Background Women in Tanzania report a high unmet need for both information about and access to family planning. Prior studies have demonstrated the complex and variable relationship between religious faith and beliefs about family planning in sub-Saharan Africa. We hypothesized that a major reason for the poor uptake of family planning in Tanzania is that women and their partners are uncertain about whether pregnancy prevention is compatible with their religious beliefs. Methods Twenty-four focus group discussions with 206 participants were conducted in Mwanza, Tanzania between 2016 and 2017: six groups were conducted among Christian men, six among Christian women, six among Muslim men, and six among Muslim women. Among Christians, 98% were Protestants. Focus groups were also divided by gender and religion to facilitate discussion about gender-specific and religion-specific factors influencing family planning utilization. Qualitative data were analyzed using a thematic, phenomenological approach. Results We identify two important themes regarding the intersections of religion and family planning practices. First, we report that dynamics of family planning are experienced differently based on gender, and that male authority conflicts with female embodied knowledge, leading to negotiation or covert contraceptive use. Second, religious acceptability of family planning methods is of central importance, though participants differed in their interpretations of their religion’s stance on this question. Most who found family planning incompatible with their faith affirmed their responsibility to give birth to as many children as God would give them. Others found family planning to be acceptable given their moral responsibility to care for and protect their children by limiting the family size. Conclusions Both religious tradition and gender dynamics strongly influence the uptake of family planning, with a wide range of interpretations of religious traditions affecting the perceived acceptability of family planning. Regardless of gender or religious affiliation, participants were unified by a desire to live according to religious tradition. Future efforts to improve uptake of family planning are likely to have maximal impact if they are tailored to inform, involve, and empower male heads of households, and to address questions of religious acceptability.

Aims In Tanzania, approximately 25% of adolescents give birth and 50% more become sexually active during adolescence. We hypothesised that reproductive health education and services for adolescent girls are inaccessible and conducted this study to gain insights into their perceptions of sexually-transmitted infections (STIs) and barriers to reproductive health service utilisation in rural Mwanza, Tanzania. Methods We conducted nine focus group among pregnant adolescents aged 15–20 years. Data was transcribed, translated, and coded for relevant themes using NVivo10 software for qualitative data analysis. Results Most participants were aware of the dangers of STIs to themselves and their unborn babies, but did not perceive themselves as at risk of acquiring STIs. They viewed condoms as ineffective for preventing STIs and pregnancies and unnecessary for those in committed relationships. Stigma, and long waiting times and lack of privacy in the clinics discouraged young females from seeking reproductive healthcare. Conclusion Reproductive healthcare for adolescent girls who are not pregnant is practically nonexistent in Tanzania. Healthcare access for pregnant young women is also limited. Targeted changes to increase clinic accessibility and to provide reproductive health education to all rather than only pregnant women have the potential to address these gaps.

BackgroundTraditionally women with a short inter-pregnancy interval will not have sufficient time to recover and get ready for the subsequent pregnancy. This includes socio-economic, cultural, psychological and physical body preparedness. The present study aimed at comparing the maternal and perinatal outcomes among parturient women with preceding short and normal inter-pregnancy interval attending at Bugando Medical Centre (BMC). This was a prospective cohort study. It was done from November 2012 to April 2013. Multiple matching design approach was used to adjust for age variable during selection of participants. Chi-square test and Relative Risk (RR) were calculated to test for strength of association between variables.ResultsFour hundred and fifty (450) women were recruited in this study in which 150 had a SIPI and 300 had a NIPI. The premature rupture of membrane (PROM) was higher [RR = 13.6; 95% CI 7.2 − 25.6] among SIPI women than in NIPI women [RR = 0.57; 95% CI 0.49–0.7]. Women with a SIPI were found to have a significantly higher risk for anemia (RR = 3.4) compared to those with a NIPI (RR = 0.08). SIPI women had a higher risk for failure of trial of vaginal birth after caesarean section (VBAC) (RR = 14.7; 95% CI 6.4 − 33.6) compared to NIPI (RR = 0.72; 95% CI 0.65–0.8). The risk of postpartum hemorrhage (PPH) was higher among SIPI women (RR = 5.8) compared to women of NIPI (RR = 0.83). Women with SIPI had higher risk for small for gestation age (SGA) babies (RR = 7.7; 95% CI 3.8-15.7), low birth weight (RR = 6.7; 95% CI 3.6-12.3), preterm delivery (RR = 9.78; 95% CI 4.9-19.5) and low Apgar score (RR = 6.9; 95% CI 0.7-0.8) compared to women in NIPI.ConclusionHigher risk for PROM, anemia, failure of trial of VBAC, PPH and preeclampsia were observed among women with SIPI. Babies born of mothers with a SIPI were significantly at higher risk for SGA, low birth weight, low Apgar score, preterm deliveries compared to women in NIPI.Birth spacing, creating more awareness of complications, on risks associated with SIPI and provision of folate supplements should be advocated.

Background Limited data document sexually-transmitted infections (STIs) among pregnant adolescents in sub-Saharan Africa, where prenatal screening typically includes only HIV and syphilis. Given that HIV incidence in this population is among the world’s highest, we sought to assess the prevalence and factors associated with STIs in a population of rural pregnant adolescents in Tanzania. Methods We enrolled 403 pregnant adolescent girls from 10 antenatal clinics near Mwanza, Tanzania. Girls answered structured interviews about sexual health and risk factors and were tested for six common STIs. Results One hundred ninety-nine girls (49.4%) had at least one STI. HSV-2 was most prevalent (34.5%), followed by trichomoniasis (12.4%), chlamydia (11.4%), gonorrhoea (6.7%), syphilis (5.2%), and HIV (4.7%). Of note, 53/199 (26.6%) of girls with laboratory-proven STIs were asymptomatic. On multivariable analysis, presence of any STI was associated with being in a long-term (as opposed to short-term) relationship (odds ratio (OR)=2.6 [1.4–4.9] p= 0.004), younger age at first sexual debut (OR =0.9 per year [0.8–0.99], p= 0.034), increasing age difference between the girl and her partner (OR=1.1 [1.0–1.1] per year, p= 0.03), and history of prior pregnancy (OR=1.6 [1.0–2.6], p=0.04). Conclusion STIs affected half of rural pregnant adolescents in Tanzania. Our work demonstrates the urgent need to incorporate routine STI testing into antenatal care in Tanzania to prevent morbidity and mortality in young girls and their babies. We also identify behavioural and demographic risk factors that can be used to target interventions to those at highest risk.

BackgroundExtended spectrum beta-lactamase producing bacteria (ESBL) are common causes of neonatal sepsis worldwide. Neonatal sepsis due to ESBL is associated with increased morbidity and mortality at Bugando Medical Centre (BMC). Due to limited information on the sources of these ESBL strains at BMC, this study was conducted to evaluate the existence, magnitude and transmission of ESBL from post-delivery women to neonates at BMC, Mwanza-Tanzania.ResultsA cross-sectional study was conducted at obstetrics and neonatal wards from May to July 2013, involving post-delivery women and their neonates. Rectal swabs were collected and processed to identify the ESBL strains and their antimicrobial susceptibility patterns. Patients’ data were obtained using a standardized data collection tool. We enrolled 113 women and 126 neonates with mean age of 26.5 ± 5.5 years and median gestation age [IQR] of 39 [35–40] weeks respectively. The prevalence of ESBL carriage among women and neonates were 15% (17/113) and 25.4% (32/126) respectively. The acquisition of ESBL isolates among neonates on day 1, day 3 and day 7 were 60.0% (21/35), 25.7% (9/35) and 14.3% (5/35) respectively. There was no phenotypic similarity between ESBL strains from women and their respective neonates, suggesting other sources of transmission. Neonates given antibiotics were more likely to carry ESBL than those not given [100% (32/32) versus 86% (81/94), p = 0.018].ConclusionThe carriage rate of ESBL strains among post-delivery women and neonates at BMC is high. Our findings suggest that neonates acquire these strains from sources other than post-delivery women and more than half acquire them on the first day of life. More studies are recommended to further explore the sources of ESBL strains among neonates.

BackgroundDespite, Cytomegalovirus (CMV) infection being associated with a potential risk to the fetus, there is limited data from Tanzania and many other developing countries regarding the epidemiology and the impact of CMV infections. This cross-sectional study was conducted between December 2014 and June 2015 among pregnant women attending antenatal clinics in the city of Mwanza, Tanzania to investigate the magnitude and associated factors of CMV infection.MethodsThe specific CMV IgM and IgG antibodies were detected using indirect enzyme linked immunosorbent assay (ELISA). Demographic and clinical data were collected using pre-tested data collection tool. Data were analysed using STATA version 13.ResultsA total of 261 pregnant women with median age of 20 (IQR 19–25) years and mean gestation age of 17 ± 7.8 weeks were enrolled. The seroprevalence of CMV IgG antibodies was 193(73.9%; 95% CI 67.2–79.6) while that of CMV IgM antibodies was 0.4%. As the age increased by one unit the IgG seroprevalence was found to increase by 0.3% (95% CI 0.13–0.47, p = 0.001) whereas the risk of being IgG positive increased by 24%. On multivariable logistic regression analysis only urban residence (OR 6.329, 95% CI 2.885–13.887, p < 0.001) was found to independently predict CMV IgG seropositivity. Regarding the outcomes of previous pregnancies the history of miscarriage independently predicted IgG seropositivity (OR 5.6, 95% CI 1.29–24.178, p = 0.021). The IgM seropositive woman had fatal outcome of the term delivery of the baby with microcephaly and spinal-bifida.ConclusionCytomegalovirus seroprevalence among pregnant women residing in urban areas of Mwanza city, Tanzania is high and is associated with poor pregnancy outcomes. There is a need to emphasize routine screening of CMV in order to establish the impact of CMV during pregnancy.

Background: Iatrogenic ureteric injuries are rare complications of abdomino-pelvic surgery but associated with high morbidity and even mortality. There is paucity of data regarding iatrogenic ureteric injuries in Tanzania and Bugando Medical Centre in particular. This study describes our experience in the management and outcome of ureteric injuries following abdomino-pelvic operations outlining the causes, clinical presentation and outcome of management of this condition in our local setting. Methods: This was a retrospective descriptive study of patients with iatrogenic ureteric injuries following abdomino-pelvic operations that were managed in Bugando Medical Centre between July 2004 and June 2014. Results: A total of 164 patients (M: F = 1: 1.6) were studied. Of these, 154 (93.9%) were referred to Bugando Medical Centre having had their initial surgeries performed at other hospitals, whereas 10 (6.1%) patients sustained ureteric injuries during abdomino-pelvic surgery at Bugando Medical Centre. The median age at presentation was 36 years. The most common cause of iatrogenic ureteric injuries was total abdominal hysterectomy occurring in 69.2% of cases. The distal ureter was more frequently injured in 75.6% of cases. Suture ligation was the commonest type of injury accounting for 36.6% of patients. One hundred and sixteen (70.7%) patients had delayed diagnosis but underwent immediate repair. Ureteroneocystostomy was the most frequent reconstructive surgery performed in 58.0% of cases. Of the 164 patients, 152 (92.7%) were treated successfully. Twelve (7.3%) patients died in hospital. The main predictors of deaths were delayed presentation, deranged renal function tests on admission, missed ureteric injuries and surgical site infections (P < 0.001). The overall median length of hospital stay was 12 days. Follow up of patients was generally poor as more than half of patients were lost to follow up. Conclusion: Total abdominal hysterectomy still accounts for most cases of iatrogenic ureteric injuries in our environment. Meticulous surgical technique as well as identification of the course of the ureter and associated anatomic locations where injury is most likely to occur is important to decrease the risk of ureteric injury. Timely recognition of ureteric injury and its management is associated with good outcome.

Background Use of family planning (FP) saves the lives of mothers and children, and contributes to better economic outcomes for households and empowerment for women. In Tanzania, the overall unmet need for FP is high. This study aimed: (1) to use focus group data to construct a theoretical framework to understand the multidimensional factors impacting the decision to use FP in rural Tanzania; (2) to design and pilot-test an educational seminar, informed by this framework, to promote uptake of FP; and (3) to assess acceptability and further refine the educational seminar based on focus group data collected 3 months after the education was provided. Methods We performed a thematic analysis of 10 focus group discussions about social and religious aspects of FP from predominantly Protestant church attenders prior to any intervention, and afterwards from six groups of church leaders who had attended the educational seminar. Results Key interpersonal influences included lack of support from husband/partner, family members, neighbours and church communities. Major intrapersonal factors impeding FP use were lack of medical knowledge and information, misconceptions, and perceived incompatibility of FP and Christian faith. Postseminar, leaders reported renewed intrapersonal perspectives on FP and reported teaching these perspectives to community members. Conclusions Addressing intrapersonal barriers to FP use for leaders led them to subsequently address both intrapersonal and interpersonal barriers in their church communities. This occurred primarily by increasing knowledge and support for FP in men, family members, neighbours and church communities.