Browsing by Author "Petrucka, Pammla"

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Colorectal Cancer Epidemiology in Tanzania: Patterns in Relation to Dietary and Lifestyle Factors
(American Society of Clinical Oncology, 2018-09-28) Katalambula, Leonard; Petrucka, Pammla; Buza, Joram; Ngoma, Twalib
Background: Chronic noncommunicable diseases are increasingly captured as contributing to morbidity and mortality in low and middle income countries. Aim: This study aimed to investigate the epidemiology of colorectal cancer and the potential modifiable local risk factors in Tanzania. Methods: A cross sectional retrospective chart audit study was conducted to establish the pattern and distribution of colorectal cancer, The Food Frequency Questionnaire and the Step® survey tool were used to collect data. Descriptive statistics, χ2 tests, and regression analysis were used and augmented by data visualization to display risk variable differences. Results: Tanzania's colorectal cancer incidence has increased six times in the last decade in which major towns and cities of Dar es Salaam (20.2 per 100,000), Pwani (7.2 per 100,000), Kilimanjaro (4.4 per 100,000), Arusha (4.2 per 100,000), and Morogoro (3.6 per 100,000) had the highest percentage. This study reported that, almost 45% of the participants were hypertensive. Two major dietary patterns, namely “healthy” and “western”, existed among the study sample. Obesity was found in 25% of participants, whereas overweight was present in 28%; of note, the prevalence was higher in females (26.9%) than in males (23.6%) respectively. The prevalence of alcohol consumption was 21.5%, with a significantly lower rate of smoking (12.2%) noted within the study subjects. Both alcohol consumption and tobacco smoking were more common in men than women (22.7 vs. 20.6% and 24.5 vs. 3.2%, respectively). The prevalence of vigorous, moderate, and low physical activity for both sexes was 18.6%, 54.1% and 42.3%, respectively. Conclusion: Evidence from this study demonstrate that, like other NCDs CRC is increasing in Tanzania. Colon cancer is increasing at higher rate than rectal cancer seeming to align with change in lifestyle. Major towns and cities had the highest share of CRC patients. Diet, obesity, tobacco smoking, alcohol consumption, and sedentary behavior have potential role to play in the rising trend of CRC and other NCDs. We recommend a large longitudinal study with robust methodology which can establish cause and effect relationships between specific lifestyle behaviors and the incidence of colorectal cancer.
Determination of Vitamins A, C and D Status Using Serum Markers and a 24-Hour Dietary Recall among Maasai Women of Reproductive Age
(Open Access Library Journal, 2014-11) Martin, Haikael; Petrucka, Pammla; Buza, Joram
We previously reported that the prevalence of oral thrush among Maasai women of reproductive age in Ngorongoro Conservation Area was abnormally high (32%) in the absence of immune-com- promising diseases such as HIV. This study was undertaken to test the hypothesis that Maasai women of reproductive age are prone to oral thrush because they are deficient in micronutrients such as Vitamins A, C, D, and B12, as well as iron and folate which are known to have immune modulating functions. Method: The study recruited 210 participants out of which 180 agreed to donate blood for serum separation and analyses. A total of 107 participants (including 28 with oral thrush and 79 without oral thrush) were assessed for dietary intake of iron, folate, Vitamins A, C, and B12 using a 24 hours dietary recall method. Further, 40 serum samples randomly selected from the 180 serum samples were tested for concentrations of Vitamins A and C using commercially available HPLC kit while the concentration of Vitamin D was tested using the commercially available 25-OH Vitamin D ELISA Assay kit. Statistical analysis was performed using IBM SPSS Statistics 20™, where descriptive and inferential statistics were applied to demographic, socioeconomic and biochemical variables. Student’s t-test was used to test for significant differences among variables at 95% confidence level. The proportion of women with deficiency was calculated for single and multiple micronutrients. Results: Results from the 24-hour dietary recall method revealed that with the exception of folate (p = 0.000), there were no significant differences in iron, Vitamins A, C, and B12 intake between participants with and without oral thrush. Of note, the in- take of these four micronutrients was below the Recommended Nutrient Intake (RNI). A similar trend was observed for serum vitamin concentrations as established by HPLC and ELISA testing. While there was no significant difference in serum concentration of Vitamins A, C, and D between participants with and without oral thrush (p > 0.05), the serum levels were all below normal signifying deficiency of micronutrients in the sample. Conclusion: Overall, this study revealed micronutrient deficiency in the women of reproductive age in the Ngorongoro Conservation Area, which may contribute to the previously reported high levels of oral thrush. Recommendations: Nutrition education directed to this community on the importance of eating micronutrient rich foods such as fruits and vegetables is highly recommended.
Dietary pattern and other lifestyle factors as potential contributors to hypertension prevalence in Arusha City, Tanzania: a population-based descriptive study
(BMC Public Health, 2017) Katalambula, Leonard; Meyer, Danielle; Ngoma, Twalib; Buza, Joram; Mpolya, Emmanuel; Mtumwa, Abdallah; Petrucka, Pammla
Background: High blood pressure is increasing worldwide, disproportionately so in developing countries. Inadequate health care systems and adoption of unhealthy lifestyles have been linked to this emergent pattern. To better understand this trend, it is imperative we measure prevalence of hypertension, and examine specific risk factors, at a local level. This study provides a cross-sectional view of urban residents of Arusha City to determine prevalence and associated risk factors. Methods: Blood pressure was measured using a digital sphygmomanometer. Interviews were conducted using the WHO STEPwise survey questionnaire to assess lifestyle factors. Dietary intake information was collected by a standardized Food Frequency Questionnaire (FFQ). Descriptive statistics were used to analyze demographic characteristics. Means and standard deviations were calculated for continuous variables and percentages for categorical variables. Pearson’s Chi Square (χ2) tests were used to determine significant risk factors for hypertension, and multivariate log binomial regression was used to reveal potential predictors of hypertension. Dietary patterns were analyzed by principal component analysis. Results: Approximately 45% of the study population was found to be hypertensive. The mean arterial blood pressure (MABP) of the sample was 102.3 mmHg (SD = 18.3). Mean systolic and diastolic blood pressure were 136.3 (SD = 30.5) and 85.3 (SD = 16.1) mmHg, respectively. Through multivariate analysis, age and body mass index were found to be independently, positively, associated with hypertension. Adherence to ‘healthy’ dietary pattern was negatively independently associated with hypertension. Conclusions: With nearly half of participants being hypertensive, this study suggests that hypertension is a significant health risk in Arusha, Tanzania. Obesity, healthy diet, and age were found to be positively associated with hypertension risk. This study did not establish any significant association between increased blood pressure and Western-dietary pattern, cigarette smoking, alcohol intake, and physical activities.
Dietary pattern as a predictor of colorectal cancer among general health population in Arusha Tanzania: A population based descriptive study
(International Journal of Nutrition and Metabolism, 2017-03) Katalambula, Leonard; Ntwenya, Julius; Ngoma, Twalib; Buza, Joram; Mpolya, Emmanuel; Paul, Edwin; Petrucka, Pammla
Proper diet is important in preventing many diseases, and colorectal cancer is no exception. The aim of this study was to identify major dietary patterns among the general population in Arusha Tanzania to determine whether diet is one of the predictors contributing to the observed pattern and distribution of colorectal cancer in Tanzania. A population based cross-sectional study recruited a sample of selfreported healthy individuals residing in four wards of the City of Arusha, Tanzania. A total of 549 participants were recruited on a voluntary basis. The Food Frequency Questionnaire and the World Health Organization (WHO) Step® survey tool were used to collect data. Factor analysis, Pearson correlation (Pearson’s r), and logistic regression were used to analyze the data.Two major dietary patterns, namely “healthy” and “western”, and one minor pattern existed among the study population. The "healthy" pattern was generally associated with females (56.2%, p=0.074), people with primary level of education (62.7%, p=0.667), age category of 25 to 44 (66.3%, p= 0.370), normal range body mass index (BMI) (42.4%, p=0.967), self-employed (78.5%), non-smokers (86.6%) and non-alcohol drinkers (51%), although the differences were not statistically significant. "Western" dietary pattern adherence was associated with area of residence (p=0.0001), gender (p=0.003) and BMI status (p=0.04) in univariate analysis. In multivariate analysis, higher odds were observed in individuals aged 25 to 34 (OR=1.104, 95%, CI(0.537-2.2267) and 45 to 54 OR=1.091, 95%, CI(0.521-2.283), alcohol drinkers (OR=1.2, 95%, CI(0.767-1.877), people with college or high levels of education (OR=0. 853, 95%, CI(0.260-2.803) and OR=0.550, 95%,CI(0. 159-1.897), smokers (OR=1.030, 95%, CI(0.519-2.044) and overweight or obese (OR=2.676, 95%, CI(0.981-7.298) and OR=2.045, 95%, CI(0.767-5.454). These data support our previous hypothesis that diet could be an important potential predictor of the previously observed pattern and distribution of colorectal cancer in Tanzania.
Differences in Hypertension Risk Factors between Rural Maasai in Ngorongoro and Urban Maasai in Arusha Municipal: A Descriptive Study
(Journal of Applied Life Sciences International, 2014-08-08) Ngoye, Abel; Petrucka, Pammla; Buza, Joram
Background: Many ethnic groups within Tanzania are migrating from rural to urban areas in search of jobs and better livelihoods. One such group is the Maasai, whose distinct ethnicity and lifestyle potentially offers significant learnings in hypertensionrelated population health. This project investigated potential risk factors for hypertension in two Maasai settings with contrasting lifestyles: rural Ngorongoro Conservation Area and urban Arusha Municipal. Methods: A cross-sectional descriptive study in three rural villages (i.e., Olbalba, Misigiyo, Alelilayi) and urban Arusha Municipal, sampling 724 individuals aged 18 to 75 years, ( i . e. , 3 35 males; 389 females). Quantitative measurements included blood pressure, body mass index (BMI), waist to hip ratio (WHR), total cholesterol, alcohol consumption, cigarette/tobacco use, and level of physical activity. Qualitative measurements included self-reports of lifestyle related risk factors such as distance walked, daily meal frequencies, alcohol and cigarette/tobacco use. Results: Prevalence of hypertension in urban Maasai 27.7% (n=97) was significantly higher (p<0.0001) than for rural Maasai 10.9% (n=41). Systolic blood pressure in urban Maasai was significantly positively correlated with obesity parameters including BMI, weight, waist- circumference, hip circumference and WHR while distance walked was significantly (p=0.004) negatively associated. In urban Maasai, hypertension prevalence increased with age being highest at 60 years and above. Gender differences were apparent between 40-59 years where prevalence in urban males was significantly higher than females. Compared to rural counterparts, urban Maasai were significantly higher (p<0.05) for overweight, number of daily meals consumed, alcohol use, and less physical activity. No difference occurred across sites with respect to WHR and total cholesterol. For rural Maasai, systolic blood pressure was only significantly (p<0.0033) positively associated with BMI. In contrast to urban Maasai, prevalence of hypertension amongst rural Maasai decreased with increasing age and, furthermore, there were no gender differences across age. Conclusions: The unique lower hypertension pattern for rural Maasai may reflect a number of emerging environmental and life style factors. Amongst rural Maasai, a distinctive pattern emerged of underweight, low WHR, lower meal consumption frequency, and more physical activities. Urban Maasai showed higher prevalence of hypertension and it risk factors compared to their rural counterparts. Findings emphasized the need for hypertension prevention lifestyle programmes including ongoing monitoring of blood pressure trends within the Maasai, especially within the context of urbanization.
Does undernutrition increase the risk of lost to follow-up in adults living with HIV in sub-Saharan Africa? Protocol for a systematic review and meta-analysis
(BMJ Publishing Group, 2021-12-01) Alebel, Animut; Demant, Daniel; Petrucka, Pammla; Sibbritt, David
Introduction Undernutrition is considered a marker for poor prognosis among people living with HIV (PLHIV), particularly in sub-Saharan Africa (SSA), where undernutrition and HIV are both highly prevalent. Evidence suggests that undernutrition (body mass index <18.5 kg/m 2) is one of the main factors that significantly increases the risk of lost to follow-up (LTFU) in PLHIV. However, primary studies in SSA have reported inconsistent findings on the relationship between undernutrition and LTFU among adults living with HIV. To the best of our knowledge, no systematic review which aimed to summarise the available evidence. Hence, this review aims to determine the pooled effect of undernutrition on LTFU among adults living with HIV in SSA. Methods and analysis PubMed, EMBASE, Web of Science, Scopus, and, for grey literature, Google Scholar will be systematically searched to include relevant articles published since 2005. Studies reporting the effect of undernutrition on LTFU in adults living with HIV in SSA will be included. The Newcastle-Ottawa Scale will be used for quality assessment. Data from eligible studies will be extracted using a standardised data extraction tool. Heterogeneity between included studies will be assessed using Cochrane Q-test and I 2 statistics. The Egger's and Begg's tests at a 5% significance level will be used to evaluate publication bias. As heterogeneity is anticipated, the pooled effect size will be estimated using a random-effects model. The final effect size will be reported using the adjusted HR with a 95% CI. Ethics and dissemination Ethical approval is not required for a protocol for a systematic review. The results of this systematic review will be published in a peer-reviewed journal and will be publicly available.
Effects of undernutrition on mortality and morbidity among adults living with HIV in sub-Saharan Africa: a systematic review and meta-analysis
(BMC Infectious Diseases, 2021) Alebel, Animut; Demant, Daniel; Petrucka, Pammla; Sibbritt, David
Background: Undernutrition is one of the most common problems among people living with HIV, contributing to premature death and the development of comorbidities within this population. In Sub-Saharan Africa (SSA), the impacts of these often inter-related conditions appear in a series of fragmented and inconclusive studies. Thus, this review examines the pooled effects of undernutrition on mortality and morbidities among adults living with HIV in SSA. Methods: A systematic literature search was conducted from PubMed, EMBASE, CINAHL, and Scopus databases. All observational studies reporting the effects of undernutrition on mortality and morbidity among adults living with HIV in SSA were included. Heterogeneity between the included studies was assessed using the Cochrane Q-test and I2 statistics. Publication bias was assessed using Egger’s and Begg’s tests at a 5% significance level. Finally, a random-effects metaanalysis model was employed to estimate the overall adjusted hazard ratio. Results: Of 4309 identified studies, 53 articles met the inclusion criteria and were included in this review. Of these, 40 studies were available for the meta-analysis. A meta-analysis of 23 cohort studies indicated that undernutrition significantly (AHR: 2.1, 95% CI: 1.8, 2.4) increased the risk of mortality among adults living with HIV, while severely undernourished adults living with HIV were at higher risk of death (AHR: 2.3, 95% CI: 1.9, 2.8) as compared to mildly undernourished adults living with HIV. Furthermore, the pooled estimates of ten cohort studies revealed that undernutrition significantly increased the risk of developing tuberculosis (AHR: 2.1, 95% CI: 1.6, 2.7) among adults living with HIV. Conclusion: This review found that undernutrition has significant effects on mortality and morbidity among adults living with HIV. As the degree of undernutrition became more severe, mortality rate also increased. Therefore, findings from this review may be used to update the nutritional guidelines used for the management of PLHIV by different stakeholders, especially in limited-resource settings.
Effects of undernutrition on opportunistic infections among adults living with HIV on ART in Northwest Ethiopia: Using inverse-probability weighting
(PLOS One, 2022-03-07) Alebel, Animut; Demant, Daniel; Petrucka, Pammla; Sibbritt, David
Background Opportunistic infections (OIs) are the leading causes of hospitalization, morbidity, and mortality (accounting for 94.1% of all deaths) in people living with human immunodeficiency virus (PLHIV). Despite evidence suggested that undernutrition significantly increases the risk of OIs in PLHIV, to our knowledge, no study has examined the actual effects of undernutrition on OIs in this population, particularly in low-income countries. Thus, this study examined the effects of undernutrition on OIs in adults living with HIV receiving antiretroviral therapy (ART). Methods We conducted a retrospective cohort study among 841adults living with HIV receiving ART between June 2014 and June 2020 at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia. Study participants were selected using a simple random sampling technique. Data from participants’ medical records were extracted using a project-specific data extraction checklist. The Kaplan Meier survival curve estimated the OIs free survival time. The effects of undernutrition on time to develop OIs was estimated using inverse-probability weighting. Finally, regression coefficients with 95% confidence intervals (95% CIs) were reported, with a statistical significance of p < 0.05. Results Of 841 study participants, 262 (31.2%) developed OIs, and the overall incidence rate was 16.7 (95% CI: 14.8, 18.8) per 100 person-years. The incWidence of OIs in undernourished participants (21/100 person-years, 95% CI: 17.8, 27.4) was higher than well-nourished participants (15.0/100 person-years, 95% CI: 12.9, 17.4). When everyone in the population of interest is well-nourished, average time to develop OIs is estimated as 26.5 (coefficient: 26.5, 95% CI: 20.6, 32.4, p < 0.001) months. When everyone in the population of interest is undernourished, average time to develop OIs is estimated as 17.7 (95% CI: 12.8, 22.6) months. However, when everyone is undernourished, average time to develop OIs decreases by 8.8 (coefficient: -8.8, 95% CI: -16.6, -1.0, p = 0.026) months. Lastly, exposure to undernourishment (intervention) (ratio of average treatment effects to well-nourished potential outcome means in this study was a 32.5% reduction in OIs among adults living with HIV on ART. Conclusion We found that undernutrition significantly shortened time to develop OIs in adults living with HIV. This implies that the occurrence of OIs in this vulnerable population can be improved through different cost-effective nutritional interventions, such as routine nutritional assessments and education.
Efficacy of Different Doses of Multiple Micronutrient Powder on Haemoglobin Concentration in Children Aged 6–59 Months in Arusha District
(Hindawi Scientiﬁca, 2019-02-03) Kejo, Dyness; Petrucka, Pammla; Martin, Haikael; Mosha, Theobald; Kimanya, Martin
In Tanzania’s Arusha District, anaemia is a signiﬁcant public health problem. Recently, home fortiﬁcation with multiple micronutrient powder was recommended, and daily use of one sachet has shown to be eﬀective. However, it is a challenge for deprived families with low income to aﬀord the daily sachet. aim of this study was to compare the eﬃcacy of diﬀerent administration frequencies of micronutrient powder in reducing anaemia in children aged 6–59 months. Is research used a community-based, randomized longitudinal trial design with the intent to treat anaemia. Children aged 6 to 59 months (n = 369) were randomly assigned to one of four intervention groups which received, on a weekly basis, either ﬁve sachets (n=60), three sachets (n=80), two sachets (n = 105), or one sachet (n = 124) for six months; 310 children completed the study. Using the Hemo Cue technique, a ﬁnger-prick blood was taken at baseline, middle, and end points of the intervention to determine haemoglobin levels. The eﬀect of treatment on haemoglobin was assessed with analysis of covariates with Bonferroni post hoc to test group diﬀerence (p > 0.05) from each other. At the end, haemoglobin levels were signiﬁcantly higher in participants who received three or ﬁve sachets of micronutrient powder per week compared to those who received one or two micronutrient powder sachets per week (p < 0.05). The prevalence of illnesses was reduced from 65% to 30.5% in all groups. This ﬁnding indicates that economically challenged families may opt for three times per week sachet administration rather than a more costly daily administration.
Factors Influencing Willingness to Pay for Multiple Micronutrient Powder (Virutubishi) Supplements for Young Children in Arusha, Tanzania
(Journal of Health & Medical Economics, 2018-11-21) Kejo, Dyness; Martin, Haikel; Mosha, Theobald; Petrucka, Pammla; Kimanya, Martin
Background: Multiple micronutrient powders have shown a positive effect on anaemia prevention in children 6-59 months. For the purposes of uptake and sustainability, we explored ‘‘willingness to pay’’ for these health products at the household level for potential of co-investment in multiple micronutrient powders. Methods: During the intervention (six months), household surveys were conducted once with mothers of children 6-59 months in the Arusha District regarding willingness to pay for the multiple micronutrient powders. Results: Results from the survey show that about 66% of the target mothers are willing to pay for multiple micronutrient powders required for feeding of children at 0.068$ per sachet. Willingness to pay was associated with higher paternal education, higher maternal age, and families which do not keep animals. Conclusion: The results findings help to know the market situation of nutritional products. This information is useful for health policy planners in assessing economic viability and sustainability of the distribution of multiple micronutrient powders to consumers to avert micronutrient deficiencies and their effects on young children.
Insulin Resistance Among Pregnant Women in Urban Areas of Arusha Region, Tanzania.
(Mary Ann Liebert, Inc., publishers, 2019-12-02) Msollo, Safiness; Martin, Haikael; Mwanri, Akwilina; Petrucka, Pammla
To establish the prevalence of insulin resistance (IR) and its determinants among selected pregnant women in urban Arusha for taking preventive measures. A cross-sectional study was conducted between March and December 2018 at Ngarenaro and Kaloleni health facilities in Arusha District involving 230 randomly selected pregnant women who were not known to have diabetes before pregnancy. Blood glucose at fasting and 2 hr after consuming 75 grams of glucose dissolved in 300 mL of water was measured using Gluco-Plus™, serum insulin concentrations using ELISA machine (Synergy/HTX™; BioTek), and IR was calculated using the Homeostasis Model of Assessment formula. Body fat was measured using a bioelectric impedance analyzer, mid-upper arm circumference using a regular tape, weight using SECA™, blood pressure using GT-868UF Geratherm™ machine, and height by stadiometer. Maternal characteristics were collected through face to face interviews using a structured questionnaire. Data were analyzed using the Statistical Package for Social Science™ Version 20. The prevalence of IR was 21% ( = 49) and significantly associated with increased body fat percentage (adjusted odds ratio [AOR]: 1.68, 95% confidence interval [CI]: 1.01-2.5), family history of Type 2 diabetes mellitus (T2DM; AOR: 2.77, 95% CI: 1.21-6.33), hypertension (AOR: 2.5, 95% CI: 1.12-5.6), edema (AOR: 3.01, 95% CI: 1.31-6.96), and proteinuria (AOR: 3.44, 95% CI: 1.11-10.69). IR was higher among pregnant women with increased body fat percentage, family history of T2DM, hypertension, edema, and proteinuria. These findings call for large-scale screening to further explore risk factors to prevent gestational diabetes mellitus.
Knowledge and Dietary Practices on Vitamin A and Iron Among Maasai Pregnant Women: A Mixed-Method Study, Ngorongoro, Tanzania
(Dovepress, 2020-09-18) Mshanga, Naelijwa; Martin, Haikael; Petrucka, Pammla
Background: Provision of micronutrients knowledge is important during pregnancy as it informs mothers what to eat and avoid, to ensure sufficient micronutrient absorption by the mothers and fetuses. Most studies focus on general nutrition knowledge and dietary prac tices, but there is minimal known about micronutrient knowledge especially in pastoral societies. Therefore, the aim of this study was to explain the current micronutrient knowl edge and dietary practices of pregnant women in this unique pastoral society. Methods: This is a mixed-method study that involves focus group discussions and question naires in assessing the micronutrient knowledge and frequency micronutrients dietary practices of Maasai pregnant women from one week to thirty-six weeks pregnant. Chi-square test and descriptive statistics, such as percentages, frequency distribution and measures of central tendency, were used to assess socio-demographic data, micronutrients knowledge and frequency of micronutrients dietary practices and the comparison between knowledge and dietary practices, while inductive thematic content analysis was used to analyze qualitative data. Results: In total, 140 questionnaires were completed with a response rate of 100% and 32 participants drawn from this group attended one of four focus group discussions. The study found that most participants had good knowledge of dietary iron, while less than a quarter (24.3%) had good knowledge of vitamin A. Moreover, there was a statistical significance difference (P=0.043) between knowledge and dietary practices. Low dietary micronutrient intake was primarily due to cultural restrictions, prohibition in cultivating and unavailability of micronutrients rich foods in this geographical area. Conclusion: The majority of the study participants had good knowledge of iron compared to vitamin A; however, they do not translate the knowledge in dietary practices. Therefore, the Government of Tanzania through Ministry of Education and Health should introduce different interventions to increase micronutrients knowledge and practices in pastoral societies.
Low macronutrients intake and associated factors among Maasai women of reproductive age in Ngorongoro Conservation Area, Tanzania
(American Journal of Research Communication, 2014) Martin, Haikael; Petrucka, Pammla; Buza, Joram
Background: It was previously reported that the prevalence of oral thrush among Maasai women of reproductive age was disproportionately high in the absence of established predisposing factors, such as HIV/AIDS, syphilis, diabetes and anaemia. This study investigated whether incidence of oral thrush was due to low serum micronutrients levels. Results showed that all study participants were deficient in Vitamins A and C; some had insufficient levels of Vitamin D. We set out to understand the normal dietary intake of Maasai women of reproductive age and their traditions associated with food intake. Our aim was to review the types of foods and amounts consumed in relation to potentials for oral thrush occurrence. Methods: Interviews were conducted using a structured questionnaire; the information collected included data on age, parity, pregnancy status, weight, height, frequently eaten foods, number of meals, and food restrictions. Clinicians also examined participants for presence/absence of oral thrush lesions. A twenty four hour dietary recall was conducted, focusing on macro and micro nutrient content of the food consumed using the Tanzania Food Composition Table and computed with Excel™ 2007 software. Results: The twenty four hour dietary recall assessment revealed that the most frequently eaten food (71%) was thin porridge made from maize flour. Carbohydrates contributed the most energy (approximately 80%), followed by fats (12%), and protein (8%). Student’s t-test showed no significant difference in dietary intake of carbohydrates and protein between women with and without oral thrush (with p>0.05). However, all groups showed low intake of protein, carbohydrates, fats and micronutrients such as vitamins A, C, B12, folate, and iron. Conclusions: There is a need of intervening in this community through nutrition education and advocacy among health workers who are expected to spread the knowledge to the community. These findings are important in addressing the type of food aid directed to this community, which should include protein sources like beans.
Maasai Community Perception of Oral Thrush: A Qualitative Study
(Journal of Scientific Research & Reports, 2015-02-03) Martin, Haikael; Petrucka, Pammla; Buza, Joram
Aim: To determine perception and understanding of oral thrush among Maasai women of reproductive age (WRA), Traditional Birth Attendants (TBAs), village leaders and health care workers in the Ngorongoro Conservation Area (NCA). Study Design: Cross sectional, qualitative research. Place and Duration: Three villages namely; Olbalbal, Misigiyo and Alelilai in the Ngorongoro Conservation Area, between March 2013 and September 2014. Methodology: We included women of reproductive age (210), village leaders (5), Traditional Birth Attendants (TBA) (13) and health care providers (18). Data was collected using focus group discussions among Traditional Birth Attendants and village leaders, interview for women of reproductive age and health care providers. Results: The community recognizes that oral thrush is a problem among pregnant and lactating Maasai women. According to the Traditional Birth Attendants and village leaders, it is believed that oral thrush came with the modern use of western medication as opposed to their traditional medications used earlier. They stated that their way of life has changed significantly causing these problems. Most WRA say oral thrush is a problem, but they do not know the cause. However, health care providers know that oral thrush is a problem with some knowing the causes and associated risk factors in the Maasai community. Conclusion: There appears to be an information gap between community members and healthcare providers with respect to the causes of oral thrush in women of child-bearing age in Ngorongoro Conservation Area. It is noted that TBAs are important to rectify this deficit, because if they understand the problem they can influence changes. Results from this research work can inform more effective health promotion initiatives and interventions. .
Maternal, newborn and child health needs, opportunities and preferred futures in Arusha and Ngorongoro: hearing women’s voices
(Petrucka et al. BMC Res Notes, 2015) Petrucka, Pammla; Bassendowski, Sandra; Leurer, Marie; Gress, Cara; Athuman, Zenath; Buza, Joram
With the approaching sunset on the Millennium Development Goals (MDGs), Tanzania continues with its final national push towards achievement of MDG #4 and MDG #5. The Mama Kwanza Socio-economic Health Initiative (MKSHI) was introduced in the hope of contributing to improving maternal, newborn, and child health in Arusha and Ngorongoro. The MKSHI project is a holistic, inter-sectoral approach to maternal, newborn, and child health which aligns with the Government of Tanzania’s Vision 2025. At the project onset, a baseline assessment was conducted to launch ongoing benchmarking, monitoring, and evaluation of the project’s impacts and implications. The aim of this baseline assessment was twofold. First it was to determine the state of maternal, newborn, and child health in the two project sites. Second it was to ensure that a baseline of key indicators was established as well as identification of unique indicators relevant to the populations of interest.
Molecular Detection of Group A Rotavirus in Children under Five in Urban and Peri-urban Arusha, Tanzania
(British Journal of Medicine & Medical Research, 2015-12-16) Gachanja, Elizabeth; Buza, Joram; Petrucka, Pammla
age of five years worldwide. However, very little information is available on Rotavirus status in Tanzania. Aims: The project aimed at investigating Rotavirus infection in Tanzanian children to reflect prevalence post introduction of the Rotarix® virus, which occurred in late 2012. Methods: The study considered prevalence in an urban and peri-urban context in Arusha, Tanzania for children under five. The study involved molecular detection of rotavirus in stool samples using PCR targeting Group A Rotavirus as well as a questionnaire to determine possible contributing factors, such as vaccination status, age, and exclusive breastfeeding to infection. Results: Out of a total of 100 stool samples collected, 37% were positive for Rotavirus. The Fisher’s Exact Test was used to relate conventional PCR test results and various factors associated with Rotavirus positive samples. Household practices of boiling water, as well as parents’/guardians’ knowledge on the Rotavirus vaccine and child vaccination status were significantly (p<0.05) associated with Rotavirus infection. Conclusion: The findings of this study should inform further studies to address the molecular epidemiology of the disease and associated risk factors. In this study we undertook surveillance for molecular detection and characterization of Rotavirus while considering the impact of prevention and control measures, such as vaccinations and uptake of safe practices (i.e., boiling water) on prevalence.
Pattern and Distribution of Colorectal Cancer in Tanzania: A Retrospective Chart Audit at Two National Hospitals
(Hindawi Publishing Corporation, 2016-08-09) Katalambula, Leonard; Ntwenya, Julius; Ngoma, Twalib; Buza, Joram; Mpolya, Emmanuel; Mtumwa, Abdallah; Petrucka, Pammla
Background. Colorectal cancer (CRC) is a growing public health concern with increasing rates in countries with previously known low incidence. This study determined pattern and distribution of CRC in Tanzania and identified hot spots in case distribution. Methods. A retrospective chart audit reviewed hospital registers and patient files from two national institutions. Descriptive statistics, Chi square (𝜒2) tests, and regression analyses were employed and augmented by data visualization to display risk variable differences. Results. CRC cases increased sixfold in the last decade in Tanzania. There was a 1.5% decrease in incidences levels of rectal cancer and 2% increase for colon cancer every year from 2005 to 2015. Nearly half of patients listed Dar es Salaam as their primary residence. CRC was equally distributed between males (50.06%) and females (49.94%), although gender likelihood of diagnosis type (i.e., rectal or colon) was significantly different (𝑃 = 0.027). More than 60% of patients were between 40 and 69 years. Conclusions. Age (𝑃 = 0.0183) and time (𝑃 = 0.004) but not gender (𝑃 = 0.0864) were significantly associated with rectal cancer in a retrospective study in Tanzania. Gender (𝑃 = 0.0405), age (𝑃 = 0.0015), and time (𝑃 = 0.0075) were all significantly associated with colon cancer in this study. This retrospective study found that colon cancer is more prevalent among males at a relatively younger age than rectal cancer. Further, our study showed that althoughmore patients were diagnosed with rectal cancer, the trend has shown that colon cancer is increasing at a faster rate.
Physical activity and sedentary behaviors associated with overweight and obesity among primary school children in Tanzania: a case-control study
(Emerald Group Holdings Ltd., 2021-11-19) Pacific, Renatha; Kulwa, Kissa; Martin, Haikael; Petrucka, Pammla
Purpose This study aims at determining the risk of physical inactivity and sedentary behaviors on overweight and obesity among primary school children aged 10–13 years in Tanzania. Design/methodology/approach A case-control study was conducted from January to March 2020 involving 69 overweight/obese children as cases and 138 normal weight children as controls. Cases were identified as having body mass index-for-age ≥ +1 standard deviation (SD) and controls as those having BMI-for-age range between −2 SD to <+1 SD. A validated questionnaire was used for data collection on daily physical activities and sedentary behavior types, frequency duration and activity score. An independent sample t-test was used to compare means of activity score between cases and controls. Binary logistic regression was used to predict risk factors for overweight/obesity. Findings Risk factors for overweight/obesity were listening to music and/or radio for >2 h/week (OR 2.7, 95% CI 1.2–6.1) and walking for exercise <2 h/week (OR 2.1, 95% confidence interval [CI] 1.1–4.1). On the other hand, rope skipping for >2 h/week (OR 0.14, 95% CI 0.03–0.7) was a protective factor against overweight/obesity. Controls had a significantly higher mean score of being active during lunch breaks compared to cases (p = 0.012). Cases had higher weight, height and percentage body fat than controls (p < 0.001). The home environment provided more avenues for physical activity than the school environment. Originality/value To the best of the authors’ knowledge, this is original research work and the first case-control study to predict physical activity and sedentary behaviors as risk factors for overweight and obesity in Tanzanian school children.
Prevalence and predictors of oral thrush among Maasai in Ngorongoro Conservation Area: A preliminary consideration
(iMedPub, 2014) Martin, Haikael; Buza, Joram; Petrucka, Pammla
Background: It was reported by clinicians working in the Ngorongoro Conservation Area that about 40% of Maasai pregnant women reporting at the Antenatal Clinic were diagnosed with oral thrush. However, it was not immediately determined what factors predispose these women to oral thrush. This study aimed at finding out the prevalence of oral thrush in the Maasai women community and the identification of predisposing factors. Methods: This was a cross sectional study done in the Ngorongoro Conservation Area among Maasai women of reproductive age (15–49 years). Convenience sampling technique was used to select participants from all participating villages. Participants were clinically examined for oral thrush lesions and a structured interview guide was used to collect information on age, parity, pregnancy status and history of breastfeeding. To explore the possible predisposing factors for oral thrush, anthropometric measurements including weight and height were taken and also blood samples were collected from participants and tested for HIV, syphilis and blood sugar. Multivariate logistic regression was used to obtain independent predictors of oral thrush. Results: The prevalence of oral thrush among study participants was 32%. Oral thrush prevalence was significantly higher in non-pregnant than pregnant women (p=0.000). Amongst the non-pregnant women, oral thrush was significantly higher in breastfeeding than the non-breast feeding participants. Univariate logistic regression showed that non-pregnant women had higher odds of getting oral thrush compared to pregnant women [OR 21.8; (95% CI 9.6, 49.6)]. Amongst the non-pregnant women, breastfeeding women had increased odds or higher chances of getting oral thrush compared to the non-breastfeeding women [OR 15.8; (95% CI: 7.2, 34.8)]. In the multivariate analysis, breastfeeding women adjusted odds ratio (AOR) 2.88; (95% CI: 0.99, 8.3) and non-pregnant women AOR 0.09; (95% CI: 0.03, 0.27). Two factors that predicted oral thrush are breastfeeding and not being pregnant. Conclusions: From the results, breastfeeding non pregnant women were at a higher risk of developing oral thrush. Possible predisposing factors are discussed.
Prevalence and predictors of undernutrition among underfive children in Arusha District, Tanzania
(Wiley Periodicals, Inc., 2018) Kejo, Dyness; Mosha, Theobald; Petrucka, Pammla; Martin, Haikael; Kimanya, Martin
Childhood undernutrition is a global health challenge impacting child growth and survival rates. This deficit in nutritional status contributes to the increasing chronic disease prevalence and economic burden in individuals and throughout developing contexts. A community-based cross-sectional study was conducted in Arusha District of Tanzania to determine the prevalence and predictors of undernutrition in 436 children. A structured questionnaire was used to collect data on demographic and socio- economic factors as well as feeding practices and prevalence of preventable childhood diseases. Anthropometric data were collected through the measurement of length/height and weight of all children. The prevalence of undernutrition was estimated based on Z-scores indices below −2SD of the reference population for weight for age (underweight), height for age (stunting), and weight for height (wasting). Fifty percent, 28%, and 16.5% of the children were stunted, underweight, and wasted, respectively. The age above 2 years and being a male were associated with stunting. The age above 2 years, nonexclusive breastfeeding children, and living at Seliani and Oturumeti were associated with being underweight. Similarly, morbidity, none exclusively breastfed children, living at Oturumeti, and being born to a mother 35 years and above were associated with wasting. In this study, we found the prevalence of child undernutrition in Arusha District is high in comparison with national and regional trends and appears to be associated with being a male. It is recommended that nutritionists and health planners should focus on these key predictors when planning nutrition interventions to address the problem of undernutrition among under-five children in Arusha District.