Background Adolescent girls (10–19 years) are at increased risk of morbidity and mortality from pregnancy and childbirth complications, compared with older mothers. Low and middle-income countries, including Tanzania, bear the largest proportion of adolescent perinatal deaths. Few adolescent girls in Tanzania access antenatal care at health facilities, the reasons for which are poorly understood. Methods We conducted a qualitative thematic analysis study of the experiences of pregnant adolescents with accessing antenatal care in Misungwi district, Tanzania. We recruited 22 pregnant or parenting adolescent girls using purposive sampling, and conducted in-depth interviews (IDIs) about antenatal care experiences. IDI data were triangulated with data from eight focus group discussions (FGDs) involving young fathers and elder men/women, and nine key informant interviews (KIIs) conducted with local health care providers. FGDs, KIIs and IDIs were transcribed verbatim in Swahili. Transcripts were then translated to English and analysed using emergent thematic analysis. Results Four main themes emerged: 1) Lack of maternal personal autonomy, 2) Stigma and judgment, 3) Vulnerability to violence and abuse, and 4) Knowledge about antenatal care, and highlighted the complex power imbalance that underlies barriers and facilitators to care access at the individual, family/interpersonal, community, and health-systems levels, faced by pregnant adolescents in rural Tanzania. Conclusion Adolescent antenatal care-seeking is compromised by a complex power imbalance that involves financial dependence, lack of choice, lack of personal autonomy in decision making, experiences of social stigma, judgement, violence and abuse. Multi-level interventions are needed to empower adolescent girls, and to address policies and social constructs that may act as barriers, thereby, potentially reducing maternal morbidity and mortality in Tanzania.

Background: Adolescent girls (age 10-19 years) are at increased risk of morbidity and mortality due to pregnancy and childbirth complications, compared with older mothers. Low and middle-income countries, including Tanzania, bear the largest proportion of adolescent perinatal deaths globally. Most adolescent girls in Tanzania do not access antenatal care at health facilities, but the reasons for lack of antenatal care attendance are poorly understood. Methods: We conducted a qualitative thematic analysis study of the experiences of pregnant adolescents with accessing antenatal care in Misungwi district, Mwanza Region, Tanzania. We recruited 22 adolescent girls who were pregnant or parenting a child aged less than 5 years, using purposive sampling, and collected data about their lived experiences using in-depth individual interviews (IDIs). IDI data were triangulated with data from eight focus group discussions (FGDs) involving young fathers and elder men/women, and nine key informant interviews (KIIs) conducted with local health care providers. FGDs, KIIs and all but two IDIs were conducted and audiotaped in Swahili. All Swahili recordings were transcribed verbatim in Swahili. Two IDIs were conducted in local vernacular (Sukuma), and were transcribed into Swahili (as Sukuma is uncommon), by bilingual research assistants. All Swahili transcripts were then translated to English. A team of researchers analysed transcripts using emergent thematic analysis and constant comparison technique. Results: We identified four main themes: 1) Lack of maternal personal autonomy (Diminished power for decision making, Lack of financial and personal independence), 2) Stigma and judgment, 3) Vulnerability to violence and abuse, and 4) Knowledge about antenatal care. Conclusion: Pregnant adolescent care seeking for antenatal services is compromised by a complex power imbalance that involves financial dependence, lack of choice, lack of personal autonomy in decision making, experiences of social stigma, judgement, violence and abuse. Multi-level interventions are needed to empower adolescent girls, and to address policies and social constructs that may contribute to observed power imbalance; addressing these barriers can improve access to antenatal care among pregnant adolescents, and potentially reduce maternal morbidity and mortality.

Background: Despite the growing recognition of domestic violence as a public health and human rights concern, it remains rampant in developing countries and has a negative impact on the victim’s health. This study describes the injury characteristics and treatment outcome of trauma associated with domestic violence in north-western Tanzania.Methods: This was a descriptive prospective study of patients who were managed for domestic violence related trauma at Bugando Medical Centre in Mwanza, Tanzania from April 2009 to March 2014.Results: A total of 324 patients (M: F = 1: 10.6) were studied. Majority of the patients were in the second and third decades of life. The perpetrators were mainly husbands and ex-partners (55.5%). Suspecting sexual partner being unfaithful was the most common reason given by victims for domestic violence in 63.4% of cases. Blunt and sharp objects (56.8%) were the most common weapons used. Gunshot injuries were recorded in 0.6% of cases. The head/neck was commonly affected in 68.5%. Soft tissue injuries (77.8%) were the most frequent type of injuries. The majority of patients (65.4%) sustained mild injuries. Twenty-three (7.1%) patients were HIV positive. Surgical treatment was performed in only 34.6% of cases.  Complication rate was 26.8%. The median hospital stay was 12 days. Mortality rate was 6.5%. The main predictors of mortality were advanced age (> 60 years),  late presentation,  severity of injury, severe head injury, HIV seropositivity, low CD 4 count (<200 cells), surgical site infection (p<0.001). More than two-thirds of patients were lost to follow up.Conclusion: Domestic violence related trauma remains rampant in northwestern Tanzania and contributes significantly to high morbidity and mortality. Urgent preventive measures targeting at reducing the occurrence of domestic physical violence is necessary to reduce the morbidity and mortality resulting from these injuries.

Background: Trauma among street children is an emerging but neglected public health problem in most low and middle income countries. This study was conducted to determine the incidence, etiological spectrum, injury characteristics and treatment outcome among street children and to identify the predictors of the outcome of these patients at Bugando Medical Centre in Mwanza, Tanzania.Methods: The study included street children aged <18 years. Routine investigations including haematological, biochemical and imaging were performed on admission. The severity of injury was determined using the Kampala Trauma Score II. Data on patient’s characteristics, circumstances of injury, injury characteristics, treatment offered, outcome variables, length of hospital stay and mortality were collected using a questionnaire.Results: A total of 342 street children (M: F = 6.8: 1) representing 11.5% of all paediatric injury patients were studied. The modal age group was 11-15 years (median = 12 years) accounting for 53.2% (n=182) of the patients. Assault was the most frequent (73.7%) cause of injury. More than three quarter of injuries occurred along the street. Most of patients (59.1%) presented late (>24 hours) after injury. Blunt injuries were the most common (76.0%) mechanism of injuries. Musculoskeletal (30.8%) and head (25.3%) were the most frequent body regions affected. Soft tissue injuries were the most common type of injuries affecting 322 (94.2%) cases. Majority of patients (96.5%) underwent surgical treatment of which wound debridement (97.6%) was the most common surgical procedure performed.  Complication rate was 39.5%. The median hospital stay was 6 days.  Mortality rate was 13.5% and it was significantly associated with injury-arrival time (OR =2.4, 95%CI (1.3-5.6), p = 0.002), severe injury (Kampala Trauma Score <6) (OR = 3.6, 95%CI (2.5-7.9), p = 0.001), severe head injuries (OR= 5.1, 95%CI (4.6 – 8.2), p =0.012) and surgical site infection.Conclusion: Trauma among street children is an emerging but neglected epidemic in Tanzania and contributes significantly to high morbidity and mortality. Assault was the most frequent cause of injury.  Urgent preventive measures targeting at reducing the occurrence of assault is necessary to reduce the incidence of trauma among street children in this region.

Introduction/Background Preventable deaths in pregnant women and newborns remain unacceptably high in East Africa. Limited antenatal, delivery and postnatal care-seeking combined with service delivery gaps at government facilities contribute to high mortality. Between 2016-2019, partners from Tanzania, Uganda, and Canada jointly developed, implemented, and evaluated a comprehensive, district-wide maternal, newborn, and child health (MNCH) ‘package’ in Lake Zone, Tanzania. Known locally as ‘Mama na Mtoto’, the scale-up programming involved training and capacity building for district managers, health facility staff and a network of volunteer community health workers selected by their own communities. Objectives To quantitatively assess changes in MNCH health outcomes following the Mama na Mtoto intervention. Design/Methods MNCH household-level care-seeking outcomes were assessed using a pre/post coverage survey adapted from the Demographic Health Survey. Households and women (15-49 years), selected through cluster sampling (cluster unit=hamlet), were surveyed by local, trained research assistants using tablet-based surveys. MNCH service outcomes were assessed at all government health facilities using a comprehensive pre/post cross-sectional audit tool; key measures included staff, equipment, infrastructure, supplies, and medication availability. Descriptive statistics for antenatal care (ANC), health facility delivery (HFD), and postnatal care (PNC)-related indicators were analyzed pre- and post-intervention using R software. Composite health facility ‘Readiness Scores’ were calculated through tallies of relevant itemized facility-based measures for each core MNCH service area across the district. Absolute percentage differences, confidence intervals and design effect are presented where relevant. Results In total, 1,977 households, 2,438 women, and 45 health facilities were surveyed pre-intervention and 1,835 homes, 2,073 women, and 49 health facilities were surveyed post. Care-seeking indicators with statistically significant changes were ANC 4+ (+11%), ANC &lt;12 weeks (+7%), HFD (+17%), and PNC for mothers (+9%); PNC for babies was not significant. Increases in composite MNCH Service Readiness Scores were as follows: ANC +24%, essential newborn care +42%, newborn resuscitation +37%, and labour and delivery +27%. Conclusion The comprehensive MnM package was associated with important improvements in the demand (care-seeking) and service (facility readiness) health outcomes. Attribution is complicated by an uncontrolled health system and lack of district controls; however, the extensive scope, reach, and positive changes are promising and consistent with sustained Ugandan experiences. Best practice documentation is critical to facilitate scale-up and progress acceleration of MNCH programs in Tanzanian and East African settings.