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.     

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.     

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 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.     

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.     

Reported heterosexual intercourse and related behaviours among primary school pupils in Kinondoni district,Dar es Salaam,Tanzania

A cross-sectional questionnaire survey was conducted among 2820 pupils in 22 randomly selected primary schools in Kinondoni district, Tanzania. The objective was to identify the proportion of pupils who reported ever having had sexual intercourse, as well as sociodemographic and psychosocial factors and other sexual-related behaviours associated with heterosexual intercourse among pupils. About 13% (376) of participating pupils reported having had heterosexual intercourse. The proportion of pupils who reported doing so varied significantly by age, sex, school grade and parents' education. Regarding psychosocial factors, pupils who agreed that having sexual intercourse implies love for a partner and that sexual intercourse creates peer approval were significantly more likely to report having had heterosexual intercourse. Pupils who reported having a girl/boy friend, kissed a boy/girl, engaged in light petting, engaged in heavy petting or practised oral sex and anal sex were more likely to report ever having heterosexual intercourse. The implications for programme and intervention development are discussed.     

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.     

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.     

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.     

不同剂量辛伐他汀对老年高血压合并高脂血症患者血压、血脂水平的影响

目的探讨不同剂量辛伐他汀治疗老年高血压合并高脂血症患者的临床效果。方法 60例老年高血压合并高脂血症患者随机分为两组各30例。在常规治疗基础上,对照组给予常规剂量(20 mg/d)辛伐他汀治疗,观察组给予高剂量(40 mg/d)辛伐他汀治疗。比较两组的临床疗效,血压、血脂指标,以及不良反应。结果观察组的总有效率显著高于对照组(P<0.05)。治疗后,观察组的舒张压、收缩压、TC、TG、LDL-C、HDL-C水平均显著优于对照组(P<0.05)。两组的不良反应发生率无统计学差异(P>0.05)。结论高剂量辛伐他汀治疗老年高血压合并高脂血症患者的临床效果显著,可有效降低血压、血脂。     

澳门地区高血压调查分析

目的掌握澳门地区高血压现状和人群血压水平。方法于１９９６年１０～１２月间,按照《全国１９９１年高血压抽样调查工作手册》的要求,对澳门地区≥１５岁的常住居民５１７７名,采用标准化调查方法,在严格质控下进行调查和血压测定。结果高血压患病粗率为２９４６％,标化患病率为２０４５％。按国内患病率标准划分属高血压高发区。收缩压及舒张压均值：男性１７１８ｋＰａ（１２８８２ｍｍＨｇ）、１０８６ｋＰａ（８１４７ｍｍＨｇ）,女性１６３２ｋＰａ（１２２３８ｍｍＨｇ）、１０１５ｋＰａ（７６１５ｍｍＨｇ）,高于国内广东省和北京市。高血压患病率男性高于女性。患病率增幅３５岁以后较快,与国内相似。同年龄组的新移民较原居民患病率低。结论本地区高血压流行状况相当严峻,是不容忽视的社会公共卫生问题。必须加强健康教育和健康促进活动,切实做好高血压的一、二级预防     

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.     

Prevalence of enteropathogenic viruses and molecular characterization of group A rotavirus among children with diarrhea in Dar es Salaam Tanzania

Background  

Different groups of viruses have been shown to be responsible for acute diarrhea among children during their first few years of life. Epidemiological knowledge of viral agents is critical for the development of effective preventive measures, including vaccines.     

老年人高血压病与高血压合并糖尿病动态血压的研究

目的探讨老年人糖尿病对高血压患者动态血压(ABP)的影响及变化特点。方法对100例高血压病和1100例高血压合并糖尿病患者进行动态血压监测,对两组患者的ABP进行进行对比分析。结果两组患者ABP参数比较,合并糖尿病的高血压患者24小时平均血压、日间平均血压、夜间平均血压的总体水平高于高血压组(P<0.05)。结论对老年高血压合并糖尿病患者,降低血压和降低血糖对糖尿病病人的血压和微血管并发症的防治同等重要。     

糖尿病合并高血压患者动态血压心电二合一监测的临床意义

目的分析动态血压心电二合一监测在糖尿病合并高血压患者病情观察中的意义。方法收集糖尿病合并高血压患者50例为观察组,单纯高血压患者50例为对照组。观察组中无靶器官损害为A组,有靶器官损害者为B组。动态监测患者的血压、心电。结果与对照组相比,观察组的24hSBP、 dSBP、 nSBP、 nDBP、 SDNN、 SDANN、 SDNN Index、 PNN50、 r MSSD均更高(P <0.05)。与A组相比, B组的24hSBP、 dSBP、 nSBP更高, 24hDBP、 dDBP均更低(P <0.05);与A组相比, B组心率变异各指标均更低(P <0.05)。结论动态血压心电二合一监测能准确评估糖尿病合并高血压患者的病情,为治疗提供指导。     

原发性高血压患者血压昼夜节律及血压变异性与血液粘度的关系

目的探讨高血压病患者血压昼夜节律及血压变异性与血液粘度之间的关系。方法对64例原发性高血压病(EH)患者血压变异性与血液粘度之间的关系进行观察；按血压昼夜节律分为血压节律消失组与血压节律正常组，观察两组血液粘度。结果两组间血液粘度有显著差异(P＜0.05)；收缩压变异性、平均动脉压变异性与血液粘度呈正相关(P＜0.05)。结论高血压病患者血压昼夜节律消失及血压变异性增高者血液粘度增加。     

The magnitude and factors associated with delays in management of smear positive tuberculosis in Dar es Salaam,Tanzania

Objective  

To assess the magnitude and factors responsible for delay in TB management.     

奉化市居民高血压患病率变化趋势分析

目的探讨奉化市居民2004—2010年血压水平与高血压患病率的变化情况。方法利用奉化市3次中国慢性病及其危险因素监测的居民高血压相关资料整理并分析高血压患病率的变化情况。结果男性收缩压与舒张压平均水平均高于女性,男女各年龄组收缩压和舒张压随着年龄的增长而升高。2004、2007和2010年高血压患病率分别为25.53%、32.81%和37.50%,标化患病率分别为20.87%、27.54%和28.70%;女性高血压患病率高于男性,60岁～组高血压患病率最高,30岁～组高血压患病率增加的幅度最大。高血压知晓率、治疗率、控制率呈增加趋势,但仍处于较低水平。结论奉化市居民高血压患病率较高,高血压知晓率、治疗率和控制率较低,应加强高血压防治的相关工作。     

福辛普利改善原发性高血压并糖耐量减低患者血压、血糖及血管功能的研究

目的：探讨福辛普利对原发性高血压并糖耐量减低患者血压、血糖及血管功能的影响。方法：选择本院2012年4月-2013年7月收治的原发性高血压并糖耐量减低患者48例,全部患者均给予福辛普利治疗,5 mg/次,1次/d,疗程为6个月,治疗前后检测患者空腹血糖（FPG）、餐后2 h血糖（2 h PG）、内皮素（ET）、收缩压（SBP）、舒张压（DBP）、空腹胰岛素（FINS）以及胰岛素抵抗指数（HOMA-IR）,并测定治疗前后脉搏波传导速度（baPWV）变化情况。结果：治疗后患者SBP、DBP、2 h PG、FINS、HOMA-IR、ET、baPWV均明显低于治疗前,前后比较差异均有统计学意义（P〈0.05）,治疗前后FPG比较差异无统计学意义（P〈0.05）。结论：福辛普利治疗原发性高血压合并糖耐量减低患者效果良好,可在降低血压的同时,减轻胰岛素抵抗,改善血管内皮功能及大动脉弹性及顺应性,值得应用。