The Third National Non-Communicable Diseases Scientific Conference 2021: Multisectoral Engagement and Collaboration in addressing Non-communicable Diseases – AICC Arusha – Tanzania.
Africa Academy for Public Health (AAPH) is a Tanzanian nonprofit, non-governmental organization established in 2009 with a focus in advancing public health priorities of sub-Saharan Africa through innovative scientific evidence generation, training and capacity building, as well as knowledge translation. In collaboration with different partners including Muhibili University of Health and Allied Sciences (MUHAS) and Harvard University, AAPH supports the government of Tanzania in advancing efforts around some of key unfinished health agenda issues that include improving population health.
AAPH was duly invited to attend and participate in the 3rd National Non-Communicable Diseases (NCD) Scientific Conference 2021. This was prepared by the Ministry of Health, Community Development, Gender, Elderly and Children through Tanzania Non-Communicable Diseases (NCDs) Prevention and Control Programme in Collaboration with MUHAS. The conference took place at the Arusha International Conference Center (AICC), Arusha - Tanzania from November 11th to November 12th 2021.
From AAPH, Dr. Isaac Lyatuu and Amani Tinkasimile were in attendance physically while Dr. Alfa Muhihi and Dr. Mashavu Yussuf attended virtually. At the conference AAPH presented on the following topics:
- Leading causes of mortality in resource extraction areas in Tanzania by Dr. Lyatuu.
- Prevalence and factors associated with under and over nutrition among in-school adolescents in urban Tanzania by Dr. Yussuf.
- Adolescent-Nutrition-and-Health: Formative Assessment of the School-Health Environment and Programs in Ethiopia, Sudan, and Tanzania by Mr. Tinkasimile.
- Evaluation of training program to community health workers and its implications for community level screening for cardiovascular disease risk factors in Tanzania by Dr. Alfa Muhihi.
- Predicted 10-year risk of developing cardiovascular disease: a sub-group analysis of adults aged 40–64 years in rural Morogoro, Tanzania by Dr. Alfa Muhihi.
AAPH was recognized for participation and Dr. Lyatuu won the Best Oral Presentation Award. AAPH is ever committed to implementing evidence-based research, training in research, capacity building and support translation of evidence for public health policy and practice. This was an avenue to share some of our works and indeed expand our network for collaborative efforts in NCDs prevention.
Leading causes of mortality in resource extraction areas in Tanzania
Isaac Lyatuu1,2,3, Mirko S. Winkler2,3, Georg Loss2,3, Andrea Farnham2,3, Dominik Dietler2 and Günther Fink2,3
Background: Resource extraction activities have been identified as hazardous with substantially increased risk of adverse health outcomes for miners and surrounding communities. Studies have linked these activities with increased levels of non-communicable diseases, adverse pregnancy outcomes, and injuries. Chronic exposures to toxic substances, poor air quality and noise pollution have been highlighted as key mechanisms underlying adverse health effects.
Objectives: To identify causes of mortality among people who live in close proximity to industrial mining.
Methodology: A mortality surveillance system was set up around two largest gold mines in Tanzania between February 2019 and February 2020. Death circumstances were collected using a standardized verbal autopsy tool. Causes of death were assigned using computational methods and we established leading causes of death by gender and age groups. We compared cause-specific mortality fractions in mining communities with subnational data and national estimates. Within mining communities, we estimated mortality risks of mining workers relative to other not working at mines.
Results: Mining communities had higher road-traffic injuries (RTIs) [RD 3.1%, CI 0.4%, 5.9%] and non-HIV infectious disease mortality [RD 5.6%, CI 0.8%, 10.3%], but lower burden of HIV mortality [RD -5.9%, CI -10.2%, -1.6%]. Relative to non-miners, mining workers had over twice the mortality risk [RR 2.09, CI 1.57, 2.79] with particularly large increases for death due to RTIs (RR 14.26, CI 4.95, 41.10) and non-RTIs (RR 10.10, CI 3.40, 30.02)
Conclusion: Presence of mining activities contributes to rapid population growth, urbanization and overall improvement in socio-economic status. This further contributes to increase access and affordability of motorcycles and other vehicles leading to increased risk of road traffic injuries. This calls for specific interventions such as community road safety programs which incorporates local communities on safety concerns particularly for commonly shared resources.
Prevalence and factors associated with under and over nutrition among in-school adolescents in urban Tanzania
Mashavu H. Yussuf 1*, Dominic Mosha, Amani Tinkasimile 1, Mary Mwanyika-Sando 1, Frank Mapendo 1, Wafaie Fawzi 2,3,4, Tara Young 2, Isaac Lyatuu 1, David Sando 1
Background: Malnutrition is a public health concern globally. The burden is higher in Asian and Sub-Saharan African countries including Tanzania. The 2015/16 TDHS concluded; 30% under-fives are stunted, 14% are underweight and 4% overweight. Malnutrition impairs growth, child’s brain development and increases risk of non-communicable diseases in adulthood. Adequate nutrition during adolescence creates a second opportunity for growth especially for children who experienced nutritional deficits during their early life. There is scarce understanding of malnutrition among adolescents in Tanzania.
Objectives: To investigate prevalence and determine the factors associated with stunting, underweight and overweight among in-school adolescents aged 10-14 years in urban Tanzania.
Methodology: This was a cross-sectional study that analyzed data of 1,219 in-school adolescents aged 10 – 14 years in Dar-es-Salaam, Tanzania. Logistic regression determined factors associated with stunting, underweight and overweight. Analyses accounted for school-level clustering and associations were statistically significant at p-value < 0.05.
Results: 11.6% of adolescents were stunted, 7.8% were underweight, 8.7% were overweight and 4.3% obese. Age, gender and wealth quintiles were significant factors for stunting. Age, gender and number of siblings in the household were significant factors for underweight. Gender, mother’s occupation and wealth quintiles were significant factors for overweight. Females were less likely to be stunted [AOR 0.68; 95%CI 0.47 – 0.98], less likely to be underweight [AOR 0.64; 95%CI 0.43 – 0.95] but more likely to be overweight compared to males [AOR 1.66; 95%CI 1.10 – 2.51].
Conclusion: Tanzania is facing double burden of under and overnutrition. Significant drivers to the double burden of malnutrition include age, gender, socio-economic status and number of siblings in the household. Health policies and interventions are urgently needed to curb this double burden of malnutrition and prevent subsequent onset of diseases in adulthood.
Key words: Nutrition, adolescents, stunting, underweight, overweight, Tanzania
Abbreviations: LMIC, Low- and middle-income countries; SDG, Sustainable Development Goals; TDHS, Tanzania demographic and health survey.
Adolescent-Nutrition-and-Health: Formative Assessment of the School-Health Environment and Programs in Ethiopia, Sudan, and Tanzania
Tinkasimile A. K, Mwanyika Sando M., Killewo J., Mosha D., Waibe M., Lyatuu I., Mbuyita S., Yussuf M., Mapendo F., Fawzi W.
Background: 90% of adolescents live in low-and-middle-income countries. They are affected by injuries, malnutrition, and diseases. Early adolescence (10-14 years) is a critical phase for research and intervention. Intervening through schools where the majority of these adolescents are found, provides an effective strategy for improving health. There is limited summative evidence linking policies and school-environments to related nutrition and health outcomes. This formative assessment sought to understand the policy surrounding school-health-environments, individual adolescent-health and population-level risk factors relevant to the design, delivery and scale-up of nutrition and health interventions through schools.
Objectives: We aimed to assess the school-health and food-environment in Ethiopia, Sudan, and Tanzania on three levels: Policy environment and existing interventions; the school food-environment; and the nutritional and health state for in-school adolescents ages 10-14.
Methodology: Multi-stage cluster random sampling was used to select participating schools and students. Mixed-methods were used to assess adolescent nutrition, health and school-food-environments among 3558 adolescent boys and girls and 52 teachers. National and subnational policies on adolescent-health in relation to school-health programs desk reviews and key informant interviews were conducted.
Results: Although national guidelines are in place, only 54%, 14% and 9% of the local authorities in Ethiopia, Tanzania and Sudan had adolescent-specific health-related policy, respectively. None of the schools provided deworming services in Ethiopia as compared to 43% in Tanzania. School feeding was provided in 90%, 24% and 18%; and drinking water in 70%, 71% and 36% of schools in Ethiopia, Tanzania and Sudan respectively. Although adolescents demonstrated understanding of healthy behavior and nutrition, their practice was limited to their socio-economic status and decision-making involvement.
Conclusion and recommendation: Efforts to improve in-school adolescent-health have been made with much work yet to be done. Improving school age adolescent-health and nutrition surpasses school environment and policy. It requires interventions through curricula and community engagement, with results frameworks to gage progress.
Evaluation of training program to community health workers and its implications for community level screening for cardiovascular disease risk factors in Tanzania
Alfa Muhihi1,2,3, Rose N.M. Mpembeni1, Amani Anaeli1, Bruno F. Sunguya1, Germana Leyna1,4, Anna Tengia Kessy1, Deodatus Kakoko1, Marina Njelekela1,5, David Urassa1
Background
Interventions conducted by community health workers (CHWs) have led to improvement in maternal and child health in developing countries. If trained, CHWs can also provide health education to improve public knowledge of risk for cardiovascular diseases (CVDs) and other non-communicable diseases (NCDs).
Objective
To evaluated knowledge gained by CHWs following a 5-days CVD-specific training conducted as part of a cluster-randomized trial of CHWs interventions for the reduction of blood pressure and other CVD risk factors in rural Morogoro.
Methods
We used a written content knowledge test to assess the knowledge of CHWs on risk factors, warning signs for CVD events, action to be taken in case of CVD event, and unhealthy dietary habits. Pre-and post-training comparison of means and proportions was done using paired sample t-test and Fisher’s exact test, respectively.
Results
The mean age (SD) of CHWs was 37.1 (8.0) years and the majority (72.2%) were males. More than half (55.6%) of CHWs scored below the passing mark during the pre-training assessment, and all (100%) scored above the passing mark during the post-training assessment. The mean (SD) test score increased from 70.3 (14.1) during pre-training to 87.7 (5.9) at post-training assessment (p<0.001). The mean knowledge scores for risk factors, warning signs, and healthy dietary habits also improved following the training (all p<0.001). The overall mean (SD) knowledge score increased from 21.1 (5.5) to 30.4 (1.3). Similarly, the proportion of CHWs with good knowledge about CVD risk factors and warning signs for CVD events increased from 44.4% to 100% and from 16.7% to 100.0% respectively (all p<0.001).
Conclusions
Short and focused training to CHWs enhanced their CVD content knowledge and skills. Trained CHWs have the potential to play a preventive role by providing health education and screening for early detection of CVD risk factors using simple non-invasive screening tool. With the increasing burden of CVDs even in rural settings, CHWs provide a culturally acceptable means to combat the rising burden of CVD risk factors through health education and healthy lifestyle promotion interventions. Further assessment should be conducted on CHWs to understand how long the knowledge gained during the training can be retained.
Predicted 10-year risk of developing cardiovascular disease: a sub-group analysis of adults aged 40–64 years in rural Morogoro, Tanzania
Alfa Muhihi1,2,3, Rose N.M. Mpembeni1, Amani Anaeli1, Bruno F. Sunguya1, Germana Leyna1,4, Anna Tengia Kessy1, Deodatus Kakoko1, Marina Njelekela1,5, David Urassa1
Background
Cardiovascular diseases (CVDs) are the leading cause of death globally, and significant contributor to poor quality of life. Countries in sub-Saharan Africa (SSA) carry a higher burden of CVDs. In Tanzania, CVD risk factors have been well characterized. However, data on the future risk of succumbing to CVD is scarce.
Objective
To examined the 10-year risk of developing CVD among middle-aged adults in rural Morogoro.
Methods
We analyzed baseline data from a sub-group of participants aged 40-64 years from a cluster-randomized trial of community health workers (CHWs) interventions for reduction of blood pressure. Socio-demographic and lifestyle-related factors were assessed using a questionnaire. Blood pressure, height, and weight were measured at home following standard protocols. The Globorisk prediction charts specific for Tanzania were used to estimate the participant’s 10-year risk of developing CVD. Associations were assessed using the chi-square test and statistical significance was considered based on a two-sided p-value of ≤0.05.
Findings
A total of 1,441 participants were included in this analysis. The median age [interquartile range] of participants was 49 [44-56] years. Majority were females (70.9%), married (69.4), farmers (94.4%), and had a primary level of education (96.0%). The proportion of alcohol drinkers was 26.2% and that of smokers was 8.2%. At least four out of ten participants (43.2%) were hypertensive, and the prevalence of overweight/obesity was 46.1%. The proportion of participants with low (<10%), moderate (10-19%), and high risk (≥20%) of developing CVD in the next 10 years was 93.6%, 5.8%, and 0.6% respectively. The use of raw table salt was positively associated with a 10-year risk of developing CVD.
Conclusions and recommendations
The risk of developing CVD in this rural population of middle-aged adults is low. The observed low risk is good news, the challenge however, is maintaining this low risk while providing targeted interventions to those at moderate and high risk to cut down their risk of succumbing to CVD. Health education on risk factors and healthy lifestyle promotion interventions are recommended in order to maintain the observed low risk of developing CVD in the future. Such interventions can be delivered through both facility-based and community-based programs.