An assessment of health information literacy among women in rural Lake Zone, Tanzania

This article presents the results from a descriptive cross-sectional survey that was conducted to assess the health information literacy skills of women of childbearing age in rural Lake Zone, Tanzania. A total of 349 women were involved in the study. The study found that most rural women in the study area have low levels of health information literacy. The aggregate scores of health information literacy indicate a mean of 42.86% with a normal distribution curve, and estimated close-to-zero skewness (0.172) and kurtosis (−0.297) measures. The causal relationships between health information literacy and women’s socio-demographic factors indicate a positive and statistically significant effect ( p < .01) of women’s level of education, income, ownership of means of communication and access to health facilities on their level of health information literacy. The women’s inadequate ability to access, read, understand, appraise and use health information is a barrier to their acquisition of relevant health information. Enhancing the health information literacy skills of these women is most likely to improve their health outcomes.

A multimodal mentorship intervention to improve surgical quality in Tanzania’s Lake Zone: a convergent, mixed methods assessment

Background Safe, high-quality surgical care in many African countries is a critical need. Challenges include availability of surgical providers, improving quality of care, and building workforce capacity. Despite growing evidence that mentoring is effective in African healthcare settings, less is known about its role in surgery. We examined a multimodal approach to mentorship as part of a safe surgery intervention (Safe Surgery 2020) to improve surgical quality. Our goal was to distill lessons for policy makers, intervention designers, and practitioners on key elements of a successful surgical mentorship program. Methods We used a convergent, mixed-methods design to examine the experiences of mentees, mentors, and facility leaders with mentorship at 10 health facilities in Tanzania’s Lake Zone. A multidisciplinary team of mentors worked with surgical providers over 17 months using in-person mentorship, telementoring, and WhatsApp. We conducted surveys, in-depth interviews, and focus groups to capture data in four categories: (1) satisfaction with mentorship; (2) perceived impact; (3) elements of a successful mentoring program; and (4) challenges to implementing mentorship. We analyzed quantitative data using frequency analysis and qualitative data using the constant comparison method. Recurrent and unifying concepts were identified through merging the qualitative and quantitative data. Results Overall, 96% of mentees experienced the intervention as positive, 88% were satisfied, and 100% supported continuing the intervention in the future. Mentees, mentors, and facility leaders perceived improvements in surgical practice, the surgical ecosystem, and in reducing postsurgical infections. Several themes related to the intervention’s success emerged: (1) the intervention’s design, including its multimodality, side-by-side mentorship, and standardization of practices; (2) the mentee–mentor relationship, including a friendly, safe, non-hierarchical, team relationship, as well as mentors’ understanding of the local context; and (3) mentorship characteristics, including non-judgmental feedback, experience, and accessibility. Challenges included resistance to change, shortage of providers, mentorship dose, and logistics. Conclusions Our study suggests a multimodal mentorship approach is promising in building the capacity of surgical providers. By distilling the experiences of the mentees, mentors, and facility leaders, our lessons provide a foundation for future efforts to establish effective surgical mentorship programs that build provider capacity and ultimately improve surgical quality.

An increasing role of pyrethroid-resistant Anopheles funestus in malaria transmission in the Lake Zone, Tanzania

Anopheles funestus is playing an increasing role in malaria transmission in parts of sub-Saharan Africa, where An. gambiae s.s. has been effectively controlled by long-lasting insecticidal nets. We investigated vector population bionomics, insecticide resistance and malaria transmission dynamics in 86 study clusters in North-West Tanzania. An. funestus s.l. represented 94.5% (4740/5016) of all vectors and was responsible for the majority of malaria transmission (96.5%), with a sporozoite rate of 3.4% and average monthly entomological inoculation rate (EIR) of 4.57 per house. Micro-geographical heterogeneity in species composition, abundance and transmission was observed across the study district in relation to key ecological differences between northern and southern clusters, with significantly higher densities, proportions and EIR of An. funestus s.l. collected from the South. An. gambiae s.l. (5.5%) density, principally An. arabiensis (81.1%) and An. gambiae s.s. (18.9%), was much lower and closely correlated with seasonal rainfall. Both An. funestus s.l. and An. gambiae s.l. were similarly resistant to alpha-cypermethrin and permethrin. Overexpression of CYP9K1, CYP6P3, CYP6P4 and CYP6M2 and high L1014S-kdr mutation frequency were detected in An. gambiae s.s. populations. Study findings highlight the urgent need for novel vector control tools to tackle persistent malaria transmission in the Lake Region of Tanzania.

Tanzanian Women Exposed to Nutrition-Related Media Messages and Interpersonal Counselling Are More Likely Than Unexposed Women to Practice Optimal Nutrition Behaviors

Objectives We tested the hypothesis that mothers of infants &lt; 2 y of age who were exposed to nutrition- and health-focused radio and TV spots, interpersonal counselling (IPC), or both were more likely than mothers with no exposure to media nor to IPC to practice the following behaviors during their most recent pregnancy: eat more food than usual, eat more frequently than usual, eat more types of food than usual, make at least one antenatal care (ANC) visit, receive or purchase iron tablets, and reduce household workload. Methods Between 2016 and 2020, the Addressing Stunting in Tanzania Early (ASTUTE) project conducted a social and behavior change intervention in the Lake zone of Tanzania that reached 8.4 million individuals, including 4.4 million people through radio and TV spots, 6.4 million through community health worker home visits, 411,000 through support groups, and 1.6 million through health facility-based counselling. We administered a cross-sectional survey to 5,000 households with children &lt; 2 y before the intervention and 5,000 households after program activities ended. We used bivariate analyses and logistic regression to test our hypotheses. Results After adjusting for maternal age, education, and household wealth, IPC alone was only associated receiving ANC (OR: 1.7, p = 0.008). Exposure to media alone was significantly associated with every behavior except self-reported increased food consumption (OR range for all comparisons: 1.2–1.9; p &lt; 0.001). Exposure to both media and IPC was associated with every behavior (p &lt; 0.001 for all comparisons) and the odds of practicing such behaviors were greater than for media alone (OR range: 1.6–3.8; p &lt; 0.01 for all comparisons). Conclusions In this program setting, exposure to IPC alone was not associated with nutrition and health behaviors in pregnancy but media and media + IPC were strongly associated with such practices. Media and IPC have the potential to improve maternal nutrition, an often-neglected public health challenge. Funding Sources ASTUTE was funded by UKAid (contract # PO 6803).

Vendian Island-Arc Intrusive Magmatism of the Lake Zone of Western Mongolia (Geological, Geochronological, and Petrochemical Data)

—Based on new geochronological data on gabbroid and plagiogranitoid associations (Tavan-Hayrhan, East Bayan Tsagaan, Bayan Tsagaan Uul, Tungalag, Three Hills, and Shutkhuin massifs) located among the Vendian island-arc volcanic complexes of the Lake Zone of Western Mongolia, an independent stage of Vendian island-arc intrusive magmatism (560–542 Ma) is substantiated. Geochronological ages determined by xenogenic zircon from Vendian gabbroids and granitoids (716–559 Ma) indicate a wide time interval of their formation and different natures of the sources. Several such sources are assumed. The source of the first type is rocks of the late Riphean oceanic crust of the Paleoasian Ocean, on which the Vendian island arc of the Lake Zone formed later. This is evidenced by the presence of xenogenic zircon with the ages of ~716, 658–642, 613–611 Ma. The source of the second (probably main) type is rocks of the Vendian island-arc crust of the Lake Zone. This is indicated by the presence of xenogenic zircon with ages of 583–559 Ma, observed in all studied Vendian intrusive associations.

Outcomes of a Multicomponent Safe Surgery Intervention in Tanzania’s Lake Zone: A Prospective, Longitudinal Study

Background Evidence-based strategies for improving surgical quality and patient outcomes in low-resource settings are a priority. We evaluated the impact of a multicomponent safe surgery intervention (Safe Surgery 2020) in Tanzania, hypothesizing it would (1) increase adherence to safety practices, teamwork and communication, and documentation in patient files, and (2) reduce the incidence of maternal sepsis, postoperative sepsis, and surgical site infection. Methods We conducted a prospective, longitudinal study in 10 intervention and 10 control facilities in Tanzania’s Lake Zone, across a three-month pre-intervention period in 2018 and three-month post-intervention period in 2019. Safe Surgery 2020 is a multicomponent intervention to support four surgical quality areas: 1) leadership and teamwork, 2) evidence-based surgery, anaesthesia, and equipment sterilization practices, 3) data completeness, and 4) infrastructure. Surgical team members received training and mentorship, and each facility received up to a $10,000 infrastructure grant. Inpatients undergoing major surgery and postpartum women were followed during their stay up to 30 days. We assessed adherence to 14 safety and teamwork and communication measures through direct observation in the operating room. We identified maternal sepsis (vaginal or caesarean delivery), postoperative sepsis, and surgical site infections prospectively through daily surveillance and assessed medical record completeness retrospectively through chart review. We compared changes in surgical quality outcomes between intervention and control facilities using difference-in-differences analyses to determine areas of impact. Results Safety practices improved significantly by an additional 20.5% (95% CI, 7.2%-33.7%; P=.003) and teamwork and communication conversations by 33.3% (95% CI, 5.7%-60.8%; P=.02) in intervention facilities compared to control facilities. Maternal sepsis rates reduced significantly by 1% (95% CI, 0.1%-1.9%; P=.02). Documentation completeness improved by 41.8% (95% CI, 27.4%-56.1%; P&lt;.001) for sepsis and 22.3% (95% CI, 4.7%-39.8%; P=.01) for surgical site infections. Conclusion Our findings demonstrate the benefit of the Safe Surgery 2020 approach. Improvement was observed in adherence to safety practices, teamwork and communication, and data quality, and there was a reduction in maternal sepsis rates. Our results support the emerging evidence that improving surgical quality in a low resource setting requires a focus on the surgical system and culture. Investigation in diverse contexts is necessary to confirm and generalize our results and to understand how to adapt the intervention for different settings. Further work is also necessary to assess the long-term effect and sustainability of such interventions.