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The impact of out-of-pocket expenditures on missed appointments at HIV r care and treatment centers in Northern Tanzania

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Global Health Journal 2021年第2期5卷 90-96页

作者： Carl Mhina Hayden Bosworth John A.Bartlett Helene Vilme Joyce H.Mosha Deborah F.Shoo Tom J.Kakumbi Glory Jacob charles muiruri Department of Population Health Sciences School of MedicineDuke University215 Morris StreetDurhamNC 27701USA Kilimanjaro Christian Medical University College Box 2240Moshi KilimanjaroTanzania Health Economics Unit School of Public Health and Family MedicineFaculty of Health SciencesUniversity of Cape TownOBSERVATORY 7925South Africa Duke Global Health Institute Duke UniversityDurhamNC 27708USA Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Affairs Health Care System508 Fulton StreetHSRD 152DurhamNC 27705USA Muhimbili University of Health and Allied Sciences P.0.Box 65001Dar-es-SalaamTanzania

Background:Missed clinic appointments negatively impact clinic patient flow and health outcomes of people living with HIV(PLHIV).PLHIV likelihood of missing clinic appointments is associated with direct and indirect expenditures made while accessing HIV *** objective of this study was to examine the relationship between out-of-pocket(OOP)health expenditures and the likelihood of missing ***:Totally 618 PLHIV older than 18 years attending two HIV care and treatment centres(CTC)in Northern Tanzania were enrolled in the *** attendance and clinical characteristics were abstracted from medical *** on OOP health expenditures,demographics,and socio-economic factors were self-reported by the *** used a hurdle *** first part of the hurdle model assessed the marginal effect of a one Tanzanian Shillings(TZS)increase in OOP health expenditure on the probability of having a missed appointment and the second part assessed the probability of having missed appointments for those who had missed an appointment over the study ***:Among these 618 participants,242(39%)had at least one missed clinic appointment in the past *** expenditure was not significantly associated with the number of missed clinic *** median amount of OOP paid was 5100 TZS per visit,about 7%of the median monthly *** who were separated from their partners(adjusted odds ratio[AOR]=1.83,95%confidence interval[CZ]:1.11-8.03)and those aged above 50 years(AOR=2.85,95%CI:1.01-8.03)were significantly associated with missing an *** those who had at least one missed appointment over the study period,the probability of missing a clinic appointment was significantly associated with seeking care in a public CTC(P=0.49,95%CI:0.88-0.09)and aged between>25-35 years(P=0.90,95%CI:0.11-1.69).Conclusion:Interventions focused on improving compliance to clinic appointments should target public CTCs,PLHIV aged between>

关键词： Missed clinic appointments Out-of-pocket expenditure HIV Tanzania

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Impact of Praziquantel on Schistosomiasis Infection and the Status of Proteinuria and Hematuria among School Children Living in Schistosoma mansoni-Endemic Communities in Northwestern Tanzania

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Advances in Infectious Diseases 2022年第3期12卷 448-465页

作者： Neema Kayange Benson R. Kidenya charles muiruri Bahati Wajanga Karl Reis Rune Nathaniel Philemon Baraka Revocatus Evarist Msaki John Bartlett Humphrey D. Mazigo Department of Pediatrics Weill Bugando School of Medicine Catholic University of Health and Allied Sciences Mwanza United Republic of Tanzania Department of Biochemistry and Molecular Biology Weill Bugando School of Medicine Catholic University of Health and Allied Sciences Mwanza United Republic of Tanzania Department of Population Health Sciences Duke University Durham USA Department of Internal Medicine Weill Bugando School of Medicine Catholic University of Health and Allied Sciences Mwanza United Republic of Tanzania Centre for Global Health at Weill Cornell New York USA Department of Paediatrics and Child Health Kilimanjaro Christian Medical Centre Moshi Tanzania Kilimanjaro Christian Medical University College Moshi Tanzania Department of Community Health Consultancy and Research Services Bugando Medical Centre Mwanza Tanzania Department of Epidemiology and Biostatistics Bugando Medical Centre Mwanza Tanzania Tanzania Duke Global Health Institute Duke University Durham USA Department of Medical Parasitology and Entomology Weill Bugando School of Medicine Catholic University of Health and Allied Sciences Mwanza United Republic of Tanzania

The aim of the study was to assess the effect of praziquantel (PZQ) treatment on hematuria, proteinuria and the status of eGFR following treatment in school children infected with S. mansoni. A cohort study among 6 - 13 years old children was conducted in the Lake Zone region of Tanzania to assess S. mansoni infection using a circulating cathodic antigen (CCA), Kato Kartz while urine dipstick to screen for urine protein levels and red blood cells. A blood sample was taken for every child to determine creatinine levels and later a status of estimated glomerular filtration rate (eGFR). The prevalence of S. mansoni infection was 64%, 46%, and 24% at baseline, 6 months, and 1 year respectively using CCA test. There was a 62.5% reduction in S. mansoni infection from baseline (p S. mansoni using CCA test, reductions in proteinuria, and hematuria in school children in Tanzania. There was complete remission in eGFR 2 from 3.9% to 0% at 6 months. This suggests that praziquantel is effective, but there is still a need for integrated strategies to minimize reinfections.

关键词： Impact Schistosoma mansoni School-Aged Children Tanzania

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Barriers in the Transition of Care for Heart Failure Patients Attending Clinics in Mwanza City, Tanzania

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World Journal of Cardiovascular Diseases 2023年第2期13卷 92-104页

作者： Bahati M. K. Wajanga Christine Y. Kim Brandon A. Knettel Adnan Juma Neema Kayange Evarist B. Msaki Deodatus Mabula Audax Z. Malulu Robert N. Peck John A. Bartlett charles muiruri Department of Internal Medicine Bugando Medical Centre Mwanza Tanzania Department of Internal Medicine Catholic University of Health and Allied Sciences—Bugando Mwanza Tanzania Department of Population Health Sciences Duke University School of Medicine Durham NC USA Department of Health Policy and Management University of North Carolina at Chapel Hill Chapel Hill NC USA Duke Global Health Institute Duke University Durham NC USA School of Nursing Duke University Durham NC USA Kilimanjaro Christian Medical University College Moshi Tanzania Department of Pediatrics Weill Bugando School of Medicine Catholic University of Health and Allied Sciences Mwanza United Republic of Tanzania Research and Consultancy Unit Bugando Medical Centre Mwanza Tanzania Division of Hospital Medicine Department of Internal Medicine Weill Cornell Medical College New York City USA Center for Global Health Department of Internal Medicine Weill Cornell Medical College New York City USA

Introduction: Transition of care strategies have shown to improve quality of lives of heart failure patients, but it has little implemented in clinical settings. Objective: To evaluate context-specific perceived barriers and experiences of heart failure patients during their admission and after they were discharged from hospital. Methods: A cross-sectional qualitative study was conducted among 13 heart failure patients at two large referral hospitals in northwestern Tanzania. In-depth interviews among heart failure patients, in line with the Consolidated Criteria for Reporting Qualitative research checklist, were used to collect data. Interviews were audio recorded, transcribed, and translated into English. Results: Three key barriers were identified, as well as possible solutions that could improve the transition of care for heart failure patients. These include strengthening healthcare provider communications, organizing medication management, and assisting with follow-up appointments. Conclusion: The barriers identified are real and challenging in clinical resource- limited settings. Findings suggest they can be overcome when realistic and tailor-made interventions are in place.

关键词： Heart Failure in Tanzania Barrier Transition of Care

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