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Dar es Salaam, Tanzania

Baumgartner J.N.,Duke University | Kaaya S.,Muhimbili University of Health and Allied Sciences | Siril H.,Management and Development for Health
Social Psychiatry and Psychiatric Epidemiology | Year: 2014

The burden of perinatal mental disorders among women in low- and middle-income countries is substantial. The current integration of mental health into maternal, neonatal and child health service platforms is limited, despite global calls to prioritize such service integration. The study by Iheanacho and colleagues (2014) entitled “Integrating mental health screening into routine community maternal and child health activity: experience from a prevention of mother-to-child HIV transmission (PMTCT) trial in Nigeria” provides promising evidence about the feasibility of a church-based strategy for screening pregnant women and their partners for mental health problems through a PMTCT program. © 2014, Springer-Verlag Berlin Heidelberg.

Abioye A.I.,Harvard University | Isanaka S.,Harvard University | Liu E.,Harvard University | Mwiru R.S.,Management and Development for Health | And 4 more authors.
AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV | Year: 2015

Human immunodeficiency virus (HIV)-infected males have poor treatment outcomes after initiation of antiretroviral therapy (ART) compared to HIV-infected women. Dietary factors might mediate the association between sex and disease progression. However, the gender difference in diet among HIV-infected individuals in sub-Saharan Africa is largely unknown. The objective of this study was to examine differences in dietary intake among HIV-infected men and women. We conducted a cross-sectional analysis of dietary questionnaire data from 2038 adults initiating ART in Dar es Salaam, Tanzania to assess whether nutrient adequacy differed by sex. We dichotomized participants' nutrient intakes by whether recommended dietary allowances (RDAs) were met and estimated the relative risk (RR) of meeting RDAs in males using binomial regression models. We also estimated the mean difference in intake of foods and food groups by gender. We found poorer dietary practices among men compared to women. Males were less likely to meet the RDAs for micronutrients critical for slowing disease progression among HIV patients: niacin (RR = 0.39, 95% confidence interval [CI]: 0.27 to 0.55), riboflavin (RR = 0.81, 95% CI: 0.73 to 0.91), vitamin C (RR = 0.94, 95% CI: 0.89 to 1.00), and zinc (RR = 0.06, 95% CI: 0.01 to 0.24). Intake of thiamine, pantothenate, vitamins B6, B12, and E did not vary by gender. Males were less likely to eat cereals (mean difference [servings per day] = -0.21, 95% CI: -0.44 to 0.001) and vegetables (mean difference = -0.47, 95% CI: -0.86 to -0.07) in their diet, but more likely to have meat (mean difference = 0.14, 95% CI: 0.06 to 0.21). We conclude that male HIV patients have poorer dietary practices than females, and this may contribute to faster progression of the disease in males. © 2015 Taylor & Francis.

Mbuya F.E.,Management and Development for Health | Fredrick F.,University of Dar es Salaam | Kundi B.,University of Dar es Salaam
Tanzania Journal of Health Research | Year: 2014

Diabetes and hypertension are among the most common non-communicable diseases (NCD) that contribute to a large number of adult morbidity and mortality. The objective of this study was to determine knowledge of diabetes and hypertension and the associated risk factors among members of teaching staff of Higher Learning Institutions in Dar es Salaam, Tanzania. A cross sectional community based study was conducted in 10 higher learning institutions including universities. A structured pretested questionnaire was utilized. A total of 139 teaching members of staff from higher learning institutions participated in the study. The majority (74.8%; n=104) of the participants were males. Mean age of the participants was 40.7 ± 12.6 Over half (56.8%; 79/139) of the respondents correctly identified failure of body to use insulin as one of the causes of diabetes. Of the respondents, 43.2% (60/139) were able to identified heredity as cause of hypertension. Increasing age was correctly identified as one of risk factors for diabetes by 38.1% (53/139) and for hypertension by 36.7% (51/139) respondents. In conclusion, the majority of teaching staff in the higher learning Institutions in Dar es Salaam were aware of the diabetes and hypertension. However the knowledge of the causes, signs and symptoms, risk factors and complications was not as high as expected. It is important that this group of professionals is appropriately informed as regards to diabetes, hypertension and other non-communicable diseases as they may serve as key advocacy group to the community and policy makers in Tanzania.

Mhalu A.,Management and Development for Health | Leyna G.H.,Muhimbili University of Health and Allied Sciences | Mmbaga E.J.,Muhimbili University of Health and Allied Sciences
Journal of the International AIDS Society | Year: 2013

Introduction: Prevention with a positive approach has been advocated as one of the main strategies to reduce new instances of HIV infection. Risky sexual behaviours among people living with HIV/AIDS are the cornerstone for this approach. Understanding the extent to which infected individuals practice risky behaviours is fundamental in designing appropriate population-specific interventions. With the HIV infection transmission rates remaining high among young people in sub-Saharan Africa, continued prevention among them remains a priority. This study therefore seeks to describe the magnitude and determinants of risky sexual behaviours among young people living with HIV. Methods: A cross-sectional study was conducted between June and July 2010 in selected Care and Treatment Clinics (CTCs) in Dar Es Salaam, Tanzania. A total of 282 HIV-positive patients aged 15-24 were interviewed about their sexual behaviours using a questionnaire. Results: Prevalence of unprotected sex was 40.0% among young males and 37.5% among young females (p < 0.001). Multiple sexual partnerships were reported by 10.6% of males and 15.9% of females (p < 0.005). More than 50% of the participants did not know about the HIV status of their sexual partners. A large proportion of participants had minimal knowledge of transmission (46.7% males vs. 60.4% females) and prevention (65.3% males vs. 73.4% females) of sexually transmitted infections (STIs). Independent predictors of condom use included non-use of alcohol [adjusted odds ratio (AOR), 0.40 95% confidence interval (CI); 0.17-0.84] and younger age (15-19 years) (AOR, 2.76, 95% CI: 1.05-7.27). Being on antiretroviral therapy (AOR, 0.38, 95% CI: 0.17-0.85) and not knowing partners' HIV sero-status (AOR, 2.62, 95% CI: 1.14-5.10) predicted the practice of multiple sexual partnership. Conclusions: Unprotected sex and multiple sexual partnerships were prevalent among young people living with HIV. Less knowledge on STI and lack of HIV disclosure increased the vulnerability and risk for HIV transmission among young people. Specific intervention measures addressing alcohol consumption, risky sexual behaviours, and STI transmission and prevention knowledge should be integrated in the routine HIV/AIDS care and treatment offered to this age group. © 2013 Mhalu A et al licensee International AIDS Society.

Sudfeld C.R.,Harvard University | Giovannucci E.L.,Harvard University | Giovannucci E.L.,Brigham and Womens Hospital | Isanaka S.,Harvard University | And 5 more authors.
Journal of Infectious Diseases | Year: 2013

Background. Maintaining vitamin D sufficiency may decrease the incidence of pulmonary tuberculosis and other infectious diseases. We present the first prospective study of vitamin D among human immunodeficiency virus (HIV)-infected adults receiving antiretrovirals in sub-Saharan Africa.Methods. Serum 25-hydroxyvitamin D (25(OH)D) level was assessed at antiretroviral therapy (ART) initiation for 1103 HIV-infected adults enrolled in a trial of multivitamins (not including vitamin D) in Tanzania. Participants were prospectively followed at monthly visits at which trained physicians performed a clinical examination and nurses took anthropometric measurements and assessed self-reported symptoms. Cox proportional hazards models estimated hazard ratios (HRs) of morbidity outcomes.Results. After multivariate adjustment, vitamin D deficiency (defined as a concentration of <20 ng/mL) had a significantly greater association with incident pulmonary tuberculosis, compared with vitamin D sufficiency (HR, 2.89; 95% confidence interval [CI], 1.31-7.41; P =. 027), but no association was found for vitamin D insufficiency (defined as a concentration of 20-30 ng/mL; P =. 687). Deficiency was also significantly associated with incident oral thrush (HR, 1.96; 95% CI, 1.01-3.81; P =. 046), wasting (HR, 3.10; 95% CI, 1.33-7.24; P =. 009), and >10% weight loss (HR, 2.10; 95% CI, 1.13-3.91; P =. 019). Wasting results were robust to exclusion of individuals experiencing pulmonary tuberculosis. Vitamin D status was not associated with incident malaria, pneumonia, or anemia.Conclusions. Vitamin D supplementation trials for adults receiving ART appear to be warranted. © 2012 The Author.

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