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The prevalence and risk-factors of pelvic organ prolapse (POP) in Tanzania are unknown. To help elucidate the problem, we assessed POP and associated risk-factors among Tanzanian women by deploying the POP-Q classification system. A cross sectional community based study conducted in Hai, Rombo and Same Districts, Kilimanjaro Region, Tanzania. Women aged 18-90 were recruited through multi-stage random sampling from January to May 2015. Home-based questionnaire interviews were performed and the women were subsequently invited to the nearest health clinic for pelvic examination. Trained physicians used the POP-Q classification system to assess the POP stage. A total of 1195 women were interviewed and invited for pelvic examination; 1063(89%) women presented at the clinic of whom 1047(88%) accepted a clinical examination. Of 1047 examined women, 64.6% had an anatomical POP stage II-IV and 6.7% had a severe POP that descended 1 cm or more below the hymen. POP stage II-IV was associated with being aged 35+ years, being a farmer, doing petty trading and having delivered 3 times or more. Severe POP was associated with carrying heavy objects for ≥ 5 hours (OR 4.70;1.67-13.2), having delivered 5 times or more (OR 10.2;2.22-48.6) and having delivered at home (OR 2.40;1.36-4.22). POP is a common condition among rural Tanzanian women where 64.6% are having POP grade II-IV and 6.7% are having a severe POP descending 1 cm or more below the hymen. Risk-factors are increasing age, heavy lifting, high parity and home-delivery.

To investigate the prevalence and risk factors of urinary incontinence (UI), the different UI subtypes and the association between UI and delivery circumstances. Cross-sectional population-based study conducted in Kilimanjaro Region, Tanzania. 1048 women aged 18-90 women living in rural Kilimanjaro. Simple random sampling was done to select villages, households and participants. Community health workers helped in identifying eligible women and trained nurses/midwives conducted face-to-face interviews. Data were analysed using descriptive statistics and Univariate and Multivariate logistic regression modelling. The overall prevalence rate of UI was 42%. When focusing on the different types of UI, 17% of the women had stress UI, 9% had urge UI and 16% had mixed UI. Only one woman (0.1%) with vesico-vaginal fistula was identified. UI was found to be significantly associated with increasing parity (OR = 2.41 (1.55-3.74). In addition, women who in relation to their first delivery had delivered at home or had been in labour for more than 24 hours, had increased adjusted ORs of 1.70(1.08-2.68) and 2.10(1.08-4.10), respectively, for having UI. UI is common in rural Tanzania and of the subtypes of UI, Stress Urinary Incontinence (SUI) is the commonest followed by Mixed Urinary Incontinence (MUI). Home delivery, prolonged labour and increasing parity especially having 5 or more deliveries are associated with increased risk for developing UI.

Background Breast cancer is a leading cause of cancer related morbidity and mortality in Sub-Saharan Africa with women often being diagnosed at advanced stages of disease. Little is known about how the role of the husband impacts the diagnosis and treatment of women with breast cancer. In this study, we aimed to describe the role of the husband in the experiences of breast cancer patients in Tanzania. Methods We conducted semi-structured in-depth interviews with breast cancer patients ( n  = 20), physicians ( n  = 10), nurses ( n  = 10), and traditional healers ( n  = 18) exploring perceptions of breast cancer diagnosis and treatment in Tanzania. Interviews were recorded, transcribed, and subsequently coded by three independent reviewers. Emergent themes were identified using thematic analysis approach. Results We identified two distinct domains from responses: supportive husbands and unsupportive husbands. Within these domains, 5 supportive and 4 unsupportive themes were identified. Supportive husbands provided financial assistance, encouraged early treatment, adopted a caregiver role, displayed leadership in decision-making, and provided emotional support. Unsupportive husbands displayed stigma and shame, refused financial support, and resorted to rejection and abandonment which ultimately led to delays in diagnosis and treatment. Conclusions Majority of patients, providers, and traditional healers described unsupportive husbands as a component contributing to the delayed presentation and negative experiences of patients. We inferred that spousal financial concerns and societal stigma often drove husband rejection, which resulted in a lack of emotional and financial support for patients and contributed to delays in diagnosis and treatment. Improvements in husband education and communication may reduce stigma and misconceptions regarding breast cancer and may help increase the number of supportive husbands.

IntroductionPrevious research has shown that vaginal pessaries are a cost-effective treatment for women worldwide suffering from stress urinary incontinence. However, little is known about African women’s experiences with vaginal pessary use. The aim of this study was to understand the experiences of vaginal pessary use among Tanzanian women who had received long-term pessary treatment for stress urinary incontinence.Methods15 semi-structured, individual interviews were conducted over a 2-month period in 2019 with Tanzanian women living in the Kilimanjaro Region who suffered from stress urinary incontinence and who had been using a pessary for at least 18 months. The interview transcripts were analysed using qualitative content analysis.ResultsThe primary motivation for seeking treatment were discomfort from symptoms, social consequences and low quality of life. Perceived benefits from pessary use included improved quality of life with reacquired abilities to perform daily activities, participate in social gatherings, feeling symptom relief and improved sexual relations. Further, some women saw pessary treatment as superior to other locally available treatment options. Perceived barriers for pessary use included shame, husband’s disapproval, limited access to treatment and lack of knowledge among the women as well as healthcare personnel.ConclusionVaginal pessaries are well-perceived as a long-term treatment method among Tanzanian women suffering from stress urinary incontinence. This method may have potential to be implemented large scale in Tanzania if combined with basic health education.

Aim To understand HIV stigma and self‐efficacy of labour and delivery (L&D) providers in caring for women living with HIV (WLHIV). Design Cross‐sectional descriptive mixed methods. Methods Data were collected in six primary healthcare facilities in the Kilimanjaro region, Tanzania between February and November 2022. We conducted eight focus groups with L&D providers (n = 36) and nurse‐midwifery students (n = 12). We conducted surveys with 60 L&D providers assessing HIV stigma (fear of acquisition, extra precautions and attitudes) and self‐efficacy in caring for WLHIV. Qualitative findings were complemented by survey data to provide a comprehensive understanding of providers' attitudes and experiences. Results Providers expressed fear of HIV acquisition when caring for WLHIV. Almost all providers noted that they used extra precautions with WLHIV; 97% used double gloves and 39% avoided touching WLHIV with bare hands, even when there were no bodily fluids. Most providers had positive attitudes towards WLHIV. Almost all rejected the idea that HIV was a punishment for bad behaviour, but 44% thought their patients might not be careful about infecting others. Qualitative data suggested providers worried that patients' reluctance to disclose their HIV status could raise the risk of occupational exposure. Provider self‐efficacy in normal birth was lower when caring for a woman with HIV compared with care for women who are HIV‐negative but did not differ significantly in other situations. Conclusion This study showed that providers had generally low‐stigmatising attitudes towards people living with HIV but feared occupational exposure, leading to avoidance of necessary patient contact. Training on clinical and interpersonal skills, coupled with evidence‐based care for women with HIV during childbirth, could benefit both providers and patients. Reporting Method The study is reported following the Good Reporting of a Mixed‐Methods Study (GRAMMS) checklist. Patient or Public Contribution Patients and the public were not involved in this research.

Background Breast cancer (BC) is the most common cancer among women in Tanzania and has one of the highest mortality rates worldwide due to late-stage diagnosis and suboptimal treatment. The role of traditional healers in late-stage diagnosis has not been widely studied. We aimed to identify the barriers to early BC diagnosis in Tanzania and possible solutions by interviewing healthcare providers (HCPs), traditional healers (THs), and other key informants (KIs). Methods We used phenomenological qualitative study design. We administered six open-ended qualitative questions to 20 HCPs (including 10 doctors and 10 nurses), 10 THs, and 9 KIs in rural and urban community settings in the Kilimanjaro region. A focus group discussion with 8 THs was also conducted. The questions explored perceived reasons for late diagnosis of BC, the initial reaction of patients who presented with a noticeable breast changes and reasons for visiting a health facility after the disease had advanced. Participants were recruited after their working hours. Data were analyzed using thematic approach and NVIvo 12 software. Results The findings were synthesized into five themes to explain late diagnosis: (1) HCPs and THs have limited knowledge and misconceptions about the causes, signs, and symptoms of breast cancer; (2) patients experience stigma (3) treatment is expensive and difficult to access; (4) patients perceive barriers based on myths, misperceptions and spiritual beliefs; and (5) HCPs and THs often blame each other for ineffective treatment and delays in effective treatment. The participants also provided suggestions to reduce delays in diagnosis and treatment, including enhancing knowledge and awareness among THs and HCPs to help them recognize the signs and symptoms of BC through education campaigns, addressing the cost of access to care and treatment, addressing stigma associated with BC, and developing collaborative efforts between HCPs and THs. Conclusion In this study, limited knowledge, misconceptions, stigma, access and cost was observed as barriers across all groups.Raising community awareness and improving understanding of BC is crucial in reducing misconceptions and stigma. Future collaboration between healthcare providers and traditional healers could be beneficial in the development of strategies to recognize the early signs and symptoms of BC and promote pathway referral to care.

In Tanzania, breast cancer (BC) is the second most common cancer among women but is far less common in men. Late-stage diagnosis often occurring due to low levels of BC awareness and low compliance with practice of breast self-examination (BSE) for early BC detection. However, the factors related to BC awareness and performance of regular BSE in Tanzania are unclear. The present study aimed to examine the extent to which several dimensions of BC knowledge are associated with BSE. This was examined through a cross-sectional study of patients who received care at the cancer care centre in the Kilimanjaro region. Multivariable relationships were tested using hierarchical linear regression. A total of 219 BC patients participated in this study, of which 193 (88.1%) were women. The findings revealed limited knowledge of breast cancer among the participants. There were significant correlations between 4 of the 6 knowledge factors and BSE, ranging from r  = .16 (knowledge of how to perform BSE) to r  = .26 (knowledge of risk factors). In the regression model, significant predictors of performing BSE included knowledge of risk factors ( B =  0.06), knowing how often to perform BSE ( B =  0.12) and awareness of normal breast appearance ( B =  0.20). Surprisingly, there was a negative association between knowledge of signs and symptoms and BSE ( B = - 0.7). Males were less likely to perform BSE than females ( B =  0.75), and BSE performance decreased with age ( B = - 0.1). In conclusion, education should focus on teaching appropriate BSE methods, the optimal frequency of BSE, and awareness of the appearance of the breast and how a normal breast should feel and look during BSE.

Introduction and hypothesisThe objective of this study was to evaluate the outcomes of vaginal pessaries in managing symptomatic pelvic organ prolapse (POP) in a low-income setting.MethodsA pre-post interventional study was conducted in the Kilimanjaro region, Tanzania. Seventy-one women with symptoms and a POP stage II or more on the POP quantification test were fitted with a vaginal pessary. Pelvic examination, POP Distress Inventory (POPDI-6) and POP Impact Questionnaire (POPIQ-7) were completed at baseline, after 3 months and after 12–18 months. Changes in the POPDI-6 and POPIQ-7 scores, complications and satisfaction associated with pessary use before and after the intervention were obtained.ResultsPessary treatment was associated with a reduction in the overall POPDI score from 55.0 (50.0, 60.0) at baseline to 25.0 (25.0, 30.0) after 12–18 months’ use. The overall POPIQ score was reduced from 54.2 (41.7, 66.7) at baseline to 25.0 (25.0, 29.2) after 12–18 months’ use of the pessary. Vaginal discharge was reported in 72.4 and 32.4% of the women after 3 and 12–18 months’ use respectively, whereas 72.4 and 25% of the women had some degree of granuloma, erosion or infection at 3 and 12–18 months respectively. Despite the reported complications, 78% of the women were satisfied with the pessary when interviewed after 12–18 months and 81% wanted to continue using it.ConclusionsVaginal pessary improves symptoms and quality of life associated with symptomatic POP. Therefore, it may be a treatment option in managing POP in low-income countries such as Tanzania.

Background Obstetric fistula has severe psychological consequences, but no evidence-based interventions exist to improve mental health in this population. This pilot trial evaluated a psychological intervention for women receiving surgical care for obstetric fistula. Methods A parallel two-armed pilot RCT was conducted between 2014 and 2016. The intervention was six individual sessions, based on psychological theory and delivered by a nurse facilitator. The study was conducted at a tertiary hospital in Moshi, Tanzania. Women were eligible if they were over age 18 and admitted to the hospital for surgical repair of an obstetric fistula. Sixty participants were randomized to the intervention or standard of care. Surveys were completed at baseline, post-treatment (before discharge), and 3 months following discharge. Standardized scales measured depression, anxiety, traumatic stress, and self-esteem. Feasibility of an RCT was assessed by participation and retention. Feasibility and acceptability of the intervention were assessed by fidelity, attendance, and participant ratings. Potential efficacy was assessed by exploratory linear regression and clinical significance analysis. Results Eighty-five percent met criteria for mental health dysfunction at enrollment. All eligible patients enrolled, with retention 100% post and 73% at 3 months. Participants rated the intervention acceptable and beneficial. There were sharp and meaningful improvements in mental health outcomes over time, with no evidence of differences by condition. Conclusions A nurse-delivered mental health intervention was feasible to implement as part of in-patient clinical care and regarded positively. Mental health treatment in this population is warranted given high level of distress at presentation to care. Trial registration ClinicalTrials.Gov NCT01934075 .

Introduction and hypothesisDelays in receiving obstetric care during labor contribute to high rates of maternal morbidity in sub-Saharan Africa. This exploratory study was conducted to identify important delays experienced during the development and subsequent repair of obstetric fistula in northern Tanzania.MethodsSixty women presenting to a tertiary hospital with obstetric fistula completed structured surveys about the birth experience that led to fistula development and their experiences seeking surgical repair. A subset of 30 provided qualitative accounts. Clinical data were collected postsurgery. Data were analyzed according to a four-delay model, with iterative analysis allowing for triangulation of all sources.ResultsDuring the index pregnancy, women labored for a median of 48 h. Most women (53/60; 88.3%) delivered in a facility but labored for a median of 12.4 h before deciding to seek care (Delay 1). Women spent a median of 1.25 h traveling to a facility (Delay 2). After presenting to care, 15/51 (29.4%) waited at least an hour to see a medical provider, and 35/53 (66.0%) required transfer to another facility (Delay 3). Women lived with fistula for a median of 10 years (Delay 4). Qualitative data provided context and a deeper understanding of the factors contributing to each delay.ConclusionsCritical delays exist both outside and within the healthcare system that contribute to the development and timely repair of obstetric fistula. Healthcare system strengthening, particularly with regard to emergency obstetric care, is critical to reduce the burden of obstetric fistula in women in Tanzania.