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Arusha, Tanzania

Furahini G.,Tumaini University Makumira | Lewallen S.,The Good
Ophthalmic Epidemiology

Purpose: To estimate the incidence of suspected ocular surface squamous neoplasia (OSSN) by Region in Tanzania and learn where these lesions are treated. Methods: We performed an analysis of existing theater records from three Tanzanian referral hospitals from 2006 to 2008 plus a prospective analysis of records from all other eye health workers who remove suspected OSSN outside the referral hospitals over 1 year. Results: Approximately 40% of suspected OSSN are operated on outside of referral hospitals. The estimated annual incidence of ocular surface squamous neoplasia in Tanzania was 2.2 per 100,000 persons. Regional incidence rates were significantly correlated with Regional HIV (Human immunodeficiency virus) prevalence (Pearson's r=0.53, P=0.03). Conclusion: The incidence rate is high, in line with estimates from other East African countries. Management of these cases requires improvement as most patients are still not tested for HIV. © 2010 Informa UK Ltd. Source

Byamukama E.,Tumaini University Makumira | Courtright P.,Kilimanjaro Center for Community Ophthalmology
International Health

The aim of this study was to assess the primary eye care knowledge, skills, and productivity of primary health workers at dispensaries in a district in Tanzania. Factors likely to contribute to knowledge, skills, and productivity were also assessed. A descriptive cross-sectional study design was used. All health workers employed at government dispensaries in Mwanga District, Kilimanjaro Region, Tanzania were included. A skills score of respondents, comprising knowledge and ability to test visual acuity and diagnosis and management of common eye conditions, was measured through interview and direct observation. Factors associated with the skills score were assessed. Forty nine health workers were assessed. There was poor understanding of basic ocular conditions and how to assess visual acuity; the mean skills score of all respondents was 6.2 out of 12. There was little association between having received training and the skills score. The mean number of eye patients managed per health worker was three per month. Findings suggest that a reassessment of the roles and responsibilities in primary eye care of dispensary health workers, review of training curriculum and teaching, and supervisory procedures may be necessary. © 2010 Royal Society of Tropical Medicine and Hygiene. Source

Okwen M.,Tumaini University Makumira | Lewallen S.,Kilimanjaro Center for Community Ophthalmology | Courtright P.,Kilimanjaro Center for Community Ophthalmology
Public Health

Introduction: Primary health care in Tanzania is provided at two types of health units, the dispensary and the health centre. Theoretically, primary health workers (with knowledge of primary eye care [PEC]) are ideally placed to identify people in need of eye care services. In Tanzania, they are expected to be able to identify, treat, or correctly refer a number of eye conditions including cataract, trauma, presbyopia, and the 'red eye'. They are also expected to be able to measure visual acuity correctly and to educate the community about prevention. Objectives: The objective was to determine the effect of enhanced supervision of health workers on PEC knowledge and skills in Kilimanjaro Region, Tanzania. Study design: This was a quasi-experimental, cluster randomized intervention study of an enhanced supervisory method compared to a routine supervisory method; 36 dispensaries were randomly allocated into the two groups. Participants: Health workers based at government dispensaries in Mwanga District. Data collection: Participants were interviewed pre and post intervention and the information was recorded using a standardized pretested questionnaire. Results: Mean scores of knowledge in healthcare workers was higher in the intervention group (score=6.43, 80.4% improvement) compared to the non-intervention group (score=4.71, 58.9% improvement). The ability to describe and demonstrate vision testing was better (score=1.8) in the enhanced supervision group compared to the routine supervision group (score=0.88, P=0.03). There was a high level of attrition (24%) within one year from the time of baseline survey, especially amongst clinical officers (44%). Conclusion: During the pilot study, enhanced supervision improved PEC knowledge and skills of health workers compared to health workers with routine supervision. Recommendations: Training in PEC needs revision to become more practicum-based. There is need to revise supervision guidelines (to be skills-based) and the supervision skills of district eye coordinators (DECs) need to be enhanced. There is a huge need to improve governance (accountability and rule of law) of health staff. © 2013 The Royal Society for Public Health. Source

Adolescents in Zanzibar are at risk of reproductive health problems including teenage pregnancies, STIs and HIV, early sexual debut and abortion complications. The national policy guideline of adolescents reproductive health needs parents to support and provide information on sexuality and reproductive health to their adolescents, however, Zanzibar has been observed to be a rich and splendid cultural and religious legacy country whereby information related to sexuality is an avoided topic of explicit discussion. Therefore the purpose of this study was to assess acceptability of caretakers in providing information on sexuality to adolescents in health centers, family, community and schools using information motivation behavioral skills (IMB) model. Probability 3 stages sampling technique was used to obtain a representative sample of 192 participant of the study (98 were female and 94 were male) who were interviewed with the use of structured questionnaire in Urban District, Zanzibar. About 100 (54.3%) respondents accept the provision of information on sexuality to their adolescents. Only 81 (44%) respondents reported to have knowledge on information on sexuality. Only 48(26%) respondents perceived that their adolescents are more vulnerable to get reproductive health problems, 73 (39.7%) reported to have less restrictive social norms regarding the provision of information on sexuality, 106 (57.6%) have positive attitude towards the provision of information on sexuality to adolescent and 96 (52.20%) have high self efficacy in the provision of information on sexuality. Indicators of motivation showed significant association and were the predictors of acceptability and self efficacy. The level of acceptability of caretakers in the provision of information on sexuality to their adolescents was nearly at the border line (54%). Providing information on sexuality and improve self efficacy are the most important factors to consider in the interventions of increasing caretakers' acceptability in the provision of information on sexuality to adolescents; however, creating less restrictive social norms, build up positive attitude and sensitizing on realization of feelings of vulnerability to caretakers add weight in plans to increase acceptability. Source

Lewallen S.,Tumaini University Makumira | Taylor T.E.,Michigan State University | Taylor T.E.,University of Malawi | Molyneux M.E.,Malawi Liverpool Wellcome Trust Clinical Research Programme
Future Microbiology

Accurate diagnosis of cerebral malaria (CM) is important for patient management, epidemiological and end point surveillance, and enrolling patients with CM in studies of pathogenesis or therapeutic trials. In malaria-endemic areas, where asymptomatic Plasmodium falciparum parasitemia is common, a positive blood film in a comatose individual does not prove that the coma is due to malaria. A retinopathy consisting of two unique features - patchy retinal whitening and focal changes of vessel color - is highly specific for encephalopathy of malarial etiology. White-centered retinal hemorrhages are a common but less specific feature. Either indirect or direct ophthalmoscopy can be used to identify the changes, and both procedures can be learned and practiced by nonspecialist clinicians. In view of its important contributions to both clinical care and research, examination of the retina should become a routine component of the assessment of a comatose child or adult when CM is a possible diagnosis. © 2011 Future Medicine Ltd. Source

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