Tumbwene Elieza Mwansisya

Background/Objectives: This review aimed to explore the pathways of nursing and midwifery education in Tanzania and compare them with global perspectives. The goal was to identify similarities, differences, and areas for potential improvement to align with international standards. Methods: A narrative literature review was carried out through databases with published studies in nursing and gray literature. The database search included Medline, PubMed, Google Scholar, EBSCO, PsycINFO, clinical nursing, and gray literature from January 2014 up to December 2024. The search process was carried out by the authors with the following key words: admission, pathway to nursing profession, delivery mode, generative dynamic, and learning models. The search strategy included studies from selected countries in East Africa, Europe, North America, Australia, and Asia. The inclusion criteria were (1) published papers or reviews addressing the review topics; (2) studies published in the English language; (3) gray literature on the reviewed topics; (4) studies originating from Tanzania, East Africa, Europe, Asia, Australia, and North America. The selected countries served as a source for comparison of nursing and midwifery education in Tanzania with the globe. Results: A total of 758 articles were reviewed from the selected databases. Finally, 27 studies and 11 gray literature sources were included. In Tanzania, the overall duration of nursing education from primary education to a bachelor’s degree for diploma graduates is relatively long. Students complete approximately 14 years of schooling from primary education to the completion of a diploma, including three years at the diploma level. To enroll in a degree program, candidates are required to have two years of professional experience, followed by four years of academic training and a mandatory one-year internship. Globally, the duration of educational programs is generally decreasing due to generational shifts and advancements in technology. Conclusions: Whilst nursing and midwifery education is regulated in Tanzania, the current admission criteria and duration of the program do not align with the global standards. Future studies that provide the comparison of curriculums among universities in Tanzania with global standards would provide a deep understanding of the competencies, teaching models, learning environment, duration, and desired learning outcomes for nursing and midwifery education.

Background: Delivery of quality reproductive health services has been documented to depend on the availability of healthcare workers who are adequately supported with appropriate training. However, unmet training needs among healthcare workers in reproductive, maternal, and newborn health (RMNH) in low-income countries remain disproportionately high. This study investigated the effectiveness of training with onsite clinical mentorship towards self-reported performance in RMNH among healthcare workers in Mwanza Region, Tanzania. Methods: The study used a quasi-experimental design with pre-and post-intervention evaluation strategy. The baseline was compared with two endline groups: those with intervention (training and onsite mentorship) and those without. The differences among the three groups in the sociodemographic characteristics were analyzed by using chi-square test for categorical variables, independent-sample t-test for continuous variables and Mann–Whitney U test for ordinal or skewed continuous data. The independent sample t-test was used to determine the effect of the intervention by comparing the computed self-reported performance on RMNH services between the intervention and control groups. The paired-samples t-test was used to measure the differences between before and after intervention groups. Significance was set at a 95% confidence interval with p ≤ 0.05. Results: The study included a sample of 216 participants with before and after intervention groups comprising of 95 (44.0%) and 121 (56.0%) in the control group. The comparison between before and after intervention groups revealed a statistically significant difference (p ≤ 0.05) in all the dimensions of the self-reported performance scores. However, the comparison between intervention groups and controls indicated a statistical significant difference on intra-operative care (t = 3.10, df = 216, p = 0.002), leadership skills (t = 1.85, df = 216, p = 0.050), Comprehensive emergency obstetric and newborn care (CEMONC) (t = 34.35, df = 216, p ≤ 0.001), and overall self-reported performance in RMNH (t = 3.15, df = 216, p = 0.002). Conclusions: This study revealed that the training and onsite clinical mentorship to have significant positive changes in self-reported performance in a wide range of RMNH services especially on intra-operative care, leadership skills and CEMONC. However, further studies with rigorous designs are warranted to evaluate the long-term effect of such training programs on RMNH outcomes.

Marriage is considered as the most important social institution and symbol of adulthood in Africa. However, the trend of divorce has increased alarmingly in recent years. We explored the constraints towards marital satisfaction by using the Delphi technique with assumptions that couples are the experts on their marriages. Participant’s panel included married heterosexual couples divided into two groups: men and women couple’s panels. The group of women’s panel included 31 participants and men’s panel contained 25 males. Then in the final stage, both groups provided their views and discussed on the possible solutions to the identified constraints. Five major themes emerged: satisfaction in sexuality among couples, difficulties in communication, economic and financial conflicts, the role of extended families, and opportunity for behavioural change to achieve marital satisfaction. Our findings support the hypothesis that satisfaction with sexual intercourse, respectful communication, financial stability and careful handling of relatives influence marital satisfaction.

Background: Continuous professional development (CPD) has been reported to enhance healthcare workers’ knowledge and skills, improve retention and recruitment, improve the quality of patient care, and reduce patient mortality. Therefore, validated training needs assessment tools are important to facilitate the design of effective CPD programs. Methods: A cross-sectional survey was conducted using self-administered questionnaires. Participants were healthcare workers in reproductive, maternal, and neonatal health (RMNH) from seven hospitals, 12 health centers, and 17 dispensaries in eight districts of Mwanza Region, Tanzania. The training needs analysis (TNA) tool that was used for data collection was adapted and translated into Kiswahili from English version of the Hennessy-Hicks’ Training Need Analysis Questionnaire (TNAQ). Results: In total, 153 healthcare workers participated in this study. Most participants were female 83 % (n = 127), and 76 % (n = 115) were nurses. The average age was 39 years, and the mean duration working in RMNH was 7.9 years. The reliability of the adapted TNAQ was 0.954. Assessment of construct validity indicated that the comparative fit index was equal to 1. Conclusions: The adapted TNAQ appears to be reliable and valid for identifying professional training needs among healthcare workers in RMNH settings in Mwanza Region, Tanzania. Further studies with larger sample sizes are needed to test the use of the TNAQ in broader healthcare systems and settings.

BackgroundDelivery of quality reproductive health services has been documented to depend on the availability of healthcare workers who are adequately supported with appropriate training. However, unmet training needs among healthcare workers in reproductive, maternal, and newborn health (RMNH) in low-income countries remain disproportionately high. This study investigated the effectiveness of trainings with onsite clinical mentorship towards perceived importance and performance in RMNH among healthcare workers in Mwanza Region of Tanzania.MethodsThe study used a quasi-experimental design using single group pre-and post-intervention evaluation strategy. The training needs of healthcare workers from the selected health facilities were assessed, skills gaps identified and ranked according to priority. Training courses that addressed skills gaps were developed and delivered with adaptations of the national guidelines followed by onsite clinical mentorship for one year. The baseline and endline survey were conducted at 3 years interval to assess change in HCWs on their perceived importance and performance on different aspects of RMNH care. Independent samples t-tests were used to compare differences in perceived performance in selected training areas between baseline and endline. Significance was set at p < 0.05.ResultsTNA was administered to 152 and 216 healthcare workers at baseline and endline respectively. In total, 141 (65%) of the 216 end line survey participants had received at least one IMPACT project training course and at least three mentorship visits. Participants were matched on their age and duration in RMNH services, but differed in age and duration of employment. Comparison between baseline and endline by using the training needs analysis questionnaire scores showed statistically significant positive changes (p ≤ .05) in most training needs analysis items, except for some items including those related to research capacity and provision of health education for cancer.ConclusionsThe findings revealed that the training and onsite clinical mentorship program that address the actual needs of healthcare workers to have significant positive changes in perceived performance in a wide range of RMNH services. However, further studies with rigorous designs are warranted to evaluate the long-term effect of such training programs on RMNH outcomes.

Background: In the face of growing modernity and the coronavirus disease 2019 (COVID-19) pandemic, open and distance learning (ODL) is considered to play an important role in increasing access to education worldwide. There is a robust evidence base demonstrating its cost effectiveness in comparison with conventional class-based teaching; however, the transition to this new paradigm of learning for nursing and midwifery courses has been difficult in low-income countries. While there are notable efforts to increase internet and education access to health care professionals, not much is known about ODL for nurses and midwives in East African countries. Objective: The objective of this scoping review is to understand whether ODL programs for nursing and midwifery education exist, the drivers of their adoption, their implementation, the topics/courses covered, their acceptability, and their impacts in East African countries. Methods: The scoping review methodology employs the framework developed by Arksey and O’Malley. Using an exploratory approach, a two-stage screening process consisting of a title and abstract scan and a full-text review will be used to determine the eligibility of articles. To be included, articles must report on an existing ODL initiative for nurses and midwives in Uganda, Tanzania, and Kenya. All articles will be independently assessed for eligibility by pairs of reviewers, and all eligible articles will be abstracted and charted in duplicate using a standardized form. Results: Details of ODL for nursing and midwifery education initiatives and study outcomes will be summarized in a table. The extracted data will undergo exploratory descriptive analysis, and the results will be classified into learner and clinical outcomes. Conclusions: Evidence on ODL for nursing and midwifery education will inform the ongoing development and restructuring of health care professional education in East Africa amidst the COVID-19 pandemic. International Registered Report Identifier (IRRID): PRR1-10.2196/17765

Background: Continuous professional development (CPD) trainings have been reported to enhance health care workers’ knowledge and skills, improve retention and recruitment, improve quality of patient care and reduce patients’ mortality. This calls for validated training needs assessment tools for facilitating the design of effective CPD programs. Methods: A cross-sectional survey was conducted using self-administered questionnaires. The survey involved selected Reproductive, Maternal and Neonatal Health (RMNH) health care workers from 7 hospitals, 12 of 51 health centers and 17 of 292 dispensaries within eight districts of Mwanza Region, Tanzania. The training needs assessment (TNA) tool adapted from the Hennessy-Hicks’ Training Needs Assessment Questionnaire (TNAQ) was used for data collection. Results: A total of 153 healthcare workers participated in this study. The majority of participants were females 83% (127) with average age of 39 years. Nurses formed a majority of participants 76% (n=115) with relatively similar mean duration in service or in RMNH of 7.9 years. The reliability of the adapted TNAQ was found to be 0.954. Relatedly, indexes for construct validity indicated that CFI was equal to 1, Chi-square Mean/Degree of Freedom (CMIN/DF) was equal to 0.000 and Mean Square Error Approximation (RMSEA) was equal to 0.185. Conclusion: The adapted TNAQ appear to be reliable and valid for identifying professional training needs of health care workers in RMNH health care settings. The tool has a considerable level of psychometric properties that makes it suitable for assessing the training needs among health care workers of different cadres. However, the applicability of the TNAQ in the wider health care systems remains unclear. Future studies with a large sample size are required to test the use of TNAQ in wider health care systems and learning opportunities.

BACKGROUND In the face of growing modernity and the coronavirus disease 2019 (COVID-19) pandemic, open and distance learning (ODL) is considered to play an important role in increasing access to education worldwide. There is a robust evidence base demonstrating its cost effectiveness in comparison with conventional class-based teaching; however, the transition to this new paradigm of learning for nursing and midwifery courses has been difficult in low-income countries. While there are notable efforts to increase internet and education access to health care professionals, not much is known about ODL for nurses and midwives in East African countries. OBJECTIVE The objective of this scoping review is to understand whether ODL programs for nursing and midwifery education exist, the drivers of their adoption, their implementation, the topics/courses covered, their acceptability, and their impacts in East African countries. METHODS The scoping review methodology employs the framework developed by Arksey and O’Malley. Using an exploratory approach, a two-stage screening process consisting of a title and abstract scan and a full-text review will be used to determine the eligibility of articles. To be included, articles must report on an existing ODL initiative for nurses and midwives in Uganda, Tanzania, and Kenya. All articles will be independently assessed for eligibility by pairs of reviewers, and all eligible articles will be abstracted and charted in duplicate using a standardized form. RESULTS Details of ODL for nursing and midwifery education initiatives and study outcomes will be summarized in a table. The extracted data will undergo exploratory descriptive analysis, and the results will be classified into learner and clinical outcomes. CONCLUSIONS Evidence on ODL for nursing and midwifery education will inform the ongoing development and restructuring of health care professional education in East Africa amidst the COVID-19 pandemic. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/17765

Background: Improving maternal health by reducing maternal mortality/morbidity relates to Goal 3 of the Sustainable Development Goals. Achieving this goal is supported by antenatal care (ANC), health facility delivery, and postpartum care. This study aimed to understand levels of use and correlates of uptake of maternal healthcare services among women of reproductive age (15–49 years) in Mwanza Region, Tanzania.Methods: A cross-sectional multi-stage sampling household survey was conducted to obtain data from 1476 households in six districts of Mwanza Region. Data for the 409 women who delivered in the 2 years before the survey were analyzed for three outcomes: four or more ANC visits (ANC4+), health facility delivery, and postpartum visits. Factors associated with the three outcomes were determined using generalized estimating equations to account for clustering at the district level while adjusting for all variables.Results: Of the 409 eligible women, 58.2% attended ANC4+, 76.8% delivered in a health facility, and 43.5% attended a postpartum clinic. Women from peri-urban, island, and rural regions were less likely to have completed ANC4+ or health facility delivery compared with urban women. Education and early first antenatal visit were associated with ANC4+ and health facility delivery. Mothers from peri-urban areas and those who with health facility delivery were more likely to attend postpartum check-ups.Conclusion: Use of ANC services in early pregnancy influences the number of ANC visits, leading to higher uptake of ANC4+ and health facility delivery. Postpartum check-ups for mothers and newborns are associated with health facility delivery. Encouraging early initiation of ANC visits may increase the uptake of maternal healthcare services.

This study aims to improve the health of children living with HIV infection by using health facility services after disclosure of HIV status. A qualitative approach with descriptive design was used to describe the disclosure process by health-care providers and parents/caregivers of children under 15 years living with HIV, through a sample of ten respondents: six health-care providers and four parents/caregivers. In-depth interviews were conducted by using an interview-guide to collect the data. The study found that there is a low rate of HIV status disclosure to children at Mbagala tertiary health facility. The common factors hindering disclosure found in this study comprised mental maturity, specific age category and fear of HIV status to be disclosed by children leading to stigma and discrimination; as well as perceptions of insecurity by parents/caregivers. This study revealed barriers related to HIV status disclosure pertaining to children. Thus, effective utilization of guidelines for the disclosure of HIV to children is needed. Further studies with rigorous research methods on barriers towards HIV disclosure to children are recommended.