Prevalence and determinants of obesity among primary school children in Dar es Salaam,Tanzania

Background

Childhood obesity has increased dramatically and has become a public health concern worldwide. Childhood obesity is likely to persist through adulthood and may lead to early onset of NCDs. However, there is paucity of data on obesity among primary school children in Tanzania. This study assessed the prevalence and determinants of obesity among primary school children in Dar es Salaam.

Methods

A cross sectional study was conducted among school age children in randomly selected schools in Dar es Salaam. Anthropometric and blood pressure measurements were taken using standard procedures. Body Mass Index (BMI) was calculated as weight in kilograms divided by the square of height in meters (kg/m²). Child obesity was defined as BMI at or above 95th percentile for age and sex. Socio-demographic characteristics of children were determined using a structured questionnaire. Logistic regression was used to determine association between independent variables with obesity among primary school children in Dar es Salaam.

Results

A total of 446 children were included in the analysis. The mean age of the participants was 11.1±2.0 years and 53.1% were girls. The mean BMI, SBP and DBP were 16.6±4.0 kg/m², 103.9±10.3mmHg and 65.6±8.2mmHg respectively. The overall prevalence of child obesity was 5.2% and was higher among girls (6.3%) compared to boys (3.8%). Obese children had significantly higher mean values for age (p=0.042), systolic and diastolic blood pressures (all p<0.001). Most obese children were from households with fewer children (p=0.019) and residing in urban areas (p=0.002). Controlling for other variables, age above 10 years (AOR=3.3, 95% CI=1.5-7.2), female sex (AOR=2.6, 95% CI=1.4-4.9), urban residence (AOR=2.5, 95% CI=1.2-5.3) and having money to spend at school (AOR=2.6, 95% CI=1.4-4.8) were significantly associated with child obesity.

Conclusions

The prevalence of childhood obesity in this population was found to be low. However, children from urban schools and girls were proportionately more obese compared to their counterparts. Primary preventive measures for childhood obesity should start early in childhood and address socioeconomic factors of parents contributing to childhood obesity.     

Nutritional status of HIV-infected women with tuberculosis in Dar es Salaam,Tanzania

Setting:

Tuberculosis (TB) treatment clinics in Dar es Salaam, Tanzania.

Objective:

To quantify anthropometrics and intake of en-ergy and protein among human immunodeficiency virus (HIV) positive women with TB.

Design:

HIV-positive women with newly diagnosed TB were assessed on their anthropometric characteristics and dietary intake. Energy and protein intake were determined using Tanzania food composition tables and compared with standard recommendations. Patients were re-evaluated after 4–6 months of anti-tuberculosis treatment.

Results:

Among 43 women, the baseline median CD4 count was 209 cells/µl (range 8–721); 19 (44%) had a CD4 count of <200; 20 (47%) were on antiretroviral therapy. Body mass index was <18.5 kg/m² in 25 (58%); the median food insecurity score was 6. The median level of kcal/day was 1693 (range 1290–2633) compared to an estimated need of 2658; the median deficit was 875 kcal (range −65–1278). The median level of protein/day was 42 g (range 27–67) compared to 77 g estimated need; the median protein deficit was 35 g (range 10–50). The median weight gain among 29 patients after 4–6 months was 6 kg.

Conclusion:

HIV-positive women with TB have substantial 24-h deficits in energy and protein intake, report significant food insecurity and gain minimal weight on anti-tuberculosis treatment. Enhanced dietary education together with daily supplementation of 1000 kcal with 40 g protein may be required.     

呼伦贝尔市城乡小学生龋齿患病情况调查及相关因素分析

目的了解呼伦贝尔市小学生龋齿患病情况及影响因素,为防治龋病提供科学依据。方法采取整群抽样方法,随机抽取1~5年级的小学生进行口腔龋齿检查,并对其口腔卫生、生活习惯等进行问卷调查。使用Epidata3.0软件录入问卷,SPSS18.0进行统计分析。结果 1 005名小学生的龋患率为22.4%,不同性别、地区、民族龋齿患病率无统计学差异(P0.5)。经分析,发现年级、刷牙次数、甜食摄入及是否挑食与患龋有着密切关系。结论应加大健康教育宣传力度,重视口腔卫生问题,养成良好的口腔卫生习惯,控制儿童龋齿患病率。     

Genetic diversity of norovirus in hospitalised diarrhoeic children and asymptomatic controls in Dar es Salaam,Tanzania

This study investigated and reports norovirus diarrhoea, genetic diversity and associated clinical symptoms, HIV status and seasonality in a paediatric population of Tanzania.Stool specimens and demographic/clinical information, were prospectively collected from 705 hospitalised children with diarrhoea (cases) and 561 children without diarrhoea (controls) between 2010 and 2011. Norovirus detection was done by real-time RT-PCR. Genotype was determined using Gel-based and real time RT-PCR methods and sequencing targeting the polymerase and the capsid region respectively. Norovirus was detected in 14.3%, 181/1266 children. The prevalence of norovirus was significantly higher in cases (18.3%, 129/705) than in controls, (9.2%, 52/561), P < 0.05. Except for one child who had double infection with GI and GII all 129 cases had GII. Among controls, 23.1% had GI and 76.9% had GII. Norovirus GII.4 was significantly more prevalent in cases 87.9% than in controls 56.5%. Other genotypes detected in both cases and controls were GII.21, GII.16 and GII.g. The highest numbers of norovirus were detected in April 2011. The number of norovirus detected was significantly higher during the first than second year of life (109/540, 20.2% vs. 20/165, 12.1%). The prevalence of norovirus in HIV-positive and negative children was (21.2%, 7/33) and (10.3%, 40/390, P = 0.05) respectively, regardless of diarrhoea symptoms. No significant difference in gender, parent’s level of education or nutritional status with norovirus infection was observed within cases or controls. This study confirms the significant role of norovirus infection, especially GII.4 in diarrhoeic children who need hospitalisation and adds knowledge on norovirus epidemiology in the African region.     

The spectrum of dermatological disorders among primary school children in Dar es Salaam

Background  

Dermatologic disorders are common in many countries but the spectrum varies greatly. Many studies have reported a significant burden of skin diseases in school children. The objective of this study was to determine the current spectrum of dermatological disorders in primary school children in Dar es Salaam city.     

The health-related microbiological quality of bottled drinking water sold in Dar es Salaam, Tanzania

The consumption of bottled and plastic-bagged drinking water in Tanzania has increased largely because of the deteriorating quality of tap water. It is uncertain whether these water products are safe for drinking. In this study, the microbiological quality of bottled and plastic-bagged drinking water sold in Dar es Salaam, Tanzania, was investigated. One hundred and thirty samples representing 13 brands of bottled water collected from shops, supermarkets and street vendors were analysed for total coliform and faecal coliform organisms as well as heterotrophic bacteria. These were compared with 61 samples of tap water. Heterotrophic bacteria were detected in 92% of the bottled water samples analysed. Total and faecal coliform bacteria were present in 4.6% and 3.6%, respectively, of samples analysed with a tendency for higher contamination rates in plastic-bagged drinking water. Microbiological quality of tap water was found to be worse compared with bottled water, with 49.2% and 26.2% of sampling points showing the presence of total coliform and faecal coliform organisms, respectively. The results suggest caution and vigilance to avert outbreaks of waterborne diseases from these types of drinking water.     

Attitudes,beliefs and norms relating to contraceptive use among young migrant and non-migrant adults in urban Dar es Salaam,Tanzania

The young urban population of Tanzania is growing rapidly, primarily due to rural-urban migration. More information is needed on the challenges facing young adult urban women and men in using family planning (FP). The purpose of this study is to identify perceptions, interpersonal and familial attitudes, and sociocultural norms regarding FP among young adults (18–25 years) in Dar es Salaam, Tanzania, comparing responses by sex, marital status and migration status. We conducted 12 focus groups with young adult men and women (n = 74) in Dar es Salaam in December 2009. Participants knew of modern contraceptive methods, but had serious concerns about side effects. Single men and women preferred condoms. Female migrants stated that traditional methods were ineffective, yet commonly used in rural areas. Men's desires for more children frequently led female migrants not to use FP, while many married long-term residents used FP discreetly. Single women sometimes received the support of their parents/boyfriends to access and use contraception. Findings highlight differences in experiences among young adult men and women based on their migrant and marital status at the individual, interpersonal and normative levels. Future efforts to promote FP should engage existing social support systems and cultivate new ones in response to barriers.     

Microfinance and health interventions: Factors influencing loan repayment success with young men in Dar es Salaam,Tanzania

Poverty is associated with numerous poor health outcomes. Youth unemployment in Tanzania is approximately 13.7%, and concentrates in urban areas. These youth lack relevant job skills and access to financial capital. Microfinance continues to be implemented globally to address poverty, and increasingly has been linked to health interventions. Men less frequently are recipients of microfinance loans. We offered microcredit to young men in an area of Dar es Salaam with high poverty as part of a randomised controlled-trial to assess the efficacy of a microfinance and health leadership intervention in preventing STI acquisition. We used mixed methods to understand predictors of successful loan repayment. Our qualitative sub-study showed that leader influence, prior business experience, personal motivation, and planning facilitated repayment. Using a modified Poisson approach, our quantitative analysis showed that successful repayment was associated with business experience, education, increasing number of children, community of residence, percentage of network members trained in business, and repayment success of peer leaders. Our results suggest that enforcing group accountability and repayment rules, offering ongoing training, and using successful entrepreneurs as role models could increase repayment success in similar populations. These strategies could provide financial opportunity for men while minimising risk for microfinance institutions.     

Challenging HIV vulnerability discourse: the case of professional and entrepreneurial women in Dar Es Salaam,Tanzania

Abstract

A poverty-HIV narrative has dominated many HIV prevention strategies in Africa despite epidemiological data showing higher prevalence of infection among educated and wealthier women in several African countries. This paper examines the perspectives of professional and entrepreneurial women on HIV risk and vulnerability based on their knowledge and lived experiences, comparing this to the HIV discourse evident in five strategic documents that shape intervention in Tanzania. The purpose is to uncover the confluence and dissonance between the discourses of government and those of professional women themselves. Qualitative research methods included critical discourse analysis of five strategic documents and thematic analysis of 37 in-depth interviews with women. The findings challenge fixed representations of women and notions of vulnerability embedded in the poverty-HIV discourse. Women described using their sexuality and sexual agency as a means to elevate their position in ways that made them vulnerable to sexual harassment and coercion. This is explored through two intersecting themes: non-marital sexual exchanges to gain an education or employment, and marriage. The intersecting social positions and constructions of female sexuality and agency expressed by the women in this study provide insights into other avenues and forms of HIV vulnerability.     

包头市区小学生近视现况调查及影响因素研究

目的 了解包头市区小学生近视现状,分析其可能的影响因素,为包头市小学生近视防治提供基础资料。 方法 采用非条件Logistic回归模型对可能与近视发生有关的29项因素进行多因素分析,筛检出包头市区小学生近视的影响因素。结果 包头市区小学生近视患病率为24.86%,其中男生为23.07%,女生为26.71%。通过非条件Logistic回归模型多因素分析,最终筛检出11个因素与小学生近视有统计学关联。 结论包头市区小学生的近视率已达较高水平,无论学校还是家庭视觉环境均存在较多问题,应采取切实措施降低小学生近视的发生率。     

Social venues that protect against and promote HIV risk for young men in Dar es Salaam,Tanzania

Developing effective place-based health interventions requires understanding of the dynamic between place and health. The therapeutic landscape framework explains how place-based social processes and physical geography interact and influence health behavior. This study applied this framework to examine how venues, or social gathering places, influenced HIV risk behavior among young, urban men in Tanzania. Eighty-three public venues where men aged 15–19 met new sexual partners were identified by community informants in one city ward. The majority (86%) of the venues were called ‘camps’, social gathering places that had formal leaders and members. Observations were conducted at 23 camps and in-depth interviews were conducted with 36 camp members and 10 camp leaders in 15 purposively selected camps.     

Causes, magnitude and management of burns in under-fives in district hospitals in Dar es Salaam, Tanzania

OBJECTIVES: To determine the causes, magnitude and management of burns in children under five years of age who were admitted in the district hospitals of Dar es Salaam City, Tanzania. METHODS: In this study, a total of 204 under fives were enrolled. Questionnaires were used to elicit if the parent/caretaker had the knowledge of the cause of the burns, what was done immediately after burn injury, first aid given immediately after burn, source of the knowledge of first aid and when the child was taken to the hospital. Also the questionnaire was cited with data on the management of burns in the hospitals through observation and checking the treatment files. RESULTS: Forty nine percent were males while 50.5% were females. Most of the children (54.9%) were aged between 1-2 years. 78.4% had scalds while 21.6% had flame burns. No children were found to have burns caused by chemicals or electricity. Most of the burns (97.5%) occurred accidentally, although some (2.5%) were intentional. 68.6% of these burn injuries occurred in the kitchen. Immediately after burn 87.3% of the children had first aid applied on their wounds while 12.7% didn't apply anything. Of the agents used, honey was the most used (32.8%) followed by cold water (16.7%). The source of knowledge on these agents was from relatives and friends (72.5%), schools (7%), media (6%) and medical personnel (14%). The study further revealed that analgesics, intravenous fluids, antiseptics and antibiotics were the drugs used for treatment of burns in the hospital and that there was no specialized unit for burns in the hospitals. CONCLUSIONS: Causes of childhood burns are largely preventable requiring active social/medical education and public enlighten campaigns on the various methods of prevention. The government to see to it that hospitals have specialized units for managing burn cases and also the socio-economic status of its people be improved.     

Difference in Blood Pressure Readings with Mercury and Automated Devices: Impact on Hypertension Prevalence Estimates in Dar es Salaam, Tanzania

Objectives

(1) To compare blood pressure (BP) readings with an automated arm cuff oscillometric device (AutoBP) to readings with a mercury sphygmomanometer (HgBP) and (2) to evaluate the impact on the prevalence of hypertension (HBP) in a population-based survey.

Methods

(1) In a convenience sample (“Comparison Study”), we measured?BP with both AutoBP (Visomat® OZ2) and?HgBP and we modeled BP difference (ΔBP = HgBP?AutoBP) with multiple regression analysis. (2) Using ΔBP, we calculated HgBP in a survey previously conducted in Dar es Salaam (“Population Survey”) in which BP was measured with the automatic device Visomat® OZ2 and we compared the prevalence of HBP (≥140/90 mmHg or treatment).

Results

In the Comparison Study (404 subjects aged 25–64), systolic/diastolic BP was higher by 4.4/4.7 mmHg (SE: 0.4/0.3) with HgBP than AutoBP. The prevalence of HBP was 42% with HgBP and 36% with AutoBP (relative difference of 14%). ΔBP was associated with age, BP and arm circumference. In the Population Survey (9.254 subjects aged 25–64), the prevalence of HBP was 17% with calculated HgBP and 14% with AutoBP (relative difference of 20%).

Conclusion

A small systematic bias in BP readings between two different devices had large impact on hypertension prevalence estimates. This suggests that automated devices used in epidemiological studies should be validated with particular care.     

Condom use among HIV-positive sexually active adults and partner's HIV status in Dar es Salaam, Tanzania

Consistent and proper use of condoms has been found to be effective in preventing HIV transmission and other sexually transmitted diseases. We examined the predictors of condom use and knowledge of partner's HIV status among 731 HIV-positive individuals who had sex in the past six months. Data are from an incoming service form administered to clients who visited the Muhimbili University College of Health Sciences' Voluntary Counseling and Testing (VCT) site in Dar es Salaam, Tanzania between 1997-2008 (N=45,071). Sixteen percent reported always using a condom in the past six months. Multivariate logistic regression revealed that age, and knowledge of partner's HIV status were the strongest predictors of consistent condom use. The risk of future HIV infections in this region remains high. Future efforts to prevent new HIV infections should aim to increase condom use, and prevention practices that facilitate HIV-positive individuals to communicate their HIV status with partners.     

Occupational exposure and health problems in small-scale industry workers in Dar es Salaam, Tanzania: a situation analysis

BACKGROUND: Workers in informal small-scale industries (SSI) in developing countries involved in welding, spray painting, woodwork and metalwork are exposed to various hazards with consequent risk to health. Aim To assess occupational exposure and health problems in SSI in Dar es Salaam, Tanzania. METHODS: Focused group discussions (FGD) were conducted among SSI workers. Participants were assessed for exposure to occupational and environmental hazards, the use of protective equipment and health complaints by interview. The findings were discussed with participants and potential interventions identified. RESULTS: Three hundred and ten workers were interviewed (response rate 98%). There was a high level (>90%) of self-reported exposure to either dust, fumes, noise or sunlight in certain occupational groups. There was low reported use of personal protective equipment. There was a high level of self-reported occupational health problems, particularly amongst welders and metalworkers. Workers reported their needs as permanent workplaces, information on work related hazards, water and sanitation, and legislation for SSI. CONCLUSIONS: In SSI in Tanzania, our study suggests that workers have high levels of exposure to multiple health hazards and that use of protective equipment is poor. This group of workers warrants improved occupational health and safety provision.     

Impact of measles outbreak response vaccination campaign in Dar es Salaam,Tanzania

We assessed the impact of a measles outbreak response vaccination campaign (ORV) in Dar es Salaam, Tanzania. Age-specific incidence rates were calculated before and after the ORV. Incidence rate ratios for the two time periods were compared and used to estimate expected cases and deaths prevented by ORV. The ratio of measles incidence rates in the age groups targeted and not targeted by ORV decreased from 5.8 prior to ORV to 1.8 (p < 0.0001) after; 506 measles cases and 18 measles deaths were likely averted. These results support the need for revised recommendations concerning ORV in general settings in Africa.