Tanzania Journal of Health Research https://www.ajol.info/index.php/thrb <p class="MsoNormal" style="margin: 0in 0in 0pt;"> </p><p class="MsoNormal" style="margin: 0in 0in 0pt; text-align: justify;"><em style="mso-bidi-font-style: normal;"><span style="font-size: 10pt;" lang="EN-GB">Tanzania</span></em><em style="mso-bidi-font-style: normal;"><span style="font-size: 10pt;" lang="EN-GB"> Journal of Health Research</span></em><span style="font-size: 10pt;" lang="EN-GB"> (<em style="mso-bidi-font-style: normal;">TJHR</em>) aims to facilitate the advance of health sciences by publishing high quality research and review articles that communicate new ideas and developments in biomedical and health research. TJHR is a peer reviewed journal and is open to contributions from both the national and the international communities. </span></p><p class="MsoNormal" style="margin: 0in 0in 0pt; text-align: justify;"><span style="font-size: 10pt;" lang="EN-GB"> </span></p><p class="MsoNormal" style="margin: 0in 0in 0pt;"><em style="mso-bidi-font-style: normal;"><span style="font-size: 10pt;" lang="EN-GB">TJHR</span></em><span style="font-size: 10pt;" lang="EN-GB"> is published quarterly in January, April, July and October as an organ of the Tanzania Health Research User’s Trust Fund</span></p><p class="MsoNormal" style="margin: 0in 0in 0pt;"><span style="font-size: 10pt;" lang="EN-GB"><br /></span></p><p class="MsoNormal" style="margin: 0in 0in 0pt;"><span style="font-size: 10pt;" lang="EN-GB">Other websites associated with this journal: <a title="http://www.bioline.org.br/toc?id=th" href="http://www.bioline.org.br/toc?id=th" target="_blank">http://www.bioline.org.br/toc?id=th</a><br /></span></p> National Institute for Medical Research en-US Tanzania Journal of Health Research 1821-6404 Copyright for articles published in this journal is retained by the journal. Aetiology, patterns and treatment modalities of paediatric fractures at Bugando Medical Centre, Mwanza, Tanzania https://www.ajol.info/index.php/thrb/article/view/230660 <p><strong>Background</strong>: Pediatric fractures are increasingly being recognized as a major public health problem worldwide. Little information is currently available on this type of injury in our local environment as there is a paucity of published data on this subject. &nbsp;This study aimed to determine the aetiological spectrum, patterns and treatment modalities of pediatric fractures at Bugando Medical Centre. The study provides baseline local data for the establishment of prevention strategies as well as treatment guidelines.</p> <p><strong>Methods</strong>: This was a cross-sectional study of pediatric patients presenting with long bone fractures at Bugando Medical Centre from January 2019 to July 2019. Ethical clearance was sought from the relevant authorities before the commencement of the study.</p> <p><strong>Results</strong>: A total of 111 pediatric trauma patients (M: F ratio = 1.2: 1) with fractures were studied. The age peak incidence at presentation was 5-10 years accounting for 48.6% of cases. The majorities of the fractures (46.8%) were due to falls and commonly occurred at home (48.6%). Upper limb fractures predominated (57.7%) with the majority involving the supracondylar of the humerus (50.5%). Open fractures were observed in 15 (13.5%) cases and all of them were Gustillo-type II. Only 7 (6.3%) patients received pre-hospital care. The majority of the patients, 74 (66.7%) were treated surgically mainly with open reduction and internal fixation accounting for 53.2% of cases.</p> <p><strong>Conclusion: </strong>This study demonstrated that the majority of pediatric fractures in our setting occur due to falls around the home environment and commonly affect children aged 5-10 years. The most common site of fracture was the humerus, most involving the supracondylar. Preventive strategies targeting reducing the occurrence of fall injuries in children are necessary to reduce the occurrence of pediatric fractures in this region.</p> <p>&nbsp;</p> <p>&nbsp;</p> Danny F Matari Isdor H. Ngayomela Nkinda Mbelenge Inyasi L. Akaro Phillipo L. Chalya Copyright (c) 2023 Tanzania Journal of Health Research 2023-01-01 2023-01-01 24 1 1 10 10.4314/thrb.v24i1. HIV treatment outcomes and their associated factors among adolescents and youth living with HIV in Tanzania https://www.ajol.info/index.php/thrb/article/view/236072 <p><strong>Introduction:</strong>&nbsp; Despite improvements in access to Ante-Retroviral therapy in Tanzania, low ART initiation rate, low retention rate, lower viral load suppression, high loss to follow up and death rate among adolescents and youth living with HIV remain a challenge.&nbsp; This study was conducted to identify factors affecting HIV treatment outcomes among adolescents and youths.</p> <p><strong>Methods</strong><strong>:</strong> A cross-sectional study was done in seven regions in Tanzania. A total of 1124 in and out of school ALYHIV were interviewed using a semi-structured questionnaire.</p> <p><strong>Results:</strong></p> <p>A total of 1120(99.6%) participants were on ART. Of those who were on ART, 606 (53.9%) participants had advanced HIV disease, 423(37.6 %) had switched to the second line of ART and 1761(7.7%) had a virological failure. After adjusting for confounders, death of both parents (APR= 1.3, 95%CI: 1.01-1.8); regions with high HIV prevalence (APR= 1.7, 95%CI: 1.2-2.3) and taking ARVs for three years and less (APR= 2.2, 95%CI: 1.4-3.6) were associated to have advanced HIV. Additionally, HIV regional prevalence level, level of perception, adherence status, ARV storage and supervision of ART use were independently associated with Virological failure. &nbsp;&nbsp;</p> <p><strong>Conclusion:</strong> This study has shown that despite an almost universal utilization of ART among adolescents and youth living with HIV unfavourable clinical ART outcomes such as advanced HIV disease, virological failure and ART switch to the second line remain a challenge, particularly among males and adolescents. Various factors at individual, community and health facility levels contribute to unfavorable ART clinical outcomes among AYLHIV. Therefore, an all-inclusive multidimensional and multi- stakeholders’ approach is needed to ensure the availability of sustainable, effective and quality care and treatment services prioritizing AYLHIV.&nbsp;</p> Doreen Philbert Judith Msovela Dorica Burengelo Frank Eric Hassan Caritas Kitinya Grace Soka Gibson Kagaruki Francis N Donard Anath Rwebembera Boniface Silvan Mastidia Rutaihwa Casiana Sanga Theresia Mwombeki Amani Wilfred Mbazi Senkoro William Kisoka Sayoki Mfinanga Esther Ngadaya Godfather Kimaro Amos Kahwa Copyright (c) 2023 Tanzania Journal of Health Research 2023-01-01 2023-01-01 24 1 1 14 10.4314/thrb.v24i1. Prevalence and determinants of overweight and obesity among school children in Morogoro region, Tanzania https://www.ajol.info/index.php/thrb/article/view/229021 <p><strong>Backgroun</strong>d<strong>:</strong> Being overweight and obese involve health risks as well as possible consequences for individuals’ and communities’ social and economic well-being. It was previously considered an adult health concern, but it is now seen among children. This study aimed to determine the prevalence and determinants of overweight and obesity among school children in rural and urban areas of Morogoro region, Tanzania.</p> <p><strong>Methods:</strong> A cross-sectional study was conducted on a total of 335 parent/caregiver-child pairs, of whom 165 were from Kilosa (rural) and 170 from Morogoro (urban) districts. The main sampling unit was registered primary schools which were stratified according to ownership, whether private or government, and sampled separately. A total of four private and four public schools were sampled, two of each of the categories in each of the locations. Weight and height were measured using standard procedures and Body Mass Index (BMI) was determined. Socio-demographic information was collected using a questionnaire with structured questions. A statistical package for social sciences version 21 was used to analyze data and a regression model was used to explore the determinants of overweight and obesity.</p> <p><strong>Results:</strong> The ages of the studied children ranged from 7 to 12 years, while those of the parents/caregivers ranged from 18 to 72 years. About 19% (n=63) of the school children were overweight or obese, while 3.9% (n=13) were underweight. The prevalence of overweight/obesity was higher among private school students than in public schools 36(24.8%) vs 27(14.2%) and more or less similar prevalence’s were observed among rural (17.6%, n=34) and urban (20.0%, n=29) settings. In a multivariate analysis, eating breakfast before going to school is associated with overweight/obesity (AOR 2.23, 95% CI: 1.06-4.68). Other factors associated with overweight/obesity were school type (AOR 1.19, 95% CI: 1.55-2.60), household daily income (AOR 1.88, 95% CI: 1.68-3.15) (AOR 2.89, 95% CI: 1.76-4.11).</p> <p><strong>Conclusion:</strong> In conclusion, the prevalence of overweight and obesity among school children was high, while underweight was very low. The prevalence of overweight/obesity was similar in rural and urban children, indicating a nutritional transition. The potential risk factors associated with being overweight or obese were school type, household daily income, provision of breakfast and being given money to buy something to eat at school. Therefore, nutrition and healthy lifestyle education should be integrated into school programs to reduce the risk of developing diseases associated with being overweight or obese.</p> Elina Stanley Muhomba Safiness Simon Msollo Akwilina Wendelin Mwanri Copyright (c) 2023 Tanzania Journal of Health Research 2023-01-01 2023-01-01 24 1 1 10 10.4314/thrb.v24i1. Assessment of spatial distribution and accessibility level of healthcare facilities from 1990 to 2020; a case of Morogoro municipality, Tanzania https://www.ajol.info/index.php/thrb/article/view/227649 <p><strong>Background:</strong> About 1.3 billion people worldwide have no reliable access to healthcare facilities and the majority of these people are residents of Developing Nations including Tanzania. The distribution of most healthcare facilities in urban areas of developing countries is characterized by location disparity. This has given rise to geographic inequality. Healthcare facilities are essential for service provision in urban areas Unfortunately these services are inadequately found in people’s settlements. The aim of this study was to assess the spatial distribution and accessibility level of healthcare facilities for a period of 30 years in an urban area.</p> <p><strong>Methods: </strong>Satellite imageries incorporate supervised classification and Kappa Index of Agreement methods were used to determine urban expansion over 30 years study period. A handheld global position system was used to geo-reference the coordinates locations of all healthcare facilities. Face-to-face interview with municipality health officers and facility in-charges was conducted to know the historical background information of healthcare facilities. The distribution and accessibility level of healthcare facilities was determined by buffering analysis in the ArchGIS program incorporated with WHO standards.</p> <p><strong>Results:</strong> From 1990 to 2020 built-up land increased from 3.9% to 18.9% and none built up land decreased from 96.1% to 81.9% of the total urban area of Morogoro municipality. A total number 69 of healthcare facilities location points were collected where 48 (69.6%) are dispensaries, 17 (24.6%) are health centres and 4 (5.8%) are hospitals<em>. </em>Out of the 69 healthcare facilities that are in existence, 79% are private institutions and 21% are government owned. Healthcare facilities accessibility decreased from 79.86% to 45.6% covering urban settlements area.</p> <p><strong>Conclusion</strong>. Despite urban settlements expansion and an increase in the number of healthcare facilities still, there is decrease in the accessible urban area to healthcare facilities. It is evident from the locations of the existing facilities that proper consultation and analysis were not carried out. The new health facilities must be located in underserved areas within urban settlements. Such planned facilities are required to be located and distributed according to geographic distance and population standards per health facility.</p> Godwin Mshana Proches Hieronimo Boniface Mbilinyi Copyright (c) 2023 Tanzania Journal of Health Research 2023-01-01 2023-01-01 24 1 1 13 10.4314/thrb.v24i1. Diagnostic value of pneumoperitoneum on plain abdominal film in patients with suspected visceral perforation at Bugando Medical Centre, Mwanza, Tanzania https://www.ajol.info/index.php/thrb/article/view/205348 <p><strong>Background:&nbsp; </strong>The presence of pneumoperitoneum on plain abdominal film has been widely used in many centres in Tanzania as primary diagnostic imaging in patients with suspected visceral perforation. However, its diagnostic value has not yet been assessed in any hospital in the country including Bugando Medical Centre (BMC), and therefore its use as a diagnostic tool in these patients is not justified. This existing knowledge gap prompted the author to conduct this study. The study aimed to determine the diagnostic value of pneumoperitoneum on plain abdominal film in patients with suspected visceral perforation in our local setting.</p> <p><strong>Methods:</strong> This was a prospective cross-sectional study among patients with suspected visceral perforation at BMC from June 2017 to May 2018. Pneumoperitoneum on plain abdominal radiography was evaluated, and the findings were cross-tabulated against operative findings, the gold standard. Then, the sensitivity, specificity, accuracy, Positive Predictive Value, Negative Predictive Value and accuracy were calculated to determine the diagnostic value of pneumoperitoneum on plain abdominal film. The Kappa statistic (қ) was calculated to determine the degree of agreement with operative findings.</p> <p><strong>Results:</strong> A total of 132 patients were studied. The median age of patients was 35 years. The diagnostic accuracy of pneumoperitoneum on plain abdominal film in the detection of perforation was 90.9% with sensitivity, specificity, PPV and NPV of 90.1%, 92.7%, 96.5% and 80.9% respectively. There was good agreement with operative findings (κ = 0.86). The perforations of the ileum, gastric, duodenum, colon and appendix accounted for 36.3%, 22.0%, 19.8%, 11.0% and 11.0% of cases, respectively. The sensitivity, specificity, PPV, NPV and accuracy perforations of the ileum, gastric, duodenum, colon and appendix were 61.5-100%, 31.7-46.5%, 10.6-37.7%, 85.1-100% and 38.6-59.1% respectively.&nbsp; The kappa statistics showed good agreement with the operative findings (ķ = 0.76-0.89).</p> <p><strong>Conclusion: </strong>The presence of pneumoperitoneum on plain abdominal film provides high diagnostic value in the detection of visceral perforation and can be employed at BMC to improve the diagnostic value in patients with suspected visceral perforation and subsequently reduce negative laparotomy and complication rates<strong>. </strong></p> Phillipo Leo Chalya Johnson N Mrema Godfrey Kisanga Fabian Massaga Leonard Washington William Mahalu Copyright (c) 2023 Tanzania Journal of Health Research 2023-01-01 2023-01-01 24 1 1 10 10.4314/thrb.v24i1. Nutrition governance at the sub-national level in Tanzania: a case of Morogoro municipality and district councils. https://www.ajol.info/index.php/thrb/article/view/231996 <p><strong>Introduction</strong>: Nutrition governance has been proven to be a relevant approach to improving nutrition services in developing countries. Tanzania has adopted it since 2011, but limited studies have been done. This study examines nutrition governance through government commitment to nutrition budget and nutrition coordination.</p> <p><strong>Methods:</strong> The study was cross-sectional, and conducted in two councils of Morogoro district. It involved the review of documents and interviews with 140 respondents, and a semi-structured questionnaire and checklist tools were used. Content analysis and the Excel database were used for the analysis.</p> <p><strong>Results:</strong> From this study, it was revealed that nutrition budget planning and spending based on own sources are not matched and spending has been low in rural councils. For the nutrition coordination, at the council level, the meetings were held as required but still faced the problem of attendance of core members and follow-up of the standard agendas. At the sub-council level inclusion of nutrition as a standing agenda in the ward and village/street development committee meetings quarterly has been less than 50%.</p> <p><strong>Conclusion:</strong> Therefore, nutrition budget provisions such as subsidies, especially to the rural council, committee member sensitization, capacity building, and investment in the ward/village/street development committees could accelerate nutrition governance thus improving nutrition intervention.</p> Ester Kawishe Nyamizi Bundala John Msuya Copyright (c) 2023 Tanzania Journal of Health Research 2023-01-01 2023-01-01 24 1 1 8 10.4314/thrb.v24i1. Analysis of recent evolution of healthy life expectancy in the MENA region, Algeria https://www.ajol.info/index.php/thrb/article/view/229190 <p><strong>Introduction</strong></p> <p>Healthy life expectancy is a significant indicator for assessing a population’s health status. It guides policymakers in designing efficient prevention strategies and global health programs. Furthermore, it enables comparisons of health status over time and space.</p> <p><strong>Methods</strong></p> <p>This paper examines the recent evolution of healthy life expectancy in the MENA region over the last two decades using the data from the Global Burden of Disease and some independent studies. Algeria has been given special consideration.</p> <p><strong>Results</strong></p> <p>The findings reveal two facts. First, while women live longer lives than men, men live healthier lives. Second, the MENA region is globally experiencing an expansion of morbidity. Nevertheless, Algeria enjoys better health conditions than the majority of MENA countries.</p> <p><strong>Conclusion</strong></p> <p>In the MENA region, there is a evident lack of data and research on healthy life expectancy. Thus, MENA countries are encouraged to strengthen their health information systems and provide independent national estimates of healthy life expectancy.</p> Meryem Chinoune Farid Flici Ghania Saidi Copyright (c) 2023 Tanzania Journal of Health Research 2023-01-01 2023-01-01 24 1 1 10 10.4314/thrb.v24i1. Length of stay of pneumonia patients associated with comorbid and complications factors in referral National Infectious Diseases Hospital https://www.ajol.info/index.php/thrb/article/view/224713 <p><strong>Introduction:</strong> The length of stay for hospitalized pneumonia patients is influenced by various factors. The study aims to describe the relationship between factors that can cause prolonged hospital stays, complications such as metabolic disorders and electrolyte imbalance and comorbidities.</p> <p><strong>Method:</strong> This study is a cross-sectional study, using total sampling with purposive sampling methods to meet the inclusion criteria. The data was taken from the medical record of adult hospitalized pneumonia patients from 1 January 2015 to 31 December 2017 in the Referral Infectious Diseases Hospital Prof. Dr Sulianti Saroso Jakarta.</p> <p><strong>Results:</strong> There were 316 hospitalized pneumonia patients enrolled in the study, most patients were 56-65 years old (29.4%). There 228 of 316 (72.2%) had comorbid and 118 of 316 (37.3%) had a complication. The most common complication was metabolic disorders of plasma proteins (31%) and electrolyte imbalance (46%). Meanwhile, patients who had comorbid complications were 95 of 316 (30.1%). The number of patients treated ≤ 10 days, with comorbid 178 of 228 patients (78.1%) and without comorbidities 82 of 88 patients (93.2%) (p-value = 0.003). There were 175 out of 198 patients (88.4%) patients without complications and treated ≤ 10 days. While pneumonia patients with complications, 85 of 118 patients (72.0%) were treated for 10 days (p-value = 0,000). 65 of 95 (68.4%) patients with both comorbid and complications, were treated for ≤ 10 days. Whereas patients with one comorbidity or complications or none, 195 of 221 (88.2%) patients were treated ≤ 10 days (p-value = 000).</p> <p><strong>Conclusion:</strong> The most common comorbid found in this study was hypertension (15.3%). The most common complication found was metabolic disorders such as electrolyte imbalance (46%). The length of stay for patients without comorbid and or complications was ≤ 10 days or less.</p> Pompini Agustina Sitompul Roza Indriani Vivi Setiawaty Copyright (c) 2023 Tanzania Journal of Health Research 2023-01-01 2023-01-01 24 1 1 5 10.4314/thrb.v24i1. Community-based HIV services during Differentiated Service Delivery Models: a cross-sectional survey from nine regions in Tanzania https://www.ajol.info/index.php/thrb/article/view/235902 <p><strong>Introduction: </strong>To combat the HIV epidemic and reach the 90-90-90 goals, community-based HIV/AIDS services (CHBS) plays a great role. However, how well CHBS works in the era of adopting differentiated service delivery models for care and treatment has not been adequately evaluated. We hence assessed CBHS programs implemented by various partners with a focus on the coverage; program needs; linkage and referral process; consistent use of guidelines and training curricula and challenges faced by providers and clients.</p> <p><strong>Methods:</strong> It was a cross-sectional study conducted in July 2020 in 9 regions using both quantitative and qualitative methods. Quantitative data were analyzed using STATA version 12 and qualitative data were managed using Thematic Content Analysis.</p> <p><strong>Results: </strong>26 implementing partners were offering CBHS in biomedical, behavioral, and structural areas. Their focus was on PLHIV, orphans, and key and vulnerable populations<em>. </em>The majority of PLHIV had a positive perception of different CBHS. Key factors in the perceived effectiveness of community HIV services were the consistent use and availability of guidelines and training curricula, standard operating procedures, and readiness of essential commodities and supplies. Out of 1391 PLHIV who were involved, 67.4% and 25.0% were tested at the health facility and communities respectively. About 69.8% were referred after confirming their seropositivity and forms were not given to about 57.5% when referred from health facilities to communities for CBHS. There was a deficit of 45% in health workers across different cadres, a deficit in all categories of supplies and equipment example the HIV test kit by 53.8%. Challenges for CBHS included financial hindrances, HIV-related stigma, and discrimination, distance to health facilities, and poor incentives for community health workers.</p> <p><strong>Conclusion:</strong> it is important to address HIV-related stigma hence accelerating efforts to limit the spread of the HIV epidemic in the respective communities.</p> Prince Mutalemwa Frank Eric Esther Ngadaya Albert Chagula Veneranda Masatu Bwana Clara Lubinza Lubinza William Kisoka Bonaventura Mpondo Anath Rwebembera Doris Mbata Mtumwa Bakari Gibson Kagaruki Godfather Kimaro Amos Kahwa Copyright (c) 2023 Tanzania Journal of Health Research 2023-01-01 2023-01-01 24 1 1 14 10.4314/thrb.v24i1. Household socio-economic status and the risk of HIV infection among under five-year children in Muheza district, north-eastern Tanzania https://www.ajol.info/index.php/thrb/article/view/230690 <p><strong>Background: </strong>There are pieces of evidence of the association between socioeconomic factors and HIV prevalence in sub-Saharan Africa. However, there is a dearth of information on such a relationship in Tanzania.</p> <p><strong>Objective: </strong>To determine the relationship between household socioeconomic factors and HIV prevalence among under five-year children in Muheza district, Tanzania.</p> <p><strong>Methods:</strong> A facility-based study among HIV-exposed children with their respective mothers/guardians was conducted from June 2015 to June 2016. Information on the HIV status of the child and household socio-demographic characteristics were analyzed in the STATA version 13.0.</p> <p><strong>Results: </strong>A total of 576 child-mother/guardian pairs were interviewed. Sixty-one (10.6%) children were confirmed to be HIV positive. The odds of HIV infection were found to be lower among children belonging to the heads of households with secondary and high levels of education (AOR = 0.5, 95% CI 0.2-0.9); <em>P</em>=0.04, those living in wealthier households (AOR = 0.5, 95% CI &nbsp;0.3-0.9; <em>P</em>=0.03) and those whose mothers/guardians had good knowledge of HIV &nbsp;(AOR = 0.2, 95% CI 0.1-0.3; <em>P</em>&lt;0.001) compared to their counterparts.</p> <p><strong>Conclusion: </strong>Children with heads of households having high educational levels and those from wealthier households were associated with reduced odds of acquiring HIV infection in Muheza district.</p> Veneranda Bwana Edgar Simulundu Leonard Mboera Sayoki Mfinanga Charles Michelo Copyright (c) 2023 Tanzania Journal of Health Research 2023-01-01 2023-01-01 24 1 1 13 10.4314/thrb.v24i1. Readiness of public healthcare facilities on the management and referral of pre-eclampsia in Zanzibar https://www.ajol.info/index.php/thrb/article/view/229338 <p><strong>Background:</strong> Proper management of pre-eclampsia/eclampsia depends on the availability of well-functioning healthcare facilities. A significant number of women with pre-eclampsia in Zanzibar are referred late and most end up with eclampsia or even death. This raised a concern about whether healthcare facilities are prepared enough for the management of pre-eclampsia/eclampsia.</p> <p><strong>Objectives:</strong> To assess the readiness of public healthcare facilities for the management and referral of pre-eclampsia/eclampsia.</p> <p><strong>Methods: </strong>A descriptive cross-sectional study was conducted in Zanzibar targeting all public healthcare facilities. A sample of 54 healthcare facilities of all levels was randomly selected. Physical observation, questionnaire and review of hospital records were used for data collection. Descriptive statistics were used for analysis.</p> <p><strong>Results: </strong>National, regional and district hospitals have all the required equipment, supplies and drugs by 100% compared to primary healthcare units where a significant shortage was observed in equipment [working oxygen cylinder 1(2.1%), strips for proteinuria 25(54.3%)], drugs [diazepam 11(23.9%) and magnesium sulphate 14(30.4%)], test [urine for protein test 29(63%)], knowledgeable healthcare providers 46(38.8%) and skilled healthcare providers 47(39.8%). All primary health care units had clear criteria for referring a patient with pre-eclampsia, but only 19(41.3%) provide pre-referral treatment and only 17(36.9%) had vehicles for transporting the referred patient.</p> <p><strong>Conclusion:</strong> There is a huge shortage of resources in lower healthcare facility levels where most pregnant women have their initial contact. Necessary measures should be taken to well-equip primary healthcare units to improve their capability to proper diagnosis, manage and timely referral of patients with pre-eclampsia.</p> Saada Ali Seif Salma Ali Rashid Copyright (c) 2023 Tanzania Journal of Health Research 2023-01-01 2023-01-01 24 1 1 13 10.4314/thrb.v24i1.