour wards should be made supportive for delivering women in upright position by ensuring availability of necessary equipment, guidelines, and standard procedures.
The effect of a sexual and reproductive health training package using A Problem-Based Learning Approach (SRHPBL) coupled with role play and lecture discussion on knowledge, attitude, and self-reported sexual behavior among secondary adolescents: a cluster-randomized control trial in Mwanza
(The University of Dodoma, 2023) Mzee, Naomi L.
Introduction: Lacks of sexual and reproductive health knowledge among secondary adolescents continue to increase vulnerability to STIs and HIV, unplanned pregnancy, and school dropouts in Tanzania. The contents and delivery methods developed by the MoH to deliver SRH information to adolescents are not adequate. Objective: This study tested the effect of a sexual and reproductive health training package using a problem-based learning approach (SRHpbl) coupled with role play and lecture discussion on knowledge, attitude, and self-reported sexual behavior among secondary adolescents in Mwanza. Method: A cluster randomized control trial was conducted from May to July 2023 among 560 school adolescents. 10 of 28 school adolescents each were randomized to receive the intervention for 3 days, whereas another ten clusters of 28 school adolescents each were randomized as usual as the care control group. Outcomes were measured at baseline (T0), immediately after intervention (T1), and at one-month follow-up (T2). Results: The knowledge score at base in the intervention group was 22.37 (3.1), in the control group 22.68 (3.6), t = 1.061, P = 0.289. Attitude score in intervention group 32.26 (5.8), control group 33.51 (5.2), t =2.697, P = 0.007. Self-reported sexual behavior in intervention group 10.23 (14.7), control group 8.43 (14.1), t = 1.478, P = 0.140.The effects of the intervention on knowledge were 0.775 (95% CI 0.068–1.482), P = 0.026, and the control group was -0.850 (95% CI 1.694 - -0.006), P = 0.048. Group X time interaction effect (F =12.629, P = <0.001), effect size 0.301 at 95% CI = 0.1344 - 0.4676). Attitude was 1.135 (95% CI -0.044-2.314), P = 0.063 in the intervention group, and in the control group, it was -.559 (95% CI -1.706-0.588), P = 0.725. Group X time interaction effect (F =6.040, P = <0.014), effect size 0.2128 at 95% CI = 0.0446 - 0.3811 immediately post intervention. The effects of the SRH intervention were continued with a 2-month follow-up. Discussion: The use of blended methods enhanced good understanding of SRH session. Conclusion: The intervention aided change of adolescent’s knowledge, attitude and their sexual behavior.
The lived experiences and factors associated with defaulting among adults with opioids use disorders enrolled for methadone assisted therapy, Dodoma region Tanzania: a sequential qual-quant mixed study
(The University of Dodoma, 2023) Temba, Neema J
Background The defaulting of patients with opioid use disorders on methadone-assisted therapy is among the main challenges in the course of treatment worldwide. Several health, social, and economic impacts ranging from the individual to the community to the nation at large may result from treatment default. The lived experiences of clients under methadone-assisted therapy that may be associated with the defaulting of clients from methadone treatment in the context of central Tanzania remain unknown. Methods: The study aimed to explore the lived experiences of clients enrolled in methadone treatment that could be associated with the defaulting among adults with opioid use disorders at the Itega Dependency Treatment Centre in Dodoma, Tanzania. A mixed-methods study using a sequential QUAL approach was employed. The qualitative approach adopted a phenomenological design. A total of 18 study participants, including both defaulters and clients on regular medication, were recruited purposefully and interviewed using an in-depth interview guided by an interview guide to explore their lived experiences. The data was analyzed using thematic analysis. Qualitative results were used to inform the quantitative study. The quantitative component is based on a survey questionnaire and secondary data. Descriptive analysis and logistic regression were employed to explain the defaulting patterns and the factors associated with defaulting. Results: Five main themes emerged, including reasons and ways of enrolling in MAT, benefits of MAT to clients, side effects of methadone, communication between health care providers and clients, guidelines for receiving MAT at the clinic, and client suggestions on the overall run-up of the MAT clinic. The prevalence of defaulting was 46.8% (95% CI). Among the defaulters, most of them—35 (22.7%) defaulted only once, 21 (13.6%) defaulted twice, and 16 (10.4%) defaulted more than twice within 12 months. Factors associated with defaulting were education level, marital status, living arrangement and living satisfaction, number of substances used before MAT and continued substance use after MAT enrollment, history of VII comorbidities and co-occurring conditions, experience, and perception of MAT (95% CI, P > 0.005). Conclusion: The defaulting of patients with opioid use disorders from dependency treatment is common in the context of central Tanzania as its worldwide. Intrapersonal, interpersonal, and organizational factors are associated with defaulting.
Incidence and predictors of non-adherence and reported barriers of adherence to medication assisted treatment with methadone among adults with opioid use disorder in Dodoma, Tanzania
(The University of Dodoma, 2023) Omary, Rehema S
Background: Medication adherence is essential to achieve successful Medication Assisted Therapy (MAT) with methadone. An essential component of the treatment strategy is encouraging recovery in patients with Opioid Use Disorder. This can result in ongoing health gains and the enhancement of these patients' quality of life (QoL). Little information is available about the adherence status to the Methadone among MAT patients in the Dodoma region as well as other parts in Tanzania. Aim: This study aimed to assess the incidence, determine predictors of adherence, and explore reported barriers in MAT with methadone patients. Method: This study applied mixed research approach with combination of qualitative and quantitative research methods. A retrospective study design was used for the quantitative phase and a case study design was used for the qualitative phase. The study was conducted in one MAT clinic namely Itega drug dependence treatment Center. The sample size of the study was obtained using convenience and purposive sampling method. The Adherence of MAT with methadone was assessed by using three questions: 1) If they missed doses in the last 30 days; 2) whether they missed doses in the past 12 months and 3) If they have been jailed for more than 30 days consecutively since in past twelve months. Adherence was considered optimal if patients reported ‘no’ to three questions. Substance Use Characteristics and ASSIST to support adherence were also collected. Results: Of 227 patients, 43.61% reported non-adherence to their prescribed medications and 56.39% adhered to the prescribed methadone medication. The findings from the ASSIST tool indicated that, clients had strong urge to use Heroin, Morphine, Pain Medication (93.83%) which arouse concerns among their relatives. Also, the findings indicated that, the majority of the clients used the Heroin, Morphine, Pain Medication drugs in the past three months. Moreover, the study found that, the factors which contributed to adherence to MAT with methadone were those with significant association to incidence rate of adherence to MAT. Such factors were (p-value=0.0356), education level (p=0.0014), Occupation (p=0.0296), Marital status (p=0.0054), Taking methadone medication at appropriate time (p=0.0001), client having other diseases (p= 0.0042), Good provider client relationship (p= 0.0034) and the good provider to client relationship (p=0.0029). on the barriers of adherence to xiii MAT with methadone, the findings of the study indicated that, hostile rapport and imbalanced treatment were among of the barriers to MAT related to health care providers. Further, lack of resources, negative attitudes and unpleasant behavioral challenges among OUDs clients were also found to affects the adherence of MAT with methadone. Conclusions: The adherence of MAT with methadone among OUDs clients is relatively low and a direct result of the aforementioned factors. To improve the adherence of MAT with methadone, health care providers and institutions urgently needs to address the barriers to MAT medications found in this study.
Farmers’ knowledge, attitude and practices on prevention of aflatoxin contamination in maize grains, level of aflatoxin and their associated factors in Chamwino district, an analytical cross section study
(The University of Dodoma, 2023) Mathemu, Salome E.
Background: Aflatoxin contamination in maize grain is a prominent public health concern as it poses an adverse health effect on society like morbidity and even death. Understanding knowledge, attitude and practices on aflatoxin health risk prevention among maize farmers as well as contamination levels and its related factors are of greater importance towards prevention and consumers’ health protection. However, this information is limited in Chamwino district in Dodoma Tanzania. Objectives: To determine the farmers’ knowledge, attitude, and practices on prevention aflatoxin contamination in maize grains, levels of aflatoxin and their associated factors in Chamwino District, Dodoma region, Tanzania. Methodology: The analytical cross-sectional design was employed in this study involved 316 maize farmers in Chamwino District. Survey data were collected using structured questionnaires. Furthermore, sixty-four maize samples were randomly collected from surveyed households and analyzed for levels of aflatoxin contamination using High Performance Liquid Chromatography (HPLC) machine. Data were analyzed for both descriptive statistics (frequency distribution, proportions and means) and inferential statistics (Chi square, logistic and linear regression analysis) Results: About 69 and 31 % of respondents were male and female respectively with majority (68.4%) having primary education while 5.7% had college/university. Most farmers (57.3%) possessed inadequate knowledge specifically on use of fertilizer as preventive strategy during planting 52(16.5%). Furthermore, 56% had positive attitude on prevention of aflatoxin contamination while 44% had negative attitude. More than half (55.1%) of the farmers practiced poor prevention of aflatoxin contamination practices. Levels of aflatoxin were 21.87% both for aflatoxin B1 and total aflatoxin. The adjusted coefficient of knowledge indicated significant association on practices during planting (β=0.82, p<0.001), storage (β=1.36, p<0.001) and transport (β=1.02, p< 0.001). Likewise, the adjusted coefficient of attitude on practices exhibited significant association during planting (β=0.65, p=0.004), harvesting (β=0.99, p=0.04) and storage (β=1.14, p< 0.001). Furthermore, the adjusted coefficient on prevention practices during drying (β=0.034, p=0.034) and storage (β =2.495, p=0.035) was found significantly associated with levels of aflatoxin contamination. Conclusion: Generally, the overall findings showed that inadequate knowledge, positive attitude and poor practices of prevention of aflatoxin contamination among maize grain producers resulted to high levels of aflatoxin contamination in maize grain as predicted by Health Promotion Model used in this study. Therefore, farmers need comprehensive education on aflatoxin prevention in all its parameters from planting to storage to ensure effective reduction and prevention of aflatoxin contamination in maize grain.
Effects of pecha kucha presentation pedagogy on knowledge, presentation skills, and learning satisfaction among nursing students in Tanzania: a quasi-experimental study
(The University of Dodoma, 2023) Haramba, Setberth J
Introduction: With an increasing number of nursing students in higher education institutions in Tanzania, traditional student presentation pedagogies are insufficient to enhance effective learning. Pecha Kucha presentation is a new promising student presentation approach that engages students in learning. It involves the use of 20 slides, displayed within 20 seconds, for 6:40 minutes. The current study assessed the effect of Pecha Kucha presentation pedagogy on knowledge, presentation skills, and learning satisfaction among nursing students in Tanzania. Methods: The study employed a quantitative, non-controlled quasi-experimental design among 230 nursing students at The University of Dodoma selected using simple and stratified sampling techniques. The study involved pre-assessment of knowledge, presentation skills and learning satisfaction followed by training of study participants on Pecha Kucha presentation, assigning topics to participants, classroom presentations and post-assessment. Data were collected using researcheradministered questionnaire and analysed using the SPPSS version 26. The mean scores of knowledge, presentation skills and learning satisfaction at baseline and endline were reported. A paired t-test was used to compare mean score changes between assessments and linear regression analysis model was used to determine factors associated with outcome variables of interest. A value of less than 0.05 was considered as statistical significane at the 95% confidence interval, and a cohen’s d effect size was reported. Findings: Demographically, 63 (70.87%) were aged ≤23 years, 151 (65.65%) were male, and 189 (82.17%) were bachelor students. The baseline mean score of knowledge was 0.10±1.05 and the endline mean score of knowledge on the Pecha Kucha presentation was 40.48±12.37. The mean score of presentation skills using traditional PowerPoint presentations was 4.07±0.56 and the mean score of presentation skills using Pecha Kucha presentation was 4.54±0.59. The mean score of learning satisfaction using traditional PowerPoint presentation was 3.88±0.544 and the mean score of learning satisfaction using Pecha Kucha presentation was 4.51±0.62. Pecha Kucha presentation pedagogy had a significant effect on knowledge (p<.0001), presentation skills (p<.0001) and satisfaction (p<.0001) among study participants. Conclusion and recommendation: Pecha kucha presentations have more significant effects on student presentation skills and learning satisfaction than traditional vi PowerPoint presentations. There is a need to incorporate Pecha Kucha presentations into the teaching and learning processes of nursing students in training institutions.
Prevalence and factors associated with relapse among patients treated for schizophrenia Spectrum at Mirembe national mental hospital Dodoma: a mixed- method study
(The University of Dodoma, 2023) Ombay, Vincent P
Background: Schizophrenia spectrum disorder is a chronic neuropsychiatric disorder that is associated with major distressing effects on the lives of patients, families, and societies. Relapse on the schizophrenia spectrum causes morbidity and burden of health costs in Tanzania compared to other mental disorders. There is a paucity of evidence on the prevalence and factors associated with relapse in the context of Tanzania. Thus, the study was conducted to determine the prevalence and factors associated with relapse at Mirembe National Mental Hospital. Methods: A concurrent mixed-method design was used. The study was conducted at MNMH. The population involved were 15 family caregivers and 20 stabilized patients who provided the qualitative data through interviews, and quantitative data was collected using a checklist from 222 patients’ files. Qualitative data were analysed using thematic analysis, whereas quantitative data were analysed using descriptive analysis and logistic regression models. Results: The study findings showed that the prevalence of relapse was 68.5%. A thematic analysis of interview data on both family caregivers’ perspectives and patients' experiences revealed that the factors for relapse were poor drug adherence, stressful life events, substance abuse, stigma, and discrimination against mentally ill patients. On the quantitative method, social disadvantage and poverty (AOR: 2.219, 95% CI: 1.054–4.672, p = 0.036) and patient adherence to drugs (AOR: 0.129, 95% CI: 0.018–0.929, p = 0.042) were independent factors associated with relapse. Conclusion: This study calls for the creation of awareness about mental health and mental illness management, especially schizophrenia, among caregivers and patients for better recovery. Thus, psychosocial education is required for both patients and their caregivers to reduce the high rate of relapse among patients with schizophrenia.
Prevalence predictors and outcomes of ventricular dyssynchrony among heart failure patients attending Benjamin Mkapa Hospital in Dodoma, Tanzania
(The University of Dodoma, 2023) Bilikundi, Patrick
Introduction: Ventricular dyssynchrony (VD) is prevalent in heart failure (HF) patients with high cost of care and potentially poor outcomes. Nevertheless, little is known about VD, especially in developing countries. The study aimed at assessing the prevalence, predictors of VD, and outcomes of heart failure patients with ventricular dyssynchrony attending the cardiology department at Benjamin Mkapa referral hospital in Dodoma central Tanzania Methods: A prospective observational study design was conducted on participants aged 18yrs and above with heart failure attending Cardiology Department at Benjamin Mkapa Hospital. Heart failure was diagnosed using Framingham's score and enrolled patients with heart failure and ventricular dyssynchrony were followed up for six months. Baseline socio-demographic and clinical characteristics were taken during enrollment. The outcomes of interest during six months were worsening heart failure, readmission, and death. Continuous data were summarized as Mean (SD) or Median (IQR), and categorical data were summarized using proportions and frequencies. Binary logistic regression was used to determine predictors of Ventricular dyssynchrony among patients with heart failure using SPSS version 26. Results. 150 heart failure patients were included in the study with a mean age of 61.97±10.77, of whom 58.7% were females. The prevalence of ventricular dyssynchrony was 55%. Ventricular Mechanical Dyssynchrony was found to be 77(51.33%), (of whom interventricular mechanical dyssynchrony was 40(51.95%), and intraventricular dyssynchrony 37(48.05%). Electrical dyssynchrony was found in 57(38%) HF patients. Both mechanical and electrical dyssynchrony was seen in 51(34%) participants with HF. The independent predictors of ventricular dyssynchrony were: Dilated Cardiomyopathy (AOR 6.968, CI: 1.108-43.84, p =0.0386), Ischemic Heart Disease (AOR 20.818, CI: 3.871-111.967, p = 0.0004), NYHA IV (AOR, 6.968 CI: 1.288-32.39, p = 0.0233), reduced ejection fraction were the predictors of the development of ventricular dyssynchrony
Prevalence and predictors of group a streptococcal pharyngitis and antibiotic susceptibility among children aged 2-15 years at two tertiary hospitals in Dodoma, Tanzania
(The University of Dodoma, 2023) Chaula, Pendo John
Background: Group A streptococcus (GAS) pharyngitis is prevalent among children aged 5 to 15 years and if left untreated it may result in deleterious long-term complications. Several studies concentrated much on diagnostic methods, clinical guidelines and management of GAS in children of five years and above but little is known about its magnitude in children of lower ages despite being common with varying predictors and antibiotic susceptibility. Broad Objective: To determine the prevalence, predictors, and antibiotic susceptibility of GAS pharyngitis in children 2-15 years attended at tertiary hospitals in Dodoma Tanzania. Methods: This was a cross-sectional study at the University of Dodoma-affiliated teaching hospitals. A total of 153 children with pharyngitis aged 2-15 years were enrolled in the study. Demographic and clinical data were recorded using a standardized semi structured questionnaire from care takers and patients’ medical charts. Pharyngeal swab from tonsils were taken using sterile swab and placed in a firmly tight labelled container, cultured on a sheep blood Agar. Antibiotic susceptibility of the bacterial isolates was tested using the disc diffusion method according to the Clinical laboratory institute guidelines. Tested antibiotic discs included Amoxicillin, Phenoxy methyl penicillin, Azithromycin, Erythromycin, Gentamicin, Amoxicillin clavulanic acid, Ceftriaxone, Ceftazidime, Meropenem, Ciprofloxacin and Amikacin. Additional tests performed included ASOT and CRP. Data were analyzed using SPSS version 26 and a p value< 0.05 was regarded as statistically significant. Results: Out of 153 participants 87(56.86%) were females and the mean age of all participants was 5.59 ± 2.85. The prevalence of Group A streptococcal among children with Pharyngitis was 38.56%. Factors significantly associated with Group A streptococcal pharyngitis were age of the child 5-9 years (AOR =1.832, 95% CI [1.21, 3.274], p=0.0372 and school status whereby those who are in kindergarten school had (AOR=10.78, 95% CI [1.60, 72.64], p=0.0145. The isolates were sensitive to Amoxycillin clavulanic acid (84.75%), Ceftriaxone (93.22%), Ciprofloxacin (96.61%) and Meropenem (96.61)

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