Deogratius Bintabara

Background: Marital dissolution, encompassing divorce and separation, poses critical social, economic, and health challenges. This study maps the prevalence and determinants of marital dissolution among ever-married women in Tanzania, employing a multilevel mixed-effects model to capture individual and community-level influences and using geospatial analysis to identify regional patterns. Methods: This population-based study utilized data from the 2022 Tanzania Demographic and Health Survey (TDHS-MIS), which employed a stratified two-stage cluster sampling design. A total of 10,837 ever-married women aged 15–49 years were included. Socio-demographic and contextual variables were analyzed. A mixed-effects multilevel logistic regression models were used to assess factors associated with marital dissolution, while geospatial analyses, including spatial autocorrelation, were conducted to examine geographic patterns across Tanzania. Results: Marital dissolution was reported by 15% of respondents. Geospatial mapping indicated pronounced regional disparities, with the highest rates in the Southern zone, particularly in Lindi (25.56%) and Mtwara (23.84%). Significant individual determinants included older age (AOR = 1.05, 95% CI 1.04–1.06), cash employment (AOR = 2.73, 95% CI 2.23–3.35), and lower educational attainment. Community-level factors, such as community-level household wealth and urban residence, also influenced marital dissolution, with urban women nearly twice as likely to experience dissolution compared to rural women. Conclusion: The findings indicate that marital dissolution is a notable concern among ever-married women in Tanzania, with important implications for family stability and social well-being. The results highlight the complex interplay of demographic, socio-economic, and regional factors associated with marital dissolution. Spatial analysis further identifies geographic disparities, with higher concentrations observed in specific regions such as the Southern zone, suggesting the need for context-specific interventions. These findings underscore the importance of integrating social and public health strategies to support stable family structures in Tanzania’s evolving socio-economic environment.

Gentamicin, a bactericidal aminoglycoside, is used with penicillins to treat neonatal infections. It has a narrow therapeutic index and can cause nephrotoxicity and/or ototoxicity even at therapeutic doses, making serum monitoring essential. In Tanzania, neonates often receive once-daily intravenous gentamicin at a dose of 5mg/kg without monitoring, raising safety concerns since toxicity relates to high, dose-dependent troughs. Although recommended neonatal doses are 4–5mg/kg, reports show 5mg/kg produces high trough concentrations. This study compared the pharmacokinetics of 5mg/kg with 4mg/kg to determine whether the lower dose is safer. Two hundred fifty term neonates with sepsis received intravenous gentamicin once-daily 5mg/kg (n=125) or 4mg/kg (n=125) based on routine clinical practice. Sparse sampling estimated clearance and volume of distribution. In addition, blood samples for peak (30 minutes post-dose) and trough (5 minutes pre-dose) were taken from each patient at steady state (after the fourth dose). Pharmacokinetic parameters were estimated using Python (version 3.12.3), and groups were compared with independent-samples t-tests. Mean steady-state peak gentamicin concentrations were higher with 5 mg/kg (18.80 ± 0.83 µg/mL) than with 4 mg/kg (7.82 ± 0.90 µg/mL), with trough concentrations also elevated (2.52 ± 0.93 vs 1.46 ± 0.36 µg/mL). Clearance was lower with 5mg/kg (0.361 vs 0.575 mL·min⁻¹·kg⁻¹), as was volume of distribution (0.248 vs 0.494 L · kg -¹). Once-daily intravenous gentamicin at 5mg/kg results in higher peak and trough concentrations with reduced clearance and distribution. In contrast, 4mg/kg achieves levels within therapeutic ranges. These findings support 4mg/kg as the safer regimen for neonates in Tanzania and similar settings.

Neonatal sepsis remains a major cause of newborn morbidity and mortality in resource-limited settings, where gentamicin is widely used as empirical therapy. In Tanzania, once-daily gentamicin (4–5 mg/kg) is recommended, but the 5 mg/kg regimen is commonly used without routine therapeutic drug monitoring (TDM), raising concerns about nephrotoxicity and ototoxicity. Although the 4 mg/kg once-daily regimen has generally been associated with a lower risk of aminoglycoside-related toxicity than higher-dose regimens, its use in Tanzania remains limited, with the 5 mg/kg regimen more commonly employed. This variation between international evidence and local prescribing practice highlights the importance of evaluating whether the lower-dose regimen may offer a safer therapeutic option for Tanzanian neonates. The growing recognition of medication-related kidney injury in children further highlights the need for safer antimicrobial strategies. However, local evidence comparing the 5 mg/kg and 4 mg/kg regimens remains limited. This study compared the renal and auditory safety of these regimens in term neonates. This prospective observational cohort study included 375 term neonates receiving gentamicin 5 mg/kg (n=125), gentamicin 4 mg/kg (n=125), or ceftriaxone/cefotaxime (n=125). Renal function was assessed using serum creatinine and urinary kidney injury molecule-1 (uKIM-1), while auditory function was evaluated using automated auditory brainstem response (AABR). Nephrotoxicity was defined using kidney disease: Improving Global Outcomes (KDIGO) criteria and ototoxicity as ≥20 dB AABR threshold increase from baseline. Acute kidney injury (AKI) was more frequent and severe in the 5 mg/kg group, with stage I, II, and III AKI occurring in 35.2%, 14.4%, and 1.6%, respectively. The 4 mg/kg group had 2.4% stage I AKI with no stage II/III cases, while no AKI occurred in the comparison group (p<0.001). Ototoxicity occurred in 4.0% receiving 5 mg/kg, with no cases in other groups (p<0.05). The 5 mg/kg regimen was associated with greater renal and auditory toxicity than 4 mg/kg, supporting lower-dose strategies where TDM is unavailable.

Neonatal sepsis remains a major cause of morbidity and mortality, particularly in low-resource settings. Gentamicin is widely used for treatment; however, its narrow therapeutic index and variable neonatal pharmacokinetics increase the risk of accumulation and toxicity. Therapeutic drug monitoring is rarely available in Tanzania. Identifying factors associated with elevated gentamicin concentrations may support safer antibiotic use where therapeutic drug monitoring is unavailable. This study aimed to identify factors associated with elevated gentamicin trough concentrations among term neonates receiving once-daily intravenous gentamicin. This sub-study was nested within a prospective observational cohort evaluating the pharmacokinetics and safety of once-daily intravenous gentamicin at doses of 4 mg/kg and 5 mg/kg among term neonates with sepsis. A total of 250 neonates receiving gentamicin were included. Trough concentrations were measured at steady state, five minutes before the fourth dose. An elevated trough concentration was defined as >2 µg/mL. Factors associated with elevated trough concentrations were assessed using multivariable logistic regression, with adjusted odds ratios and 95% confidence intervals. Elevated trough concentrations occurred in 27.2% of neonates. Independent factors associated with elevated trough concentrations included age <7 days (adjusted odds ratio, 4.41; 95% confidence interval, 2.16–8.99), weight 100 µmol/L within the laboratory reference range of 44.22 - 132.63 µmol/L) (adjusted odds ratio, 2.21; 95% confidence interval, 1.03–4.73). More than one-quarter of neonates receiving once-daily gentamicin had elevated trough concentrations. Clinical and dosing-related factors may help identify neonates at risk of gentamicin accumulation and support safer antibiotic use where therapeutic drug monitoring is unavailable.

Introduction: More than 90% of the highest incidence rates of cervical cancer occur in sub-Saharan Africa region. However, this region has low uptake of cervical cancer screening compared to other World Health Organization (WHO) regions. Therefore, the current study aimed to show the geographical and regional variation and predictors of low uptake of cervical cancer screening among women aged 30–49 years in Tanzania. Methods: This study analyzed data from 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey (TDHS-MIS). The uptake of cervical cancer screening was the outcome variable which dichotomized into “Yes” for the women who reported a doctor or other healthcare provider ever tested her for cervical cancer otherwise it was coded “No.” Besides, descriptive and geospatial analysis, the mixed-effect multilevel logistic regression analysis was performed to determine predictors of low uptake of cervical cancer screening. Results: This study included a total of 6911 women between 30 and 49 years old, with the median age (interquartile range) of 38 (34–43) years. The overall uptake of cervical cancer in Tanzania remain low (12.2%). The geospatial analysis indicates the lowest uptake was observed in Southern (4.7%) and Central (5.9%). The random effect model revealed that the variation in uptake of cervical cancer screening, 26% was attributed to between clusters within regions or geographical zones differences [ICC = 0.26, 95%CI; 0.22–0.31]. Fixed effect model revealed that women with older ages, formal education, health insurance coverage, employed for cash, being in rich household, listen to radio, reading newspapers, magazines, or using the internet had higher odds of uptake cervical cancer screening than their counterparts. Conclusion: For realization of WHO target on elimination of cervical cancer by screening 70% of all eligible women age 30 and above by 2030, more efforts on addressing social determinants of health and provision of health education through mass media should be considered. Clinical trial number: Not applicable.

Background: Sub‐Saharan Africa (SSA) is a region with a high burden of hepatitis B virus (HBV) infection. Medical students face an elevated risk of HBV exposure due to occupational hazards, particularly during clinical placement rotations. Despite the proven efficacy of HBV vaccination in preventing HBV infection, vaccination uptake remains suboptimal in many clinical settings across SSA. This study aimed to characterize HBV vaccination coverage among medical students in Tanzania. Methods: A total of 1,463 medical students from all medical universities in Tanzania completed an online survey. The questionnaire captured sociodemographic characteristics, awareness, perceptions, and access to the hepatitis B (HBV) vaccine. The outcome variable, uptake of the HBV vaccine, was measured by self‐report of having received one or more doses of the vaccine. Multivariable logistic regression was used to identify factors associated with HBV vaccine uptake, and results were reported as odds ratios (ORs) with 95% confidence intervals (CIs). A p ‐value < 0.05 was considered statistically significant. Results: A total of 1,463 medical students from nine medical universities in Tanzania completed an online survey, and were included in the final analysis. Male respondents accounted for the majority 932 (63.7%), the median age of 24 years (IQR: 22–25). Awareness of the HBV vaccine was notably high, with 93.98% of respondents reporting knowledge of the vaccine. Only 27.96% participants completed HBV vaccination. In adjusted logistic regression model, clinical‐year students were over 10 times more likely to be vaccinated compared to those in basic years (adjusted OR = 10.27, 95% CI: 6.99–15.10), and the availability of vaccination programs in the university increased the vaccination ratio by nearly two‐folds (adjusted OR = 1.83, 95% CI: 1.30–2.58). It was observed that, adverse effects also had no significant impact on vaccination likelihood (adjusted OR = 0.77, 95% CI: 0.50–1.19). Conclusion: Despite high awareness and knowledge of HBV infection among medical students in Tanzania, HBV vaccination coverage remains substantially low. HBV vaccine has considerably high confidence among medical students in Tanzania. We are recommending the policy makers to ensure that HBV vaccine is available free of charge across medical universities in Tanzania.

Renal dysfunction is one of the complications of malignancy which can be due to malignancy itself, treatment related and or other associated medical compli

Hypertension, the leading risk factor for cardiovascular diseases, remains largely undiagnosed in low-resource settings. This study focuses on the hidden c

Introduction: Breast cancer remains an important public health problem with high mortality in low-income countries like Tanzania. This is because of the low uptake of screening for breast cancer, an intervention that could be cost-effective and significant in reducing mortality and poor prognosis in such a setting. This is a population-based survey to uncover the spatial distribution and determinants of low uptake of breast cancer screening among women of reproductive age in Tanzania. Methods: This analytical cross-sectional study utilized data from 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey (TDHS-MIS). A total of 15254 women aged 15–49 years were included in the analysis. The outcome variable was the uptake of breast cancer screening, coded as “1” for the women who reported a doctor or other healthcare provider examined their breasts to check for cancer, and “0” otherwise. Descriptive and geospatial analyses were conducted to assess patterns of screening uptake across regions. To identify associated factors, a mixed-effect multilevel logistic regression analysis was performed using Stata version 17. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported, and a significance level of p < 0.05 was used. Results: The findings revealed that only 5% of the respondents reported having undergone breast cancer screening in Tanzania. The lowest uptake was in the Western (2.17%) and Southern (3.34%) zones of Tanzania. Regions with the poorest uptake of breast cancer screening were Kigoma (1.68%), Katavi (1.94%), Singida (1.54%), and Tabora (1.66%). Women with older ages, formal education, health insurance coverage, and reading newspapers, magazines, or using the internet had higher odds of uptake breast cancer screening than their counterparts. Conclusions: The uptake of breast cancer screening remains low throughout Tanzania and worst situation was noted in rural areas. Formal education, insurance coverage, and access to information continue to propel the low uptake of breast cancer screening in Tanzania. The fair distribution of health-promotive services could be vital in increasing uptake of breast cancer screening for the early detection and prevention of mortalities and other outcomes related to this severe disease.