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Worldwide, alcohol is a leading risk factor for death and disability. Tanzania has particularly high rates of consumption and few resources dedicated to minimizing alcohol-related harm. Ongoing policy efforts are hampered by dynamic sociocultural, economic, and regulatory factors contributing to alcohol consumption. Through the voices of Kilimanjaro Christian Medical Centre (KCMC) patients, this study aimed to investigate community perceptions surrounding alcohol and the impact of its use in this region. This mixed-methods study was conducted at KCMC between October 2021 and May 2022. 676 adult (≥18 years old) Kiswahili-speaking patients who presented to KCMC's Emergency Department (ED) or Reproductive Health Clinic (RHC) were enrolled through systematic random sampling to participate in quantitative surveys. Nineteen participants were selected for in-depth interviews (IDIs) through purposeful sampling. The impact and perceptions of alcohol use were measured through Drinkers' Inventory of Consequences (DrInC) scores and analyzed in RStudio using means and standard deviations. IDI responses were explored through a grounded theory approach using both inductive and deductive coding methodologies in NVivo. Men attending the ED were found to have the highest average [SD] DrInC scores (16.4 [19.6]), followed by ED women (9.11 [13.1]), and RHC women patients (5.47 [9.33]), with higher scores indicating a broader array of consequences. Participants noted alcohol to have both perceived advantages and clear harms within their community. Increased conflict, long-term health outcomes, financial instability, stigma, and sexual assault were seen as negative consequences. Benefits were primarily identified for men and included upholding cultural practices, economic growth, and social unity. Physical and financial harm from alcohol impacted both genders; however, alcohol-related stigma and sexual assault were found to affect women disproportionately. Our findings suggest that perceptions around drinking are nuanced, and alcohol's social and physical consequences differ significantly by gender. To effectively minimize local alcohol-related harm, future alcohol-focused research and policy efforts should consider the complex sociocultural role that alcohol holds in the Moshi community.

For children with cancer in low- and middle-income countries, medical and non-medical expenses are often paid through out-of-pocket (OOP) expenditures, which pose significant barriers to timely care. Our study aims to estimate the impact of OOP expenditures for cancer care for children in Tanzania through a mixed-methods approach. We used an explanatory mixed-method design to evaluate the impact of OOP expenditures for children receiving cancer care at the Kilimanjaro Christian Medical Center in Tanzania based on the Three Delays Framework. Quantitative data were collected to measure OOP expenditures and to assess the risk of catastrophic health expenditure or depth of impoverishment associated. Qualitative interviews were conducted to evaluate financial barriers and facilitators to care and were analyzed using thematic content analysis. Qualitative and quantitative data were triangulated to compare themes, identify areas of agreement or dissonance, and assess for complementarity. Thirteen caregivers of children with cancer at KCMC formed the study cohort. Most lived in a rural setting (92%) and were farmers or livestock keepers (68%). Quantitative analysis showed that total median OOP health expenditures were $53.01 (IQR: 26.50-106.01). All families were pushed further into poverty from the OOP expenses as shown by widening poverty gaps. Qualitative interviews revealed several themes related to financial challenges for families with cancer, particularly during the time period prior to definitive care including worry about job losses and having to sell assets to reach care. Data triangulation confirmed strong agreement between qualitative and quantitative data on the impact of financial barriers on care. However, families stated higher OOP costs in qualitative interviews compared to quantitative data. Protecting families from impoverishment by reducing OOP costs during time periods prior to receiving definitive care may be a strategic way to improve timely diagnosis and early treatment for children with cancer.

Introduction The SARS-CoV-2 (COVID-19) pandemic has strained healthcare systems and presented unique challenges for children requiring cancer care, particularly in low- and middle-income countries. This study aimed to assess the impact of the COVID-19 pandemic on access to cancer care for children and adolescents in Northern Tanzania. Methods In this cross-sectional study, we assessed the demographic and clinical characteristics of 547 pediatric and adolescent cancer patients (ages 0–19 years old) between 2016 and 2022 using the population-based Kilimanjaro Cancer Registry (KCR). We categorized data into pre-COVID-19 (2016–2019) and COVID-19 (2020–2022) eras, and performed descriptive analyses of diagnostic, treatment, and demographic information. A secondary analysis was conducted on a subset of 167 patients with stage of diagnosis at presentation. Results Overall admissions nearly doubled during the pandemic ( n  = 190 versus 357). The variety of diagnoses attended at KCMC increased during the pandemic, with only five groups of diseases reported in 2016 to twelve groups of diseases in 2021. Most patients were diagnosed at a late stage (stage III or IV) across eras, with the proportion of under-five years old patients increasing late-diagnoses from 29.4% (before the pandemic), 52.8% (during the pandemic), when compared to the overall cohort. Around 95% of children in this age category reported late-stage diagnosis during the pandemic. Six out of the twelve cancer site groups also reported an increase in late-stage diagnosis. During the pandemic, the proportion of children receiving surgery increased from 15.8 to 30.8% ( p  < 0.001). Conclusion Childhood and adolescent cancer care changed in Northern Tanzania during the COVID-19 pandemic, with increased late-stage diagnoses presentations among younger patients and the increased use of surgical therapies in the context of a growing practice. Understanding the impact of the COVID-19 pandemic on pediatric and adolescent cancer care can help us better adapt healthcare systems and interventions to the emerging needs of children and adolescents with cancer in the midst of a health crisis.

Background: In areas of new-immigrant population growth, medical and social infrastructure may be lagging behind the needs of those who do not identify with the majority culture or language. Subsequently, information regarding this population's health status and access to care is limited. Montana's Hispanic population is one such group. Despite its low total population, the state has experienced unprecedented growth in the number of Spanish-speaking individuals and families over the last decade. Objectives: We utilized a community based participatory research framework to emphasize equal partnership between lay community members and researchers to ensure adherence to community priorities and strengthen trust between the two parties allowing for future collaboration. Based on community request, we designed four health screening events to provide needed health prevention services to the Hispanic community. Methods: Through collaboration with a Community Advisory Board, we created four health screening events to provide basic primary care services, including height and weight, blood pressure, diabetes, and mental health screenings. We partnered with a team of dental hygienists to provide oral preventive health. We conducted a cost-effectiveness analysis, comparing our approach to traditional health services. Study variables were analyzed using analysis of variance to examine differences in health outcomes between health screening events. Results: We screened 140 persons and found that 85.7% lacked health insurance and 80.7% lacked a usual source of care. We also found overweight and obesity in 47.1% and 27.1%, respectively, and hypertension in 63.6%. Services provided by the health screening events were up to $239 less expensive than comparable services provided at local health centers. Conclusions: Working directly with the community, we designed and implemented health prevention events which served to meet a growing need and to identify and address health concerns among the Hispanic immigrant community.

A well-prepared nursing workforce is essential to meet the healthcare needs of rural, underserved, and Indigenous communities. This study examines nursing students' perceptions of a Mobile Health Training Program (MHTP) that integrates AACN core competencies, with a focus on culturally responsive care, interprofessional collaboration, and professional development. Over the past two years, the MHTP conducted preschool health screenings for children aged 0–5 at four Tribal nations in Montana. Survey followed by qualitative analysis. A total of 160 nursing undergraduate nursing students completed post-clinical surveys between September 2022 and May 2024. The survey responses were analyzed qualitatively to identify themes related to rural healthcare, culturally responsive care, exposure to diverse communities and professional growth. The MHTP was valued by 95 % of students. Four key themes emerged: insights into rural healthcare, practicing culturally responsive care, exposure to diverse communities, and professional growth. American Indian/Alaska Native students emphasized the need for culturally reflective opportunities for all. The MHTP aligned with AACN competencies, enhancing skills in patient-centered care, cultural competence, interprofessional collaboration, and systems-based practice. The MHTP represents a practical model for nursing education, providing immersive, pediatric patient-focused experiences while engaging with high-priority communities. This study contributes to the limited literature on rural and Tribal clinical placements, highlighting the value of balancing simulation with direct clinical practice and preparing nursing students to address healthcare challenges in underserved areas.

Background: Pediatric cancer is a significant and growing burden in low- and middle-income countries such as Tanzania. The objective of this project was to describe the barriers and facilitators to accessing pediatric cancer care in Northern Tanzania using the Three Delays ModelMethods: This was a cross-sectional qualitative study conducted between June and September 2023 at Kilimanjaro Christian Medical Center (KCMC). Parents and caregivers of children obtaining pediatric cancer care at KCMC were approached for participation in in-depth interviews (IDIs) and complimentary demographic surveys. This study is part of an ongoing collaboration between researchers from Duke Global Health Institute at Duke University and KCMC.Results: Participants suggested significant financial barriers to accessing pediatric cancer care along the entire care continuum. Early delays were impacted by waiting for symptoms to resolve and the use of traditional medicine. Additional delays resulted from health infrastructure at mid-level health facilities, misdiagnoses, and delayed referral to KCMC for definitive treatment. Participants did not describe clinical delays after arrival to KCMC and rather offered perspective on their child’s cancer diagnosis, their concerns while obtaining care, and their hopes for the future.Conclusions: The most significant clinical delays occurred within Delay 1 (the decision to seek care) and Delay 2 (reaching a medical facility). Advancements in clinical infrastructure and training at intermediary medical centers should be considered to support the prompt diagnosis and treatment for pediatric cancer. Lastly, financial and social schemes which limit out-of-pocket expenses should be considered.

The purpose of this study is to explore immigrants’ perceptions of their daily lives in a state with anti-immigrant policies in the United States. Using snowball sampling, researchers recruited a sample of 30 Latino immigrants in southwest Montana. The research team conducted semi-structured interviews in Spanish and analyzed the data using thematic analysis. We identified four themes: difficulty accessing healthcare, frustration over the inability to obtain driver’s licenses, challenges related to employment, and desire to make a life in Montana. Fear permeated all topics. Lack of documentation presents complex economic, health, and social challenges that prevent immigrants from fully integrating into their communities. These are exacerbated in states that employ anti-immigrant policies. As Western states continue to experience growth in immigrant populations, it is critical to develop policies to support integration and equitable access to health and social services.