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BACKGROUND: Childhood mortality is high in sub-Saharan Africa. Mother-to-child transmission (MTCT) of HIV and congenital syphilis are among significant causes. Dual elimination of these two infections is one of the international goals. Community-based studies on the burden of HIV and syphilis among children will contribute to fine-tuning the interventions to achieve the elimination goal. This study aims to describe the prevalence of HIV and syphilis among children aged 0-36 months and associated factors in northern Tanzania. METHODS: This was a community-based cross-sectional study, which was conducted in all the seven districts of Kilimanjaro region. Multistage sampling was used, and a total of 2452 children aged 0 to 36 months and their primary caretakers were enrolled. Interviews were conducted with the mother/caretaker, and dried blood samples were collected from the children and processed for laboratory diagnosis of HIV and syphilis. HIV ELISA was first performed on all the samples. Positive samples of children < 18 months were confirmed using PCR. RESULTS: The prevalence of HIV among 2452 children aged 0-36 months was 1.7% (n = 42). There was a significant difference in the distribution of HIV by age of the child, maternal antenatal attendance, and breastfeeding history.The prevalence of syphilis was 0.4% (n = 10). Five of the children were more than 1 year old. All children with a positive test for syphilis were from Moshi rural district, and their mothers consumed alcohol. No child was co-infected with HIV and syphilis. CONCLUSIONS: Though the prevalence of the two infections was low, detecting syphilis in children suggests a missed opportunity in screening women during pregnancy. The region may be on track with the goal to achieve dual elimination of mother-to-child transmitted HIV and syphilis. However, efforts are needed to reduce missed opportunities for screening women for syphilis and HIV early in pregnancy and retesting at 3rd trimester/delivery. Strategies to improve testing for HIV-exposed children are needed.

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Background Congenital rubella syndrome is a global health problem. The incidence is much higher in Africa and Southeast Asia than the rest of the world, especially in countries where universal rubella vaccination has not been implemented. Healthcare worker's knowledge on rubella infection and the rubella vaccine is of utmost importance in achieving and maintaining vaccination coverage targets. This study aimed to assess health care workers knowledge on rubella infection in Kilimanjaro Tanzania, after the introduction of a rubella vaccination. Methods This was a health facility-based cross sectional study. It was conducted in three districts of the Kilimanjaro region between August and October 2016. The study involved eligible health care workers in selected health facilities. An interview guide was used for collecting information by face-to-face interviews. Multivariate analysis was used to assess factors associated with rubella knowledge among healthcare workers. Results A total of 126 health care workers were interviewed. An acceptable level of knowledge was considered if all five questions about rubella were correctly answered. Only 26.4% (n = 31) answered all questions correctly. In multivariate analysis education level and working department were predictors of rubella knowledge; health care workers with an advanced diploma had an adjusted odds ratio (AOR) of 7.7 (95% Confidence interval; CI: 1.4, 41.0), those with a university degree (AOR: 10; 95% CI: 2.4; 42.5) and health care workers in the outpatient department (AOR: 0.06; 95% CI: 0.04; 0.29). Conclusions Our study confirmed that health care worker's knowledge on rubella infection was low in the areas where rubella vaccination had been introduced. We recommend continuous education and supportive supervision post vaccine introduction in order to increase healthcare worker's knowledge on rubella infection, congenital rubella syndrome and prevention through sustained high vaccination coverage.

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BACKGROUND: Exclusive breastfeeding (EBF) has many benefits to the child from mental to physical growth and development; however, methods of measuring EBF have raised a number of policy and programmatic questions. This study assesses EBF rates and factors associated with EBF practices in Northern Tanzania using two different methodologies, namely, the 24-hours recall and recall-since-birth. METHODS: A cohort study was conducted from October 2013 to December 2015 among mother-infants' pairs. Mothers with child delivery information (N=430) were followed and included in the analyses. We enrolled pregnant women who were in their third trimesters and interviewed them with the help of questionnaires at enrollment, delivery, 7 days and thereafter monthly up to nine months after delivery. At each visit after delivery, information on breastfeeding using the two methods (24 hours recall and recall-since-birth) was collected. RESULTS: The prevalence of EBF dropped from one month to six months when using both the 24 hours recall and the recall since birth methods, but at different rates. At six months, 24.2% of the mothers practiced EBF when measured with the recall since birth method, compared to 38.8% when measured with the 24 hour recall. Predictors of EBF were also different. When using the recall since birth method, women who had received counseling on infant feeding had increased odds of practicing EBF compared to those who did not receive counseling, [AOR=2.3; 95% CI (1.2, 3.7)]. When using 24 hours recall, women who were unemployed had increased odds of practicing EBF compared to those who were employed [AOR=1.5;95% CI(1.1,2.5)], and women aged 35 - 49 years had decreased odds of practicing EBF compared to younger women[AOR=0.28; 95 % CI(0.1,0.7)]. CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS: The two methods for EBF give substantially different results, both in the prevalence of EBF and factors associated with EBF. The higher EBF obtained with 24 hours recall represents an overestimation and thereby an overly positive picture of the situation.

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BACKGROUND: Childhood rubella infection is a mild, self-limiting illness. Rubella infection among pregnant women however, is a major public health concern. Depending on gestation age, it may result in fetal death, stillbirth or a new-born with congenital rubella syndrome (CRS). Maternal antibodies protect young infants from rubella infection and lifelong immunity is acquired by vaccination or post-rubella infection. This study aims at characterizing rubella infection and its epidemiology in the Kilimanjaro region, prior to the introduction of the rubella vaccine in Tanzania. METHODS: This was a population based cross-sectional study, covering all the seven districts in Kilimanjaro region, North-eastern Tanzania. The study population included children of 0 to 36 months of age and their mothers/primary caretakers. A multistage sampling method was used to obtain a representative sample of the children. Interviews were conducted using a structured questionnaire. Dried blood spot (DBS) samples were taken from eligible children. Rubella specific IgG antibodies were detected from eluted serum by enzyme-linked immunosorbent assay (ELISA). Descriptive statistics were used to summarize the data, the difference between groups was tested by Fishers exact test or chi square test as appropriate. Univariate and multivariate analysis was used, with rubella sero-positive groups as dependent variables and the socio-demographic, children, paediatric and parental factors as independent variables, the Odds ratio and their 95% confidence intervals were calculated to assess the strength of association between the dependent and independent variables. A p value less than 0.05 was considered significant. RESULTS: The overall rubella sero-prevalence was 1.8%. Rural residence was associated with greater risk for rubella infection. Other family characteristic did not predict rubella infection. CONCLUSIONS: This study highlights the low natural immunity to rubella among children prior to the introduction of rubella vaccine in Tanzania. Our research underscores the need for an effective rubella vaccination program to prevent CRS. More epidemiologic and immunologic studies are needed to guide the vaccination deployment and administration strategy in Tanzania.

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This study assessed the prevalence and risk factors associated with underweight, stunting and wasting among children aged 0-24 months in six districts of Kilimanjaro region, northern Tanzania. A cross-sectional population-based study using a multistage, proportionate to size sampling was conducted from June 2010 to March 2011. A structured questionnaire was used to collect sociodemographic, economic, feeding and child information. Anthropometric data were collected by trained field workers, and the data were used to assess child nutritional status. A total of 1870 children were enrolled in this study. The prevalence of children classified as underweight was 46.0%, stunting was 41.9%, and wasting was 24.7%. About 33% were both underweight and stunted, and 12% had all three conditions. In a multivariate logistic regression, child age, child being ill and birth weight were associated with all anthropometric indices. Child being breastfed was associated with being underweight and wasting. Mother's education was associated with being underweight and stunting. Fathers aged 35+ years, and living in the Hai district was associated with stunting, and being female was associated with wasting. The prevalence of child undernutrition is high in this region. Strategies that target each risk factor for child undernutrition may help to reduce the problem in the region.

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BACKGROUND: Knowledge on infant feeding among pregnant women is essential when promoting optimal breastfeeding practices. This study aimed to assess the knowledge of women on optimal breastfeeding during pregnancy and associated factors as well as performance of the health system in reaching women with information on breastfeeding and infant feeding issues. METHODS: A cross-sectional study was conducted from October 2013 to April 2014 among pregnant women, in their third trimester, attending for routine care at two primary health care facilities in Moshi urban, northern Tanzania. RESULTS: A total of 536 women were enrolled, with mean age of 25.9 (SD 5.7) years. Only 51% (n = 274) reported to have received counselling on breastfeeding from their healthcare providers during the current pregnancy. More than seven out of ten pregnant women were knowledgeable about key issues regarding appropriate breastfeeding practices: importance of colostrum (95%), time of breastfeeding initiation (71%), exclusive breastfeeding (EBF) (81%), and time of introducing complementary feeding (83%). Receiving counselling on breastfeeding during the current pregnancy (Adjusted Odds Ratio [AOR] 3.7; 95% Confidence Interval [CI]: 2.4, 5.7), having two children (AOR 2.6; 95% CI: 1.5, 4.4), having three or more children (AOR 3.5; 95% CI: 1.8, 6.9) and intention to breastfeed the child exclusively (AOR 3.6; 95% CI: 2.0, 6.5) were significantly associated with appropriate breastfeeding knowledge. CONCLUSIONS: The health system failed to reach the 49% of women who did not receive counselling on infant feeding. Pregnant women who had received counselling on optimal breastfeeding and women with more than one child were more likely to have knowledge of optimal breastfeeding practices.

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BACKGROUND: Exclusive breastfeeding (EBF) is a simple and cost-effective intervention to improve child health and survival. Effective EBF has been estimated to avert 13% - 15% of under-five mortality and contribute to reduce mother to child transmission of HIV. The prevalence of EBF for infant less than six months is low in most developing countries, including Tanzania (50%). While the Tanzania Demographic Health Survey collects information on overall EBF prevalence, it does not evaluate factors influencing EBF. The aim of this paper was to determine the prevalence and predictors of exclusive breastfeeding in urban and rural areas in Kilimanjaro region. METHODS: A population-based cross-sectional study was conducted between June 2010 to March 2011 among women with infants aged 6-12 months in Kilimanjaro. Multi-stage proportionate to size sampling was used to select participants from all the seven districts of the region. A standardized questionnaire was used to collect socio-demographic, reproductive, alcohol intake, breastfeeding patterns and nutritional data during the interviews. Estimation on EBF was based on recall since birth. Multivariable logistic regression was used to obtain independent predictors of EBF. RESULTS: A total of 624 women participated, 77% (483) from rural areas. The prevalence of EBF up to six months in Kilimanjaro region was 20.7%, without significant differences in the prevalence of EBF up to six months between urban (22.7%) and rural areas (20.1%); (OR = 0.7, 95% CI 0.5,1.4).In multivariable analysis, advice on breastfeeding after delivery (Adjusted odds ratio, AOR = 2.6, 95% CI 1.5, 4.6) was positively associated with EBF up to six months. Compared to married/cohabiting and those who do not take alcohol, single mothers (AOR = 0.4, 95% CI 0.2, 0.9) and mothers who drank alcohol (AOR = 0.4, 95% CI 0.3, 0.7) had less odds to practice EBF up to six months. CONCLUSION: Prevalence of EBF up to six months is still low in Kilimanjaro, lower than the national coverage of 50%. Strengthening of EBF counseling in all reproductive and child health clinics especially during antenatal and postnatal periods may help to improve EBF rates.

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BACKGROUND: Although poor maternal mental health is a major public health problem, with detrimental effects on the individual, her children and society, information on its correlates in low-income countries is sparse. AIMS: This study investigates the prevalence of common mental disorders (CMD) among at-risk mothers, and explores its associations with sociodemographic factors. METHODS: This population-based survey of mothers of children aged 0-36 months used the 14-item Shona Symptom Questionnaire (SSQ). Mothers whose response was "yes" to 8 or more items on the scale were defined as "at risk of CMD." RESULTS: Of the 1,922 mothers (15-48 years), 28.8% were at risk of CMD. Risk of CMD was associated with verbal abuse, physical abuse, a partner who did not help with the care of the child, being in a polygamous relationship, a partner with low levels of education, and a partner who smoked cigarettes. Cohabiting appeared to be protective. CONCLUSIONS: Taken together, our results indicate the significance of the quality of relations with one's partner in shaping maternal mental health. The high proportion of mothers who are at risk of CMD emphasizes the importance of developing evidence-based mental health programmes as part of the care package aimed at improving maternal well-being in Tanzania and other similar settings.

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The current study investigated the prevalence and risk factors for poor nutritional status among children less than 36 months of age in the Kilimanjaro region of Tanzania. Using a cross sectional study design, children and their caregivers were recruited into the study. Anthropometric measures were taken based on established protocol while a standard questionnaire was utilized to collect socio-demographic data. A finger-prick blood sample was collected from all the children and haemoglobin (Hb) concentration analyzed using a HemoCue photometer (HemoCue AB, Angelholm, Sweden). Four hundred and twenty three (423) children (214 females) took part in this study. Participating children were aged between 1­35 months (mean = 13.04, SD = 7.70). We observed high rates of stunting (44.2%) and underweight (19.1%). Nearly 70% (n = 295) of the sample was anaemic (Hb < 11 g/dL). In a multivariate logistic regression model concerns on child growth, maternal education, and child's age were found to independently predict stunting; whereas concerns over child's growth and development, and distance to water source were found to uniquely predict being underweight. Maternal education was the only factor related to the child's anaemia. The current study further emphasizes the need to implement context relevant interventions to combat malnutrition in this region of Tanzania and other similar settings.

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Anaemia during pregnancy is associated with negative maternal and neonatal outcomes. However, there is limited data regarding prevalence and effects of anaemia during pregnancy in northern Tanzania. The objective of this study was to determine the prevalence and possible risk factors for anaemia and its effect on perinatal outcomes among pregnant women attending antenatal care in Moshi Municipality in northern Tanzania. A cohort of pregnant women aged 14-43 years and in their 3rd trimester, was recruited from two primary health care clinics between June 2002 and March 2004. Interviews, anthropometric measurements and haematological examinations were conducted on 2654 consenting women. Perinatal outcomes were recorded during delivery and at 1 week after delivery. Of the 2654 participants, 47.4% had anaemia (haemoglobin [Hb] <11g/dl), 35.3% had mild anaemia (Hb= 9-10.9g/dl), 9.9% had moderate anaemia (Hb =7- 8.9g/dl), and 2.1% had severe anaemia (Hb < 7 g/dl). Anaemia was significantly more prevalent in HIV-positive (56.4%) than in HIV-negative women (46.7%), (P = 0.01). In logistic regression anaemia was independently associated with maternal HIV (OR= 1.5), malaria (OR= 5.2), clinic of recruitment (OR= 1.5) and low income (OR= 1.9). Pregnant women with anaemia were more likely to have low birth weight (LBW) infants. Compared with non-anaemic women, the risk of LBW was 1.6 times and 4.8 times higher for children born to women with moderate and severe anaemia, respectively. In conclusion, anaemia in pregnancy is a severe public health problem in northern Tanzania. Control of maternal anaemia may be one important strategy to prevent LBW in this setting. Measures to prevent malaria and to control anaemia among all pregnant women irrespective of HIV status, should be strengthened. Outside of the health sector broader approaches for anaemia prevention targeting women of lower income, are required.

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OBJECTIVES: To determine the prevalence of sexually transmitted infections (STIs) and other reproductive tract infections (RTIs) among pregnant women in Moshi, Tanzania and to compare the occurrence of STIs/RTIs among human immunodeficiency virus (HIV)-infected and uninfected women. METHODS: Pregnant women in their 3rd trimester (N = 2654) were recruited from two primary health care clinics between June 2002 and March 2004. They were interviewed, examined and genital and blood samples were collected for diagnosis of STIs/RTIs and HIV. RESULTS: The prevalence of HIV, active syphilis and herpes simplex virus - type 2 (HSV-2) were 6.9%, 0.9% and 33.6%, respectively, while 0.5% were positive for N gonorrhoeae, 5.0% for T vaginalis and 20.9% for bacterial vaginosis. Genital tract infections were more prevalent in HIV-seropositive than seronegative women, statistically significant for syphilis (3.3% vs 0.7%), HSV-2 (43.2% vs 32.0%), genital ulcers (4.4% vs 1.4%) and bacterial vaginosis (37.2% vs 19.6%). In comparison with published data, a declining trend for curable STIs/RTIs (syphilis, trichomoniasis and bacterial vaginosis) was noted. CONCLUSION: Rates of STIs and RTIs are still high among pregnant women in Moshi. Where resources allow, routine screening and treatment of STIs/RTIs in the antenatal care setting should be offered. Higher STIs/RTIs in HIV-seropositive women supports the expansion of HIV-counseling and testing services to all centers offering antenatal care. After identification, STIs/RTIs need to be aggressively addressed in HIV-seropositive women, both at antenatal and antiretroviral therapy care clinics.

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BACKGROUND: 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. RESULTS: 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 syphilis and herpes simplex virus type 2. CONCLUSION: Development of programs that actively involve men in HIV prevention is important in reducing transmission of HIV in this population. Further, interventions that focus on STI control, the mobile population, sexual risk behavior and responsible alcohol use are required.

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Identification of HIV-infected women is a prerequisite in HIV perinatal prevention programs. The aim of this study was to determine the predictors of failure to return for HIV posttest results among pregnant women (N=2654) receiving antenatal care at primary health clinics in Moshi urban district, Tanzania. Consenting pregnant women, who were in the third trimester of pregnancy, received individual pretest counseling, followed by interview and screening for HIV. Posttest counseling and results were given after 1 week. A total of 182 (7%) failed to return for their HIV test results. Women were less likely to return for test results if their partners did not come for testing (adjusted odds ratio [AOR], 12.6; 95% CI, 3.1-51.4), if their partners consumed alcohol (AOR, 1.8; 95% CI, 1.3-2.7), and if they had never discussed reproductive health matters with their partners (AOR, 1.7; 95% CI, 1.1-2.7). Additionally, the site of recruitment, age, alcohol consumption, and advanced gestation age predicted failure to return for HIV test results. These results indicate that male partner factors were important in determining whether women returned for results. We therefore recommend promotion of antenatal couple counseling and strengthening of community awareness of the availability of perinatal interventions, with special efforts targeting men. Furthermore, the predictors for failure to collect test-results need to be addressed during pretest counseling.

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