IntroductionThere are concerns about the impact of the COVID-19 pandemic on the continuation of essential health services in sub-Saharan Africa. Through the Countdown to 2030 for Women’s, Children’s and Adolescents’ Health country collaborations, analysts from country and global public health institutions and ministries of health assessed the trends in selected services for maternal, newborn and child health, general service utilisation.MethodsMonthly routine health facility data by district for the period 2017–2020 were compiled by 12 country teams and adjusted after extensive quality assessments. Mixed effects linear regressions were used to estimate the size of any change in service utilisation for each month from March to December 2020 and for the whole COVID-19 period in 2020.ResultsThe completeness of reporting of health facilities was high in 2020 (median of 12 countries, 96% national and 91% of districts ≥90%), higher than in the preceding years and extreme outliers were few. The country median reduction in utilisation of nine health services for the whole period March–December 2020 was 3.9% (range: −8.2 to 2.4). The greatest reductions were observed for inpatient admissions (median=−17.0%) and outpatient admissions (median=−7.1%), while antenatal, delivery care and immunisation services generally had smaller reductions (median from −2% to −6%). Eastern African countries had greater reductions than those in West Africa, and rural districts were slightly more affected than urban districts. The greatest drop in services was observed for March–June 2020 for general services, when the response was strongest as measured by a stringency index.ConclusionThe district health facility reports provide a solid basis for trend assessment after extensive data quality assessment and adjustment. Even the modest negative impact on service utilisation observed in most countries will require major efforts, supported by the international partners, to maintain progress towards the SDG health targets by 2030.

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Background Despite extensive efforts to scale up counseling and testing services and care and treatment clinics (CTCs) in Tanzania, linkage between points of diagnosis and CTCs remains low. Studies have looked at barriers such as lack of trained health providers, poor referral system, economic costs or distance to health facilities, but fewer assessed the association between caregivers’ vulnerability such as disability and linkage of orphans and vulnerable children (OVCs) in their care to health facilities. This study describes the magnitude of caregivers’ disability and assesses its relationship with successful linkage to care of their OVC living with HIV/AIDS in Tanzania. Methods Data for this analysis came from the USAID Kizazi Kipya project in 79 councils of Tanzania. Data on HIV risk, service use and ART adherence among OVC aged 0–19 years were collected during the project’s quarterly routine data collection (Oct 2017-Sep 2018). Characteristics of caregivers were collected during the project beneficiary screening and enrollment process. Generalized estimating equation models were used to analyze the factors that are associated with linkage of 14,538 HIV positive OVC to CTC, who were taken care of by 11,834 caregivers. Results The majority of caregivers (70%) were females, had completed primary education (67%), 54% were married or cohabiting. Of all the OVC, 3% were living with disabled caregivers; of whom 89% were physically disabled while 11% were mentally disabled. OVCs living with disabled caregivers were less likely to be linked to care (OR 0.76, 95% CI 0.58, 0.99). Factors positively associated with OVC linkage to care were high caregivers’ education level (OR 1.99, 95% CI 1.51, 2.63) and OVC living with a HIV positive caregivers (OR 1.25, 95% CI 1.12, 1.41). OVC living in household with high socio-economic status were less likely to be linked to care (OR 0.76, 95% CI 0.67, 0.86) than those in low-SES households. Conclusion These results suggest HIV positive OVC living with disabled caregivers had poor linkage to care. The findings highlighted the need to focus attention to the disabilities-led household to promote inclusion and improve access to the HIV services.

Background Intermittent preventive treatment during pregnancy (IPTp) is a highly-recommended intervention to prevent maternal and neonatal complications associated with malaria infection. Despite fairly high antenatal care (ANC) coverage in Tanzania, low IPTp uptake rates represent a gap in efforts to decrease complications attributed to malaria in pregnancy. The objective of this study was to examine if availability, readiness and managing authority are associated with uptake of IPTp during ANC. Methods Data for this analysis come from a cross-sectional survey, the Tanzania Service Provision Assessment conducted between 2014 and 2015. Principal component analysis was used to create scores for availability of malaria services and readiness for the provision of services. Generalized estimating equation models with logit link and the binomial distribution assessed factors that impact the uptake of IPTp by pregnant women attending ANC. Results Higher fraction of women in their third trimester than second (68% versus 49%, OR = 2.6; 95% CI (2.1–3.3)), had received at least one dose of IPTp. There was a wide variation in the availability and readiness of malaria services provision and diagnostic tools by managing authorities. Public facilities were more likely than private to offer malaria rapid diagnostic test, and more providers at public facilities than private diagnosed and/or treated malaria. Women who attended facilities where direct observation therapy was practiced were more likely to have received at least one dose of IPTp (64% versus 46% who received none; p < 0.001). Women who attended ANC at a facility with a high readiness score were more likely to take IPTp than those attending facilities with low readiness scores (OR = 2.1; 95% CI (1.4–3.3)). Reported stock out on the day of interview was negatively associated with IPTp uptake (OR 0.09; 95% CI 0.07–0.1). Conclusion Readiness of health facilities to provide malaria related services, the number of ANC visits and gestational age were associated with uptake of IPTp among women attending ANC. There are disparities in malaria service availability and readiness across geographical location and managing authorities. These findings could be used to assist the malaria programme and policymakers to appropriately decide when planning for malaria service deliveries and interventions. Electronic supplementary material The online version of this article (10.1186/s12936-019-2862-3) contains supplementary material, which is available to authorized users.

Background. The Tanzanian national guideline for pediatric HIV disclosure recommends beginning disclosure as early as age 4–6 years; full disclosure is recommended at the age of 8–10 years. Despite clear procedures, the disclosure rate in Tanzania remains relatively low. This study assessed the factors associated with HIV status disclosure to orphans and vulnerable children living with HIV (OVCLHIV). Methods. Data for this analysis come from the USAID-funded Kizazi Kipya program in Tanzania that provides health and social services to OVC and caregivers of HIV-affected households. Data were collected between January 2018 and March 2019. Disclosure status was self-reported by caregivers of children aged 8 years or above. Beneficiary characteristics were included as independent variables. Generalized estimating equations took into account the clustering effect of the study design. Results. Of the 10673 OVCLHIV, most were females (52.43%), and 80.67% were enrolled in school. More than half (54.89%) were from households in rural areas. Caregivers were mostly females (70.66%), three quarters were between 31 and 60 years old and had a complete primary education (67.15%), and 57.75% were HIV-infected. Most of the OVCLHIV (87.31%) had a disclosed HIV status. Greater OVCLHIV age p < 0.001 , school enrollment (OR = 1.22; 95% CI 1.06, 1.41), urban location of household (OR = 1.64; 95% CI 1.44, 1.86), caregivers’ higher education level p < 0.001 , and caregiver HIV-positive status (OR = 1.25; 95% CI 1.09, 1.43) were positively associated with disclosure status. OVCLHIV of female caregivers were 27% less likely to have been disclosed than those of male caregivers. Conclusion. The disclosure rate among OVCLHIV in this study was high. Disclosure of HIV status is crucial and beneficial for OVCLHIV continuum of care. Caregivers should be supported for the disclosure process through community-based programs and involvement of health volunteers. Policymakers should take into consideration the characteristics of children, their caregivers, and location of households in making disclosure guidelines as adaptable as possible.

Background Trained community workers (CWs) successfully deliver health and social services, especially due to greater community acceptance. Orphans and vulnerable children (OVC) and their caregivers (CG) often need support from several sectors. We identified CW, program and referral characteristics that were associated with success of referrals provided to OVC and their CG in Tanzania in a cross-sectoral bi-directional referral system. Methods Data for this secondary analysis come from the first two years (2017-2018) of the USAID funded Kizazi Kipya project. Referral success was defined as feedback and service received within 90 days post-referral provision. We analyzed factors that are associated with the referral success of HIV related, education, nutrition, parenting, household economic strengthening, and child protection services among OVC and CG, using generalized estimating equations. Results During the study period, 19,502 CWs in 68 councils provided 146,996 referrals to 132,640 beneficiaries. OVC had much lower referral success for HIV related services (48.1%) than CG (81.2%). Adjusted for other covariates, CW age (26-49 versus 18-25 years, for OVC aOR = 0.83, 95%CI (0.78, 0.87) and CW gender (males versus females, for OVC aOR = 1.12, 95%CI (1.08, 1.16); CG aOR = 0.84, 95%CI (0.78, 0.90)) were associated with referral success. CWs who had worked > 1 year in the project (aOR = 1.52, 95%CI 1.46, 1.58) and those with previous work experience as CW (aOR = 1.57, 95%CI (1.42, 1.74) more successfully referred OVC. Referrals provided to OVC for all other services were more successful compared to HIV referrals, with aORs ranging from 2.99 to 7.22. Longer project duration in the district council was associated with increased referral success for OVC (aOR = 1.16 per

About 2 billion people worldwide suffer moderate or severe forms of food insecurity, calling for correctional measures involving economic strengthening interventions. This study assessed the impact of household economic strengthening (HES) intervention on food security among caregivers of orphans and vulnerable children (OVC) in Tanzania. The study was longitudinal in design, based on OVC caregivers’ baseline (2017–2018) and midline (2019) data from the USAID Kizazi Kipya project. Food security, the outcome, was measured using the Household Hunger Scale (HHS) in three categories: little to no hunger (food secure), moderate hunger, and severe hunger. Membership in the USAID Kizazi Kipya-supported economic strengthening intervention (i.e. WORTH Yetu) was the main independent variable. Data analysis involved generalized estimating equation (GEE) for multivariate analysis. With mean age of 50.3 years at baseline, the study analyzed 132,583 caregivers, 72.2% of whom were female. At midline, 7.6% of all caregivers enrolled at baseline were members in WORTH Yetu. Membership in WORTH Yetu was significantly effective in reducing household hunger among the caregivers: severe hunger dropped from 9.4% at baseline to 4.1% at midline; moderate hunger dropped from 65.9% at baseline to 62.8% at midline; and food security (i.e., little to no hunger households) increased from 25.2% at baseline to 33.1% at midline. In the multivariate analysis, membership in WORTH Yetu reduced the likelihood of severe hunger by 47% (OR = 0.53, 95% CI 0.48–0.59), and moderate hunger by 21% (OR = 0.79, 95% CI 0.76–0.83), but increased the likelihood of food security by 45% (OR = 1.45, 95% CI 1.39–1.51). The USAID Kizazi Kipya’s model of household economic strengthening for OVC caregivers was effective in improving food security and reducing household hunger in Tanzania. This underscores the need to expand WORTH Yetu coverage. Meanwhile, these results indicate a potential of applying the intervention in similar settings to address household hunger.

BackgroundDespite extensive efforts to scale up counseling and testing services and care and treatment clinics (CTCs) in Tanzania, linkage between points of diagnosis and CTCs needs to be improved for children. Studies have looked at barriers such as lack of trained health providers, poor referral system, economic costs or distance to health facilities, but fewer assessed the association between caregivers’ vulnerability such as disability and linkage of orphans and vulnerable children (OVCs) in their care to health facilities. This study describes the magnitude of caregivers’ disability and assesses its relationship with successful linkage to care of their OVC living with HIV/AIDS in Tanzania.Methods Data for this analysis come from the USAID Kizazi Kipya project in 79 councils of Tanzania. Data on HIV risk, service use and ART adherence among OVC aged 0-19 years were collected during the project’s quarterly routine data collection (Oct 2017-Sep 2018). Characteristics of caregivers were collected during the project beneficiary screening and enrollment process. Generalized estimating equation models were used to analyze the factors that are associated with linkage of 14,538 HIV positive OVC to CTC, who were taken care of by 11,834 caregivers. ResultsThe majority of caregivers (70%) were females, had completed primary education (67%), 54% were married or cohabiting. Of all the OVC, 3% were living with disabled caregivers; of whom 89% were physically disabled while the rest were mentally disabled. OVCs living with disabled caregivers were less likely to be linked to care (OR 0.76, 95% CI 0.58, 0.99). Factors positively associated with OVC linkage to care were high caregivers education level (OR 1.99, 95% CI 1.51, 2.63) and OVC living with a HIV positive caregivers (OR 1.25, 95% CI 1.12, 1.41). OVC living in household with high socio-economic status were less likely to be linked to care (OR 0.76, 95% CI 0.67, 0.86) than those in low-SES households.ConclusionThese results suggest HIV positive OVC living with disabled caregivers had poor linkage to care. The findings highlight the need to focus attention to the disabilities-led household to promote inclusion and improve access to the HIV services.