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  1. Article ; Online: Effectiveness of instructional videos for enhancing healthcare provider competencies for hypertension management – a pre-post study in primary healthcare settings, Tanzania

    Anbrasi Edward / Gibson B. Kagaruki / Frank Manase / Lawrence J. Appel / Kunihiro Matsushita

    BMC Health Services Research, Vol 22, Iss 1, Pp 1-

    2022  Volume 14

    Abstract: Abstract Background Inadequate adherence to hypertension (HT) clinical standards by healthcare providers is one of the major barriers for HT management. We examined the effectiveness of four short instructional training videos on HT management. Methods ... ...

    Abstract Abstract Background Inadequate adherence to hypertension (HT) clinical standards by healthcare providers is one of the major barriers for HT management. We examined the effectiveness of four short instructional training videos on HT management. Methods Eighteen primary health care facilities were randomly selected using systematic sampling from five districts in the Dar es Salaam region, Tanzania. Pre-post provider knowledge assessments were conducted six months after training and provider performance was measured using patient observations on 8-10 consecutive adult patients per facility. A Screening Quality Index (SQI), comprised of ten HT screening standards, was used to measure adherence. Results Pre-post knowledge scores improved significantly, for, time between blood pressure (BP) readings (28.1% to 72.7%, p=0.01), BP threshold for patients with complications (21.2% to 97.0%, p<0.001), and lifestyle/dietary counseling (from 36.4% to 97.0%, p<0.001). SQI was significantly higher following the training for all provider groups; Nurses (3.0±3.5 to 8.4±1.0, p<0.001), Assistant Medical Officers and Medical Officers (3.5±4.1 to 7.6±2.4, p<0.001), and Assistant Clinical Officers and Clinical Officers (5.4±3.8 to 8.4±2.0, p<0.001). After training, significantly higher adherence was evident for key aspects of managing patients with HT: e.g., counseling on medication (62.1% to 92.7%, p=0.002), side effects (41.4% to 56.1%, p=0.009), reducing caloric intake (69.0 % to 95.1%, p=0.003), reducing cooking salt (65.5% to 97.6%, p<0.01), increasing physical activity (55.2% to 92.7% p<0.001), stopping/reducing cigarette smoking (24.1% to 63.4%, p=0.001), and reducing alcohol consumption (24.1% to 68.3%, p<0.001). SQI was significantly associated with number of years of provider experience (more than 2 years), type of primary healthcare facility (public facility), and exposure to the training intervention. Conclusion Training with short instructional videos can improve provider competency and clinical ...
    Keywords Hypertension Management ; Healthcare Provider Competency ; Instructional Video Training ; Tanzania ; Public aspects of medicine ; RA1-1270
    Subject code 796
    Language English
    Publishing date 2022-05-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: The effectiveness of interventions to reduce cardio-metabolic risk factors among regular street food consumers in Dar es Salaam, Tanzania

    Gibson B Kagaruki / Michael J Mahande / Mary T Mayige / Katharina S Kreppel / Esther S Ngadaya / Daniel Haydon / Godfather D Kimaro / Sayoki G Mfinanga / Bassirou Bonfoh

    PLoS ONE, Vol 18, Iss 11, p e

    The pre-post findings from a cluster randomized trial (Registered by Pan African clinical trial registry with trial # PACTR202208642850935).

    2023  Volume 0289289

    Abstract: Introduction The healthy plate model (HPM) is a practical guide to modulate the portion of staple food in main meals, subsequently affecting the risks associated with Non-communicable Diseases include type2 diabetes mellitus (T2DM). Objective This study ... ...

    Abstract Introduction The healthy plate model (HPM) is a practical guide to modulate the portion of staple food in main meals, subsequently affecting the risks associated with Non-communicable Diseases include type2 diabetes mellitus (T2DM). Objective This study investigated the effectiveness of health information and the healthy plate model on cardio-metabolic risk factors, knowledge and attitude towards T2DM prevention measures. Methods A pre-post analysis, as part of a cluster randomized trial with street food vendors and their customers, was implemented in three randomly selected districts in Dar es Salaam, Tanzania. Two vendor-customer clusters each with 15 and more vendors from each district were randomly assigned to receive either T2DM health information only (Intervention package1 [IP1]) or IP1 plus a subsidized meal with vegetables and fruits, following the principles of the HPM (Intervention package2 [IP2]). Within the clusters the participants were informed on the importance of the intervention they received. An intervention period lasted for three months from 1st April to 31st June 2019. We applied Generalized Linear Mixed Models and Bayesian Modelling (for sensitivity analysis) to assess the effectiveness of the interventions. Results Overall, 336 (IP2 = 175 and IP1 = 161) out of 560 (280/arm) previous study participants participated in evaluation. Diastolic BP was lower among IP2 participants in the evaluation than baseline AβC = -4.1mmHg (95%CI:-5.42 to -2.76). After adjusting for the interaction between IP2 and age of the consumers, the BMI was significantly lower among IP2 in the evaluation than baseline AβC = -0.7kg/m2 (95%CI: -1.17 to -0.23). With interaction between IP2 and income, BMI was higher in the IP2 in the evaluation than baseline AβC = 0.73kg/m2 (95%CI: 0.08 to 1.38). Systolic and diastolic BP were significantly lower among IP1 in the evaluation than baseline AβC = -3.5mmHg (95%CI:-5.78 to -1.24) and AβC = -5.9mmHg (95%CI:-7.34 to -4.44) respectively. Both the knowledge scores and positive ...
    Keywords Medicine ; R ; Science ; Q
    Subject code 796
    Language English
    Publishing date 2023-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Sociodemographic inequities associated with participation in leisure-time physical activity in sub-Saharan Africa

    Anna Louise Barr / Uttara Partap / Elizabeth H. Young / Kokou Agoudavi / Naby Balde / Gibson B. Kagaruki / Mary T. Mayige / Benjamin Longo-Mbenza / Gerald Mutungi / Omar Mwalim / Chea S. Wesseh / Silver K. Bahendeka / David Guwatudde / Jutta M. Adelin Jørgensen / Pascal Bovet / Ayesha A. Motala / Manjinder S. Sandhu

    BMC Public Health, Vol 20, Iss 1, Pp 1-

    an individual participant data meta-analysis

    2020  Volume 13

    Abstract: Abstract Background Leisure-time physical activity (LTPA) is an important contributor to total physical activity and the focus of many interventions promoting activity in high-income populations. Little is known about LTPA in sub-Saharan Africa (SSA), ... ...

    Abstract Abstract Background Leisure-time physical activity (LTPA) is an important contributor to total physical activity and the focus of many interventions promoting activity in high-income populations. Little is known about LTPA in sub-Saharan Africa (SSA), and with expected declines in physical activity due to rapid urbanisation and lifestyle changes we aimed to assess the sociodemographic differences in the prevalence of LTPA in the adult populations of this region to identify potential barriers for equitable participation. Methods A two-step individual participant data meta-analysis was conducted using data collected in SSA through 10 population health surveys that included the Global Physical Activity Questionnaire. For each sociodemographic characteristic, the pooled adjusted prevalence and risk ratios (RRs) for participation in LTPA were calculated using the random effects method. Between-study heterogeneity was explored through meta-regression analyses and tests for interaction. Results Across the 10 populations (N = 26,022), 18.9% (95%CI: 14.3, 24.1; I 2 = 99.0%) of adults (≥ 18 years) participated in LTPA. Men were more likely to participate in LTPA compared with women (RR for women: 0.43; 95%CI: 0.32, 0.60; P < 0.001; I 2 = 97.5%), while age was inversely associated with participation. Higher levels of education were associated with increased LTPA participation (RR: 1.30; 95%CI: 1.09, 1.55; P = 0.004; I 2 = 98.1%), with those living in rural areas or self-employed less likely to participate in LTPA. These associations remained after adjusting for time spent physically active at work or through active travel. Conclusions In these populations, participation in LTPA was low, and strongly associated with sex, age, education, self-employment and urban residence. Identifying the potential barriers that reduce participation in these groups is necessary to enable equitable access to the health and social benefits associated with LTPA.
    Keywords Leisure-time physical activity ; Physical activity ; Sub-Saharan Africa ; Occupational physical activity ; Active travel ; Global physical activity questionnaire ; Public aspects of medicine ; RA1-1270
    Subject code 796
    Language English
    Publishing date 2020-06-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Barriers and facilitators to enrollment and re-enrollment into the community health funds/Tiba Kwa Kadi (CHF/TIKA) in Tanzania

    Ntuli A. Kapologwe / Gibson B. Kagaruki / Albino Kalolo / Mariam Ally / Amani Shao / Manoris Meshack / Manfred Stoermer / Amena Briet / Karin Wiedenmayer / Axel Hoffman

    BMC Health Services Research, Vol 17, Iss 1, Pp 1-

    a cross-sectional inquiry on the effects of socio-demographic factors and social marketing strategies

    2017  Volume 9

    Abstract: Abstract Background Introduction of a health insurance scheme is one of the ways to enhance access to health care services and to protect individuals from catastrophic health expenditures. Little is known on the influence of socio-demographic and social ... ...

    Abstract Abstract Background Introduction of a health insurance scheme is one of the ways to enhance access to health care services and to protect individuals from catastrophic health expenditures. Little is known on the influence of socio-demographic and social marketing strategies on enrollment and re-enrollment in the Community Health Fund/Tiba Kwa Kadi (CHF/TIKA) in Tanzania. Methods This cross-sectional study employed quantitative methods for data collection between November 2014 and March 2015 in Singida and Shinyanga regions. Relationship between variables was obtained through Chi-square test and multivariate logistic regression. Results We recruited 496 participants in the study. Majority (92.7%) of participants consented to participate, with 229 (49.8%) and 231 (50.2%) members and non members of CHF/TIKA respectively. Majority (90.9%) were aware of CHF/TIKA. Majority of CHF/TIKA members and non-members (90% and 68.3% respectively) reported health facility-based sensitization as the most common social marketing approach employed to market the CHF/TIKA. The most popular marketing strategies in the country including traditional dances, football games, radio, television, news papers, and mosques/church were reported by few CHF and non CHF members. Multivariate Logistic regression models revealed no significant association between social marketing strategies and enrollment, but only socio-demographics; including marital status (AOR = 2.0, 95% CI 1.1–3.8) and family size (household with ≥ 6 members) (AOR = 1.5, 95% CI 1.0–2.5), were significant factors associated with enrollment/re-enrollment rate. Conclusions This study indicated that low level of utilization of available social marketing strategies and socio-demographic factors are the barriers for attracting members to join the schemes. There is a need for applying various social marketing strategies and considering different facilitating and impending socio-demographic factors for the growth and sustainability of the scheme as we move towards universal health ...
    Keywords Social marketing ; Barriers ; Facilitators ; Community health funds ; Tanzania ; Public aspects of medicine ; RA1-1270
    Subject code 300
    Language English
    Publishing date 2017-04-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Knowledge and perception on type2 diabetes and hypertension among HIV clients utilizing care and treatment services

    Gibson B. Kagaruki / Mary T. Mayige / Esther S. Ngadaya / Andrew M. Kilale / Amos Kahwa / Amani F. Shao / Godfather D. Kimaro / Chacha M. Manga / Doris Mbata / Godlisten S. Materu / Ray M. Masumo / Sayoki G. Mfinanga

    BMC Public Health, Vol 18, Iss 1, Pp 1-

    a cross sectional study from Mbeya and Dar es Salaam regions in Tanzania

    2018  Volume 9

    Abstract: Abstract Background Type2 Diabetes and Hypertension (T2DM/HTN) have become serious threats to the health and socio-economic development in the developing countries. People living with HIV (PLHIV) infection are more vulnerable of developing T2DM/HTN due ... ...

    Abstract Abstract Background Type2 Diabetes and Hypertension (T2DM/HTN) have become serious threats to the health and socio-economic development in the developing countries. People living with HIV (PLHIV) infection are more vulnerable of developing T2DM/HTN due to HIV infection itself and antiretroviral treatments. The situation is worse when behavioral and biological risk factors are pervasive to PLHIV. Despite this vicious circle; information on the level of knowledge and perception regarding prevention of T2DM/HTN, risks factors and associated complications among PLHIV is not well documented in Tanzania. The aim of this paper was assess the level of T2DM/HTN knowledge and perception among PLHIV and utilizing care and treatment clinic (CTC) services. Methods A cross-sectional study was conducted in randomly selected 12 CTCs between October 2011 and February 2012. Data on demographic characteristics, type 2 diabetes and hypertension knowledge and perception were collected from the study participants. Results Out of 754 PLHIV and receiving HIV services at the selected CTCs, 671 (89%) consented for the study. Overall 276/671(41.1%) respondents had low knowledge on type2 diabetes and hypertension risk factors and their associated complications. Locality (rural) (AOR = 2.2; 95%CI 1.4–3.4) and never/not recalling if ever measured blood glucose in life (AOR = 2.3; 95%CI 1.1–5.7) were significant determinants of low knowledge among clients on ART. Being currently not having HIV and T2DM/HTN co-morbidities (AOR = 2.2; 95%CI 1.2–4.9) was the only determinant of low knowledge among ART Naïve clients. With regard to perception, 293/671(43.7%) respondents had negative perception on diabetes and hypertension prevention. Sex (female) (AOR = 2.0, 95%CI 1.2–2.9), being aged < 40 years (AOR = 1.6; 95%CI 1.1–2.5) and education (primary/no formal education) (AOR = 4.4; 95%CI 2.0–9.8) were determinants for negative perception among clients on ART while for ART Naïve clients; HIV and T2DM/HTN co-morbidities (AOR = 2.0; 95%CI 1.2–4.6) was ...
    Keywords Type2 diabetes/hypertension ; Knowledge ; Perception ; ART and ART Naïve clients ; Tanzania ; Public aspects of medicine ; RA1-1270
    Subject code 390
    Language English
    Publishing date 2018-07-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Association between country preparedness indicators and quality clinical care for cardiovascular disease risk factors in 44 lower- and middle-income countries

    Justine I Davies / Sumithra Krishnamurthy Reddiar / Lisa R Hirschhorn / Cara Ebert / Maja-Emilia Marcus / Jacqueline A Seiglie / Zhaxybay Zhumadilov / Adil Supiyev / Lela Sturua / Bahendeka K Silver / Abla M Sibai / Sarah Quesnel-Crooks / Bolormaa Norov / Joseph K Mwangi / Omar Mwalim Omar / Roy Wong-McClure / Mary T Mayige / Joao S Martins / Nuno Lunet /
    Demetre Labadarios / Khem B Karki / Gibson B Kagaruki / Jutta M A Jorgensen / Nahla C Hwalla / Dismand Houinato / Corine Houehanou / David Guwatudde / Mongal S Gurung / Pascal Bovet / Brice W Bicaba / Krishna K Aryal / Mohamed Msaidié / Glennis Andall-Brereton / Garry Brian / Andrew Stokes / Sebastian Vollmer / Till Bärnighausen / Rifat Atun / Pascal Geldsetzer / Jennifer Manne-Goehler / Lindsay M Jaacks

    PLoS Medicine, Vol 17, Iss 11, p e

    A multicountry analysis of survey data.

    2020  Volume 1003268

    Abstract: Background Cardiovascular diseases are leading causes of death, globally, and health systems that deliver quality clinical care are needed to manage an increasing number of people with risk factors for these diseases. Indicators of preparedness of ... ...

    Abstract Background Cardiovascular diseases are leading causes of death, globally, and health systems that deliver quality clinical care are needed to manage an increasing number of people with risk factors for these diseases. Indicators of preparedness of countries to manage cardiovascular disease risk factors (CVDRFs) are regularly collected by ministries of health and global health agencies. We aimed to assess whether these indicators are associated with patient receipt of quality clinical care. Methods and findings We did a secondary analysis of cross-sectional, nationally representative, individual-patient data from 187,552 people with hypertension (mean age 48.1 years, 53.5% female) living in 43 low- and middle-income countries (LMICs) and 40,795 people with diabetes (mean age 52.2 years, 57.7% female) living in 28 LMICs on progress through cascades of care (condition diagnosed, treated, or controlled) for diabetes or hypertension, to indicate outcomes of provision of quality clinical care. Data were extracted from national-level World Health Organization (WHO) Stepwise Approach to Surveillance (STEPS), or other similar household surveys, conducted between July 2005 and November 2016. We used mixed-effects logistic regression to estimate associations between each quality clinical care outcome and indicators of country development (gross domestic product [GDP] per capita or Human Development Index [HDI]); national capacity for the prevention and control of noncommunicable diseases ('NCD readiness indicators' from surveys done by WHO); health system finance (domestic government expenditure on health [as percentage of GDP], private, and out-of-pocket expenditure on health [both as percentage of current]); and health service readiness (number of physicians, nurses, or hospital beds per 1,000 people) and performance (neonatal mortality rate). All models were adjusted for individual-level predictors including age, sex, and education. In an exploratory analysis, we tested whether national-level data on facility ...
    Keywords Medicine ; R
    Subject code 360
    Language English
    Publishing date 2020-11-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  7. Article ; Online: Health system performance for people with diabetes in 28 low- and middle-income countries

    Jennifer Manne-Goehler / Pascal Geldsetzer / Kokou Agoudavi / Glennis Andall-Brereton / Krishna K Aryal / Brice Wilfried Bicaba / Pascal Bovet / Garry Brian / Maria Dorobantu / Gladwell Gathecha / Mongal Singh Gurung / David Guwatudde / Mohamed Msaidie / Corine Houehanou / Dismand Houinato / Jutta Mari Adelin Jorgensen / Gibson B Kagaruki / Khem B Karki / Demetre Labadarios /
    Joao S Martins / Mary T Mayige / Roy Wong McClure / Omar Mwalim / Joseph Kibachio Mwangi / Bolormaa Norov / Sarah Quesnel-Crooks / Bahendeka K Silver / Lela Sturua / Lindiwe Tsabedze / Chea Stanford Wesseh / Andrew Stokes / Maja Marcus / Cara Ebert / Justine I Davies / Sebastian Vollmer / Rifat Atun / Till W Bärnighausen / Lindsay M Jaacks

    PLoS Medicine, Vol 16, Iss 3, p e

    A cross-sectional study of nationally representative surveys.

    2019  Volume 1002751

    Abstract: BACKGROUND:The prevalence of diabetes is increasing rapidly in low- and middle-income countries (LMICs), urgently requiring detailed evidence to guide the response of health systems to this epidemic. In an effort to understand at what step in the ... ...

    Abstract BACKGROUND:The prevalence of diabetes is increasing rapidly in low- and middle-income countries (LMICs), urgently requiring detailed evidence to guide the response of health systems to this epidemic. In an effort to understand at what step in the diabetes care continuum individuals are lost to care, and how this varies between countries and population groups, this study examined health system performance for diabetes among adults in 28 LMICs using a cascade of care approach. METHODS AND FINDINGS:We pooled individual participant data from nationally representative surveys done between 2008 and 2016 in 28 LMICs. Diabetes was defined as fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl), random plasma glucose ≥ 11.1 mmol/l (200 mg/dl), HbA1c ≥ 6.5%, or reporting to be taking medication for diabetes. Stages of the care cascade were as follows: tested, diagnosed, lifestyle advice and/or medication given ("treated"), and controlled (HbA1c < 8.0% or equivalent). We stratified cascades of care by country, geographic region, World Bank income group, and individual-level characteristics (age, sex, educational attainment, household wealth quintile, and body mass index [BMI]). We then used logistic regression models with country-level fixed effects to evaluate predictors of (1) testing, (2) treatment, and (3) control. The final sample included 847,413 adults in 28 LMICs (8 low income, 9 lower-middle income, 11 upper-middle income). Survey sample size ranged from 824 in Guyana to 750,451 in India. The prevalence of diabetes was 8.8% (95% CI: 8.2%-9.5%), and the prevalence of undiagnosed diabetes was 4.8% (95% CI: 4.5%-5.2%). Health system performance for management of diabetes showed large losses to care at the stage of being tested, and low rates of diabetes control. Total unmet need for diabetes care (defined as the sum of those not tested, tested but undiagnosed, diagnosed but untreated, and treated but with diabetes not controlled) was 77.0% (95% CI: 74.9%-78.9%). Performance along the care cascade was significantly better in upper-middle income countries, but across all World Bank income groups, only half of participants with diabetes who were tested achieved diabetes control. Greater age, educational attainment, and BMI were associated with higher odds of being tested, being treated, and achieving control. The limitations of this study included the use of a single glucose measurement to assess diabetes, differences in the approach to wealth measurement across surveys, and variation in the date of the surveys. CONCLUSIONS:The study uncovered poor management of diabetes along the care cascade, indicating large unmet need for diabetes care across 28 LMICs. Performance across the care cascade varied by World Bank income group and individual-level characteristics, particularly age, educational attainment, and BMI. This policy-relevant analysis can inform country-specific interventions and offers a baseline by which future progress can be measured.
    Keywords Medicine ; R
    Subject code 360
    Language English
    Publishing date 2019-03-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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