Undernutrition and food insecurity are critical problems among under-five children in many developing countries. This study was carried out for eight months between 2009 and 2011. It combined quantitative data (N=156) and qualitative data to explore nutritional status among under-five children in Jibondo and Chole villages within Mafia Island Marine Park in Tanzania. Weight-for-age analysis was performed according to World Health Organization standards to determine the proportion of underweight children among the samples. The prevalence of underweight children was high in both villages, and in Jibondo village it was even higher (69%) than in Chole village (40%). Interviewees attributed the exceptionally high underweight problems in Jibondo to a substantial reduction in breast-feeding frequency. This was because mothers resumed seaweed farming and octopus fishing soon after delivery. Consequently, infants were fed poor-quality nutritional substitute foods at a tender age. Decreased family income, food insecurity, changes in gender roles and increased responsibilities for women were also perceived to be key underlying problems contributing to higher levels of undernutrition among children in the study areas. If healthy generations and sustainable social-ecological systems are to be achieved within the Park in the future, policies that review fishing restrictions, improve fish trading, increase household food security and liberate mother's time for breastfeeding and child-caring activities would be essential to address the current undernutrition among the under-fives.
The Partnership for HIV-Free Survival initiative in Tanzania integrated postnatal nutrition and mother-to-child transmission (MTCT) cascades to reduce vertical HIV transmission. Quality improvement (QI) was implemented in 30 health facilities. Net positive gain resulted in overall improvement in all indicators (above 80%) by the end of the reporting period. Retention in postnatal care (mean = 49.8, standard deviation [SD] = 27.6) and in monthly HIV services (mean = 65.4, SD = 29.5) had the lowest average but showed consecutive and significant (P ≤ .001) gains except for significant decreases in 1 of 6 periods assessed. Average antiretroviral therapy uptake among women (mean = 81.7, SD = 29.5) was highest, with an initial positive gain of 78.9% (P ≤ .001). DNA/polymerase chain reaction for HIV-exposed infants (mean = 71.8, SD = 20.9) and nutrition counseling (mean = 71.2, SD = 26.3) showed similar average performance, with the latter being the only indicator with significant equal periods of gain and decreases. The collaborative QI approach improved process indicators for reducing MTCT in resource-constrained health systems.
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