Estimating the prevalence, quality of life, economic and societal impact of arthritis in Tanzania: protocol for a mixed methods study [Protocol]

Introduction: Musculoskeletal (MSK) disorders are one of the major causes of disability globally. A 2010 Global Burden of Disease study reported that MSK diseases account for 20% of all Years Lived with Disability (YLDs) in Low- and Middle-Income countries. This study will use mixed methods to generate new findings on the prevalence, quality of life, economic and societal impact of musculoskeletal disorders (including arthritis) in the Hai district in Tanzania. Methods and analysis: In this mixed-methods study funded by the UK’s National Institute for Health Research (NIHR) Global Health Research Units and Groups (Award no: 17/63/35) we will conduct quantitative, community-based (urban, peri - urban and rural) and hospital based prospective surveys, supported by rapid ethnographic assessments (REAs), in-depth interviews, focus group discussions (FGDs) and clinical diagnostic screening to estimate the prevalence, economic and societal impact of arthritis. A retrospective medical records baseline review at the Kilimanjaro Christian Medical Centre (KCMC) will also be conducted to assess prevailing documentation and management of arthritis. Ethics and dissemination: Ethical approval has been obtained through Kilimanjaro Christian Medical University College (KCMUCo) Research Ethics and Review committee (CRERC) in Moshi, National Health Research Ethics Committee (NatHREC) of the National Institute for Medical research (NIMR) in Tanzania and the Medical Veterinary and Life Sciences (MVLS) Ethics committee at the University of Glasgow, UK (MVLS ethics project number:20018010). We will disseminate the findings in clinical, epidemiological, and economic peer reviewed journals. Other dissemination modalities include professional conferences, short reports, community leaflets, policy briefs and dissemination events to communities and various stakeholders including the Ministry of health in Tanzania

Rituximab in Combination with Corticosteroids for the Treatment of Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis: A NICE Single Technology Appraisal

As part of its single technology appraisal (STA) process, the National Institute for Health and Care Excellence (NICE) invited the manufacturer of rituximab (Roche Products) to submit evidence of the clinical and cost effectiveness of rituximab in combination with corticosteroids for treatment of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). The School of Health and Related Research Technology Appraisal Group at the University of Sheffield was commissioned to act as the independent Evidence Review Group (ERG). The ERG produced a critical review of the evidence for the clinical and cost effectiveness of the technology, based upon the manufacturer’s submission to NICE. The evidence was derived mainly from a double-blind, phase III, placebo-controlled trial of rituximab in patients with new or relapsed ‘severe’ AAV, which compared a rituximab treatment regimen with an oral cyclophosphamide treatment regimen. Intravenous cyclophosphamide is also commonly used but was not included in the pivotal trial. The evidence showed that rituximab is noninferior to oral cyclophosphamide in terms of induction of remission in adults with AAV and de novo disease, and is superior to oral cyclophosphamide in terms of remission in adults who have relapsed once on cyclophosphamide. The ERG concluded that the results of the manufacturer’s economic evaluation could not be considered robust, because of errors and because the full range of relevant treatment sequences were not modelled. The ERG amended the manufacturer’s model and demonstrated that rituximab was likely to represent a cost-effective addition to the treatment sequence if given after cyclophosphamide treatment

The role of rodents and small carnivores in plague ende- micity in Tanzania

Belgian journal of zoology 2005; 135 (supplement): 119-125Between 1974 and 2003, blood samples were collected from wild and commensal rodents, and wild and domestic small carnivores in selected villages of seven districts in Tanzania that have experienced human plague outbreaks and seven districts that have not experienced any outbreak of the disease. The samples were tested for antibodies against Yersinia pestis Fraction I antigen, using passive haemagglutination (PHA) or ELISA tests. Of the 3354 rodents and 558 small carnivores from the plague infected districts, 122 (3.6 %) rodents (captured in Mbulu and Lushoto districts) were plague positive ; 29 (5.2 %) small carnivores from Mbulu, Arumeru, Hai and Lushoto districts were plague positive, 28 of these were domestic dogs (Canis familiaris). PCR tests showed that 17.5 % of 211 rodents tested from Lushoto contained Y. pestis DNA. In the non-infected districts, 1545 rodents and 171 domestic dogs were tested. 11 (0.7 %) of the rodents (captured in Monduli, Chunya and Masasi districts) were plague-positive. In Masasi district, 10.4% (7/67) of the rodents and 43.6 % (17/39) of the dogs were positive for anti-Y. pestis IgG. It was concluded that wild and commensal rodents as well as wild and domestic small carnivores play a potential role as reservoirs and/or carriers of sylvatic plague in Tanzania, and that the disease exists in areas where human plague outbreaks have not occurred before. In order to update the distribution of the disease it is pro- posed that further epidemiological surveillance activities are established

Wildlife, Livestock, and Companion Animals

Outbreaks of foodborne illness associated with the consumption of leafy green produce from California and across the United States have heightened the need to identify vertebrate sources of these microbial hazards. Concern has focused on wildlife species that have direct access to the produce production environment and irrigation water supplies. Recent fecal surveys of California wildlife, feral animals, and livestock and companion animals are allowing regulators to compare the food safety risks of such pathogens as E. coli O157:H7 and Salmonella from these various animal species. In order to make valid food safety risk comparisons between wildlife, livestock, and companion animals, a variety of methodological and epidemiological issues need to be addressed in order to avoid substantial biases. For example, the amount of feces tested per animal can vary up to a 1000-fold, substantially biasing the probability of testing positive for large fecal contributors (e.g., cattle) compared to smaller wildlife (e.g., deer mice). Many wildlife species intrude and forage as a group in fields of produce, which can lead to in-field defecation, substantially, elevating the risk of microbial contamination compared to many larger animal species that do not have direct access to produce fields due to fencing. This paper highlights the technical challenges of making valid quantitative comparisons of microbial food safety risks from wildlife compared to other domestic animals

Data from: Comanaging fresh produce for nature conservation and food safety

Fresh produce has become the primary cause of foodborne illness in the United States. A widespread concern that wildlife vector foodborne pathogens onto fresh produce fields has led to strong pressure on farmers to clear noncrop vegetation surrounding their farm fields. We combined three large datasets to demonstrate that pathogen prevalence in fresh produce is rapidly increasing, that pathogens are more common on farms closer to land suitable for livestock grazing, and that vegetation clearing is associated with increased pathogen prevalence over time. These findings contradict widespread food safety reforms that champion vegetation clearing as a pathogen mitigation strategy. More generally, our work indicates that achieving food safety and nature conservation goals in produce-growing landscapes is possible