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BackgroundExclusive breastfeeding (EBF) is a simple and cost-effective intervention to improve child health and survival. Effective EBF has been estimated to avert 13% - 15% of under-five mortality and contribute to reduce mother to child transmission of HIV. The prevalence of EBF for infant less than six months is low in most developing countries, including Tanzania (50%). While the Tanzania Demographic Health Survey collects information on overall EBF prevalence, it does not evaluate factors influencing EBF. The aim of this paper was to determine the prevalence and predictors of exclusive breastfeeding in urban and rural areas in Kilimanjaro region.MethodsA population-based cross-sectional study was conducted between June 2010 to March 2011 among women with infants aged 6–12 months in Kilimanjaro. Multi-stage proportionate to size sampling was used to select participants from all the seven districts of the region. A standardized questionnaire was used to collect socio-demographic, reproductive, alcohol intake, breastfeeding patterns and nutritional data during the interviews. Estimation on EBF was based on recall since birth. Multivariable logistic regression was used to obtain independent predictors of EBF.ResultsA total of 624 women participated, 77% (483) from rural areas. The prevalence of EBF up to six months in Kilimanjaro region was 20.7%, without significant differences in the prevalence of EBF up to six months between urban (22.7%) and rural areas (20.1%); (OR = 0.7, 95% CI 0.5,1.4).In multivariable analysis, advice on breastfeeding after delivery (Adjusted odds ratio, AOR = 2.6, 95% CI 1.5, 4.6) was positively associated with EBF up to six months. Compared to married/cohabiting and those who do not take alcohol, single mothers (AOR = 0.4, 95% CI 0.2, 0.9) and mothers who drank alcohol (AOR = 0.4, 95% CI 0.3, 0.7) had less odds to practice EBF up to six months.ConclusionPrevalence of EBF up to six months is still low in Kilimanjaro, lower than the national coverage of 50%. Strengthening of EBF counseling in all reproductive and child health clinics especially during antenatal and postnatal periods may help to improve EBF rates.

Current follow-up practices are inadequate. Significant investment in surgical interventions may not lead to improved visual rehabilitation or quality of life, if investments in follow-up are not increased. Linking individual children, their families, and the hospital needs to be approached systematically, if follow-up is to be improved. Improved hospital-based counseling should focus on families who bring their child late for surgery and with girls.

Objectives Obstetric fistula is a maternal injury that causes uncontrollable leaking of urine or stool, and most women who develop it live in poverty in low-income countries. Obstetric fistula is associated with high rates of stigma and psychological morbidity, but there is uncertainty about the impact of surgical treatment on psychological outcomes. The objective of this exploratory study was to examine changes in psychological symptoms following surgical fistula repair, discharge and reintegration home. Methods Women admitted for surgical repair of obstetric fistula were recruited from a Tanzanian hospital serving a rural catchment area. Psychological symptoms and social functioning were assessed prior to surgery. Approximately 3 months after discharge, a data collector visited the patients' homes to repeat psychosocial measures and assess self-reported incontinence. Baseline to follow-up differences were measured with paired t tests controlling for multiple comparisons. Associations between psychological outcomes and leaking were assessed with t tests and Pearson correlations. Results Participants (N = 28) had been living with fistula for an average of 11 years. Baseline psychological distress was high, and decreased significantly at follow-up. Participants who self-reported continued incontinence at follow-up endorsed significantly higher PTSD and depression symptoms than those who reported being cured, and severity of leaking was associated with psychological distress. Conclusions Fistula patients experience improvements in mental health at 3 months after discharge, but these improvements are curtailed when women experience residual leaking. Given the rate of stress incontinence following surgery, it is important to prepare fistula patients for the possibility of incomplete cure and help them develop appropriate coping strategies.

BackgroundInsufficient physical activity (PA) is a major contributing factor in the growing problem of non-communicable diseases (NCDs) in urban and rural Sub-Saharan Africa. This study aimed to determine PA and associated factors among adults in Northern Tanzania.MethodsWe analyzed secondary data from a cross-sectional serological survey nested within the Magu health and demographic sentinel surveillance population in Magu District Northwestern Tanzania. All resident adults aged 15 years and older were invited to participate in the study, and physical activity data were analyzed for 5663 participants. Data were analyzed using Stata version 13.0. We used logistic regression to obtain odds ratios and 95% confidence intervals (CI) for risk factors associated with differences in PA.ResultsIn this mainly rural population, 96% reported sufficient PA, with a higher proportion in males (97.3%) compared to females (94.8%). In males the odds of sufficient PA were lower in rural areas compared to urban areas (OR = 0.19; P < 0.001; 95% CI = 0.08–0.42), while in females the odds of sufficient PA were higher in rural areas compared to urban areas (OR = 2.27; P < 0.001; 95%CI = 1.59–3.24). Leisure-related activity was low compared to work-related and transport-related activity. Farmers had a higher odds of sufficient PA than those in professional jobs in both males (OR = 9.75; P < 0.001; 95% CI = 3.68–5.82) and females (OR = 2.83; P = 0.021; 95% CI = 1.17–6.86).ConclusionThe prevalence of PA in this population was high. However, there is need for PA programs to maintain the high level of compliance during and following the transition to a more urban-based culture.