Neema Mosha - Academia.edu (original) (raw)

Papers by Neema Mosha

International Journal of STD & AIDS

Background Sub-Saharan countries bear a disproportionate percentage of HIV infections and HIV-rel... more Background Sub-Saharan countries bear a disproportionate percentage of HIV infections and HIV-related deaths despite the efforts to strengthen HIV prevention and treatments services, including ART. It is important to demonstrate how these services have contributed to reducing the epidemic using available population data. Methods We estimated the prevalence and incidence rates from a cohort running over 23 years in Magu District, Mwanza Region-North West Tanzania. Adults 15 years and over who were residents of the Kisesa observational HIV cohort study between 2006 and 2016 were eligible for inclusion. Survival analysis was used to calculate person-time at risk, incidence rates and 95% confidence intervals (CIs). Cox regression models were used for the risk factor analyses disaggregated by sex and age group. Results The HIV prevalence in the sero-surveys decreased from 7.2% in 2006/07 to 6.6% in 2016, with a notable decrease of over 50% for both men and women aged 15–24 years. The inc...

Intimate partner violence (IPV) is a public health concern in Tanzania because of its prevalence ... more Intimate partner violence (IPV) is a public health concern in Tanzania because of its prevalence and documented negative effect on pregnancy outcomes. There has been limited information available in Tanzania on the relationship between IPV and women’s use of reproductive and maternal health services. This study uses data from the most recent DHS survey in Tanzania to examine the associations between IPV women’s empowerment and use of reproductive and maternal health services taking into account the effects of key sociodemographic variables. The study analyzed the data on 4471 currently married or cohabiting women age 15-49 interviewed with the domestic violence module in the 2010 Tanzania Demographic and Health Survey (TDHS). Thirty-nine percent of the women reported physical or sexual violence by their current partner at least once. Thirty percent of the women were defined as “empowered” according to participation in household decision-making. After controlling for other factors wo...

Background Population surveys and demographic studies are the gold standard for estimating HIV pr... more Background Population surveys and demographic studies are the gold standard for estimating HIV prevalence. However, non-response in these surveys is of major concern especially if it is not random and complete case analysis becomes an inappropriate method to analyse the data. Therefore, a comprehensive analysis that will account for the missing data must be used to obtain unbiased HIV prevalence estimates. MethodsSerological samples were collected from participants who were resident in a Demographic Surveillance System (DSS) in Kisesa, Tanzania. HIV prevalence was estimated using three methods. Firstly, using the Complete case analysis (CCA), assuming data were Missing Completely at Random (MCAR). The other two methods, multiple imputations (MI) and inverse probability weighting (IPW), assumed that non-response was missing at random (MAR). For MI, a logistic regression model adjusting for age, sex, residence, and marital status was used to impute 20 datasets to re-estimate the HIV p...

BMC Medical Research Methodology

Background Sero- prevalence studies often have a problem of missing data. Few studies report the ... more Background Sero- prevalence studies often have a problem of missing data. Few studies report the proportion of missing data and even fewer describe the methods used to adjust the results for missing data. The objective of this review was to determine the analytical methods used for analysis in HIV surveys with missing data. Methods We searched for population, demographic and cross-sectional surveys of HIV published from January 2000 to April 2018 in Pub Med/Medline, Web of Science core collection, Latin American and Caribbean Sciences Literature, Africa-Wide Information and Scopus, and by reviewing references of included articles. All potential abstracts were imported into Covidence and abstracts screened by two independent reviewers using pre-specified criteria. Disagreements were resolved through discussion. A piloted data extraction tool was used to extract data and assess the risk of bias of the eligible studies. Data were analysed through a quantitative approach; variables were...

PLOS ONE

Background Dyslipidemia is a leading risk factor for atherosclerotic cardiovascular disease. Ther... more Background Dyslipidemia is a leading risk factor for atherosclerotic cardiovascular disease. There are few published epidemiological data regarding dyslipidemia in Africa. We determined full lipid and apolipoprotein profiles and investigated factors associated with lipid levels in urban and rural populations of northwestern Tanzania and southern Uganda. Methods We conducted a cross-sectional survey of randomly-selected, community-dwelling adults (�18yrs) including five strata per country: one municipality, two district towns and two rural areas. Participants were interviewed and examined using the World Health Organization STEPwise survey questionnaire. Serum levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, and apolipoproteins were measured. Factors associated with mean lipid levels were assessed by multivariable linear regression. Framingham 10-year cardiovascular risk scores were calculated with and without lipids. Results One-third of adults in the study population had dyslipidemia. Low high-density lipoprotein cholesterol affected 32-45% of rural adults. High total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B were found in <15% of adult population in all strata, but were more common in urban adults. Factors independently associated with higher mean low-density lipoprotein cholesterol and apolipoprotein B were female gender, older age,

PloS one, 2017

Fever in malaria endemic areas, has been shown to strongly predict malaria infection and is a key... more Fever in malaria endemic areas, has been shown to strongly predict malaria infection and is a key symptom influencing malaria treatment. WHO recommended confirmation testing for Plasmodium spp. before initiation of antimalarials due to increased evidence of the decrease of morbidity and mortality from malaria, decreased malaria associated fever, and increased evidence of high prevalence of non-malaria fever. To immediately diagnose and promptly offer appropriate management, caretakers of children with fever should seek care where these services can be offered; in health facilities. This study was conducted to describe healthcare seeking behaviors among caretakers of febrile under five years, in Tanzania. And to determine children's, household and community-level factors associated with parents' healthcare seeking behavior in health facilities. Secondary data analysis was done using the Tanzania HIV and Malaria Indicator Surveys (THMIS) 2011-2012. Three-level mixed effects lo...

Tropical medicine & international health : TM & IH, Feb 1, 2017

Measurement of respiratory rate is an important clinical sign in the diagnosis of pneumonia but s... more Measurement of respiratory rate is an important clinical sign in the diagnosis of pneumonia but suffers from interobserver variation. Here, we assess the use of video recordings as a quality assurance tool that could be useful both in research and in training of staff. Respiratory rates (RR) were recorded in children aged 2-59 months presenting with cough or difficulty breathing at two busy outpatient clinics in Tanzania. Measurements were repeated at 10-min intervals in a quiet environment with simultaneous video recordings that were independently reviewed by two paediatricians. Eight hundred and fifty-nine videos were sent to two paediatricians; 148 (17.2%) were considered unreadable by one or both. For the 711 (82.8%) videos that were readable by both paediatricians, there was perfect agreement for the presence of raised RR with a kappa value (κ) of 0.85 (P < 0.001); and in 476 (66.9%) cases, both paediatricians agreed on the RR within 2 breaths per minute (±2 bpm). A reported...

Asian Pacific Journal of Reproduction, 2016

Abstract Objective To determine the trend, causes and characteristics of maternal deaths in a ter... more Abstract Objective To determine the trend, causes and characteristics of maternal deaths in a tertiary hospital in Northern Tanzania. Methods A descriptive retrospective review of hospital based maternal death data that occurred at Kilimanjaro Christian Medical Center (KCMC) between the years 2003–2012. Descriptive statistics were used to summarize the socio-demographic characteristics, causes and risk factors for maternal deaths using STATA version 12. Yearly maternal mortality ratio (MMR) was calculated to estimate the trend over years under the review. Results Between years 2003–2012, a total of 34 953 live deliveries and 172 maternal deaths were recorded at KCMC, giving an overall MMR of 492.1/100 000 live deliveries. Direct causes accounted for 107 (62.2%) of maternal deaths, indirect causes 49 (28.5%) and 16 (9.3%) were due to both direct and indirect causes. Hemorrhage was the overall leading cause of maternal death, accounting for 33 (19.2%) of mortality, followed by hypertensive disorders in pregnancy 31 (18.0%). HIV/AIDS and Heart diseases accounted for 8.7% and 6.4% of maternal deaths, and were the leading causes of indirect maternal deaths by contributing 31% and 22% respectively. Majority 67 (38.9%) of deaths were attributed to type II delay followed by type I delay 59 (34.3%). Conclusion MMR is still very high in northern Tanzania with hemorrhage and hypertensive diseases the major preventable causes of deaths. Efforts must be made at the community, lower and tertiary health facilities to improve risk detection, management of risk cases to prevent severe forms of diseases and ensure timely referrals.

Tropical Medicine & International Health, 2015

objective Cough or difficult breathing and an increased respiratory rate for their age are the co... more objective Cough or difficult breathing and an increased respiratory rate for their age are the commonest indications for outpatient antibiotic treatment in African children. We aimed to determine whether respiratory rate was likely to be transiently raised by a number of contextual factors in a busy clinic leading to inaccurate diagnosis. methods Respiratory rates were recorded in children aged 2-59 months presenting with cough or difficulty breathing to one of the two busy outpatient clinics and then repeated at 10-min intervals over 1 h in a quiet setting. results One hundred and sixty-seven children were enrolled with a mean age of 7.1 (SD AE 2.9) months in infants and 27.6 (SD AE 12.8) months in children aged 12-59 months. The mean respiratory rate declined from 42.3 and 33.6 breaths per minute (bpm) in the clinic to 39.1 and 32.6 bpm after 10 min in a quiet room and to 39.2 and 30.7 bpm (P < 0.001) after 60 min in younger and older children, respectively. This resulted in 11/13 (85%) infants and 2/15 (13%) older children being misclassified with non-severe pneumonia. In a random effects linear regression model, the variability in respiratory rate within children (42%) was almost as much as the variability between children (58%). Changing the respiratory rates cutoffs to higher thresholds resulted in a small reduction in the proportion of non-severe pneumonia mis-classifications in infants. conclusion Noise and other contextual factors may cause a transient increase in respiratory rate and consequently misclassification of non-severe pneumonia. However, this effect is less pronounced in older children than infants. Respiratory rate is a difficult sign to measure as the variation is large between and within children. More studies of the accuracy and utility of respiratory rate as a proxy for non-severe pneumonia diagnosis in a busy clinic are needed. keywords pneumonia, respiratory rate, children, Integrated

The Lancet Global Health

Background Globally, about 30% of women have experienced physical or sexual violence, or both, fr... more Background Globally, about 30% of women have experienced physical or sexual violence, or both, from an intimate partner during their lifetime. Associations between poverty and women's increased risk of intimate partner violence have been observed. We therefore aimed to assess the effect of a violence prevention intervention delivered to women participating in a group-based microfinance scheme in Tanzania. Methods We did a cluster randomised controlled trial among women taking part in a microfinance loan scheme in Mwanza city, Tanzania. A microfinance loan group was only enrolled if at least 70% of members consented. We randomly assigned the microfinance groups in blocks of six to receive either the intervention (ie, the intervention arm) or be wait-listed for the intervention after the trial (ie, the control arm). Women in both arms of the trial met weekly for loan repayments. Only those in the intervention arm participated in the ten-session MAISHA intervention that aims to empower women and prevent intimate partner violence. Given the nature of the intervention, it was not possible to mask participants or the research team. The primary outcome was a composite of reported past-year physical or sexual intimate partner violence, or both. Secondary outcome measures were past-year physical, sexual, and emotional intimate partner violence; acceptability and tolerance of intimate partner violence; and attitudes and beliefs related to intimate partner violence. These outcomes were assessed 24 months after the intervention. An intention-to-treat analysis was done, adjusting for age, education, and baseline measure of the respective outcome. The study is registered with ClinicalTrials.gov, number NCT02592252. Findings Between September, 2014, and June, 2015, 66 (65%) of 101 microfinance groups approached in the study area met the trial eligibility criteria and were enrolled, of which 33 (n=544 women) were allocated to the intervention arm and 33 (n=505 women) to the control arm. Overall, 485 (89%) of 544 women in the intervention arm and 434 (86%) of 505 in the control arm completed the outcomes assessment. Among the intervention arm, 112 (23%) of 485 women reported past-year physical or sexual intimate partner violence, or both, compared with 119 (27%) of 434 in the control arm (adjusted odds ratio [aOR] 0•69, 95% CI 0•47-1•01; p=0•056). Women in the intervention arm were less likely to report physical intimate partner violence (aOR 0•64, 95% CI 0•41-0•99; p=0•043) and were less likely to express attitudes accepting of intimate partner violence (0•45, 0•34-0•61; p<0•0001) or beliefs that intimate partner violence is a private matter (0•51, 0•32-0•81; p=0•005) or should be tolerated (0•68, 0•45-1•01; p=0•055). There was no evidence of an effect on reported sexual or emotional intimate partner violence. There were no reports that participation in the trial had led to new episodes of violence or worsening of ongoing violence and abuse. Interpretation Reported physical or sexual intimate partner violence, or both, was reduced among women who participated in the intervention arm, although the effect was greater for physical intimate partner violence, suggesting that intimate partner violence is preventable in high-risk settings such as Tanzania. Funding Anonymous donor and STRIVE Consortium.