Improving Maternal and Reproductive Health in Kigoma, Tanzania: A 13-Year Initiative.

The Program to Reduce Maternal Deaths in Tanzania was a 13-year (2006-2019) effort in the Kigoma region that evolved over 3 phases to improve and sustain the availability of, access to, and demand for high-quality maternal and reproductive health care services. The Program intended to bring high-quality care closer to more communities. Cutting across the Program was the routine collection of monitoring and evaluation data.

A Comprehensive Approach to Improving Emergency Obstetric and Newborn Care in Kigoma, Tanzania.

Introduction: To address high levels of maternal mortality in Kigoma, Tanzania, stakeholders increased women's access to high-quality comprehensive emergency obstetric and newborn care (EmONC) by decentralizing services from hospitals to health centers where EmONC was delivered mostly by associate clinicians and nurses. To ensure that women used services, implementers worked to continuously improve and sustain quality of care while creating demand.

Methods: Program evaluation included periodic health facility assessments, pregnancy outcome monitoring, and enhanced maternal mortality detection region-wide in program- and nonprogram-supported health facilities.

Factors Associated with Contraceptive Use in Sub-Saharan Africa.

Globally 10% of women have an unmet need for contraception, with higher rates in sub-Saharan Africa. Programs to improve family planning (FP) outcomes require data on how service characteristics (, geographic access, quality) and women's characteristics are associated with contraceptive use. We combined data from health facility assessments (2018 and 2019) and a population-based regional household survey (2018) of married and in-union women ages 15-49 in the Kigoma Region of Tanzania.

Birth companionship in a government health system: a pilot study in Kigoma, Tanzania.

Background: Having a companion of choice throughout childbirth is an important component of good quality and respectful maternity care for women and has become standard in many countries. However, there are only a few examples of birth companionship being implemented in government health systems in low-income countries. To learn if birth companionship was feasible, acceptable and led to improved quality of care in these settings, we implemented a pilot project using 9 intervention and 6 comparison sites (all government health facilities) in a rural region of Tanzania.

Factors related to the practice of vacuum-assisted birth: findings from provider interviews in Kigoma, Tanzania.

Background: Vacuum-assisted birth is not widely practiced in Tanzania but efforts to re-introduce the procedure suggest some success. Few studies have targeted childbirth attendants to learn how their perceptions of and training experiences with the procedure affect practice. This study explores a largely rural cohort of health providers to determine associations between recent practice of the procedure and training, individual and contextual factors.

Referral transit time between sending and first-line receiving health facilities: a geographical analysis in Tanzania.

Background: Timely, high-quality obstetric services are vital to reduce maternal and perinatal mortality. We spatially modelled referral pathways between sending and receiving health facilities in Kigoma Region, Tanzania, identifying communication and transportation delays to timely care and inefficient links within the referral system.

Methods: We linked sending and receiving facilities to form facility pairs, based on information from a 2016 Health Facility Assessment.

Client and provider factors associated with companionship during labor and birth in Kigoma Region, Tanzania.

Background: Labor and birth companionship is a key aspect of respectful maternity care. Lack of companionship deters women from accessing facility-based delivery care, though formal and informal policies against companionship are common in sub-Saharan African countries.

Aim: To identify client and provider factors associated with labor and birth companionship DESIGN: Cross-sectional evaluation among delivery clients and providers in 61 health facilities in Kigoma Region, Tanzania, April-July 2016.

Identifying Frailty and its Outcomes in Older People in Rural Tanzania.

Unlabelled: Background/Study Context: Interest in frailty is growing in low- and middle-income countries, due to demographic aging and resource limitations. However, there is a paucity of data on the nature of frailty in Africa.

Methods: The study collected frailty data from people aged 70 years and over living in six villages in the rural Hai District of northern Tanzania.

Community validation of the IDEA study cognitive screen in rural Tanzania.

Objectives: The dementia diagnosis gap in sub-Saharan Africa (SSA) is large, partly because of difficulties in screening for cognitive impairment in the community. As part of the Identification and Intervention for Dementia in Elderly Africans (IDEA) study, we aimed to validate the IDEA cognitive screen in a community-based sample in rural Tanzania METHODS: Study participants were recruited from people who attended screening days held in villages within the rural Hai district of Tanzania. Criterion validity was assessed against the gold standard clinical dementia diagnosis using DSM-IV criteria.

Rates and predictors of three-year mortality in older people in rural Tanzania.

Background: There are few data on mortality rates in the general elderly living in sub-Saharan Africa. We aimed to detail three-year mortality rates in a population of rural community-dwelling older adults in northern Tanzania.

Methods: We performed a community-based study of 2232 people aged 70 years and over living in Hai district, Tanzania.

Mortality rates in community-dwelling Tanzanians with dementia and mild cognitive impairment: a 4-year follow-up study.

Background: we have previously conducted a community-based prevalence study of dementia in older adults living in the rural Hai district of Tanzania. The aim of this study was to record mortality rates at 4 years post-diagnosis, of those with dementia, mild cognitive impairment (MCI) and no cognitive impairment.

Methods: during Phase I of the prevalence study, 1,198 people aged 70 years and over were screened, and a stratified sample of 296 was assessed for the presence of dementia or MCI in Phase II.

Levels of functional disability in elderly people in Tanzania with dementia, stroke and Parkinson's disease.

Background: Disability is associated with increasing age and poverty, yet there are few reliable data regarding disability amongst the elderly in low-income countries. The aim of this study was to compare disability levels for three of the most common neurological, non-communicable diseases: dementia, stroke and Parkinson's disease (PD).

Methods: We performed a community-based study of people aged 70 years and over in 12 randomly selected villages in the rural Hai district of Tanzania.

The association between disability and cognitive impairment in an elderly Tanzanian population.

Cognitive impairment is thought to be a major cause of disability worldwide, though data from sub-Saharan Africa (SSA) are sparse. This study aimed to investigate the association between cognitive impairment and disability in a cohort of community-dwelling older adults living in Tanzania. The study cohort of 296 people aged 70years and over was recruited as part of a dementia prevalence study.

Ambulatory blood pressure monitoring to assess the white-coat effect in an elderly East African population.

The authors hypothesized that published hypertension rates in Tanzania were influenced by the physiological response of individuals to blood pressure (BP) testing, known as the white-coat effect (WCE). To test this, a representative sample of 79 participants from a baseline cohort of 2322 people aged 70 years and older were followed to assess BP using conventional BP measurement (CBPM) and ambulatory BP monitoring (ABPM). There was a significant difference between daytime ABPM and CBPM for both systolic BP (mean difference 29.

Mild Cognitive Impairment in Rural Tanzania: Prevalence, Profile, and Outcomes at 4-Year Follow-up.

Objective: Mild cognitive impairment (MCI) is recognized as a high-risk condition for conversion to dementia, although data on outcomes of MCI in sub-Saharan Africa are scarce. We investigated outcomes of MCI over a 4-year period in Tanzania and considered risk factors for conversion to dementia.

Methods: In a longitudinal cohort study in the Hai district, Tanzania, patients with MCI were identified during a two-phase prevalence study carried out in 2010.

Development and community-based validation of the IDEA study Instrumental Activities of Daily Living (IDEA-IADL) questionnaire.

Background: The dementia diagnosis gap in sub-Saharan Africa (SSA) is large, partly due to difficulties in assessing function, an essential step in diagnosis.

Objectives: As part of the Identification and Intervention for Dementia in Elderly Africans (IDEA) study, to develop, pilot, and validate an Instrumental Activities of Daily Living (IADL) questionnaire for use in a rural Tanzanian population to assist in the identification of people with dementia alongside cognitive screening.

Design: The questionnaire was developed at a workshop for rural primary healthcare workers, based on culturally appropriate roles and usual activities of elderly people in this community.

The prevalence of dementia subtypes in rural Tanzania.

Objectives: The prevalence of dementia is predicted to increase rapidly in developing countries. Vascular risk factors may contribute to this rise. Our aim was to estimate the proportions of Alzheimer's disease (ADD) and vascular dementia (VAD) in a prevalent cohort of dementia cases in rural Tanzania.

The association between educational level and dementia in rural Tanzania.

Unlabelled: The majority of people with dementia worldwide live in developing countries. Studies from the developed world have reported an association between lower educational attainment and dementia, but there are few data from the developing world where literacy and educational levels are frequently much lower. In this study we assessed the association between education and dementia prevalence in a rural Tanzanian setting.

Development and Validation of the Identification and Intervention for Dementia in Elderly Africans (IDEA) Study Dementia Screening Instrument.

Aim: The aim of this project was to develop a dementia screening instrument for use in the hospital or community in populations with low levels of formal education.

Methods: A screening instrument was developed from retrospective data collected in a rural area of Tanzania in 2010. The community screening instrument for dementia was administered to over 95% of the population aged 70 years and older of 6 villages (n = 1198) in Hai district, Tanzania.

Rates of diagnosis and treatment of neurological disorders within a prevalent population of community-dwelling elderly people in sub-Saharan Africa.

Background: The prevalence of neurological disorders in those aged 70years and over in the Hai district of Tanzania has been previously reported. The following research reports rates of patient's: treatment seeking, diagnosis and treatment within this prevalent population.

Methods: All people identified as having at least one neurological disorder in the prevalence study were questioned regarding whether they had sought treatment for their disorder, whether they had had a previous correct diagnosis and whether they were being currently treated.

Dementia prevalence estimates in sub-Saharan Africa: comparison of two diagnostic criteria.

Background: We have previously reported the prevalence of dementia in older adults living in the rural Hai district of Tanzania according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria. The aim of this study was to compare prevalence rates using the DSM-IV criteria with those obtained using the 10/66 diagnostic criteria, which is specifically designed for use in low- and middle-income countries.

Methods: In phase I, 1,198 people aged 70 and older were screened for dementia.

The prevalence of dementia in rural Tanzania: a cross-sectional community-based study.

Objectives: Despite the growing burden of dementia in low-income countries, there are few previous data on the prevalence of dementia in sub-Saharan Africa. The aim of this study was to estimate the prevalence of dementia in those who are 70 years and older in the rural Hai District of Tanzania.

Methods: This was a two-phase cross-sectional survey.

Strikingly low prevalence of atrial fibrillation in elderly Tanzanians.

Objectives: To determine the prevalence of atrial fibrillation (AF) in individuals aged 70 and older in a rural African community.

Design: Community-based cross-sectional survey.

Setting: A demographic surveillance site (DSS) within the rural Hai district of northern Tanzania.

The prevalence of disability in older people in Hai, Tanzania.

Background: the World Health Organization estimates that more than one billion of the world's population are disabled. Disability is associated with increasing age and poverty, yet there are few reliable data regarding disability among the elderly in low-income countries. The aim of this study was to accurately document the prevalence of disability in those aged 70 years and over in a community-based setting in sub-Saharan Africa.