Research report in partial fulfillment for the degree of MSc (Med), Population Based Field Epidemiology, University of the Witwatersrand / Background Worldwide, injuries are ranked among the leading causes of death and disability, killing over 5 million people and injuring over 50 million others globally. Approximately 90% of these deaths occur in developing countries. The burden and pattern of injuries in low-income countries are poorly known and not well studied. Few studies have been conducted on injury mortality and therefore this study can add to the scientific literature. Analyzing injury mortality in rural Tanzania can assist African countries to develop intervention programmes and policy reform to reduce the burden caused by injuries. Objectives The objective of this study was to identify the risk factors and trend in injury mortality in the Rufiji Demographic Surveillance Area in rural Tanzania from 2002-2007. Specifically, the study would identify and describe the types and trends in injury mortality, calculate the crude death rates of injury mortality by gender, SES and age groups, describe the risks factors associated with injury mortality, and measure association between the risk factors and injury mortality. Methods Rufiji HDSS data used included people aged 1 year and older from 2002-2007. Verbal Autopsy data was used to determine the causes of death which was based on the tenth revision of the International Classification of Diseases (ICD 10) recommended by WHO. Injury Crude death rates (ICDR) were calculated by dividing number of deaths in each year by person years observed and multiplying by 100,000. Principal Component Analysis (PCA) was used to construct household wealth index using household characteristics and assets ownership. Also trend test analysis was done to assess a linear relationship in the injury mortality rates across the six year period. Poisson regression was used to investigate v association between risk factors and injury mortality and all tests for significant associations were based on p-values at 5% significance level and a 95% confidence interval. Results The overall injury crude mortality rate was 33.4 per 100,000 PYO. Injuries contributed 4% of total mortality burden with statistical significant association between gender, age and occupation. Mortality rate was higher for males [Adjusted IRR=3.04, P=0.001, 95% CI (2.22 - 4.17)]. The elderly (65+) were 2.8 times more likely to die from injuries compared to children [Adjusted IRR=2.83, P=0.048, 95% CI (1.01 - 7.93)]. The unemployed, casual workers, the retired, and farmers all had an increased risk of dying from injuries compared to students (P<0.005). Most injury deaths were due to road traffic accidents (28%), unspecified external injuries (20%), drowning (16%), burns (9%), accidental poisoning (8%), homicidal (8%) and animal attack (5%). Conclusion The contribution of injury to mortality burden in the Rufiji Demographic Surveillance Area was relatively low. However, there is the need to institute measures that would help prevent injuries. Life saving interventions such as road safety education, regular road maintenance, rapid response to accidents, use of life jackets for fishermen and recreational swimmers are very necessary in preventing injuries. Also, proper fishing practices should be imparted to the populace as precautionary measures to reduce the burden of injury mortality.

Thesis advisor: Raymond G. Helmick / Examines Christian-Muslim relations in Tanzania. / Thesis (STL) — Boston College, 2011. / Submitted to: Boston College. School of Theology and Ministry. / Discipline: Sacred Theology.

Recent attempts to improve science teaching and learning in Tanzania required teachers to adopt a learner-centred pedagogy. Although researchers widely acknowledge a lack of sustained success in science teachers' adoption of learner-centred pedagogy, the reasons for teachers' reluctance to adopt learner-centred pedagogy remain debated. Various contextual constraints, including resource shortages, overcrowded classrooms, ineffective teacher education, and high-stakes exams, render learner-centred pedagogy unsuccessful. However, in the Tanzanian context, teacher educators and researchers seem to overlook the critical role science teachers' beliefs about science knowledge, teaching, and learning play in their teaching practices. Thus, attempts to identify and address Tanzanian science teachers' deeply held beliefs are uncommon. Therefore, I interviewed six secondary school science teachers to explore their beliefs about science knowledge, teaching and learning and to show how these forms. I also observed their lessons to examine how the teachers' beliefs manifest in their classroom practices. The findings showed that teachers largely espoused ‘traditional beliefs' about science knowledge, teaching, and learning. They viewed science as a fixed body of discrete facts that mirrors natural phenomena. They believe the body of science knowledge is absolute and handed down by omniscient authorities, such as textbooks and teachers. The teachers consistently described teaching science as conveying textbook facts for students to accumulate and reproduce during exams. Social and contextual factors, including teachers' childhood, schooling, and training experiences, as well as the bureaucratic demands, paradoxical curriculum, and students' reticence reinforced these beliefs. Teachers' beliefs, though consistent with their teaching practices, were largely antithetical to the principles and practices of learner-centred pedagogy. Therefore, I propose that Tanzanian secondary school teachers consider their beliefs and the social and contextual conditions of the schools in adopting learner-centred pedagogy. They weigh their beliefs against the social and contextual conditions to decide how to teach. These results suggest that teacher educators and policy makers should seek to transform teachers' beliefs about science knowledge, teaching, and learning through learning trajectories that require teachers to articulate and interrogate their beliefs. Such attempts should consider the social, cultural, and material contexts of the schools in which teachers teach.

MSc (Med), Population-Based Field Epidemiology, School of Public Health, University of the Witwatersrand, 2009 / Background: MDG 4 commits the international community to reducing mortality in children younger than 5 years by two-thirds by 2015.The biggest burden of child mortality lies in Saharan Africa. Objective: To investigate how distance from home to the nearest health facility is associated with infant and child (1-4 years) mortality in a typical rural setting of sub Saharan Africa. Methods: A secondary analysis of 28,823 under five children in Ifakara Health and Demographic surveillance system between 2005 and 2007 was carried out. Both Euclidean and networked distance from the household to the nearest health facility was estimated using geographical information system methods. Cox proportional hazard regression models were used to investigate the effect of distance from home to the nearest health facility on infant and child mortality. Results: Children who lived in homes with networked distance >5KM experienced about 18% increased mortality risk [HR=1.18;95%CI 1.02-1.38 p-value 0.05] compared to those who lived less than 5KM networked distance to the nearest health facility. Death of mother, death of preceding sibling and multiple births were the strongest independent predictors of child mortality. Malaria/AFI and pneumonia/ARI were the leading causes of death in children although there was no evidence to show association of cause specific mortality with networked distance in the study. vi Conclusions: Staying closer to the health facility improved the survival probability of the children. This effect was similar to that reported elsewhere in other studies which re-emphasize the usefulness of having fully functional health facilities closer to the populations that need them. The inconsistency of the Euclidean distance in the study further suggests that the networked distance is a better estimator of geographical accessibility and should be the preferred proxy distance measurement option in public health research. 1 Faculty of Health Sciences, University of the Witwatersrand; South Africa. 2 Ifakara Health & Demographic Surveillance System; Tanzania. 3 Iganga/Mayuge Health & Demographic Surveillance System; Uganda

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The purpose of this master’s thesis was to produce a national wilderness map of Tanzania by using a Norwegian method for mapping wilderness like areas, called Inngrepsfrie naturområder i Norge (INON). In English this means Areas without major infrastructure development in Norway. There are currently no national wilderness maps of Tanzania, just maps on regional or global scale. The INON methodology was assessed in relation to Tanzanian conditions, and to some degree compared with Landscan population data, protected areas from World Database on Protected Areas (WDPA), as well as the Last of the Wild dataset from the Human Footprint project. The INON methodology is based solely on distance from elements defined as major infrastructure development by the Directorate of Nature Management (DN) in Norway, and its methodology is much simpler than other methods for mapping wilderness, such as for instance GLOBIO and the Human Footprint. Its simplicity makes it easy to use, but also insufficient for decision making. It can be used as a reference map, indicating where to find possible wilderness like areas, but additional information is needed before making a decision. As the INON methodology is based on distance from infrastructure, this raises some issues in a Tanzanian context. This works in Norway because people usually live in close proximity to infrastructure. However, this is not always the case in Tanzania, where the infrastructure is not yet fully developed. Many people live in villages not connected to the road network or other infrastructure defined by DN. These areas will show up in the map as wilderness like areas, when they are actually filled with human settlements. To solve such issues, the INON methodology must be adapted to Tanzanian conditions before it can be used in land use management and planning.

Thesis--Munich. / Includes bibliographical references (p. 455-467).

Proefschrift--Leyden. / "Stellingen": leaf inserted. Bibliography: p. 141-145.