Knowledge, attitudes and practices regarding malaria and mosquito net use among women seeking antenatal care in Iringa, south-western Tanzania

To improve control measures against malaria, Tanzania has increased the distribution of free and subsidized insecticide-treated mosquito nets (ITNs) to pregnant women. However, data on knowledge, attitudes and practices of these women regarding malaria are scarce. This study was carried out to describe knowledge, attitudes and practices towards malaria, mosquito net ownership and use among women seeking antenatal care at Iringa Regional Hospital in south-western Tanzania. The study involved women attending the antenatal clinic of the hospital. A pre-tested structured questionnaire was applied to collect information on socio-demographic characteristics, mosquito net ownership and use, as well as knowledge, attitudes and practices about malaria and its control. Among the 222 pregnant women included, 173 (78%, 95%CI, 72-84.2) owned a mosquito net, and 150 (68%, 95%CI, 61-75) reported to sleep always under a mosquito net. The use of mosquito nets was mentioned by 142 (64%, 95%CI, 56.2-72). Of the 46 women who did not own a mosquito net, seven (15.2%) reported cost as the main obstacle for owning one. About 53% (95%CI, 44-62) preferred to use mosquito nets they bought rather than the one provided for free. Several factors such as gravidity, fearing of getting malaria, knowledge on the cause, marital status, and ways used to prevent malaria were significantly associated with mosquito net ownership (all

Home treatments with antipyretics and antimalarials given to underfives with fever in Mwanza, north-western Tanzania

Early diagnosis and prompt treatment is the recommended management for febrile illness among underfives. However, improper home management may be the cause of delay in seeking professional health care. This cross-sectional study was conducted at the outpatient department of Buzuruga Health Centre in Mwanza, Tanzania and involved 372 children 1 day (OR= 2.69; 95% CI: 1.95-3.70;

Mono-parasite infection versus co-infections in Tanzania: the need to revise our research focus

Parasitic infectious agents in endemic African countries including Tanzania rarely occurs in isolation and co-infections within a single host in populations are norms rather than exceptions (Brooker et al., 2007; Mazigo et al., 2010a; Mboera et al., 2011). Coinfection refers to a situation in which an individual harbours two or more infections from different species simultaneously, where as mono-infection refers to a situation in which an individual harbours only one infection from a single species (Brooker et al., 2007). Several factors determines the wide geographical distributions of helminth and protozoan parasites and they include climate, environment, socio-economic status, human behaviour and host-specific factors such as genetics, host physiology, host immunological status and population dynamics (Mwangi et al., 2007)

Utility of paper-based sickle cell test compared to sodium metabisulfite sickling test using hemoglobin electrophoresis as a gold standard at Bugando Medical Center, Mwanza

BACKGROUND: Sickle cell disease (SCD) describes a group of inherited red blood cell disorders. People with SCD have abnormal haemoglobin (Hb), called Hb S. In all forms of SCD, at least one of the two abnormal genes causes a person's body to make Hb S. In countries with limited resources, diagnostic technique should be simple and easy to perform with high sensitivity and specificity. METHODS: This study compared the paperbased sickle cell test and sodium metabisulfite sickling test using Hb electrophoresis as a gold standard. It was a crosssectional hospitalbased study which was conducted from July to October 2017 involving a total of 140 blood samples of under 10 years children presumed to have SCD. Blood samples in ethylenediaminetetraacetic acid anticoagulantcontaining vacutainers were used for SCD diagnosis by using paperbased and sodium metabisulfite sickling tests then confirmed by Hb electrophoresis as the gold standard. RESULTS: Blood specimens were from individuals aged 4 years ranged from 2 to 9 years. Slightly majority of blood specimens belonged to males, 54.3% (76/140) while the majority was from inpatients, 82.9% (116/140). Paperbased sickle cell test identified 46/140 (32.9%) Hb AA, 81/140 (57.9%) Hb, and 6/140 (4.3%) Hb AS. Sickling test identified 50/140 (35.7%) Hb AA and 87/140 (62.1%) Hb SS. Hb electrophoresis identified 50/140 (35.7%) Hb AA, 83/140 (59.3%) Hb SS, and 7/140 (5%) Hb AS. The paperbased sickle cell test had a sensitivity of 97.8% and specificity of 96.7% while the sickling test had the sensitivity of 96.7% and specificity of 100%. CONCLUSION: Paperbased sickle cell test was able to detect sickle cell carriers, Hb AS and shown high sensitivity and specificity; therefore, it can be used as a substitute for sickling test in countries with limited resource. However, paperbased sickle test is suitable for adults' population

Association of intestinal helminths and P. falciparum infections in co-infected school children in northwest Tanzania

Plasmodium falciparum malaria and intestinal helminth infections are among the most common infections in the tropics and they share the same spatial distribution.The objective of this study was to explore the association between infections with intestinal helminths and P. falciparum infection as single helminth infections or co-infections among school children. A cross-sectional study was conducted among 400 school children in Nyamtongo, Sengerema District in Tanzania. The study involved examination of single stool and finger prick blood samples for intestinal helminths and malaria parasites. A Kato-Katz technique was employed to screen for intestinal helminths and Giemsa stained thin and thick blood smears were used to screen for malaria parasites. The results of logistic regression model adjusted for age and sex indicated no association between P. falciparum and S. mansoni (OR= 0.749, 95%CI 0.418-1.344), P. falciparum and hookworm (OR= 0.885, 95%CI 0.489-1.605) and P. falciparum and co-infection of S. mansoni and hookworm (OR=0.859, 95%CI 0.422-1.745). Using multinomial regression model adjusted for age and sex, no association was observed between P. falciparum with Schistosoma mansoni [Ratio of Relative Risk (RRR) = 0.651, 95% Confidence Interval (CI) 0.331-1.363] and hookworm (RRR=0712, CI 0.280-1.765). Similarly, no association was observed between co-infections of S. mansoni + hookworm (RRR=0.635, CI 0.268-1.504) with P. falciparum infection. Co-infections of S. mansoni, hookworm and P. falciparum among school children is common in the Nyamatongo ward, Sengerema District. We recommend prospective longitudinal studies to elucidate the interactions of malaria and helminths and its health impact in risk groups

Reported knowledge, attitudes and practices regarding malaria and mosquito net use among women seeking antenatal care in south-western Tanzania

To improve control measures against malaria, Tanzania has increased the distribution of free and subsidized insecticide-treated mosquito nets (ITNs) to pregnant women. However, data on ownership and use of ITNs, as well as knowledge, attitudes and practices of these women regarding malaria are scarce. The objective of this study was to describe knowledge, attitudes and practices towards malaria, frequency of bed net use and level of ownership of bed nets among women seeking antenatal care in Iringa regional hospital, southern Tanzania. This cross-sectional study involved women attending antenatal clinic at Iringa Regional Hospital in south-western Tanzania. A pre-tested structured questionnaire was applied. Among the 222 pregnant women included, 173 (78%, 95%CI, 72-84.2) owned a bed net, and 150 (68%, 95%CI, 61- 75) reported to sleep always under a bed net. The use of bed nets was mentioned by 142 (64%, 95%CI, 56.2-72). Of the 46 women who did not own a bed net, seven (15.2%) reported cost as the main obstacle for owning one. About 53% (95%CI, 44-62) preferred to use mosquito nets they bought rather than the one provided for free. Several factors such as gravidity, fearing of getting malaria, knowledge on the cause, marital status, and ways used to prevent malaria were significantly associated with mosquito net ownership (all P<0.001). Education level and gravidity were associated with the behaviour to sleep always under bed nets (P<0.002). Multigravidae (2-4 pregnancies) (OR 2.1, 95%CI 1.2-4.8) and married women (OR, 1.9, 95%CI, 1.2-5.2) were more likely to own a net, as compared to primigravidae and single women. In conclusion, ITNs ownership and use among pregnant women was good and they preferred to use the nets they bought from private sector. Thus, integrating public and private sector will improve the distribution and coverage of insecticides treated mosquito among high risk groups, such as pregnant women

Home treatments with antipyretics and antimalarials given to underfives with fever in Mwanza, north-western Tanzania

Early diagnosis and prompt treatment is the recommended management for febrile illness among underfives. However, improper home management may be the cause of delay in seeking professional health care. This cross-sectional study was conducted at the outpatient department of Buzuruga Health Centre in Mwanza, Tanzania and involved 372 children <5 years of age. Socio-demographic data of caregivers and children, type and source of treatment, and duration of fever were recorded. A total of 283 (76.1%) febrile underfives had received different types of treatment at home, before presenting at the hospital. The majority received antipyretics (204; 72.1%), and only a few (31; 10.9%) received antimalarials. The major sources of drugs were local drug stores (270; 94.7%). Duration of fever >1 day (OR= 2.69; 95% CI: 1.95-3.70; P<0.001), low grade fever (OR= 4.37, 95% CI: 2.60-7.35; P<0.001) and fever accompanied with other major complaints (OR= 1.14, 95%CI: 1.05 – 1.23; P=0.002) were significantly associated with prompt home medication before presenting to the health centre. In logistic regression analysis, duration of fever, low-grade fever and the presence of other symptoms remained significant predictors to receive antimalarial and or antipyretic drugs. In conclusion, home treatments with antipyretics and antimalarials in preschool children are common in Mwanza. Management of fevers may be improved by educating caregivers on community standard case definition of malaria while emphasizing the importance of early seeking of health facility services

Outcomes of Hydroxyurea Accessed via Various Means and Barriers Affecting Its Usage Among Children with Sickle Cell Anaemia in North-Western Tanzania.

Purpose To assess clinical and haematological outcomes of Hydroxyurea accessed via various access means and uncover the barriers to its utilization in children with Sickle cell anaemia (SCA), North-western Tanzania. Patients and Methods A retrospective study was conducted between October 2020 and April 2021 at Bugando Medical Centre (BMC) through review of medical files to compare the clinical and haematological outcomes among children with SCA at baseline and followed up retrospectively for at least one year of hydroxyurea utilization, accessed via cash, insurance and projects. Subsequently, a cross-sectional survey was conducted among parents and caregivers to ascertain the barriers to access of hydroxyurea via the various means. The p-values \u3c0.05 were considered statistically significant. Results We identified 87 children with SCA who were on hydroxyurea for at least one year. The median age at baseline (before hydroxyurea) was 99 [78–151] months, and 52/87 (59.8%) were male. Compared to baseline, there was a significant reduction in proportion of patients reporting vaso-occlusive crisis, admissions and blood transfusions, a significant increase in Haemoglobin and mean corpuscular volume, conversely a significant reduction in absolute neutrophil and reticulocytes to both insurance and project participants. There was no significant change in most of these parameters among patients who accessed hydroxyurea via cash. Further, a total of 24/87 (27.6%) participants reported different barriers to access of hydroxyurea, where 10/24 (41.7%) reported hydroxyurea to be very expensive, 10/24 (41.7%) reported insurance challenges, and 4/21 (16.6%) reported unavailability of the drug. Conclusion The paediatric patients utilizing hydroxyurea accessed via insurance and projects, but not cash, experienced significant improvement in the clinical and haematological outcomes. Several barriers for access to hydroxyurea were observed which appeared to impact these outcomes. These findings call for concerted efforts to improve the sustainable access to hydroxyurea among all patients with SCA

Very severe anemia and one year mortality outcome after hospitalization in Tanzanian children: A prospective cohort study.

BackgroundAfrica has the highest rates of child mortality. Little is known about outcomes after hospitalization for children with very severe anemia.ObjectiveTo determine one year mortality and predictors of mortality in Tanzanian children hospitalized with very severe anemia.MethodsWe conducted a prospective cohort study enrolling children 2-12 years hospitalized from August 2014 to November 2014 at two public hospitals in northwestern Tanzania. Children were screened for anemia and followed until 12 months after discharge. The primary outcome measured was mortality. Predictors of mortality were determined using Cox regression analysis.ResultsOf the 505 children, 90 (17.8%) had very severe anemia and 415 (82.1%) did not. Mortality was higher for children with very severe anemia compared to children without over a one year period from admission, 27/90 (30.0%) vs. 59/415 (14.2%) respectively (Hazard Ratio (HR) 2.42, 95% Cl 1.53-3.83). In-hospital mortality was 11/90 (12.2%) and post-hospital mortality was 16/79 (20.2%) for children with very severe anemia. The strongest predictors of mortality were age (HR 1.01, 95% Cl 1.00-1.03) and decreased urine output (HR 4.30, 95% Cl 1.04-17.7).ConclusionsChildren up to 12 years of age with very severe anemia have nearly a 30% chance of mortality following admission over a one year period, with over 50% of mortality occurring after discharge. Post-hospital interventions are urgently needed to reduce mortality in children with very severe anemia, and should include older children