Heavenlight A. Paulo

Background There have been claims amongst nutrition stakeholders in Tanzania that the food basket regions, are the regions most affected by stunting among children. However, this study could not find evidence that combines food production and stunting levels, to substantiate this claim. Therefore, this study aims to compare data on stunting, food production and consumption within administrative regions of the Tanzania mainland. Methods The study used an ecological study design to show the relationship between stunting, poverty, food production and food and non-food consumption expenditure across administrative regions in Tanzania mainland. The study used data from three national wide surveys: 2017/2018 Household Budget Survey (HBS), Tanzania National Nutrition Survey (TNNS) 2018 and Agriculture Statistics for Food Security report 2018/2019. Results The study showed that there is a positive relationship between the prevalence of stunting and food production (r=0.43, p=0.03), while there is a negative relationship between stunting and the level of both the average monthly household food consumption expenditure (r = -0.51, p = 0.01) and average monthly household non-food consumption expenditure (r = -0.51, p = 0.01). Furthermore, some regions with high stunting prevalence (e.g., Njombe) were found to have relatively low basic-needs poverty rates. Conclusion The study found a positive relationship between food production and the prevalence of stunting using data across regions in mainland Tanzania. This is an indication that regional food production may not entail nutrition outcomes, hence a call for more advocacy on nutrition-sensitive agriculture.

There have been claims amongst nutrition stakeholders in Tanzania that the food basket regions, are the regions most affected by stunting among children. However, this study could not find evidence that combines food production and stunting levels, to substantiate this claim. Therefore, this study aims to compare data on stunting, food production and consumption within administrative regions of the Tanzania mainland. The study used an ecological study design to show the relationship between stunting, poverty, food production and food and non-food consumption expenditure across administrative regions in Tanzania mainland. The study used data from three national wide surveys: 2017/2018 Household Budget Survey (HBS), Tanzania National Nutrition Survey (TNNS) 2018 and Agriculture Statistics for Food Security report 2018/2019. The study showed that there is a positive relationship between the prevalence of stunting and food production (r=0.43, p=0.03), while there is a negative relationship between stunting and the level of both the average monthly household food consumption expenditure (r = -0.51, p = 0.01) and average monthly household non-food consumption expenditure (r = -0.51, p = 0.01). Furthermore, some regions with high stunting prevalence (e.g., Njombe) were found to have relatively low basic-needs poverty rates. The study found a positive relationship between food production and the prevalence of stunting using data across regions in mainland Tanzania. This is an indication that regional food production may not entail nutrition outcomes, hence a call for more advocacy on nutrition-sensitive agriculture.

Background There have been claims amongst nutrition stakeholders in Tanzania that the food basket regions, are the regions most affected by stunting among children. However, this study could not find evidence that combines food production and stunting levels, to substantiate this claim. Therefore, this study aims to compare data on stunting, food production and consumption within administrative regions of the Tanzania mainland. Methods The study used an ecological study design to show the relationship between stunting, poverty, food production and food and non-food consumption expenditure across administrative regions in Tanzania mainland. The study used data from three national wide surveys: 2017/2018 Household Budget Survey (HBS), Tanzania National Nutrition Survey (TNNS) 2018 and Agriculture Statistics for Food Security report 2018/2019. Results The study showed that there is a positive relationship between the prevalence of stunting and food production (r=0.43, p=0.03), while there is a negative relationship between stunting and the level of both the average monthly household food consumption expenditure (r = -0.51, p = 0.01) and average monthly household non-food consumption expenditure (r = -0.51, p = 0.01). It was further found that some regions which have higher levels of stunting such as Njombe, have the lowest level of basic need poverty. Conclusion The study found a positive relationship between food production and the prevalence of stunting using data across regions in mainland Tanzania. This is an indication that regional food production may not entail nutrition outcomes, hence a call for more advocacy on nutrition-sensitive agriculture.

Background/Objectives: It is well documented that people with human immunodeficiency virus (HIV) have nearly twice the risk of incident acute myocardial infarction compared to the general population. The elevated risk stems from a multi-layered interplay of factors such as persistent immune activation inherent to HIV infection and higher prevalence of traditional risk factors associated with nutritional needs. A large proportion of people living with HIV (PWH) reside in Sub-Saharan African countries such as Tanzania; however, there is a dearth of data on nutrition, particularly fruit and vegetable (F&V) intake, a key factor in the prevention of cardiovascular disease (CVD). This study aimed to contribute to the growing literature on CVD prevention for PWH globally. Methods: We conducted secondary analyses of original data collected from a study using the World Health Organization (WHO) STEPS survey among PWH and the general population in Mwanza City between December 2018 and May 2019. Approval for the parent study was obtained from Bugando Medical Center. Multinomial logistic regression analysis examined F&V intake and associated factors between PWH and people living without HIV (PWoH) using sex, employment, and BMI. Results: A total of 537 participants (277 PWoH and 260 PWH) were included in the analysis. PWH were more likely to consume fruits ≥ 4 days per week than PWoH (38% vs. 25%, p = 0.002), whereas vegetable intake did not differ significantly between groups. Fruit intake was higher in males (OR = 5.63; 95% CI: 2.48–12.79) and employed individuals (OR = 3.85; 95% CI: 1.82–8.14). Conclusions: PWH were more likely to consume more fruits than PWoH in this study, a phenomenon that is more novel than previous research. These findings are encouraging to support nutrition-based interventions for PWH who are at a higher risk of CVD.

Background/Objective—It is well documented that people with human immunodeficiency virus (HIV) have nearly twice the risk of incident acute myocardial infarction compared to the general population. The elevated risk stems from a multi-layered interplay of factors such as persistent immune activation inherent to HIV infection and higher prevalence of traditional risk factors associated with nutritional needs. A large proportion of people living with HIV (PWH) reside in Sub-Saharan African countries such as Tanzania; however, there is a dearth of data on nutrition, particularly fruit and vegetable (F&V) intake, a key factor in the prevention of cardiovascular disease (CVD). This study aimed to contribute to the growing literature on CVD prevention for PWH globally. Methods—We conducted secondary analysis of data collected using the World Health Organization (WHO) STEPS survey among PWH and the general population in Mwanza City between December 2018 and May 2019. Approval for the parent study had been obtained from Bugando Medical Center. Multinomial logistic regression analysis examined F&V intake and associated factors between PWH and people living without HIV (PWoH) using sex, employment, and BMI. Results—A total of 537 participants (277 PWoH and 260 PWH) were included in the analysis. PWH were more likely to consume fruits > 4 days per week than PWoH (38% vs. 25%, p = 0.002), whereas vegetable intake did not differ significantly between groups. Fruit intake was higher in males (OR = 5.63; 95% CI: 2.48-12.79) and employed individuals (OR = 3.85; 95% CI: 1.82-8.14). Conclusions—PWH were more likely to consume more fruits than PWoH in this study, a phenomenon that is more novel than previous research. These findings are encouraging to support nutrition-based interventions for PWH who are at a higher risk of CVD.

Background: Financial compensation is an important aspect of respect for people enrolled in clinical research, yet continues to raise ethical questions. Respondents’ characteristics, shaped by contextual and geographic factors, may influence perceptions of the ethical implications of financial compensation. This study explored the relationship between respondents’ characteristics and their ethical perspective on the role of financial compensation in prevention trials in Tanzania. Materials and methods: A cross-sectional survey of 537 participants from two prevention studies within Tanzania was conducted. Participants were eligible if they participated in either the HIV Pre-Exposure Prophylaxis Vaccine Trial (PrEPVacc) trial or a non-inferiority trial of low-dose compared to standard high-dose calcium supplementation in pregnancy in Tanzania. A questionnaire was used to collect participants’ sociodemographic characteristics and motivating reasons for research participation. Data analysis was performed using descriptive statistics for all variables. The chi-square test was used to assess associations between categorical demographic characteristics and binary outcomes scores. Modified Poisson regression models were employed to examine predictors of positive or negative perspectives for each outcome. The P value of < 0.05 was used to ascertain the significant association between the variables. Results: Most participants (82.5%) were young adults between the ages of 18–28 years, married or cohabiting (60.7%), and self-employed (55.9%). All participants in the cohort were female. Key motivations for research participation included medical follow-up (96.8%), quality information (94.4%), and disease control (92.2%). The majority also reported feeling a duty to participate (90.5%) with 50.1% indicating that they felt an obligation to the person who requested their participation. More than a third (36.9%) wanted to receive an incentive and reimbursement (38.7%) for out-of-pocket expenses. Financial compensation was a less common motivator among married or cohabiting participants compared to single individuals (APR = 0.54, 95% CI: 0.42–0.71, p < 0.001). Participants with primary education were also less likely to report financial compensation motivations compared to those with no formal education (APR = 0.57, 95% CI: 0.41–0.78, p < 0.001). Also, participants who had taken part in two or more trials had significantly higher non-financial participation motivations compared to those with only one research experience (p < 0.001). Conclusion: Financial compensation matters to certain participant subgroups, but its role varies. While some value monetary benefits, others prioritize altruism and trust in research oversight. A balanced, transparent compensation framework is needed to address financial needs while maintaining ethical integrity.

Introduction: Hypertensive disorders of pregnancy (HDP) have been linked with increased risk for maternal and offspring complications in high-income settings. However, in resource-limited settings, studies with robust measurement of HDP, including severity and timing, and perinatal outcomes are limited. Methods: We analysed data from two prospective cohorts of nulliparous women in India (n=10 570 pregnancies) and Tanzania (n=10 299 pregnancies) who were enrolled in calcium supplementation trials and had blood pressure and proteinuria assessments throughout pregnancy and at the time of labour and delivery. Generalised estimating equations were used to assess the relationship between HDP severity categories (gestational hypertension, preeclampsia without severe features and preeclampsia with severe features) and timing of HDP onset (early-onset <34 weeks vs late-onset ≥34 weeks gestation) with adverse perinatal outcomes. Results: The cumulative incidence of HDP was 3.7% and 4.5% in the India and Tanzania cohorts, respectively. All HDP severity categories were associated with a significantly higher risk for perinatal death in both cohorts (p values<0.05). Pregnancies complicated by pre-eclampsia with severe features had the largest magnitude of increased risk for perinatal death as compared with pregnancies without an HDP (India RR 8.60; 95% CI 5.90 to 12.53; Tanzania RR 4.05; 95% CI 2.91 to 5.66). In both cohorts, pre-eclampsia with and without severe features, but not gestational hypertension, was associated with increased risks for preterm birth and low birth weight. Pregnancies with early-onset HDP had a high absolute risk of perinatal death (India 25.6% and Tanzania 36.9%), and the risk was markedly increased as compared with late-onset HDP (India RR 4.79; 95% CI 2.68 to 8.54; Tanzania RR 5.79; 95% CI 3.56 to 9.41). Conclusion: HDP were differentially associated with risks for perinatal outcomes by severity and timing of onset. Interventions that prevent, reduce the severity or delay the onset of HDP may improve perinatal outcomes in resource-limited settings. Trial registration number: ClinicalTrials.gov number, NCT03350516

Background: Prompt diagnosis and effective treatment within 24 hours of fever onset is crucial for reducing malaria-related morbidity and mortality in under five children. However, research on the prompt care-seeking behaviors and their determinants in this demographic is limited. This study examined the prevalence of prompt care-seeking behaviors among under five febrile children in Tanzania and the associated determinants. Methods: This cross-sectional study analyzed data from the 2022 Tanzania Demographic and Health Survey (TDHS), including a nationally representative and weighted sample of 1,050 under-five children who experienced fever within two weeks prior to the survey. A weighted univariable and multivariable modified Poisson regression model with robust estimator was used to examine the association between prompt care seeking behaviors and explanatory variables, including child and caregivers’ factors. Results: The prevalence of prompt care seeking for febrile children was 43.2%. Caregivers of female children had 18% less prevalences of seeking prompt care (95% CI 0.68–0.98) compared to caregivers with their male children. Caregivers aged 25–34 and 35–49 years had 36% (95% CI 1.05–1.78) and 61% (95% CI 1.16–2.23) higher prevalences of seeking prompt care for their children respectively, compared to younger caregivers aged 15–24 years. Caregivers with at least primary education had 50% (95% CI 1.12–2.02) higher prevalences of seeking prompt care compared to those with no formal education. Additionally, an increase in one household member was associated with a 3% increase in the prevalence of seeking prompt malaria care (95% CI 1.01–1.05). Conclusion: In Tanzania, female children under five experience delays in care-seeking for malaria, whereas older and more educated caregivers are more likely to seek timely treatment for their children. To enhance health outcomes in this vulnerable group, targeted interventions should prioritize raising awareness among caregivers, particularly younger ones and prompting equitable care seeking to all children regardless of sex.

Feeding practices during infancy have a significant impact on a child’s cognitive development and long-term health outcomes. Dietary diversity guidelines from the WHO and UNICEF recommend a diverse range of foods for children aged below 24 months for their optimal growth and development. However, in sub-Saharan Africa (SSA), little is known about the extent to which dietary diversity behaviour in children aged 6 to 24 months aligns with the recommendations and the factors associated with the differentials in dietary behaviour. This study aimed to fill this gap. This study employed an analytical cross-sectional approach, drawing on recent Demographic and Health Survey (DHS) data from 31 SSA countries. The study included a weighted sample of 44,071 children aged between 6 and 24 months, and their respective mothers aged 15–49 years. The primary outcome was Minimum Dietary Diversity (MDD) categorised per WHO recommendation. Multivariable logistic regression was used to examine the association of MDD with demographic and socio-economic characteristics. The pooled MDD intake among children aged 6–24 months in SSA was 11% ranging from as low as 1.3% in Burkina Faso to 32.9% in South Africa. Children of mothers aged 45–49 years had 52% significant higher likelihood of MDD compared to those aged 15–19 years (AOR = 1.52, 95% CI:1.03, 2.24). Higher maternal education levels also increased MDD odds in the children: 22% higher for mothers who had attained secondary education (AOR = 1.22, 95% CI:1.07, 1.39), and 36% higher for those with education beyond secondary level (AOR = 1.36, 95% CI:1.09, 1.71) compared to no education. Children of rich mothers had 44% higher odds of MDD than those with poor mothers (AOR = 1.44, 95% CI:1.27, 1.62). Increased antenatal visits, and urban residence also contributed to higher MDD odds. Based on the current global estimate of approximately 28% MDD rate, the reported 11% MDD intake among children in this study is relatively low. There is a positive association between MDD intake in children and several factors, including maternal education, antenatal visits, wealth index, and residency. These findings highlight the need for policymakers and other stakeholders to give urgent attention to empowering parents to ensure adequate nutrient intake among children for better child growth and development.

Background Insufficient and above WHO-recommended levels of iodine intake during pregnancy can lead to serious health outcomes. This study aimed to assess median urine iodine concentration and its associated risk factors among pregnant women in the Mbeya region, Tanzania. Method A cross sectional survey involving 420 pregnant women (n=420) aged 15-49, registered in Reproductive and Child Health Clinics was conducted. Socio-demographic and dietary factors were assessed by structured questionnaire and the urine samples were analyzed using the ammonium persulfate digestion method. Results Median urinary iodine concentration (mUIC) was 279.4μg/L and it ranged from 26.1 to 1915μg/L. Insufficient mUIC (below 150μg/L) was observed in 17.14% of participants, sufficient mUIC was 24.29% and 58.57% had mUIC above the recommended level (>250μg/L). Sample women who reported consuming fish in the last 24 hours had an increased risk of insufficient mUIC [Adjusted OR= 2.60 (95%CI 1.31-5.15)] while the risk was lower for those who attended at least primary education [AOR= 0.29 (CI 0.08-0.99)]. Further, sample women resident in Mbarali district, in the oldest age group (35-49) and having a higher socio-economic status were associated with an increased risk of having MUIC above recommended level [AOR=4.09 (CI 1.85-9.010], [AOR=2.51 (CI 0.99-6.330] and, [AOR=2.08 (CI 0.91-4.71) respectively. Conclusion This study demonstrated a significant association between geographical, age and socio-economic factors and median urine iodine concentration above the WHO-recommended level. Further, this study found association between inadequate iodine in diet and insufficient median urine iodine concentration. Therefore, educational programs on iodine intake should be strengthened.