Sia Msuya

Background and Objective. The aim of this study was to determine factors associated with repeat blood donation. Methods. This was a cross-sectional study carried out among blood donors aged 18-65 years in northern Tanzania. The questionnaire was administered among 454 participants through the phone. Results. Of the 454 participants, the proportion of repeat donation was 63.9%. In the backward logistic regression analysis, the significant predictors were living in Arusha which had lower odds of repeat donation compared to those living in Kilimanjaro. Knowledge of time interval between donations increased odds of repeating donations. High intention increased odds of repeat donation compared to low intention. Altruistic score had minor effect on increasing odds of repeating donation. Conclusion. Repeat blood donation is affected by proximity of donating site, awareness of the blood donation interval, intention to donate, and experience on previous donation. We recommend continuous education concerning blood donors and donation among health workers and society as a whole; this will create awareness on motivational factors for repeat donations.

To evaluate the effectiveness of the syndromic approach in management of vaginal infections among pregnant women in Moshi urban, Tanzania. Between June 2002 and March 2004, 2654 pregnant women in their 3rd trimester were recruited from two community primary health care clinics. They were interviewed using a structured questionnaire, examined and genital samples collected. Vaginal secretions were evaluated for bacterial vaginosis (BV) by Amsel's criteria, for trichomoniasis (TV) and candidiasis (CA) by wet mount microscopy. Sensitivity, specificity, and positive and negative predictive values were used to assess the effectiveness of syndromic management for vaginal infections. The prevalence of TV, BV and CA were 5.0%, 20.9% and 11.4% respectively. Nearly 70% of the vaginal infections with trichomoniasis and/or bacterial vaginosis were asymptomatic. Self reported vaginal discharge or the presence of vaginal discharge during examination were poor predictors of vaginal infections w...

Background: Exclusive breastfeeding (EBF) practice is safe and simple intervention in improving child health and growth. However the practice of EBF is still low especially in developing countries. Objective: The objective of this paper is to assess the factors associated with EBF among women with infants' aged 0-5 months in Kilimanjaro region. Methods: This was a population based cross sectional study conducted between June 2010 and March 2011 in Kilimanjaro region to investigate local factors for adverse child development. A structured questionnaire was used to collect socio demographic data, breastfeeding history and reproductive information from mothers. Recall since birth was used to estimate EBF prevalence. Multivariable logistic regression was used to assess the factors associated with EBF among women with infants' aged 0-5 months in Kilimanjaro region. Results: Out of 462 women, 95% (n=437) were still breastfeeding their infants during the study period. About 29% of ...

BACKGROUND:Tanzania has extended prevention of mother-to-child HIV transmission (PMTCT) services to primary health care clinics (PHC). Information on challenges and rates of MTCTC of HIV at this level is limited. The study aimed to describe theuptake of PMTCT interventions and MTCT rates at 18 months post-delivery. METHODS:Pregnant women,in their 3 rd trimester (N=2654),attending 2 primary health facilities in Moshi were recruited. They were interviewed, tested and women-infant pairs were followed-up for 18 months post-delivery, at which point the exposed children were tested for HIV. RESULTS:Of the 2654 women, 99% accepted testing, 93% returned for their HIV-test results and 7% (184) were HIV-positive. Of the 184 HIV-positive women, 93% (171/184) came for test-results, 71% (130/184) took anti-retroviral prophylaxis (sdNVP) in labor and 59% (103/175) infants received ARV (sdNVP) prophylaxis. HIV-testing at 18 months was conducted for 68% of the exposed infants. The rate of MTCT of H...

Women continue to be disproportionately affected by HIV in Tanzania, and factors contributing to this situation need to be identified. The objective of this study was to determine social, behavioral and biological risk factors of HIV infection among pregnant women in Moshi urban, Tanzania. In 2002-2004, consenting women (N = 2654), attending primary health clinics for routine antenatal care were interviewed, examined and biological samples collected for diagnosis of HIV and other sexually transmitted/reproductive tract infections. The prevalence of HIV was 6.9%. The risk for HIV was greater among women whose male partner; had other sexual partners (adjusted odds ratio [AOR], 15.11; 95% confidence interval [CI], 8.39-27.20), traveled frequently (AOR, 1.79; 95% CI, 1.22-2.65) or consumed alcohol daily (AOR, 1.68; 95% CI, 1.06-2.67). Other independent predictors of HIV were age, number of sex partners, recent migration, and presence of bacterial vaginosis, genital ulcer, active syphili...

To identify risk factors for sexually transmitted infections (STI) and to evaluate the accuracy of using risk assessment for identifying infected women in Moshi, Tanzania. A cross sectional study. Three primary health care clinics in Moshi. 382 consenting women attending the clinics for routine reproductive health care were interviewed followed by a pelvic examination between September and December 1999. Blood and genital specimens were collected for STI diagnosis. Prevalent STIs, risk factors and accuracy of using risk factors to identify infected women. Among 382 women, 118 (31%) had at least one STI diagnosed clinically or by a laboratory test; (T. vaginalis 21%, syphilis 4.2%, chlamydia and/or gonococcal cervicitis 3.2%, genital ulcer 4.5% and warts 2%). The risk of CT/GC cervicitis was greater among women aged < 20 years (p = 0.04), with cervical friability (p = 0.01) and with > 10 cervical leucocytes (p < 0.001), while having more than one partner in the past three months (p = 0.008) predicted syphilis infection. Trichomoniasis was associated with the presence of vaginal discharge (p = 0.001) and pH > 4.5 (p < 0.001). However, using these risk factors as a screening tool for various STIs achieved a low sensitivity and a low positive predictive value, hence a low utility for case detection. STIs were prevalent in this setting. However, risk factors were not a good tool for identifying infected women. While there is an urgent need to develop low cost microbiological tests for case detection, efforts should be made to maximise the available control strategies, such as proper treatment of symptomatic patients and their partners.

To determine the prevalence of and risk factors for reproductive tract infections (RTI) among asymptomatic women attending primary health care clinics in Harare, Zimbabwe. A cross sectional study. Prevalent RTI, HIV and socio-demographic data. Two primary health care clinics in Harare. 393 consecutive, consenting women aged 15 to 49 years, presenting at the clinics for antenatal care, family planning, or bringing their children to attend preventive care clinics. More than half of the women had at least one ongoing RTI. Voluntary reporting of symptoms was almost non-existent. Prevalence of HIV was 29.3% and that of classical STIs was 15.4% Trichomoniasis vaginalis, 3.9% syphilis, 3.9% Chlamydia trachomatis and 1.8% Neisseria gonorrhoea. Bacteria vaginosis was diagnosed in 30.3% of the women and candidiasis in 25.4%. Presence of any RTI was significantly associated with lower level of education, sexual debut < 20 years, a non-monogamous partner, and use of a condom during the last sexual encounter. Independent factors associated with cervical infections were young age (< 20 years), being unmarried, current dysuria, warts, clinical signs of purulent or yellowish discharge, lower abdominal pain and cervical friability. Vaginitis was associated with sexual debut or marriage < 20 years, a partner who was a frequent traveller, history of STI, and presence of abnormal vaginal discharge. In view of the high prevalence of RTI and HIV and the low reporting of symptoms by infected women, it is recommended that strategies that improve women's awareness of urogenital symptoms be adopted, along with pro-active inquiry of genital symptoms by the health care workers, and treatment of RTIs, in order to reduce the unnecessary burden of RTIs.

Although most developing countries monitor the proportion of births attended by skilled birth attendants (SBA), they lack information on the availability and performance of emergency obstetric care (EmOC) signal functions by different cadres of health care providers (HCPs). The World Health Organisation signal functions are set of key interventions that targets direct obstetric causes of maternal deaths. Seven signal functions are required for health facilities providing basic EmOC and nine for facilities providing comprehensive EmOC. Our objectives were to describe cadres of HCPs who are considered SBAs in Tanzania, the EmOC signal functions they perform and challenges associated with performance of EmOC signal functions. We conducted a cross-sectional study of HCPs offering maternity care services at eight health facilities in Moshi Urban District in northern Tanzania. A questionnaire and health facility assessment forms were used to collect information from participants and health facilities. A total of 199 HCPs working at eight health facilities in Moshi Urban District met the inclusion criteria. Out of 199, 158 participated, giving a response rate of 79.4 %. Ten cadres of HCPs were identified as conducting deliveries regardless of the level of health facilities. Most of the participants (81 %) considered themselves SBAs, although some were not considered SBAs by the Ministry of Health and Social Welfare (MOHSW). Only two out of the eight facilities provided all of the required EmOC signal functions. While Assistant Medical Officers are expected to perform all the signal functions, only 38 % and 13 % had performed vacuum extraction or caesarean sections respectively. Very few registered and enrolled nurse-midwives had performed removal of retained products (22 %) or assisted vaginal delivery (24 and 11 %). Inadequate equipment and supplies, and lack of knowledge and skills in performing EmOC were two main challenges identified by health care providers in all the level of care. In the district, gaps existed between performance of EmOC signal functions by SBAs as expected by the MOHSW and the actual performance at health facilities. All basic EmOC facilities were not fully functional. Few health care providers performed all the basic EmOC signal functions. Competency-based in-service training of providers in EmOC and provision of enabling environment could improve performance of EmOC signal functions in the district.

To implement quality screening in a blood service requires the presence of screening strategy with a clear algorithm and supporting standard operating procedures (SOPs), skilled and motivated human resource to perform testing, infrastructure, regular available test kits, and other supplies. In developing countries, smooth supply chain management of critical transfusion transmissible infections (TTIs) screening reagents is a challenge. Therefore, managing the little available kits by knowing the rate of consumption, good forecasting, and monitoring expiry date may be a key in ensuring regular supply. Test kit monitoring tool (TKMT) for Vironostika HIV Uni-Form kit/192 1&2 Ag/Ab, Genedia kits for HBsAg and HCV, and RPR for syphilis was developed to track these reagents. This excel tool was developed to assess received reagents, quantity used, quantity remaining, and date of expiration. The tool was evaluated by assessing rerun for each test kits, match tests conducted with blood units tested, adherence to the principle of first in-first out (FIFO), and quantity remaining in the center against the need. The mean rerun for HIV ELISA Vironistika uniform II Ag/Ab observed over expected was 6.9% (n = 3.8) than 2.4% (n = 1.3), HBsAg was 9.9% (n = 5.7) than 6.7% (3.5) (expected), Genedia for HCV was 1.3% (n = 0.7) than 0.5% (n = 0.3), and RPR test for syphilis 3.3% (n = 1.5) than 0.5%. During implementation, TKMT managed to detect expiring kits in the zonal blood transfusion centers. A tool-like TKMT may capture other supplies within blood when expanded. Monitoring of supplies may enable blood service actual accounting and in forecasting supplies and reagents.

The objective was to determine the magnitude of HIV as well as the associations between HIV seropositivity with reproductive tract infections (RTIs) among healthy women in Harare, Zimbabwe. In a cross-sectional study, 393 informed consenting women aged 15--49 years, attending 2 primary healthcare clinics, were interviewed and screened for HIV and RTIs. HIV seroprevalence was 29.3%. Seropositivity was significantly associated with bacterial vaginosis, syphilis, gonorrhoea and/or Chlamydia trachomatis infection, warts and genital ulcers. Risk factors for HIV were absence of lactobacilli in vaginal fluid, vaginal pH >4.5, age >20 years, being unmarried, having had more than one lifetime sexual partner, having used a condom at least once in their lifetime, having experienced an infant mortality, and a partner who was non-monogamous or a frequent traveller. In view of the very high seroprevalence and concomitant RTIs in this population, we recommend promotion of women-controlled prevention methods along with proactive detection and treatment of RTIs.

A cross-sectional study at two urban primary health care clinics in Zimbabwe was conducted among 393 consecutive women. The purpose was to determine the seroprevalence of herpes simplex virus type 2 (HSV-2), to identify coinfections and to determine the association between HSV-2, HIV and other sexually transmitted infections (STIs). Sera were tested for HSV-2, HIV and syphilis. Genital specimens were tested for the other STIs. The seroprevalence of ulcerative STIs tested was 42.2% for HSV-2 and 3.9% for syphilis. HSV-2 seropositive women had twice the risk of being HIV infected compared to HSV-2 seronegative women, adjusted OR=2.05 (95% CI=1.29-3.23). HSV-2 seropositivity was also associated with older age, a lower level of education, increase in the number of lifetime sexual partners and history of genital ulcers in the past six or more months. Our data suggest that in this population HSV-2 may contribute more to HIV infection than syphilis because of its high frequency. There is an urgent need for development of an effective HSV-2 vaccine.

Women in developing countries often present for medical care with advanced cervical cancer, although this condition is preventable through regular screening and early treatment. This study sought to identify the prevalence and risk factors for cervical dyskaryosis among women in Zimbabwe with and without HIV. In a cross-sectional study, 200 consenting women were screened for cervical dyskaryosis and sexually transmitted infections (STI). The relationship between various risk factors for cervical dyskaryosis was examined. The overall prevalence of cervical dyskaryosis was high (19%), and significantly higher among HIV-infected women at 30% compared with 13% among seronegative women, with a peak at a younger age among seropositive women. Use of intravaginal herbs, practising intravaginal cleansing, being single, a history of three or more lifetime sexual partners and a history of previous STI were associated with cervical dysplasia. The high frequency of cervical abnormality lends weight to the demand for implementation of regular screening programmes and health education.

This study examined the level of knowledge of sexually transmitted infections (STI) and HIV, knowledge of symptoms and potential sequelae of STI and perceived personal risks of infection among urban women in Zimbabwe. The women consented to being interviewed, examined, tested and treated for curable diagnosed STIs. Prevalence of both STI and HIV was high 11.4% and 54.5% among women aged 15-19 years, 28.5% and 62.4% among those 20-29 years and was highest among the age group >/=30 years 39.0% and 67.0% respectively. Women aged 15-19 years least perceived their risk of infection. Of the women with the highest rates of STI/HIV infection, less than 30% were aware of their vulnerability to such infections. Knowledge of specific STIs, their symptoms and sequelae was generally low. Women who did not know about syphilis, gonorrhoea, chancroid or warts were more likely to perceive themselves at no risk of infection. Condom use was very low (16.5%). There is an urgent need to improve current education programmes to raise awareness of STIs and the dangers of their long-term sequelae along with behavioural skills building interventions that include equipping women with negotiating skills, making female condoms available at affordable prices and motivating condom use.

To determine the prevalence and risk factors for reproductive tract infections (RTIs), the frequency of asymptomatic genital tract infections, the frequency of genitourinary symptoms and signs and to assess their associations with vaginal and cervical infections. A cross sectional study carried out between September and December 1999. Three primary health care centres in Moshi, Tanzania. A total of 382 consenting women attending Maternal Child Health (MCH) and Family planning clinics (FP). Women were interviewed and then pelvic examination was performed. Blood and genital specimens were collected for laboratory diagnosis of RTIs. Of the 382 women, 64% had-at least one RTI (33.9% bacterial vaginosis, 27% C. albicans, 21.2% T. vaginalis, 5% C. trachomatis, 4% syphilis and 0.5% N. gonorrhoea) and 26% had at least one STI. Nearly 43% of laboratory diagnosed RTIs were asymptomatic. Although none of the women had reported abnormal urogenital symptoms during routine clinical consultation, 64% revealed such symptoms on direct questioning. Reported genital symptoms and signs were significantly associated with vaginal, but not cervical infection. Curable RTIs are prevalent among women attending the MCH and FP clinics. Symptomatic infections were frequently not recognised or reported. We recommend introduction of routine RTI screening and treatment service in the MCH and FP clinics. Strategies to improve women's awareness and knowledge of urogenital symptoms should be instituted.

The objectives of the study were to determine the prevalence of HIV and reproductive tract infections (RTIs); to compare the occurrence of RTIs among HIV-infected and non-infected women; and to assess the association of HIV with RTIs and behavioral factors among women aged 15-49 years. A cross-sectional study was conducted in late 1999 among 382 consenting women attending three primary healthcare clinics. They were interviewed and screened for HIV-1 and RTIs. The prevalence of HIV-1 was 11.5%. Sixty-four percent of the women had one ongoing treatable RTI. Endogenous and sexually transmitted RTIs were higher in HIV-positive than negative women and 84% of the HIV seropositive women were co-infected with one treatable RTI. HIV was significantly associated with cervicitis (chlamydial or gonococcal) [OR = 3.2 (CI 1.1-13.2)], HSV-2 [OR = 2.6 (CI 1.3-5.1)], bacterial vaginosis [OR = 1.9 (CI 1.1-4.1)], genital warts [OR = 4.8 (CI 1.1-22.2)], and presence of vaginal discharge [OR = 2.7 (CI 1.3-5.2)]. Having more than one lifetime sexual partner, a history of infant mortality or a partner who had other wives or resided away from home > 6 months, were risk factors for HIV infection. HIV-1 and RTIs are a major public health problem among women in this population. Integration of routine screening and treatment of RTIs in the reproductive health clinics will be an important strategy to combat HIV in the area. Further, innovative behavior interventions targeting both men and women, preferably as couples are needed.

This study aimed to describe the prevalence and predictors for male partner participation in HIV voluntary counselling and testing (VCT) at two primary healthcare clinics in Moshi urban, Tanzania as well as the effect of partner participation on uptake of HIV perinatal interventions. Pregnant women (n = 2654) in their third trimester, participating in a prevention of mother to child tranmission (PMTCT) program between June 2002 and March 2004 were encouraged to inform and invite their partners for HIV-VCT. Trained nurses conducted pre-test counselling, interviews, clinical examinations and blood sampling from the participating women and their partners. Test results were presented and post-test counselling was conducted individually or in couples, depending on the wishes of the participants. Three-hundred-and-thirty-two male partners (12.5%) came for HIV-VCT. A high proportion (131; 40%) came after the woman had delivered. HIV-seropositive women whose partners attended were three times more likely to use Nevirapine prophylaxis, four times more likely to avoid breastfeeding and six times more likely to adhere to the infant feeding method selected than those whose partners didn't attend. Women were more likely to bring their partner for VCT if they collected their own test results, were living with their partner, had a high monthly income and had expressed at enrolment the intention to share HIV results with their partner. Although PMTCT programs are presumably a good entry point for male involvement in prevention of sexual and perinatal HIV transmission, this traditional clinic-based approach reaches few men. Given the positive influence male participation has on the acceptance of perinatal interventions, a different approach for promoting male participation in VCT is urgently required. Within PMTCT programs, counseling should emphasize the advantages of partner participation to encourage women to inform and convince male partners to come for VCT. Also, promotion of couple VCT outside antenatal settings in male friendly and accessible settings should be given priority.