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Article ; Online: Do health workers’ preferences influence their practices? Assessment of providers’ attitude and personal use of new treatment recommendations for management of uncomplicated malaria, Tanzania

Masanja Irene M / Lutambi Angelina M / Khatib Rashid A

BMC Public Health, Vol 12, Iss 1, p

2012 Volume 956

Abstract: Abstract Background Due to growing antimalarial drug resistance, Tanzania changed malaria treatment policies twice within a decade. First in 2001 chloroquine (CQ) was replaced by sulfadoxine-pyrimethamine (SP) for management of uncomplicated malaria and ... ...

Abstract	Abstract Background Due to growing antimalarial drug resistance, Tanzania changed malaria treatment policies twice within a decade. First in 2001 chloroquine (CQ) was replaced by sulfadoxine-pyrimethamine (SP) for management of uncomplicated malaria and by late 2006, SP was replaced by artemether-lumefantrine (AL). We assessed health workers’ attitudes and personal practices following the first treatment policy change, at six months post-change and two years later. Methods Two cross-sectional surveys were conducted in 2002 and 2004 among healthcare workers in three districts in South-East Tanzania using semi-structured questionnaires. Attitudes were assessed by enquiring which antimalarial was considered most suitable for the management of uncomplicated malaria for the three patient categories: i) children below 5; ii) older children and adults; and iii) pregnant women. Practice was ascertained by asking which antimalarial was used in the last malaria episode by the health worker him/herself and/or dependants. Univariate and multivariate logistic regression was used to identify factors associated with reported attitudes and practices towards the new treatment recommendations. Results A total of 400 health workers were interviewed; 254 and 146 in the first and second surveys, respectively. SP was less preferred antimalarial in hospitals and private health facilities (p<0.01) in the first round, and the preference worsened in the second round. In the first round, clinicians did not prefer SP for children below age of 5 and pregnant women (p<0.01), but two years later, they did not prefer it for all patient scenarios. SP was the most commonly used antimalarial for management of the last malaria episode for health workers and their dependants in both rounds, in the public sector (p<0.01). Health workers in the dispensaries had the highest odds of using SP for their own treatment [adjusted OR- first round: 6.7 (95%CI: 1.9-23.4); crude OR- second round: 4.5 (1.5-13.3)]. Conclusion Following changes in malaria treatment recommendations, most health workers did not prefer the new antimalarial drug, and their preferences worsened over time. However, many of them still used the newly recommended drug for management of their own or family members’ malaria episode. This indicates that, other factors than providers’ attitude may have more influence in their personal treatment practices.
Keywords	Health workers ; Attitude ; Practices ; New treatment guidelines ; Malaria ; Public aspects of medicine ; RA1-1270
Subject code	360 ; 300
Language	English
Publishing date	2012-11-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Modelling the requirements and benefits of mosquito control interventions in the presence of mosquito dispersal

Lutambi Angelina M / Chitnis Nakul / Smith Tom / Penny Melissa

Malaria Journal, Vol 11, Iss Suppl 1, p P

2012 Volume 67

Keywords	Arctic medicine. Tropical medicine ; RC955-962 ; Infectious and parasitic diseases ; RC109-216
Language	English
Publishing date	2012-10-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
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Article ; Online: Do health workers' preferences influence their practices? Assessment of providers' attitude and personal use of new treatment recommendations for management of uncomplicated malaria, Tanzania.

Masanja, Irene M / Lutambi, Angelina M / Khatib, Rashid A

BMC public health

2012 Volume 12, Page(s) 956

Abstract: Background: Due to growing antimalarial drug resistance, Tanzania changed malaria treatment policies twice within a decade. First in 2001 chloroquine (CQ) was replaced by sulfadoxine-pyrimethamine (SP) for management of uncomplicated malaria and by late ...

Abstract	Background: Due to growing antimalarial drug resistance, Tanzania changed malaria treatment policies twice within a decade. First in 2001 chloroquine (CQ) was replaced by sulfadoxine-pyrimethamine (SP) for management of uncomplicated malaria and by late 2006, SP was replaced by artemether-lumefantrine (AL). We assessed health workers' attitudes and personal practices following the first treatment policy change, at six months post-change and two years later. Methods: Two cross-sectional surveys were conducted in 2002 and 2004 among healthcare workers in three districts in South-East Tanzania using semi-structured questionnaires. Attitudes were assessed by enquiring which antimalarial was considered most suitable for the management of uncomplicated malaria for the three patient categories: i) children below 5; ii) older children and adults; and iii) pregnant women. Practice was ascertained by asking which antimalarial was used in the last malaria episode by the health worker him/herself and/or dependants. Univariate and multivariate logistic regression was used to identify factors associated with reported attitudes and practices towards the new treatment recommendations. Results: A total of 400 health workers were interviewed; 254 and 146 in the first and second surveys, respectively. SP was less preferred antimalarial in hospitals and private health facilities (p<0.01) in the first round, and the preference worsened in the second round. In the first round, clinicians did not prefer SP for children below age of 5 and pregnant women (p<0.01), but two years later, they did not prefer it for all patient scenarios. SP was the most commonly used antimalarial for management of the last malaria episode for health workers and their dependants in both rounds, in the public sector (p<0.01). Health workers in the dispensaries had the highest odds of using SP for their own treatment [adjusted OR- first round: 6.7 (95%CI: 1.9-23.4); crude OR- second round: 4.5 (1.5-13.3)]. Conclusion: Following changes in malaria treatment recommendations, most health workers did not prefer the new antimalarial drug, and their preferences worsened over time. However, many of them still used the newly recommended drug for management of their own or family members' malaria episode. This indicates that, other factors than providers' attitude may have more influence in their personal treatment practices.
MeSH term(s)	Adult ; Antimalarials/therapeutic use ; Attitude of Health Personnel ; Child ; Child, Preschool ; Cross-Sectional Studies ; Female ; Guideline Adherence/statistics & numerical data ; Humans ; Malaria/drug therapy ; Practice Patterns, Physicians'/statistics & numerical data ; Pregnancy ; Surveys and Questionnaires ; Tanzania
Chemical Substances	Antimalarials
Language	English
Publishing date	2012-11-08
Publishing country	England
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ISSN	1471-2458
ISSN (online)	1471-2458
DOI	10.1186/1471-2458-12-956
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Space-Time Smoothing of Complex Survey Data: Small Area Estimation for Child Mortality.

Mercer, Laina D / Wakefield, Jon / Pantazis, Athena / Lutambi, Angelina M / Masanja, Honorati / Clark, Samuel

The annals of applied statistics

2016 Volume 9, Issue 4, Page(s) 1889–1905

Abstract: Many people living in low and middle-income countries are not covered by civil registration and vital statistics systems. Consequently, a wide variety of other types of data including many household sample surveys are used to estimate health and ... ...

Abstract	Many people living in low and middle-income countries are not covered by civil registration and vital statistics systems. Consequently, a wide variety of other types of data including many household sample surveys are used to estimate health and population indicators. In this paper we combine data from sample surveys and demographic surveillance systems to produce small area estimates of child mortality through time. Small area estimates are necessary to understand geographical heterogeneity in health indicators when full-coverage vital statistics are not available. For this endeavor spatio-temporal smoothing is beneficial to alleviate problems of data sparsity. The use of conventional hierarchical models requires careful thought since the survey weights may need to be considered to alleviate bias due to non-random sampling and non-response. The application that motivated this work is estimation of child mortality rates in five-year time intervals in regions of Tanzania. Data come from Demographic and Health Surveys conducted over the period 1991-2010 and two demographic surveillance system sites. We derive a variance estimator of under five years child mortality that accounts for the complex survey weighting. For our application, the hierarchical models we consider include random effects for area, time and survey and we compare models using a variety of measures including the conditional predictive ordinate (CPO). The method we propose is implemented via the fast and accurate integrated nested Laplace approximation (INLA).
Language	English
Publishing date	2016-07-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	2376910-5
ISSN	1941-7330 ; 1932-6157
ISSN (online)	1941-7330
ISSN	1932-6157
DOI	10.1214/15-AOAS872
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Article ; Online: Multiple sexual partners and condom use among 10 - 19 year-olds in four districts in Tanzania

Kweka Khadija / Mbaruku Godfrey / Mubyazi Godfrey M / Lutambi Angelina M / Exavery Amon / Masanja Honorati

BMC Public Health, Vol 11, Iss 1, p

What do we learn?

2011 Volume 490

Abstract: Abstract Background Although some studies in Tanzania have addressed the question of sexuality and STIs among adolescents, mostly those aged 15 - 19 years, evidence on how multiple sexual partners influence condom use among 10 - 19 year-olds is limited. ... ...

Abstract	Abstract Background Although some studies in Tanzania have addressed the question of sexuality and STIs among adolescents, mostly those aged 15 - 19 years, evidence on how multiple sexual partners influence condom use among 10 - 19 year-olds is limited. This study attempts to bridge this gap by testing a hypothesis that sexual relationships with multiple partners in the age group 10 - 19 years spurs condom use during sex in four districts in Tanzania. Methods Secondary analysis was performed using data from the Adolescents Module of the cross-sectional household survey on Maternal, Newborn and Child Health (MNCH) that was done in Kigoma, Kilombero, Rufiji and Ulanga districts, Tanzania in 2008. A total of 612 adolescents resulting from a random sample of 1200 households participated in this study. Pearson Chi-Square was used as a test of association between multiple sexual partners and condom use. Multivariate logistic regression model was fitted to the data to assess the effect of multiple sexual partners on condom use, having adjusted for potential confounding variables. STATA (10) statistical software was used to carry out this process at 5% two-sided significance level. Results Of the 612 adolescents interviewed, 23.4% reported being sexually active and 42.0% of these reported having had multiple (> 1) sexual partners in the last 12 months. The overall prevalence of condom use among them was 39.2%. The proportion using a condom at the last sexual intercourse was higher among those who knew that they can get a condom if they want than those who did not. No evidence of association was found between multiple sexual partners and condom use (OR = 0.77, 95% CI = 0.35 - 1.67, P = 0.504). With younger adolescents (10 - 14 years) being a reference, condom use was associated with age group (15 - 19: OR = 3.69, 95% CI = 1.21 - 11.25, P = 0.022) and district of residence (Kigoma: OR = 7.45, 95% CI = 1.79 - 31.06, P = 0.006; Kilombero: OR = 8.89, 95% CI = 2.91 - 27.21, P < 0.001; Ulanga: OR = 5.88, 95% CI = 2.00 - ...
Keywords	Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2011-06-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
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Article ; Online: Assessing the effects of mosquito nets on malaria mortality using a space time model: a case study of Rufiji and Ifakara Health and Demographic Surveillance System sites in rural Tanzania.

Selemani, Majige / Msengwa, Amina S / Mrema, Sigilbert / Shamte, Amri / Mahande, Michael J / Yeates, Karen / Mbago, Maurice C Y / Lutambi, Angelina M

Malaria journal

2016 Volume 15, Issue 1, Page(s) 257

Abstract: Background: Although malaria decline has been observed in most sub-Saharan African countries, the disease still represents a significant public health burden in Tanzania. There are contradictions on the effect of ownership of at least one mosquito net ... ...

Abstract	Background: Although malaria decline has been observed in most sub-Saharan African countries, the disease still represents a significant public health burden in Tanzania. There are contradictions on the effect of ownership of at least one mosquito net at household on malaria mortality. This study presents a Bayesian modelling framework for the analysis of the effect of ownership of at least one mosquito net at household on malaria mortality with environmental factors as confounder variables. Methods: The analysis used longitudinal data collected in Rufiji and Ifakara Health Demographic Surveillance System (HDSS) sites for the period of 1999-2011 and 2002-2012, respectively. Bayesian framework modelling approach using integrated nested laplace approximation (INLA) package in R software was used. The space time models were established to assess the effect of ownership of mosquito net on malaria mortality in 58 villages in the study area. Results: The results show that an increase of 10 % in ownership of mosquito nets at village level had an average of 5.2 % decrease inall age malaria deaths (IRR = 0.948, 95 % CI = 0.917, 0.977) in Rufiji HDSS and 12.1 % decrease in all age malaria deaths (IRR = 0.879, 95 % CI = 0.806, 0.959) in Ifakara HDSS. In children under 5 years, results show an average of 5.4 % decrease of malaria deaths (IRR = 0.946, 95 % CI = 0.909, 0.982) in Rufiji HDSS and 10 % decrease of malaria deaths (IRR = 0.899, 95 % CI = 0.816, 0.995) in Ifakara HDSS. Model comparison show that model with spatial and temporal random effects was the best fitting model compared to other models without spatial and temporal, and with spatial-temporal interaction effects. Conclusion: This modelling framework is appropriate and provides useful approaches to understanding the effect of mosquito nets for targeting malaria control intervention. Furthermore, ownership of mosquito nets at household showed a significant impact on malaria mortality.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Epidemiological Monitoring ; Family Characteristics ; Female ; Humans ; Infant ; Infant, Newborn ; Longitudinal Studies ; Malaria/mortality ; Malaria/prevention & control ; Male ; Middle Aged ; Mosquito Nets/statistics & numerical data ; Rural Population ; Spatio-Temporal Analysis ; Tanzania/epidemiology ; Young Adult
Language	English
Publishing date	2016-05-04
Publishing country	England
Document type	Journal Article
ISSN	1475-2875
ISSN (online)	1475-2875
DOI	10.1186/s12936-016-1311-9
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Article: Gender-based distributional skewness of the United Republic of Tanzania's health workforce cadres: a cross-sectional health facility survey.

Exavery, Amon / Lutambi, Angelina M / Wilson, Neema / Mubyazi, Godfrey M / Pemba, Senga / Mbaruku, Godfrey

Human resources for health

2013 Volume 11, Page(s) 28

Abstract: Background: While severe shortages, inadequate skills and a geographical imbalance of health personnel have been consistently documented over the years as long term critical challenges in the health sector of the United Republic of Tanzania, there is ... ...

Abstract	Background: While severe shortages, inadequate skills and a geographical imbalance of health personnel have been consistently documented over the years as long term critical challenges in the health sector of the United Republic of Tanzania, there is limited evidence on the gender-based distribution of the health workforce and its likely implications. Extant evidence shows that some people may not seek healthcare unless they have access to a provider of their gender. This paper, therefore, assesses the gender-based distribution of the United Republic of Tanzania's health workforce cadres. Methods: This is a secondary analysis of data collected in a cross-sectional health facility survey on health system strengthening in the United Republic of Tanzania in 2008. During the survey, 88 health facilities, selected randomly from 8 regions, yielded 815 health workers (HWs) eligible for the current analysis. While Chi-square was used for testing associations in the bivariate analysis, multivariate analysis was conducted using logistic regression to assess the relationship between gender and each of the cadres involved in the analysis. Results: The mean age of the HWs was 39.7, ranging from 15 to 63 years. Overall, 75% of the HWs were women. The proportion of women among maternal and child health aides or medical attendants (MCHA/MA), nurses and midwives was 86%, 86% and 91%, respectively, while their proportion among clinical officers (COs) and medical doctors (MDs) was 28% and 21%, respectively. Multivariate analysis revealed that the odds ratio (OR) and 95% confidence interval (CI) that a HW was a female (baseline category is "male") for each cadre was: MCHA/MA, OR = 3.70, 95% CI 2.16-6.33; nurse, OR = 5.61, 95% CI 3.22-9.78; midwife, OR = 2.74, 95% CI 1.44-5.20; CO, OR = 0.08, 95% CI 0.04-0.17 and MD, OR = 0.04, 95% CI 0.02-0.09. Conclusion: The distribution of the United Republic of Tanzania's health cadres is dramatically gender-skewed, a reflection of gender inequality in health career choices. MCHA/MA, nursing and midwifery cadres are large and female-dominant, whereas COs and MDs are fewer in absolute numbers and male-dominant. While a need for more staff is necessary for an effective delivery of quality health services, adequate representation of women in highly trained cadres is imperative to enhance responses to some gender-specific roles and needs.
Language	English
Publishing date	2013-06-24
Publishing country	England
Document type	Journal Article
ZDB-ID	2126923-3
ISSN	1478-4491
ISSN	1478-4491
DOI	10.1186/1478-4491-11-28
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Article ; Online: Clustering of under-five mortality in Rufiji Health and Demographic Surveillance System in rural Tanzania.

Shabani, Josephine / Lutambi, Angelina M / Mwakalinga, Victoria / Masanja, Honorati

Global health action

2010 Volume 3

Abstract: Background: Less than 5 years remain before the 2015 mark when countries will be evaluated on their achievements for the Millennium Development Goals (MDGs). The MDG 4 and 6 call for a reduction of child mortality by two-thirds and combating malaria, ... ...

Abstract	Background: Less than 5 years remain before the 2015 mark when countries will be evaluated on their achievements for the Millennium Development Goals (MDGs). The MDG 4 and 6 call for a reduction of child mortality by two-thirds and combating malaria, HIV/AIDS, TB, and other diseases, respectively. To accelerate the achievement of these goals, focused allocation of resources and high deployment of cost-effective interventions is paramount. The knowledge of spatial and temporal distribution of diseases is important for health authorities to prioritize and allocate resources. Methods: To identify possible significant clusters, we used SatTScan software, and analyzed 2,745 cases of under-five with 134,099 person-years for the period between 1999and 2008. Mortality rates for every year were calculated, likewise a spatial scan statistic was used to test for clusters of total under-five mortalities in both space and time. Results: A number of significant clusters from space, time, and space-time analysis were identified in several locations for a period of 10 years in the Rufiji Demographic Surveillance Site (RDSS). These locations show that villages within the clusters have an elevated risk of under-five deaths. The spatial analysis identified three significant clusters. The first cluster had only one village, Kibiti A (p < 0.05, the second cluster involved five villages (Mtawanya, Pagae, Kibiti A, Machepe, and Kibiti B; p < 0.05), the third cluster involved one village, Jaribu Mpakani (p < 0.05). A space-time cluster of 10 villages for the period between 1999 and 2002 with a radius of 14.73 km was discovered with the highest risk (RR 1.6, p < 0.001). The mortality rates were very high for the years 1999-2002 according to the analysis. The death rates were 33.5, 26.4, 24.1, and 24.9, respectively. Total childhood mortality rates calculated for the period of 10 years were 21.0 per 1,000 person-years. Conclusion: During the 10 years of analysis, mortality seemed to decrease in RDSS. The mortality decline should be taken with caution because the Demographic Surveillance System is not statistically representative of the whole population; therefore, inference should not be made to the general population of Tanzania. The pattern observed could be attributed to demographic and weather characteristics of RDSS. This should provide new insights for further studies and interventions toward reducing under-five mortality.
Language	English
Publishing date	2010-08-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	2540569-X
ISSN	1654-9880 ; 1654-9880
ISSN (online)	1654-9880
ISSN	1654-9880
DOI	10.3402/gha.v3i0.5264
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Multiple sexual partners and condom use among 10 - 19 year-olds in four districts in Tanzania: what do we learn?

Exavery, Amon / Lutambi, Angelina M / Mubyazi, Godfrey M / Kweka, Khadija / Mbaruku, Godfrey / Masanja, Honorati

BMC public health

2011 Volume 11, Page(s) 490

Abstract: Background: Although some studies in Tanzania have addressed the question of sexuality and STIs among adolescents, mostly those aged 15 - 19 years, evidence on how multiple sexual partners influence condom use among 10 - 19 year-olds is limited. This ... ...

Abstract	Background: Although some studies in Tanzania have addressed the question of sexuality and STIs among adolescents, mostly those aged 15 - 19 years, evidence on how multiple sexual partners influence condom use among 10 - 19 year-olds is limited. This study attempts to bridge this gap by testing a hypothesis that sexual relationships with multiple partners in the age group 10 - 19 years spurs condom use during sex in four districts in Tanzania. Methods: Secondary analysis was performed using data from the Adolescents Module of the cross-sectional household survey on Maternal, Newborn and Child Health (MNCH) that was done in Kigoma, Kilombero, Rufiji and Ulanga districts, Tanzania in 2008. A total of 612 adolescents resulting from a random sample of 1200 households participated in this study. Pearson Chi-Square was used as a test of association between multiple sexual partners and condom use. Multivariate logistic regression model was fitted to the data to assess the effect of multiple sexual partners on condom use, having adjusted for potential confounding variables. STATA (10) statistical software was used to carry out this process at 5% two-sided significance level. Results: Of the 612 adolescents interviewed, 23.4% reported being sexually active and 42.0% of these reported having had multiple (> 1) sexual partners in the last 12 months. The overall prevalence of condom use among them was 39.2%. The proportion using a condom at the last sexual intercourse was higher among those who knew that they can get a condom if they want than those who did not. No evidence of association was found between multiple sexual partners and condom use (OR = 0.77, 95% CI = 0.35 - 1.67, P = 0.504). With younger adolescents (10 - 14 years) being a reference, condom use was associated with age group (15 - 19: OR = 3.69, 95% CI = 1.21 - 11.25, P = 0.022) and district of residence (Kigoma: OR = 7.45, 95% CI = 1.79 - 31.06, P = 0.006; Kilombero: OR = 8.89, 95% CI = 2.91 - 27.21, P < 0.001; Ulanga: OR = 5.88, 95% CI = 2.00 - 17.31, P = 0.001), Rufiji being a reference category. Conclusion: No evidence of association was found between multiple sexual partners and condom use among adolescents in the study area. The large proportion of adolescents who engage in sexual activity without using condoms, even those with multiple partners, perpetuates the risk of transmission of HIV infections in the community. Strategies such as sex education and easing access to and making a friendly environment for condom availability are important to address the risky sexual behaviour among adolescents.
MeSH term(s)	Adolescent ; Child ; Condoms/statistics & numerical data ; Cross-Sectional Studies ; Female ; Humans ; Interviews as Topic ; Logistic Models ; Male ; Safe Sex/psychology ; Sexual Behavior ; Sexual Partners ; Sexually Transmitted Diseases/epidemiology ; Sexually Transmitted Diseases/prevention & control ; Tanzania/epidemiology ; Young Adult
Language	English
Publishing date	2011-06-22
Publishing country	England
Document type	Journal Article
ZDB-ID	2041338-5
ISSN	1471-2458 ; 1471-2458
ISSN (online)	1471-2458
ISSN	1471-2458
DOI	10.1186/1471-2458-11-490
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Under-five mortality: spatial-temporal clusters in Ifakara HDSS in South-eastern Tanzania.

Lutambi, Angelina M / Alexander, Mathew / Charles, Jensen / Mahutanga, Chrisostom / Nathan, Rose

Global health action

2010 Volume 3

Abstract: Background: Childhood mortality remains an important subject, particularly in sub-Saharan Africa where levels are still unacceptably high. To achieve the set Millennium Development Goals 4, calls for comprehensive application of the proven cost- ... ...

Abstract	Background: Childhood mortality remains an important subject, particularly in sub-Saharan Africa where levels are still unacceptably high. To achieve the set Millennium Development Goals 4, calls for comprehensive application of the proven cost-effective interventions. Understanding spatial clustering of childhood mortality can provide a guide in targeting the interventions in a more strategic approach to the population where mortality is highest and the interventions are most likely to make an impact. Methods: Annual child mortality rates were calculated for each village, using person-years observed as the denominator. Kulldorff's spatial scan statistic was used for the identification and testing of childhood mortality clusters. All under-five deaths that occurred within a 10-year period from 1997 to 2006 were included in the analysis. Villages were used as units of clusters; all 25 health and demographic surveillance sites (HDSS) villages in the Ifakara health and demographic surveillance area were included. Results: Of the 10 years of analysis, statistically significant spatial clustering was identified in only 2 years (1998 and 2001). In 1998, the statistically significant cluster (p < 0.01) was composed of nine villages. A total of 106 childhood deaths were observed against an expected 77.3. The other statistically significant cluster (p < 0.05) identified in 2001 was composed of only one village. In this cluster, 36 childhood deaths were observed compared to 20.3 expected. Purely temporal analysis indicated that the year 2003 was a significant cluster (p < 0.05). Total deaths were 393 and expected were 335.8. Spatial-temporal analysis showed that nine villages were identified as statistically significant clusters (p < 0.05) for the period covering January 1997-December 1998. Total observed deaths in this cluster were 205 while 150.7 were expected. Conclusion: There is evidence of spatial clustering in childhood mortality within the Ifakara HDSS. Further investigations are needed to explore the source of clustering and identify strategies of reaching the cluster population with the existing effective interventions. However, that should happen alongside delivery of interventions to the broader population.
Language	English
Publishing date	2010-08-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	2540569-X
ISSN	1654-9880 ; 1654-9880
ISSN (online)	1654-9880
ISSN	1654-9880
DOI	10.3402/gha.v3i0.5254
Database	MEDical Literature Analysis and Retrieval System OnLINE

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