American Journal of Public Health Research

Effectiveness of a Community Health Worker–Led Hypertension Screening and Referral Program in Rural Western Tanzania: A Pilot Implementation Study

Getera Isack Nyangi, Olela Manuel Dennish, Witness Erick Macha — 2026-06-26

Hypertension remains a leading modifiable risk factor for cardiovascular diseases globally, yet early detection is still limited in many rural settings of low- and middle-income countries. This study evaluated the effectiveness of a Community Health Worker (CHW)–led hypertension screening program by assessing screening performance, referral completion, concordance between CHW and facility-based diagnosis, and changes in facility-level hypertension detection. A quasi-experimental study was conducted in Kakonko District, Tanzania, where CHWs carried out household-based blood pressure screening and referred individuals with elevated readings to nearby health facilities (dispensaries). Participants who completed referral underwent repeat blood pressure measurements at health facilities to assess diagnostic concordance. Routine DHIS2 data were analyzed using a Difference-in-Differences approach to evaluate changes in hypertension detection. A total of 981 adults were screened by CHWs, of whom 224 (22.8%) were identified with elevated blood pressure. Referral slips were available for 201 (89.7%) participants, while referral slips for the remaining 23 (10.3%) participants were not observed. Among those who received referral slips, 161 (80.1%) completed referral to health facilities. Of the participants reassessed at the health facilities, 130 (80.7%) were confirmed to have hypertension, indicating good agreement between community- and facility-based blood pressure measurements. Facility-level hypertension detection increased markedly in intervention facilities compared to control facilities. The Difference-in-Differences analysis showed an additional 6.6 percentage point increase in hypertension detection attributable to the intervention. In conclusion, CHW-led hypertension screening is a feasible, accurate, and effective strategy for improving early detection and linkage to care in rural Tanzania.

Prevalence and Determinants of Alcohol Use Disorder among Drivers of Public Service Vehicles in Kilimanjaro, Tanzania: A Mixed-Method Study

2026-06-29

Alcohol use disorder poses serious dangers to public safety. It causes approximately three million deaths and 132 million Disability-Adjusted Life Years (DALYs), with nearly three-quarters of the global burden affecting men. Alcohol use disorder (AUD) continues to exist and is associated with a range of negative consequences. Adverse alcohol use disorders are becoming more prevalent in low- and middle-income countries, including Tanzania. Drivers of public service vehicles experience recurrent episodes of alcohol use disorder. However, little is known about its burden, socio-demographic and social determinant in Tanzania, which limits the development and implementation of evidence-based interventions. The purpose of this study was to determine the prevalence, socio-demographic and social determinants of alcohol use disorder among public service vehicle drivers in Kilimanjaro, Tanzania in 2023. Analytical cross-sectional survey was carried out in May 2023 among public service drivers in Kilimanjaro, Tanzania. Stratified proportional random sampling was used alongside with mixed approaches to gather the data. Quantitative data were processed and analyzed using descriptive statistics and multivariable log-binomial model, using STATA version 15 software. Qualitative data on determinants of AUD among public services vehicles drivers were analyzed thematically through an iterative process using NVivo software. A total of 292 males who were recruited in the study were analyzed. The majority of respondents, (83.0%) acknowledged alcohol consumption. The study showed that AUD had a prevalence of 63% among drivers of public service vehicles (PSV). After controlling for confounding variables, alcohol use disorders had a positive association with stress (PR=1.56; 95% CI, 1.05 - 2.32; p<0.027), sources of alcoholic beverages used (PR=3.84; 95%CI, 1.37 - 10.72; p<.01), low prices of alcoholic beverages (PR= 2.06; 95%CI, 1.09 - 3.88; p<.025), and employment status (PR=0.52; 95%CI, 0.27 - 0.94; p=0.041). This study revealed a high burden of AUD among PSV drivers and its determinants in Tanzania. This suggests a major public health risk. There is an urgent need to enhance the detection of AUD and to develop additional preventive and protective strategies. These interventions are essential to promote the health and wellbeing of public service vehicle drivers.

Breaking the Cycle: Applying Systems Thinking to Violence Prevention in Africa

Begna Fufa Dugassa — 2026-07-03

Background: African populations continue to grapple with the cumulative impacts of the slave trade, colonialism, and ongoing neocolonialism. This violence—encompassing epistemic, physical, psychological, and economic dimensions—is both intergenerational and interconnected, manifesting in complex systems of ongoing harm. Objectives: To identify the root causes of violence in Africa by examining the racist knowledge system and to highlight Indigenous African knowledge systems, specifically Oromummaa, as vital counter-epistemes. Methods: Utilizing a systems thinking framework, this paper investigates the structural drivers and social determinants of contemporary violence in Africa. The analysis maps the root causes and examines the interplay between positive and negative feedback loops that sustain cycles of conflict. Findings: Through a public health lens, violence is conceptualized as a contagious, predictable, and preventable phenomenon with a distinct incubation period. This study identifies a "racist episteme" as the foundational driver of systemic violence. This framework underpinned the colonial and neocolonial exploitation of African human and natural resources, directly resulting in societal fragmentation, poverty, and climate vulnerability. These stressors—specifically food and water insecurity—act as catalysts that intensify competition and trigger further violence. Conclusions: Breaking the cycle of violence requires delegitimizing the racist episteme and advancing Afrocentric knowledge systems, such as Oromummaa, which emphasize social justice, gender equity, and ecological harmony. True progress demands transformative education for healing and policy frameworks that are intersectional: just, environmentally sustainable, and culturally grounded.