Lusajo Kajula

Muhimbili University of Health and Allied Sciences | MUHAS

Parent-child sexuality communication has been identified as a protective factor for adolescent sexual and reproductive health, including HIV infection. The available literature on this topic in sub-Saharan Africa is increasing; however a systematic review of studies has not been conducted. This article reviews the literature in the area of parental...

Communication between parents and their adolescent children has been identified as one of the potential protective factors for adolescent sexual health. Qualitative exploration of sexual health communication with adolescents aged 12-15 (N = 114) and a sub-group of the parents (N = 20) was carried out. Four major themes emerged: reasons for parent-a...

Background Intimate partner violence (IPV) and sexually transmitted infections (STIs), including HIV, remain important public health problems with devastating health effects for men and women in sub-Saharan Africa. There have been calls to engage men in prevention efforts, however, we lack effective approaches to reach and engage them. Social netwo...

Parenting styles and practices are suggested to be important predictors of adolescent sexual health, mostly in Europe and North America. Limited research has been conducted on these processes in Sub-Saharan Africa, which has different patterns of adolescent sexual behavior and family traditions. This study qualitatively explored parenting practices...

There is a shortage of health-related questionnaires developed specifically for African countries' cultural contexts and local languages. Researchers have translated some tools to the target local languages. However, poor-quality or even high-quality translation can lead to an instrument that is not comparable with the original language if linguist...

This paper explores the definition of, and perceived community attitudes, toward kudanga, a Swahili street term for a type of transactional sex practised in Dar es Salaam, Tanzania. Rooted in economic and gender disparity, transactional sex increases adolescent girls' and young women's vulnerability to HIV and gender-based violence. We sought to un...

Background The COVID-19 pandemic has exacerbated struggles for youth living in poor households. Youth in rural Tanzania are particularly vulnerable given widespread poverty, lack of formal sector employment opportunities, and health risks. We examine influences of the pandemic on economic insecurity and mental health and explore the coping strategi...

Patriarchal systems in Africa can perpetuate inequitable gender norms and power differentials that disadvantage women. This study aimed to examine the influence of community and individual gender-equitable attitudes on adolescents’ sexual health and risk behaviour in rural Tanzania, and whether the association of those attitudes differs between mal...

Patriarchal systems in Africa can perpetuate inequitable gender norms and power differentials that disadvantage women. This study aimed to examine the influence of community and individual gender-equitable attitudes on adolescents’ sexual health and risk behaviour in rural Tanzania, and whether the association of those attitudes differs between mal...

Out-of-school adolescent girls/young women (AGYW) in Africa are at increased risk for HIV and are underserved by HIV prevention interventions. Identifying social networks of out-of-school AGYW may be a strategic approach for reaching them. A sequential mixed methods study design was used. The PLACE (Priorities for Local AIDS Control Efforts) method...

Introduction: Transactional sex or material exchange for sex is associated with HIV infection among adolescent girls and young women in sub-Saharan Africa. The motivations for engaging in transactional sex vary from the fulfilment of basic needs, to enhancing social status or for romantic reasons with the expectation that men should provide. Trans...

Currently, there are few conversations about the term ‘Sub-Saharan Africa (SSA)’ (L.T. 2019) and its continued use (Zeleza 2022; Daley and Murrey, 2022). An end to the use of this problematic term is long overdue, and African voices on this matter should be amplified. This contribution to the literature aims to offer a solid reference point to supp...

We assessed the impacts of Tanzania’s Cash Plus adolescent-focused intervention on depression. In this pragmatic cluster-randomized controlled trial, 130 villages were randomly allocated to intervention or control (1:1). Youth aged 14-19 years living in households receiving governmental cash transfers were invited to participate. The intervention i...

In this study we examined factors that predict involvement in different patterns of sexual risk behavior and IPV perpetration among young men in Tanzania (n = 979), with a focus on identifying factors that distinguish men who engage in both behaviours from those who do not. Risk factors were drawn from three domains thought to be upstream drivers o...

Few studies of intimate partner violence (IPV) perpetration and sexual risk behavior among men have examined how multiple dimensions of these behaviors intersect in ways that may uniquely elevate health risks. The current study used latent class analysis to: (1) identify distinct patterns of IPV and sexual risk behavior in a sample of Tanzanian men...

Objectives. To examine the impacts of a government-implemented cash plus program on violence experiences and perpetration among Tanzanian adolescents. Methods. We used data from a cluster randomized controlled trial (n = 130 communities) conducted in the Mbeya and Iringa regions of Tanzania to isolate impacts of the “plus” components of the cash pl...

AimProcess evaluations for social and behavioral interventions are increasingly important as interventions become more complex and multi-faceted. Conducting process evaluations in low-resource international settings can be challenging. Process evaluations in low-resource international settings can help inform and improve the quality of ongoing inte...

Background Depression has substantial and enduring impacts for adolescents, particularly those living in poverty. Yet, evidence on its determinants in low-income countries remains scarce. We examined the social determinants of depressive symptoms for Tanzanian adolescents. Methods We used cross-sectional data for 2458 adolescents (aged 14–19), to...

Childhood exposure to adversity, including abuse and neglect, is consistently found to be a predictor of intimate partner violence (IPV) and peer violence (PV) perpetration in adulthood. The purpose of this study is to qualitatively examine factors that may facilitate or impede the use of violence among those who have been exposed to adversity earl...

Societal factors influencing adolescent alcohol initiation and use are not well documented in Tanzania. The goal of this qualitative study was to explore the structural and environmental factors influencing adolescent alcohol uptake and use in urban Tanzania. 177 adolescents aged 15–19 from varying socioeconomic backgrounds participated in 16 parti...

Background Depression has substantial and enduring impacts for adolescents, particularly those living in poverty. Yet, evidence on its determinants in low-income countries remains scarce. We examined the social determinants of depressive symptoms for Tanzanian adolescents. Methods We used cross-sectional data for 2458 adolescents (aged 14-19), to d...

Adolescent dating violence negatively affects millions of young people worldwide. Through a global systematic review, we synthesised evidence from rigorous studies of prevention programmes for adolescent dating violence. Our aims were to: (1) describe the breadth of research in this area and evidence of programme effects, and (2) identify gaps in t...

Background: The shaping of gender beliefs and attitudes in early adolescence affects the way young people internalize and self-enforce prevalent notions of masculinity and femininity, with lifelong consequences for sexual and reproductive health. This cross-sectional study examines determinants of gender attitudes among some of the poorest and mos...

Adolescent alcohol use remains an under-addressed population health issue across Africa. Although the literature explores the intersection of alcohol use and vulnerability to HIV and AIDS, there is limited evidence on the gendered uptake and use of alcohol among adolescents. Capturing adolescents’ voiced experiences about the societal influences sh...

Depression and anxiety are important sources of morbidity globally, but we have little knowledge of risk groups and risk factors for both classes of disorders in Tanzania and other low-resource settings. We aimed to identify sociodemographic markers and risk and protective factors associated with symptoms of anxiety and depression among 1249 young...

This rapid review seeks to inform initial and long-term public policy responses to the COVID-19 pandemic by assessing evidence on past economic policy and social protection responses to health and economic crises and their effects on children and families. The review focuses on virus outbreaks/emergencies, economic crises and natural disasters whic...

Despite calls to engage men in HIV and intimate partner violence (IPV) prevention efforts, effective approaches to reach and engage men in low-resource, high-HIV prevalence settings are limited. We identified and engaged social networks of mostly young men in a study designed to evaluate the efficacy of a combined microfinance and peer health leade...

An endline review of the Stawisha Maisha pilot programme implemented under Tanzania's Social Action Fund's (TASAF) Productive Social Safety Net Programme.

Background This article presents lessons learned from a microfinance and health intervention for young men designed to prevent sexually transmitted infections (STI) and intimate partner violence (IPV) in Dar es Salaam, Tanzania. We describe the different strategies we used to identify and train young men to become change agents within their social...

Background: Adverse childhood experiences (ACEs), including abuse and neglect, are consistently found to be predictors of perpetration of intimate partner violence (IPV) and peer violence (PV) in adulthood. Children are often exposed to patterns of ongoing and/or multiple-type polyvictimization throughout the life course. Objectives: To identify...

A significant under-addressed issue in the global adolescent health agenda is the interaction between alcohol use and sexual encounters among adolescent boys and girls in sub-Saharan Africa. The aim of this study was to explore the structural and environmental factors influencing young people’s access to and use of alcohol, and subsequent engagemen...

The Tathmini GBV study was a cluster randomized trial to assess the impact of a comprehensive health facility- and community-based program delivered through the HIV/AIDS program platform on reduction in gender-based violence and improved care for survivors. Twelve health facilities and surrounding communities in the Mbeya Region of Tanzania were ra...

Kiswahili questionnaire. (PDF)

Adolescents in Tanzania face numerous risks related to poverty, early pregnancy and marriage, gender based violence, HIV and few livelihood opportunities. Social protection, including cash transfers, are a leading tool in the fight against poverty, and have also shown potential in facilitating safe transitions to adulthood. This mixed method study...

The Tathmini GBV study was a cluster randomized trial to assess the impact of a comprehensive health facility- and community-based program delivered through the HIV/AIDS program platform on reduction in gender-based violence and improved care for survivors. Twelve health facilities and surrounding communities in the Mbeya Region of Tanzania were ra...

We examined factors associated with HIV self-testing (HIVST) willingness among male ever-testers and never-testers who participated in a midpoint survey of a cluster randomized controlled HIV prevention trial in Dar es Salaam. Linear mixed binary logistic regression models were constructed to examine factors (demographic, HIV risk behavior, and sex...

The effectiveness of peer leaders in promoting health may depend on the position they occupy within their social networks. Using sociocentric (whole network) and behavioral data from the intervention arm of a cluster-randomized HIV prevention trial in Dar es Salaam, Tanzania, we used generalized linear models with standardized predictors to examine...

Men continue to test for HIV at a low rate in sub-Saharan Africa. Recent quantitative evidence from sub-Saharan Africa indicates that encouragement to test for HIV from men’s network members is associated with higher previous HIV testing and HIV self-testing (HIVST) willingness. Leveraging this positive network influence to promote HIVST among men...

The purpose of this formative research, guided by the Integrated Behavioral Model, was to assess men’s attitudes and personal agency towards HIV self-testing (HIVST) and confirmatory HIV testing in order to inform the development of the Tanzania STEP (Self-Testing Education and Promotion) Project, a peer-based HIV self-testing intervention for youn...

Poverty is associated with numerous poor health outcomes. Youth unemployment in Tanzania is approximately 13.7%, and concentrates in urban areas. These youth lack relevant job skills and access to financial capital. Microfinance continues to be implemented globally to address poverty, and increasingly has been linked to health interventions. Men le...

Young men are important targets in HIV prevention in Tanzania and throughout sub-Saharan Africa. Anxiety and depression are common among youth and may be important predictors of HIV risk behaviors; evidence of these relationships in high-risk populations is needed. Using baseline and 1 year follow-up assessments from an HIV prevention trial we asse...

Caregivers at an institution for motherless infants in rural Tanzania participated in focus group interviews and participant observations. This paper aims at describing how they perceive infancy, caring and sensitivity in their everyday context. It adds knowledge from Tanzania about institutional infant care and the concept of sensitivity in caregi...

Injury according to the United States National Library of Medicine, is defined as damage to the body caused by accidents, falls, blows ant the like (https://www.nlm.nih.gov/medlineplus/woundsandinjuries.html). As of 2004, the global burden of disease estimated that, almost 6 million deaths were due to injury. The burden of injury is higher than tha...

Background: Young men living in Dar es Salaam's informal settlements face environmental stressors that may expose them to multiple determinants of HIV risk including poor mental health and risky sexual behavior norms. We aimed to understand how these co-occurring risk factors not only independently affect men's condom use and sexual partner concur...

Male perpetration of intimate partner violence (IPV) against women in sub-Saharan Africa is widespread. Theory and empirical evidence suggest peer networks may play an important role in shaping IPV perpetration, though research on this topic in the region is limited. We assessed the degree to which peer network gender norms are associated with Tanz...

Male perpetration of intimate partner violence (IPV) against women in Tanzania is widespread. Theory and empirical evidence suggest peer networks may play an important role in shaping IPV perpetration, although research on this topic in sub-Saharan Africa is limited. Grounded in social learning theory, social influence theory, and the theory of gen...

Impoverished men have lower rates of facility-based HIV counseling and testing and higher unknown HIV-positive status than women. Economic theory suggests that individuals will obtain an HIV test if anticipated benefits are greater than anticipated costs. Yet, few studies have investigated the range of financial preferences of HIV self-testing (HIV...

Background Unsafe sexual practices continue to put adolescents at risk for a number of negative health outcomes in Tanzania. While there are some effective theory-based intervention packages with positive impact on important mediators of sexual behaviours, a context specific and tested intervention is urgently needed in Tanzania. PurposeTo develop...

Men in sub-Saharan Africa have low HIV testing rates. Social networks exert an important influence on men’s HIV-related behavior. We examined associations between network factors and HIV testing among men in Dar es Salaam, Tanzania. Data are from the baseline assessment of an HIV prevention trial with 48 primarily male networks. Among 923 sexually...

Men have lower rates of HIV testing and higher rates of AIDS-related mortality compared to women in sub-Saharan Africa. To assess whether there is an opportunity to increase men’s uptake of testing by correcting misperceptions about testing norms, we compare men’s perceptions of their closest friend’s HIV testing behaviors with the friend’s actual...

This study tested the association between mental health scores and sexual risk behaviors among male members of social groups known as "camps" in Dar es Salaam, Tanzania. Anxiety and depression were measured using the HSCL-25 and condom use and sexual partner concurrency were assessed through self-report. A total of 1113 sexually active men with an...

Background: Mental illness may cause a variety of psychosocial problems such as decreased quality of life of the patient's family members as well as increased social distance for the patient and the family caring for the patient. Psychosocial challenges are enhanced by the stigma attached to mental illness, which is a problem affecting not only th...

Research on network-level influences on HIV risk behaviors among young men in sub-Saharan Africa is severely lacking. One significant gap in the literature that may provide direction for future research with this population is understanding the degree to which various HIV risk behaviors and normative beliefs cluster within men’s social networks. Su...

We describe and compare the baseline rates of victimization and perpetration of three forms of intimate partner violence (IPV)—psychological, physical, and sexual—among sexually active men (n = 1,113) and women (n = 226) enrolled in an ongoing cluster-randomized HIV and gender-based violence prevention trial in Dar es Salaam, Tanzania. IPV was meas...

Gender inequality is at the core of the HIV patterns that are evident in sub-Saharan Africa. Gender-based violence (GBV) and lack of economic opportunity are important structural determinants of HIV risk. We piloted a microfinance and health promotion intervention among social networks of primarily young men in Dar es Salaam. Twenty-two individuals...

Social network influence on young people's sexual behavior is understudied in sub-Saharan Africa. Previous research identified networks of mostly young men in Dar es Salaam who socialize in "camps". This study describes network characteristics within camps and their relationship to young men's concurrent sexual partnerships. We conducted surveys wi...

Cluster-randomized controlled trials were carried out to examine effects on sexual practices of school-based interventions among adolescents in three sites in sub-Saharan Africa. In this publication, effects on communication about sexuality with significant adults (including parents) and such communication as a mediator of other outcomes were exami...

HIV/AIDS disproportionally affects youth in sub-Saharan Africa. Identifying venues to access male social networks, especially in urban settings where HIV prevalence is often highest and men are not being reached, is a challenge. Camps, the U.S. equivalent of a club or support group, were previously identified as potential venues to access men. In r...

Polygyny has been identified both as a 'benign' form of concurrency and as the cultural basis of concurrent partnerships that are considered important drivers of the HIV epidemic in sub-Saharan Africa. This paper investigates the changing cultural and economic dynamics of polygyny in concurrency in Iringa, Tanzania, a region with traditions of poly...

Understanding the uptake and patterns of sexual partnerships of adolescent males reveals their risky behaviors that could persist into adulthood. Using venue-based sampling, we surveyed 671 male youth ages 15-19 from an urban Tanzanian neighborhood about their sexual partnerships during the past 6 months. The proportion of males who had ever had se...

Abstract Although concurrent sexual partnerships (CPs) have been hypothesized to be an important risk factor for HIV in sub-Saharan Africa, the social and cultural factors that encourage CPs are not well understood. This study explored the community's perspectives on the role that parents can play in influencing their children's decision to engage...

Background The objective of this formative research was to engage multiple stakeholders to identify specific factors that may influence program development for Project Prepare Tanzania- an innovative, school-based sexual health curriculum for young adolescents in Tanzania. Methods Focus group discussions (FGDs) and structured interviews were used t...

Program affiliations at the time of the study:

Developing effective place-based health interventions requires understanding of the dynamic between place and health. The therapeutic landscape framework explains how place-based social processes and physical geography interact and influence health behavior. This study applied this framework to examine how venues, or social gathering places, influe...

Early sexual debut is associated with increased HIV risk among young adolescents in sub-Saharan Africa. Our study examines parents' and teachers' communication about sexual matters in relation to the timing of sexual initiation among students aged 12-14 years old in Dar es Salaam, Tanzania. Virgin primary school students were followed prospectively...