Africa Academy for Public Health

PurposeEnhancing community knowledge about risk factors and warning signs for stroke and heart attack is important for effective prevention and control. This study evaluated the effects of home-based health education and healthy lifestyle interventions delivered by community health workers (CHWs) on knowledge of risk factors and warning signs for stroke and heart attack.Patients and MethodsWe conducted a 1:1 cluster-randomized trial in twelve villages in rural Morogoro, Tanzania. Participants in the intervention received monthly home-based health education and healthy lifestyle promotion from CHWs for 6 months, followed by bi-monthly follow-up visits until 12 months. Participants in the control group followed the standard of care. Knowledge regarding risk factors and warning signs for stroke and heart attack was assessed through two independent cross-sectional surveys, one before and another after the intervention. The analyses were adjusted for baseline factors.ResultsBoth intervention and control groups experienced an increase in mean knowledge scores between baseline and evaluation survey, with a significant increase in the intervention group. Mean knowledge for risk factors increased by 4.0 (SD 2.7) in the intervention compared to 2.5 (SD 3.1) in the control group. That of warning signs increased by 3.1 (SD 2.4) in the intervention group compared to 2.4 (SD 2.8) in the control group. Overall, mean knowledge of risk factors and warning signs increased by 7.1 (SD 4.3) in the intervention group and by 4.9 (SD 5.3) in the control group. After adjusting for selected baseline characteristics, participants in the intervention group experienced a 2.1 greater increase in mean knowledge of risk factors and warning signs [difference in differences 2.1 (95% CI, 1.4 to 2.8)].ConclusionCHWs’ home-delivered health education and healthy lifestyle promotion interventions resulted in a significant enhancement in knowledge of risk factors and warning signs for stroke and heart attack. These findings provide insight into the potential of CHW-led interventions in the prevention and control of stroke and heart attacks in Tanzania.Clinical Trial RegistrationPan African Clinical Trial Registry (PACTR201801002959401).

Infants born to pregnant women living with HIV (WLHIV) are at greater risk for morbidity and mortality and may also have poorer developmental outcomes as compared with infants who are not exposed to HIV. Nutrition interventions in pregnancy may affect developmental outcomes. This study evaluated the effect of maternal vitamin D supplementation on infant development outcomes. We conducted a secondary analysis of a randomised, triple-blind, placebo-controlled trial of maternal vitamin D supplementation from June 2015 to October 2019. Antenatal care clinics in Dar es Salaam, Tanzania. Pregnant WLHIV and their offspring. Daily 3000 IU vitamin D3 or placebo supplements taken during pregnancy and lactation. Infants were assessed for cognitive, language and motor development at 1 year of age with the Caregiver Reported Early Development Instruments (CREDI). A total of 2167 infants were eligible, and 1312 of them completed CREDI assessments at 1 year of age. Vitamin D supplementation had no effect on overall CREDI z-scores (standardised mean difference (SMD) 0.03, 95% CI -0.09, 0.15, p value 0.66). There was also no evidence of a difference between vitamin D and placebo groups in language (SMD 0.06, 95% CI -0.08, 0.21, p value 0.40), motor (SMD 0.02, 95% CI -0.09, 0.14, p value 0.69) or cognitive domain z-scores (SMD 0.05, 95% CI -0.08, 0.17, p 0.48). Maternal vitamin D supplementation during pregnancy and lactation did not affect infant development outcomes. ClinicalTrials.gov identifier: NCT02305927.

Abstract The current development trajectory in developing countries suggests that the Sustainable Development Goals (SDGs), which aim to alleviate poverty in all its forms, may not be achieved by 2030 without deliberate efforts. The incidence of poverty has increased in many developing countries, with the situation worsening among rural dwellers than their urban counterparts. This systematic review explores the hurdles to achieving poverty alleviation and sustainable rural development in Southern Africa, taking Tanzania and Malawi as a reference point. The study employed the PRISMA procedures to guide the selection of related articles for review. The findings indicate that, despite notable progress achieved through initiatives such as social and conditional cash transfers, as well as investment in agriculture, both countries still face significant structural and institutional barriers. Hurdles such as overdependence on agriculture, health challenges, limited access to education, poor governance and corruption, rapid population growth, slow technology adoption, and political uncertainty and policy changes hinder the promotion of rural development and poverty alleviation. The study emphasises the importance of addressing these challenges and developing a multidimensional, actor-inclusive approach to integrate social, institutional, and environmental factors in combating poverty. The study further informs policymakers and development partners on designing more effective rural development strategies to align with the 2030 SDGs and Africa’s Development Agenda 2063.

ABSTRACTBackground and AimsMaternal and neonatal mortality remain high in sub‐Saharan Africa (SSA), which can be reduced by the expanded antenatal care (ANC) services intervention. Challenges exist in the quality coverage of ANC in Tanzania. We aimed to assess inequalities and determinants of quality ANC coverage among women of reproductive age (WRA, 15–49 years) in Tanzania.MethodsWe performed a secondary analysis of cross‐sectional data from 6620 women of reproductive age using the 2022 Tanzania Demographic and Health Survey. Quality ANC coverage (ANCq) was measured using seven indicators, with scores ≥ 7 classified as adequate. Log‐linear regression models were used to determine factors associated with ANCq using Stata version 18.0. Inequalities in ANCq by age categories, education level, socioeconomic status (SES), area of residence, and geographical zones were analyzed using WHO HEAT 3.1 through Difference and Population Attributable Risk measures.ResultsAmong 6620 WRA (43%), had adequate ANCq coverage. Higher inequalities were observed among women with low education, low SES, rural residence, and living in western zones. ANCq coverage was positively associated with high SES (RR 1.35, 95% CI: 1.20–1.52), secondary/higher education (RR 1.21, 95% CI: 1.06–1.38), high media exposure (RR 1.11, 95% CI: 1.00–1.21), easy access to health facility (RR 1.11, 95% CI: 1.01–1.27), and partner's higher education (RR 1.28, 95% CI: 1.08–1.52). Inverse associations were observed among older women (35–49 years) (RR 0.89, 95% CI: 0.80–0.97) and those with higher birth order (RR 0.78, 95% CI: 0.72–0.84).ConclusionThe study demonstrates suboptimal ANCq coverage in Tanzania, especially among disadvantaged groups, which quality ANCq having a positive association with rich wealth status, higher education level, high media exposure, health facility access, and older maternal age. Addressing these socioeconomic disparities is crucial for improving ANCq coverage and maternal and child health outcomes.

Low-income and middle-income countries continue to face challenges in financing health programmes due to budgetary constraints and decreased donor funding. Off-budget financing has become crucial for controlling diseases like malaria, HIV/AIDS and tuberculosis (TB). However, there is limited evidence on alternative domestic funding approaches to support implementation of healthcare programmes in Tanzania. The study explored stakeholder perspectives on alternative domestic funding approaches to support malaria, HIV/AIDS and TB services in Tanzania. A qualitative descriptive design was employed to gather insights from 76 purposely selected stakeholders, including policymakers, programme managers, regional health managers, district health managers and healthcare workers. Data were managed and analysed thematically. Four major themes emerged: current sources of funds, financial resources needed, proposed alternative domestic funding mobilisation strategies to support implementation of malaria, HIV/AIDS and TB and challenges of implementing the proposed strategies. Current major sources of funds included multilateral donors, development partners, the central government and internal sources. There was a consensus on a decrease in donor funding due to the COVID-19 pandemic. The proposed alternative domestic funding strategies included establishing universal health insurance, reducing beneficiaries of service exemptions, establishment of disease-specific funds and taxation of certain products. Implementation challenges for the proposed strategies included poor awareness, conflicting political promises and accountability issues. The financing gap for malaria, HIV/AIDS and TB services is significant due to decreasing donor funding. Strategies such as strengthening insurance schemes, reducing exemption groups and taxation could help, but community sensitisation and improved fund accountability are crucial.

Efforts have been made to address climate change and improve people's lives; however, the psychological outcomes of climate change have not been adequately explored. While environmental and economic impacts have been widely studied, the mental health consequences of climate change continue to affect communities, particularly vulnerable populations. This study examined the perceived psychological outcomes of climate change among youth and adults in Kinondoni District, located in the Dar es Salaam region of Tanzania. A total of 360 respondents aged 15 years and above participated in the study. The research employed a convergent parallel design with a mixed-method approach, allowing for the simultaneous collection of both quantitative and qualitative data. Data were collected using structured questionnaires with closed-ended questions and in-depth interviews with key informants, while a documentary review of written and electronic materials was conducted for secondary data analysis. The findings indicate that flooding and increased temperatures were reported at moderate levels, posing significant challenges to daily life and well-being. Furthermore, psychological outcomes such as depression, anxiety disorders, stress, grief, and trauma were found to be moderately prevalent among respondents. The study recommends that the government, through the Ministry of Health, Community Development, Gender, Elderly, and Children, should collaborate with non-governmental organizations (NGOs), community-based organizations (CBOs), and local authorities to develop targeted interventions addressing climate-induced mental health challenges. Psychological support services should be integrated into disaster response mechanisms to ensure timely assistance for individuals experiencing climate-related anxiety, stress, depression, and trauma. Keywords: Psychological outcomes, climate change, mental health, Tanzania 

The study addressed the challenge of improving human resource performance within Local Government Authorities (LGAs), particularly in Kinondoni Municipality, where inefficiencies and limited technological integration have hindered effective governance and service delivery. Recognizing the potential of Information and Communication Technology (ICT) to transform organizational processes, the study explored its contributions to human resource performance, focusing on the policy and legal framework governing ICT use, its influence on efficiency and effectiveness, and the challenges of adoption. Guided by the Technology Acceptance Model (TAM), which emphasizes the role of perceived ease of use and usefulness in technology adoption, the study targeted employees and stakeholders, including human resource officers, IT personnel, administrative staff, and community leaders. Using a sample of 100 respondents selected through purposive and stratified random sampling, data were collected through interviews and questionnaires and analyzed using SPSS for descriptive statistics and thematic analysis for qualitative insights. Findings showed that ICT policies are well-established (mean = 4.2, SD = 0.75) and that ICT improves efficiency, accessibility, and data integrity, with record-keeping identified as a significant benefit (40%). Offices were well-equipped with internet-connected computers (mean = 4.3, SD = 0.75), though Human Resource Information Systems (HRIS) adoption was moderate (mean = 3.9, SD = 0.85), reflecting limited utilization. Key challenges included inadequate training and insufficient integration of ICT into human resource practices. Despite these obstacles, ICT was found to significantly enhance human resource performance, supporting governance and service delivery. The study recommended increased investments in infrastructure, continuous training, implementation of e-governance initiatives, and the establishment of impact evaluation frameworks to maximize ICT’s potential.

This study explores the complex relationship between phonological processes and verb extensions, focusing on the concept of word elasticity, which describes the transformations words undergo based on linguistic contexts. Anchored in the Generative Phonology Theory, which postulates a transition from underlying representation to surface structure, the research aims to understand the phonological outcomes stemming from verb extension morphology, particularly in Bantu languages. Employing a qualitative approach through a documentary systematic review of peer-reviewed literature and academic articles across diverse languages, findings reveal multiple phonological processes, such as elision, assimilation, and palatalization, demonstrating the dynamic shifts induced by verb conjugations. The study concludes that understanding the interplay between morphology and phonology is fundamental, emphasizing the transformative nature of verb extensions in shaping phonological processes across languages.