| 1. |
- Mbekenga, Columba K, 1972-
(författare)
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Striving to Promote Family Health after Childbirth : Studies in Low-Income Suburbs of Dar es Salaam, Tanzania
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Deeper understanding of family health and support after childbirth from the perspective of first-time parents and their informal support network is needed. Postpartum experiences and health concerns of first-time mothers and fathers and, discourses on sexuality and informal support after childbirth were explored in low-income, suburban areas in Ilala, Dar es Salaam, Tanzania. Individual qualitative interviews with first-time mothers (n=10) and fathers (n=10), and 14 focus group discussions with first-time parents (n=40) and informal support persons (n=42) provided the data, which were analyzed through qualitative content and discourse analysis. First-time parents’ areas of concern were newborn care and hygiene, infant feeding, handling crying infant, maternal nutrition and hygiene, uncertain body changes for the mother and, sexuality. The mothers were burdened with caring responsibilities and fathers felt neglected and excluded from the care of the mother and infant after childbirth, both by the families and the health care system. Sexuality after childbirth created tension between new parents due to the understanding that abstinence would protect child health during the breastfeeding period, which could be several years. Women’s adherence to sexual abstinence was more emphasized compared to men’s. Men’s engagement with other sex partners and the risk of contraction HIV was a threat to family health. First-time parents drew on support from both informal and formal sources. Informal support networks played a major role in providing information, materials, guidance and supervision while conveying stereotypic gender norms. Contradictions in the messages to parents within and between the support systems created uncertainties that might have negative implications for family health. Poor parents and those who did not adherence to the social norms were less likely to get informal support than others were. There is a need for information and practical guidance on basic aspects of care for the mother and infant, male involvement, and the importance of social support to first-time parents, as new parents face physical, social and relational challenges after childbirth. The link between the health care system and informal networks need to be strengthened to enable them to complement each other in promoting family health after child health.
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| 2. |
- Abeid, Muzdalifat, et al.
(författare)
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A community-based intervention for improving health-seeking behavior among sexual violence survivors: A controlled before and after design study in rural Tanzania
- 2015
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Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite global recognition that sexual violence is a violation of human rights, evidence still shows it is a pervasive problem across all societies. Promising community intervention studies in the low- and middle-income countries are limited.Objective: This study assessed the impact of a community-based intervention, focusing on improving the community’s knowledge and reducing social acceptability of violence against women norms with the goal to prevent and respond to sexual violence.Design: The strategies used to create awareness included radio programs, information, education communication materials and advocacy meetings with local leaders. The intervention took place in Morogoro region in Tanzania. The evaluation used a quasi-experimental design including cross-sectional surveys at baseline (2012) and endline (2014) with men and women aged 18-49. Main outcome measures were number of reported rape cases at health facilities and the community’s knowledge and attitudes towards sexual violence.Results: The number of reported rape events increased by more than 50% at health facilities during the intervention. Knowledge on sexual violence increased significantly in both areas over the study period (from 57.3% to 80.6% in the intervention area and from 55.5% to 71.9% in the comparison area; p<.001), and the net effect of the intervention between the two areas was statistically significant (6.9, 95% CI 0.2–13.5, p= 0.03). There was significant improvement in most of attitude indicators in the intervention area, but not in the comparison area. However, the intervention had no significant effect in the overall scores of acceptance attitudes in the final assessment when comparing the two areas (-2.4, 95%CI: -8.4 – 3.6, p= 0.42).Conclusions: The intervention had an effect on some indicators on knowledge and attitudes towards sexual violence even after a short period of intervention. This finding informs the public health practitioners of the importance of combined strategies in achieving changes.
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| 3. |
- Abeid, Muzdalifat, 1973-, et al.
(författare)
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Community perceptions of rape and child sexual abuse : a qualitative study in rural Tanzania
- 2014
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Ingår i: BMC International Health and Human Rights. - 1472-698X. ; 14, s. 23-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Rape of women and children is recognized as a health and human rights issue in Tanzania and internationally. Exploration of the prevailing perceptions in rural areas is needed in order to expand the understanding of sexual violence in the diversity of Tanzania's contexts. The aim of this study therefore was to explore and understand perceptions of rape of women and children at the community level in a rural district in Tanzania with the added objective of exploring those perceptions that may contribute to perpetuating and/or hindering the disclosure of rape incidences. Methods: A qualitative design was employed using focus group discussions with male and female community members including religious leaders, professionals, and other community members. The discussions centered on causes of rape, survivors of rape, help-seeking and reporting, and gathered suggestions on measures for improvement. Six focus group discussions (four of single gender and two of mixed gender) were conducted. The focus group discussions were recorded, transcribed verbatim, and analyzed using manifest qualitative content analysis. Results: The participants perceived rape of women and children to be a frequent and hidden phenomenon. A number of factors were singled out as contributing to rape, such as erosion of social norms, globalization, poverty, vulnerability of children, alcohol/drug abuse and poor parental care. Participants perceived the need for educating the community to raise their knowledge of sexual violence and its consequences, and their roles as preventive agents. Conclusions: In this rural context, social norms reinforce sexual violence against women and children, and hinder them from seeking help from support services. Addressing the identified challenges may promote help-seeking behavior and improve care of survivors of sexual violence, while changes in social and cultural norms are needed for the prevention of sexual violence.
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| 4. |
- Abeid, Muzdalifat, 1973-, et al.
(författare)
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Evaluation of a training program for health care workers to improve the quality of care for rape survivors : a quasi-experimental design study in Morogoro, Tanzania
- 2016
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Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 9
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Forskningsöversikt (refereegranskat)abstract
- BACKGROUND:Sexual violence against women and children in Tanzania and globally is a human rights violation and a developmental challenge.OBJECTIVE:The aim of this study was to assess the impact of training health professionals on rape management. The specific objectives were to evaluate the changes of knowledge and attitudes toward sexual violence among a selected population of health professionals at primary health care level.DESIGN:A quasi-experimental design using cross-sectional surveys was conducted to evaluate health care workers' knowledge, attitude, and clinical practice toward sexual violence before and after the training program. The study involved the Kilombero (intervention) and Ulanga (comparison) districts in Morogoro region. A total of 151 health professionals at baseline (2012) and 169 in the final assessment (2014) participated in the survey. Data were collected using the same structured questionnaire. The amount of change in key indicators from baseline to final assessment in the two areas was compared using composite scores in the pre- and post-interventions, and the net intervention effect was calculated by the difference in difference method.RESULTS:Overall, there was improved knowledge in the intervention district from 55% at baseline to 86% and a decreased knowledge from 58.5 to 36.2% in the comparison area with a net effect of 53.7% and a p-value less than 0.0001. The proportion of participants who exhibited an accepting attitude toward violence declined from 15.3 to 11.2% in the intervention area but increased from 13.2 to 20.0% in the comparison area.CONCLUSIONS:Training on the management of sexual violence is feasible and the results indicate improvement in healthcare workers' knowledge and practice but not attitudes. Lessons learned from this study for successful replication of such an intervention in similar settings require commitment from those at strategic level within the health service to ensure that adequate resources are made available.
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| 5. |
- Abeid, Muzdalifat, 1973-, et al.
(författare)
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Knowledge and attitude towards rape and child sexual abuse - a community-based cross-sectional study in Rural Tanzania
- 2015
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Violence against women and children is globally recognized as a social and human rights concern. In Tanzania, sexual violence towards women and children is a public health problem. The aim of this study was to determine community knowledge of and attitudes towards rape and child sexual abuse, and assess associations between knowledge and attitudes and socio-demographic characteristics.METHODS: A cross-sectional study was undertaken between May and June 2012. The study was conducted in the Kilombero and Ulanga rural districts in the Morogoro Region of Tanzania. Men and women aged 18-49 years were eligible for the study. Through a three-stage cluster sampling strategy, a household survey was conducted using a structured questionnaire. The questionnaire included socio-demographic characteristics, attitudes about gender roles and violence, and knowledge on health consequences of rape. Data were analyzed using the Statistical Package for Social Sciences (SPSS) software, version 21. Main outcome measures were knowledge of and attitudes towards sexual violence. Multivariate analyses were used to assess associations between socio-demographic characteristics and knowledge of and attitudes towards sexual violence.RESULTS: A total of 1,568 participants were interviewed. The majority (58.4%) of participants were women. Most (58.3%) of the women respondents had poor knowledge on sexual violence and 63.8% had accepting attitudes towards sexual violence. Those who were married were significantly more likely to have good knowledge on sexual violence compared to the divorced/separated group (AOR = 1.6 (95% CI: 1.1-2.2)) but less likely to have non-accepting attitudes towards sexual violence compared to the single group (AOR = 1.8 (95%CI: 1.4-2.3)). Sex of respondents, age, marital status and level of education were associated with knowledge and attitudes towards sexual violence.CONCLUSIONS: Our study showed that these rural communities have poor knowledge on sexual violence and have accepting attitudes towards sexual violence. Increasing age and higher education were associated with better knowledge and less accepting attitudes towards sexual violence. The findings have potentially important implications for interventions aimed at preventing violence. The results highlight the challenges associated with changing attitudes towards sexual violence, particularly as the highest levels of support for such violence were found among women.
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| 6. |
- Adams, Emma A., et al.
(författare)
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Perceptions on the sexual harassment of female nurses in a state hospital in Sri Lanka : a qualitative study
- 2019
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Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Sexual harassment occurs within the nursing profession globally, challenging the health and safety of nurses and the quality and efficiency of health systems. In Sri Lanka, no studies have explored this issue in the health sector; however, female employees face sexual harassment in other workplace settings.Objective:To explore female nurses' perceptions of workplace sexual harassment in a large state hospital in Sri Lanka.Methods:This is a qualitative study conducted in an urban, mainly Buddhist and Singhalese context. We invited all female senior and ward nurses working in the hospital to participate in the study. We conducted individual in-depth interviews with four senior nurses and focus group discussions with 29 nurses in three groups.Results:The nurses described a variety of perceived forms of sexual harassment in the hospital. They discussed patient-perpetrated incidents as the most threatening and the clearest to identify compared with incidents involving doctors and other co-workers. There was significant ambiguity regarding sexual consent and coercion in relationships between female nurses and male doctors, which were described as holding potential for exploitation or harassment. The nurses reported that typical reactions to sexual harassment were passive. Alternatively, they described encountering inaction or victim blaming when they attempted to formally report incidents. They perceived that workplace sexual harassment has contributed to negative societal attitudes about the nursing profession and discussed various informal strategies, such as working in teams, to protect themselves from sexual harassment in the hospital.Conclusions:Sexual harassment was a perceived workplace concern for nurses in this hospital. To develop effective local prevention and intervention responses, further research is required to determine the magnitude of the problem and explore differences in responses to and consequences of sexual harassment based on perpetrator type and intent, and personal vulnerabilities of the victims, among other factors.
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| 7. |
- August, Furaha, et al.
(författare)
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Birth preparedness and complication readiness - a qualitative study among community members in rural Tanzania
- 2015
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Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 8, s. 1-U12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Birth preparedness and complication readiness (BP/CR) strategies are aimed at reducing delays in seeking, reaching, and receiving care. Counselling on birth preparedness is provided during antenatal care visits. However, it is not clear why birth preparedness messages do not translate to utilisation of facility delivery. This study explores the perceptions, experiences, and challenges the community faces on BP/CR. Design: A qualitative study design using Focused Group Discussions was conducted. Twelve focus group discussions were held with four separate groups: young men and women and older men and women in a rural community in Tanzania. Qualitative content analysis was used to analyse the data. Results: The community members expressed a perceived need to prepare for childbirth. They were aware of the importance to attend the antenatal clinics, relied on family support for practical and financial preparations such as saving money for costs related to delivery, moving closer to the nearest hospital, and also to use traditional herbs, in favour of a positive outcome. Community recognised that pregnancy and childbirth complications are preferably treated at hospital. Facility delivery was preferred; however, certain factors including stigma on unmarried women and transportation were identified as hindering birth preparedness and hence utilisation of skilled care. Challenges were related to the consequences of poverty, though the maternal health care should be free, they perceived difficulties due to informal user fees. Conclusions: This study revealed community perceptions that were in favour of using skilled care in BP/CR. However, issues related to inability to prepare in advance hinder the realisation of the intention to use skilled care. It is important to innovate how the community reinforces BP/CR, such as using insurance schemes, using community health funds, and providing information on other birth preparedness messages via community health workers.
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| 8. |
- August, Furaha, 1973-, et al.
(författare)
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Community Health workers can improve male involvement in maternal health : Evidence from rural Tanzania
- 2016
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Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Male involvement in maternal health is recommended as one of the interventions to improve maternal and newborn health. There have been challenges in realising this action, partly due to the position of men in society and partly due to health system challenges in accommodating men. The aim of this study was therefore to evaluate the effect of Home Based Life Saving Skills training by community health workers on improving male involvement in maternal health in terms of knowledge of danger signs, joint decision-making, birth preparedness, and escorting wives to antenatal and delivery care in a rural community in Tanzania.DESIGN:A community-based intervention consisting of educating the community in Home Based Life Saving Skills by community health workers was implemented using one district as the intervention district and another as comparison district. A pre-/post-intervention using quasi-experimental design was used to evaluate the effect of Home Based Life Saving Skills training on male involvement and place of delivery for their partners. The effect of the intervention was determined using difference in differences analysis between the intervention and comparison data at baseline and end line.RESULTS:The results show there was improvement in male involvement (39.2% vs. 80.9%) with a net intervention effect of 41.1% (confidence interval [CI]: 28.5-53.8; p <0.0001). There was improvement in the knowledge of danger signs during pregnancy, childbirth, and postpartum periods. The proportion of men accompanying their wives to antenatal and delivery also improved. Shared decision-making for place of delivery improved markedly (46.8% vs. 86.7%), showing a net effect of 38.5% (CI: 28.0-49.1; p <0.0001). Although facility delivery for spouses of the participants improved in the intervention district, this did not show statistical significance when compared to the comparison district with a net intervention effect of 12.2% (95% CI: -2.8-27.1: p=0.103).CONCLUSION:This community-based intervention employing community health workers to educate the community in the Home Based Life Saving Skills programme is both feasible and effective in improving male involvement in maternal healthcare.
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| 9. |
- August, Furaha, 1973-
(författare)
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Effect of Home Based Life Saving Skills education on knowledge of obstetric danger signs, birth preparedness, utilization of skilled care and male involvement : A Community-based intervention study in rural Tanzania
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Use of skilled care during antenatal visits and delivery is recommended to address the burden of maternal mortality. However there are few facility deliveries and insufficient knowledge of danger signs, especially in rural Tanzania. The aim of this thesis was to explore the perceptions and challenges that the community faces while preparing for childbirth and to evaluate an intervention of the Home Based Life Saving Skills education programme on knowledge of danger signs, facility delivery and male involvement when delivered by rural community health workers in Tanzania.In Paper I, Focus Group Discussions explored the perceptions and challenges that the community encounters while preparing for childbirth. Structured questionnaires assessed men’s knowledge of danger signs and birth preparedness and complication readiness in Paper II. The effect of the Home Based Life Saving Skills education programme in the community was assessed with a before-and-after evaluation in two districts; one intervention and one comparison. Paper III assessed the effect of the programme on knowledge of danger signs and birth preparedness and facility delivery among women, while Paper IV evaluated its effect on male involvement.The community perceived that all births must be prepared for and that obstetric complication demands hospital care; hence skilled care was favoured. Men’s knowledge of danger signs was limited; only 12% were prepared for childbirth and complications. Preparedness was associated with knowledge of obstetric complications (AOR=1.4 95% CI 1.8 – 2.6). The intervention showed women utilizing antenatal care (four visits) significantly more (43.4 vs 67.8%) with a net effect of 25.3% (95% CI: 16.9 – 33.2; p < .0001). The use of facility delivery improved in the intervention area (75.6 vs 90.2%; p = 0.0002), but with no significant net effect 11.5% (95% CI: -5.1 – 39.6; p = 0.123) when comparing the two districts. Male involvement improved (39.2% vs 80.9%) with a net intervention effect of 41.1% (CI: 28.5 – 53.8; p < .0001). Improvements were demonstrated in men’s knowledge level, in escorting partners for antenatal care and delivery, making birth preparations, and shared decision-making.The intervention, in educating this rural community, is effective in improving knowledge, birth preparedness, male involvement and use of skilled care.
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