BACKGROUND & AIMS: Background:Point-of-care (PoC) systems for early infant diagnosis (EID) may improve timely infant human immunodeficiency virus (HIV) management. Experiences within African public health settings are limited. Methods:We evaluated the accuracy and operational feasibility of the Xpert HIV-1 Qual for PoC-EID testing, using fresh blood and dried blood spots (DBS) samples at obstetric health facilities in Tanzania at birth and at postpartum weeks 1, 2, 3, and 6 in HIV-exposed infants. Test results were confirmed using TaqMan DBS HIV-deoxyribonucleic acid and/or plasma HIV-ribonucleic acid (RNA) testing. Results:At week 6, 15 (2.5%) out of 614 infants were diagnosed with HIV; 10 (66.7%) of them at birth (median HIV-RNA 4570 copies/mL). At birth, the Xpert-PoC and Xpert-DBS were 100% sensitive (95% confidence intervals: PoC, 69.2-100%; DBS, 66.4-100%) and 100% specific (PoC, 92.1-100%; DBS, 88.4-100%). By week 3, 5 infants with intra/postpartum HIV-infection (median HIV-RNA 1 160 000 copies/mL) were all correctly diagnosed by Xpert. In 2 cases, Xpert-PoC testing correctly identified HIV-infection when DBS tests (Xpert and TaqMan) were negative, suggesting a greater sensitivity. In 2 infants with confirmed HIV at birth, all tests were negative at week 6, possibly because of viral suppression under nevirapine prophylaxis. Problems were reported in 183/2736 (6.7%) of Xpert-PoC tests, mostly related to power cuts (57.9%). Conclusions:We demonstrated excellent Xpert HIV-1 Qual performance and good operational feasibility for PoC-EID testing at obstetric health facilities. Week 6 sensitivity issues were possibly related to nevirapine prophylaxis, supporting additional birth PoC-EID testing to avoid underdiagnosis. Clinical Trials Registration:NCT02545296.

背景与目标：

BACKGROUND & AIMS: :There are striking similarities in health system and other contexts between Tanzania and Ghana that are relevant to the scaling up of continuous delivery of insecticide treated nets (ITNs) for malaria prevention. However, specific contextual factors of relevance to ITN delivery have led implementation down very different pathways in the two countries. Both countries have made major efforts and investments to address this intervention through integrating consumer discount vouchers into the health system. Discount vouchers require arrangements among the public, private and non-governmental sectors and constitute a complex intervention in both health systems and business systems. In Tanzania, vouchers have moved beyond the planning agenda, had policies and programmes formulated, been sustained in implementation at national scale for many years and have become as of 2012 the main and only publicly supported continuous delivery system for ITNs. In Ghana national-scale implementation of vouchers never progressed beyond consideration on the agenda and piloting towards formulation of policy; and the approach was replaced by mass distribution campaigns with less dependency on or integration with the health system. By 2011, Ghana entered a phase with no publicly supported continuous delivery system for ITNs. To understand the different outcomes, we compared the voucher programme timelines, phases, processes and contexts in both countries in reference to the main health system building blocks (governance, human resources, financing, informatics, technologies and service delivery). Contextual factors which provided an enabling environment for the voucher scheme in Tanzania did not do so in Ghana. The voucher scheme was never seen as an appropriate national strategy, other delivery systems were not complementary and the private sector was under-developed. The extensive time devoted to engagement and consensus building among all stakeholders in Tanzania was an important and clearly enabling difference, as was public sector support of the private sector. This contributed to the alignment of partner action behind a single co-ordinated strategy at service delivery level which in turn gave confidence to the business sector and avoided the 'interference' of competing delivery systems that occurred in Ghana. Principles of systems thinking for intervention design correctly emphasize the importance of enabling contexts and stakeholder management.

背景与目标： : 坦桑尼亚和加纳在卫生系统和其他情况下有惊人的相似之处，这些相似之处与扩大持续提供杀虫剂处理过的蚊帐 (itn) 以预防疟疾有关。但是，与ITN交付相关的特定背景因素导致两国的实施途径截然不同。两国通过将消费折扣券纳入卫生系统，为解决这一干预措施做出了重大努力和投资。折扣券需要公共、私营和非政府部门之间的安排，是对卫生系统和商业系统的复杂干预。在坦桑尼亚，凭单已经超出了规划议程，制定了政策和方案，并在全国范围内持续执行了多年，2012年已成为itn的主要和唯一的公共支持的持续交付系统。在加纳，全国范围内对凭单的实施从未超出对议程的考虑和制定政策的试点; 这种方法被对卫生系统的依赖或一体化程度较小的大规模分发运动所取代。到2011年，加纳进入了一个没有公共支持的itn连续交付系统的阶段。为了了解不同的结果，我们参考了主要的卫生系统组成部分 (治理，人力资源，融资，信息学，技术和服务提供)，比较了两国的凭证计划时间表，阶段，流程和背景。为坦桑尼亚的代金券计划提供有利环境的背景因素在加纳没有这样做。凭单计划从未被视为适当的国家战略，其他交付系统也不是互补的，私营部门也不发达。坦桑尼亚所有利益攸关方在参与和建立共识方面投入了大量时间，这是一个重要且明显促成的差异，公共部门对私营部门的支持也是如此。这有助于在服务交付层面采取单一协调战略的伙伴行动，这反过来又给商业部门带来信心，避免了加纳发生的竞争性交付系统的 “干扰”。干预设计的系统思想原则正确地强调了启用环境和利益相关者管理的重要性。

BACKGROUND & AIMS: Considerable levels of resistance to sulfadoxine-pyrimethamine (SP) have been reported in Plasmodium falciparum in north-eastern Tanzania, and the identification of a suitable antimalarial to replace SP is now a high priority. We conducted a trial in July 2000 to determine the efficacy of proguanil (PG) plus dapsone (DS), compared with that of SP, for the treatment of asymptomatic falciparum infection. A total of 220 children with parasitaemia > or = 2000 per microL completed the study; 112 had received a single dose of SP (dosage calculated for pyrimethamine 1.25 mg/kg and sulfadoxine 25 mg/kg) and 108 had taken PG 10 mg/kg with DS 2.5 mg/kg each day for 3 days. Clearance of asexual parasites at day 7 was 14.3% with SP, but 93.5% with PG-DS. The remarkably high failure rate with SP was not associated with occurrence of leucine substitution at position 164 of the dhfr gene. Both treatment regimens were well tolerated. Compared with available data on another antifolate combination, chlorproguanil-dapsone ('Lapdap'), PG-DS was slightly but significantly inferior in achieving parasite clearance (99.5% versus 93.5%). The estimated cost of a 3-day course of PG-DS treatment for a child weighing 18 kg is US $0.15. With the rising incidence of SP-resistant P. falciparum infection, PG-DS could provide an effective, affordable and already available therapeutic alternative for malaria in East Africa at least until chlorproguanil-dapsone is registered.

背景与目标： 据报道，在坦桑尼亚东北部的恶性疟原虫中，对磺胺多辛-乙胺嘧啶 (SP) 的耐药性相当高，现在确定合适的抗疟药来替代SP是当务之急。我们2000年7月进行了一项试验，以确定与SP相比，丙胍 (PG) 加氨苯砜 (DS) 治疗无症状恶性疟原虫感染的疗效。共有220名寄生虫血症> 或 = 2000名儿童完成了研究; 112接受了单剂量的SP (对于乙胺嘧啶1.25 mg/kg和磺胺多辛25 mg/kg计算的剂量)，108每天服用PG 10 mg/kg和DS 2.5 mg/kg，持续3天。在第7天，无性寄生虫的清除用SP 14.3%，但用PG-DS 93.5%。SP极高的失败率与dhfr基因164位亮氨酸取代的发生无关。两种治疗方案均具有良好的耐受性。与另一种抗叶酸药物组合氯丙胍-氨苯砜 ('Lapdap') 的可用数据相比，PG-DS在获得寄生虫清除方面略有下降，但明显逊色 (99.5% 比93.5%)。对于体重18千克的儿童，为期3天的PG-DS治疗的估计费用为0.15美元。随着抗SP的恶性疟原虫感染发病率的上升，PG-DS可以为东非的疟疾提供一种有效，负担得起且已经可用的治疗替代品，至少直到氯丙胍-氨苯砜注册为止。

BACKGROUND & AIMS: BACKGROUND:Childbirth is a momentous event for women and their partners, yet women continue to die in childbirth worldwide, particularly in sub-Saharan Africa. To reduce maternal mortality and increase the number of women delivering at health facilities, it is important to understand reasons why women who do deliver at health facilities chose to do so. Therefore, the objective of this qualitative study was to explore the perceptions of women and men on (i) when women go to the hospital; (ii) where women deliver; and (iii) who is involved in the delivery process related to accessing health facilities for delivery care in Tanzania. METHODS:Using a qualitative design, four focus group discussions (n = 23) and semi-structured interviewers (n = 12) were held with postnatal women and men who were attending a postnatal clinic in the Lake Zone region of Tanzania. Data was analyzed using thematic coding. RESULTS:Women and men expressed factors that influenced when, where, and with whom they accessed health facilities for delivery care, with the quality of care received providing a significant influence. When decisions were made about going to the hospital, there were challenges that resulted in delayed treatment seeking; however, couples recognized the need to seek care earlier to prevent complications. Private hospitals were the preferred location for delivery with public hospitals and home deliveries with traditional birth attendants being less desirable. Both when and where delivery took place was influenced by the desire for better quality of care received as well as financial costs. Finally, there was mixed evidence on who was involved in decision making around delivery location from the perspective of women and men, but both groups expressed a preference for more male involvement during the delivery. CONCLUSION:Men and women show desire for women to delivery at health facilities; however, improvements are needed with respect to maternal care and humanizing the birth process in Tanzania. Greater emphasis needs to be placed on including men during the birth process, improving the quality of care received in public hospitals, and reducing the barriers to accessing health facilities for delivery care.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Timely intrapartum referral between facilities is pivotal in reducing maternal/neonatal mortality and morbidity but is distressing to women, resource-intensive and likely to cause delays in care provision. We explored the complexities around referrals to gain understanding of the characteristics, experiences and outcomes of those being transferred. METHODS:We used a mixed-method parallel convergent design, in Tanzania and Zambia. Quantitative data were collected from a consecutive, retrospective case-note review (target, n = 2000); intrapartum transfers and stillbirths were the outcomes of interest. A grounded theory approach was adopted for the qualitative element; data were collected from semi-structured interviews (n = 85) with women, partners and health providers. Observations (n = 33) of transfer were also conducted. Quantitative data were analysed descriptively, followed by binary logistic regression models, with multiple imputation for missing data. Qualitative data were analysed using Strauss's constant comparative approach. RESULTS:Intrapartum transfer rates were 11% (111/998; 2 unknown) in Tanzania and 37% (373/996; 1 unknown) in Zambia. Main reasons for transfer were prolonged/obstructed labour and pre-eclampsia/eclampsia. Women most likely to be transferred were from Zambia (as opposed to Tanzania), HIV positive, attended antenatal clinic < 4 times and living > 30 min away from the referral hospital. Differences were observed between countries. Of those transferred, delays in care were common and an increase in poor outcomes was observed. Qualitative findings identified three categories: social threats to successful transfer, barriers to timely intrapartum care and reparative interventions which were linked to a core category: journey of vulnerability. CONCLUSION:Although intrapartum transfers are inevitable, modifiable factors exist with the potential to improve the experience and outcomes for women. Effective transfers rely on adequate resources, effective transport infrastructures, social support and appropriate decision-making. However, women's (and families) vulnerability can be reduced by empathic communication, timely assessment and a positive birth outcome; this can improve women's resilience and influence positive decision-making, for the index and future pregnancy.

背景与目标：

BACKGROUND & AIMS: :With increased access to HIV treatment throughout Africa, a generation of HIV positive children is now transitioning to adulthood while living with a chronic condition requiring lifelong medication, which can amplify the anxieties of adolescence. This qualitative study explored how adolescents in Tanzania with HIV experience their nascent sexuality, as part of an evaluation of a home-based care programme. We interviewed 14 adolescents aged 15-19 who had acquired HIV perinatally, 10 of their parents or other primary caregivers, and 12 volunteer home-based care providers who provided support, practical advice, and referrals to clinical services. Adolescents expressed unease about their sexuality, fearing that sex and relationships were inappropriate and hazardous, given their HIV status. They worried about having to disclose their status to partners, the risks of infecting others and for their own health. Thus, many anticipated postponing or avoiding sex indefinitely. Caregivers and home-based care providers reinforced negative views of sexual activity, partly due to prevailing misconceptions about the harmful effects of sex with HIV. The adolescents had restricted access to accurate information, appropriate guidance, or comprehensive reproductive health services and were likely to experience significant unmet need as they initiated sexual relationships. Care programmes could help to reduce this gap by facilitating open communication about sexuality between adolescents and their caregivers, providers, and HIV-positive peers.

背景与目标： : 随着整个非洲越来越多地获得艾滋病毒治疗，一代艾滋病毒阳性儿童现在正过渡到成年，同时患有需要终身服药的慢性病，这可能会加剧青春期的焦虑。作为对家庭护理计划的评估的一部分，这项定性研究探讨了坦桑尼亚的艾滋病毒青少年如何经历新生的性行为。我们采访了14名15-19岁的青少年，他们在围产期间感染了HIV，10名父母或其他主要照顾者，以及12名自愿的家庭护理提供者，他们提供了支持，实用建议和转诊临床服务。青少年对自己的性行为表示不安，他们担心性和人际关系是不适当和危险的，因为他们的艾滋病毒感染状况。他们担心必须向伴侣透露自己的身份，感染他人的风险以及自己的健康。因此，许多人预计无限期推迟或避免性行为。护理人员和家庭护理提供者加强了对性行为的负面看法，部分原因是对艾滋病毒性行为的有害影响普遍存在误解。青少年无法获得准确的信息，适当的指导或全面的生殖健康服务，并且在开始性关系时可能会遇到大量未满足的需求。护理计划可以通过促进青少年与其照顾者，提供者和HIV阳性同伴之间关于性行为的公开交流来帮助缩小这种差距。

BACKGROUND & AIMS: BACKGROUND:Early initiation of breastfeeding (EIBF) is a predetermining factor for exclusive breastfeeding, and thus a foundation for optimal breastfeeding practices. Rates of EIBF are low globally (42%) and in Tanzania (51%), yet few studies have been done on this issue in Tanzania. This study aimed to determine the prevalence and factors associated with early initiation of breastfeeding among women in northern Tanzania. METHODOLOGY:This study extracted information from a cohort of 536 women who were followed from 3rd trimester period October 2013 to December 2015 in Moshi municipal, northern Tanzania. The data for this paper was collected by the use of questionnaires at enrolment, delivery and 7 days after delivery. The analysis is based on data from 413 women for whom complete information was obtained. Log binomial regression analysis was used to determine factors associated with early initiation of breastfeeding. RESULTS:The prevalence of EIBF was 83%. Overall, women had high knowledge on colostrum (94%), knowledge on exclusive breastfeeding (81%) and time of breastfeeding initiation (71%), but only 54% were counseled on breastfeeding during antenatal care. Knowledge on timely initiation of breastfeeding during pregnancy and vaginal delivery were associated with EIBF. CONCLUSION:Early initiation of breastfeeding is high (83%) in Moshi Municipal but still below the universal coverage recommended by WHO and UNICEF. There is missed opportunity by health facilities to counsel and support early initiation of breastfeeding given high antenatal and facility delivery in this setting. There is a need to evaluate health facility bottle necks to optimal support of early initiation of breastfeeding in Tanzania.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:There is a high and rising prevalence of cardiovascular risk in sub-Saharan Africa, a development typical for countries in epidemiological transition. Contrary to recommendations in treatment guidelines, medical interventions to prevent cardiovascular disease are implemented only on a limited scale in these settings. There is a widespread concern that such treatment is not cost-effective compared to alternative health interventions. The main objectives of this article are therefore to calculate costs-, effects and cost-effectiveness of fourteen medical interventions of primary prevention of cardiovascular disease in Tanzania, including Acetylsalicylic acid, a diuretic drug (Hydrochlorothiazide), a beta-blocker (Atenolol), a calcium channel blocker (Nifedepine), a statin (Lovastatin) and various combinations of these. METHODS:Effect sizes were derived from systematic reviews or meta-analyses, and calculated as Disability Adjusted Life Years (DALYs). Data on drug costs were calibrated to a Tanzanian setting. Other recurrent and capital costs were derived from previous studies and reviewed by local experts. Expected lifetime costs and health outcomes were calculated using a life-cycle model. Probabilistic cost-effectiveness analysis was performed using Monte Carlo simulation, and results presented as cost-effectiveness acceptability curves and frontiers. The potential impacts of uncertainty in value laden single parameters were explored in one-way sensitivity analyses. RESULTS:The incremental cost-effectiveness ratios for the fourteen interventions and four different levels of risk (totally 56 alternative interventions) ranged from about USD 85 per DALY to about USD 4589 per DALY saved. Hydrochlorothiazide as monotherapy is the drug yielding the most favorable cost-effectiveness ratio, although not significantly lower than when it is combined in duo-therapy with Aspirin or a beta-blocker, in triple-therapy with Aspirin and a beta-blocker, or than Aspirin given as mono-therapy. CONCLUSION:Preventive cardiology is not cost-effective for any patient group in this setting until willingness to pay exceeds USD 85 per DALY. At this level of willingness to pay, the optimal intervention is Hydrochlorothiazide to patients with very high cardiovascular risk. As willingness to pay for health increase further, it becomes optimal to provide this treatment also to patients with lower cardiovascular risk, and to substitute to more sophisticated interventions.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Oral diseases may cause serious health problems, especially in socially disadvantaged populations and in low-income countries. In populations living in the rural areas of Tanzania there is paucity of reports on oral health. The study aim was to estimate the prevalence, severity and socio-demographic distribution of oral diseases/conditions in adolescents living in Maasai population areas of Tanzania and to compare oral diseases/conditions between Maasai and non-Maasai ethnic groups. METHODS:A total of 23 schools were randomly selected from 66 rural public primary schools in Monduli and Longido districts, Tanzania. All pupils in the selected classes, 6th grade, were invited to participate in the study. A total of 989 were invited and 906 (91.6%) accepted the invitation and completed an interview and a clinical oral examination. RESULTS:Out of 906 study participants (age range 12-17 years), 721(79.6%) were from Maasai and 185 (20.4%) from non-Maasai ethnic groups. Prevalence of poor oral hygiene, gingival bleeding, dental caries experience (DMFT> 0), dental fluorosis TF grade 5-9, dental erosion (into dentin), tooth wear (into dentin) and TMD was 65.6, 40.9, 8.8, 48.6, 1.9, 16.5 and 11.8%, respectively. Multiple variable logistic regression analysis revealed that, girls (OR = 2.0) and participants from Longido (OR = 2.6) were more likely to present with good oral hygiene (p < 0.05). Adolescents from Monduli (OR = 1.7), males (OR = 2.1), being born within Arusha region (OR = 1.9) and Maasai (OR = 1.7) were more likely to present with gingival bleeding (p < 0.05). DMFT> 0 increased by age (OR = 2.0) and was associated with non-Maasai ethnic group (OR = 2.2), (p < 0.05). Adolescents from Monduli district (OR = 10.0) and those born in Arusha region (OR = 3.2) were more likely to present with dental fluorosis (p < 0.05). Dental erosion was more common among non-Maasais (OR = 2.0) as well as having mother with high education (OR = 2.3), (p < 0.05). CONCLUSIONS:Oral diseases like dental caries and dental erosion were less common, but gingival bleeding, dental fluorosis, tooth wear and TMD were common findings in adolescents attending primary schools in the Maasai population areas of Tanzania. Notable differences between Maasai and non-Maasai ethnic groups and certain correlations to sociodemographic factors were detected. Our findings can be utilized by policy makers in the planning of oral health programs in public primary schools of Maasai population areas of Tanzania.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Upper gastrointestinal bleeding (UGIB) is a common emergency department (ED) presentation with high morbidity and mortality. There is a paucity of data on the profile and outcome of patients who present with UGIB to EDs, especially within limited resource settings where emergency medicine is a new specialty. We aim to describe the patient profile, clinical severity and outcomes of the patients who present with UGIB to the ED of tertiary referral hospitals in Tanzania. METHODS:This was a prospective cohort study of consecutive adult (≥18 years) patients presenting to the EDs of Muhimbili National Hospital (ED-MNH) and MUHAS Academic Medical Centre (ED-MAMC), in Tanzania with non-traumatic upper gastrointestinal bleeding (UGIB) from July 2018 to December 2018. Patient demographic data, clinical presentation, and ED and hospital management provided were recorded. We used the clinical Rockall score to assess disease severity. The primary outcome of 7- day mortality was summarized using descriptive statistics. Regression analysis was performed to identify predictors of mortality. RESULTS:During the study period, 123 patients presented to one of the two EDs with an UGIB. The median age was 42 years (Interquartile range (IQR) 32-64 years), and 87 (70.7%) were male. Hematemesis with melena was the most frequently encountered ED complaint 39 (31.7%). Within 7 days, 23 (18.7%) patients died and one-third 8 (34.8%) of these died within 24 h. There were no ED deaths. About 65.1% of the patients had severe anemia but only 60 (48.8%) received blood transfusion in the ED. Amongst those with history of (h/o) esophageal varices 7(41.2%) did not receive octreotide. Upper GI endoscopy, was performed on 46 (37.4%) patients, of whom only 8 (17.4%) received endoscopy within 24 h (early UGI endoscopy). All patients who received early UGI endoscopy had a low or moderate clinical Rockall score i.e. < 3 and 3-4. No patient with scores of > 4 received early UGI endoscopy. Age > 40 years was a significant independent predictor of mortality (OR = 7.00 (95% CI 1.7-29.2). Having a high clinical Rockall score of ≥ 4 was a significant independent predictor of mortality (OR = 6.4 (95% CI 1.8-22.8). CONCLUSIONS:In this urban ED in Sub-Saharan Africa, UGIB carried a high mortality rate. Age > 40 years and clinical Rockall score ≥ 4 were independent predictors of higher mortality. Future studies should focus on evaluating how to improve access to UGI endoscopy so as to improve outcomes.

背景与目标：

BACKGROUND & AIMS: :Effective implementation of policies for expanding antiretroviral therapy (ART) requires a well-trained and adequately staffed workforce. Changes in national HIV workforce policies, health facility practices, and provider experiences were examined in rural Malawi and Tanzania between 2013 and 2017. In both countries, task-shifting and task-sharing policies were explicit by 2013. In facilities, the cadre mix of providers varied by site and changed over time, with a higher and growing proportion of lower cadre staff in the Malawi site. In Malawi, the introduction of lay counsellors was perceived to have eased the workload of other providers, but lay counsellors reported inadequate support. Both countries had guidance on the minimum numbers of personnel required to deliver HIV services. However, patient loads per provider increased in both settings for HIV tests and visits by ART patients and were not met with corresponding increases in provider capacity in either setting. Providers reported this as a challenge. Although increasing patient numbers bodes well for achieving universal antiretroviral therapy coverage, the quality of care may be undermined by increased workloads and insufficient provider training. Task-shifting strategies may help address workload concerns, but require careful monitoring, supervision and mentoring to ensure effective implementation.

背景与目标： : 有效执行扩大抗逆转录病毒疗法 (ART) 的政策需要训练有素和人员充足的劳动力。在马拉维农村和坦桑尼亚，2013年和2017年研究了国家艾滋病毒劳动力政策，卫生设施做法和提供者经验的变化。在这两个国家，任务转移和任务共享政策都是明确的2013年。在设施中，提供者的干部组合因地点而异，并随着时间的推移而变化，马拉维地点的低级干部人员比例越来越高。在马拉维，外行顾问的引入被认为减轻了其他提供者的工作量，但外行顾问报告说支持不足。两国都就提供艾滋病毒服务所需的最低人数提供了指导。但是，在HIV检测和ART患者就诊的两种情况下，每个提供者的患者负荷都增加了，而在这两种情况下，提供者的容量都没有相应的增加。提供商将此报告为挑战。尽管患者人数的增加预示着实现抗逆转录病毒疗法的普及，但工作量增加和提供者培训不足可能会损害护理质量。任务转移策略可能有助于解决工作量问题，但需要仔细监测、监督和指导，以确保有效实施。

BACKGROUND & AIMS: OBJECTIVE:Hypertension is believed to be an increasingly common driver of the epidemic of noncommunicable diseases (NCDs) in sub-Saharan Africa, but prospective data are scarce. The objective of this prospective study was to determine the contribution of hypertension to deaths, admissions, and hospital days at a Tanzanian zonal hospital. METHODS:Between 2009 and 2011, diagnoses were recorded for all medical admissions together with age, sex, length of hospitalization and in-hospital mortality. RESULTS:Among 11045 consecutive admissions, NCDs accounted for nearly half of all deaths, admissions, and hospital days. Among NCDs, hypertension-related diseases were the most common and accounted for 314 (33.9%) of the total NCD deaths, 1611 (29.9%) of the NCD admissions, and 12837 (27.8%) NCD hospital days. Stroke (167 deaths) was the leading cause of hypertension-related death. Hypertension was the leading cause of death in patients over the age of 50 years and 57% of hypertension-related deaths occurred in patients less than 65 years old. CONCLUSION:NCDs account for half of all deaths, admissions and hospital days at our Tanzanian hospital and hypertension-related diseases were the most common NCD. Hypertension accounted for 34% of NCD deaths and 15% of all deaths. Hypertension was the second most common cause of death overall and the leading cause of death in patients more than 50 years old. More than half of hypertension-related deaths occurred before retirement age. These findings have important implications for public health and medical education in sub-Saharan Africa, wherein hypertension and related diseases have not traditionally been given a high priority.

背景与目标：

BACKGROUND & AIMS: :From 2008 to 2011, the School of Dentistry at Muhimbili University of Health and Allied Sciences in Tanzania revised and then initiated implementation of a curriculum to improve the educational process for, and competence of, its graduates. As an increasing body of research demonstrates the detrimental effects of oral diseases on health and the interrelationships between oral and systemic diseases (including HIV and diabetes), the importance of dentistry education grows. We describe the population oral health problems in Tanzania, the need to enhance the dental workforce, and the process of curricular reform to meet these needs. This reform included transition to a competency-based curriculum featuring teaching methods that will enhance the effectiveness of the education and performance of graduates in traditional and new roles. We conclude with lessons for Tanzania and for health professions educational institutions elsewhere, as well as for public health-care planners concerned about linking health professions education to improving population health in resource-poor countries.

背景与目标： : 从2008 2011年起，坦桑尼亚Muhimbili健康与联合科学大学牙科学院修订并开始实施课程，以改善其毕业生的教育过程和能力。随着越来越多的研究表明口腔疾病对健康的有害影响以及口腔和全身疾病 (包括艾滋病毒和糖尿病) 之间的相互关系，牙科教育的重要性日益提高。我们描述了坦桑尼亚的人口口腔健康问题，需要增加牙科劳动力以及满足这些需求的课程改革过程。这项改革包括过渡到以能力为基础的课程，其教学方法将提高传统和新职位毕业生的教育和表现的有效性。最后，我们为坦桑尼亚和其他地方的卫生专业教育机构以及关注将卫生专业教育与改善资源贫乏国家人口健康联系起来的公共卫生保健规划者提供了经验教训。

BACKGROUND & AIMS: :Well-educated and competent health professionals influence the health system in which they work to improve health outcomes, through clinical care and community interventions, and by raising standards of practice and supervision. To prepare these individuals, training institutions must ensure that their faculty members, who design and deliver education, are effective teachers. We describe the experience of the Muhimbili University of Health and Allied Sciences (MUHAS) in encouraging improvements in the teaching capacity of its faculty and postgraduate students triggered by a major institutional transition to competency-based education. We employed a multi-stage process that started by identifying the teaching and learning needs and challenges of MUHAS students and faculty. Collaborating with the University of California San Francisco (UCSF), MUHAS responded to these needs by introducing faculty to competency-based curricula and later to strategies for long term continuing improvement. We demonstrate that teaching faculty members are keen for local institutional support to enable them to enhance their skills as educators, and that they have been able to sustain a program of faculty development for their peers.

背景与目标： : 受过良好教育和称职的卫生专业人员通过临床护理和社区干预以及提高实践和监督标准，影响他们致力于改善健康结果的卫生系统。为了使这些人做好准备，培训机构必须确保设计和提供教育的教师是有效的教师。我们描述了穆希比利健康与相关科学大学 (Muhimbili University of Health and Allied Sciences，Muhimbili) 在鼓励其教师和研究生的教学能力提高方面的经验，这是由向基于能力的教育的重大机构过渡引发的。我们采用了一个多阶段的过程，该过程首先确定了mu的学生和教职员工的教学需求和挑战。与加州大学旧金山分校 (UCSF) 合作，muhua通过向教师介绍基于能力的课程以及后来的长期持续改进策略来满足这些需求。我们证明，教职员工渴望获得当地机构的支持，以使他们能够提高其作为教育者的技能，并且他们已经能够为同龄人维持教师发展计划。

BACKGROUND & AIMS: BACKGROUND:Ambitious targets have been set to end the HIV epidemic by 2030. Such targets assume that tools to end HIV exist and are successfully being deployed across populations, albeit unequally. Implementation science approaches are needed to understand the drivers of disparities and how to bring effective interventions to those most in need. We describe a hybrid implementation science approach, adapting a strategy to facilitate retention and viral suppression (VS) among people living with HIV/AIDS in Tanzania. METHODS/DESIGN:We used Proctor framework and the multiphase optimization strategy to optimize a cash transfer to improve antiretroviral therapy adherence and VS among people living with HIV/AIDS in Tanzania. This involved 3 trials. The first trial tested the efficacy of cash and food assistance compared with the standard of care in improving antiretroviral therapy adherence among treatment initiators. Cash transfers were superior to the standard of care and noninferior, less expensive, and logistically simpler to implement compared with food. The second trial is dose-finding: identifying the optimal amount of cash for a 20% improvement in VS at 6 months. Before this, components were simplified to maximize reach, align with local policies, and reduce staff time. We assessed implementation science constructs to understand barriers to uptake and sustainability. Trial 3 is a cluster randomized controlled trial, testing the effectiveness of the optimized intervention in multiple settings. DISCUSSION/IMPLICATIONS:Our process illustrates the utility of applying multiple implementation science frameworks to arrive at an optimal implementation strategy to bridge the know-do gap with data to show efficacy and maximum potential for scalability and sustainability.

背景与目标：