Studies on the epidemiology and control of rabies

The work described in this dissertation falls into two main parts;Firstly, the epidemiology of rabies in Iowa is discussed in the first three sections. A retrospective study has shown a close association between rabies in skunks and rabies in domestic and other wild animals. Skunks were recognized as the main reservoir hosts to be considered in planning and targeting control measures in all species. The epidemiology of rabies in raccoons was investigated in two geographical locations. In both locations, there was a correlation in this species between the sero-positive rate and age as well as between the sero-positive rate and weight. This is an indication of continuous exposure to the infection throughout the life of the animals. This also was reflected in the difference in the percentage of positive sera between juvenile and adults. The juvenile raccoons have shown a positive rate which is one-third that of the adults. Female raccoons have shown a higher percentage of positive sera than males in general. There were some differences among both weight and age groups in the positive rates in each sex. In Guthrie County, the spring percentage of positive sera was higher than the percentages in summer or the fall. However, in Cerro Gordo County, the spring percentage of positive sera was lower than in summer. The skunks from Cerro Gordo County have shown a lower positive rate in the spring than in the summer. In skunks, the females also showed a higher positive rate than the males. However, a negative correlation between weight and positive rate was detected in the skunks. In both species, the probably time of transmission of the infection was considered to be during over-winter communal denning when the population density were high, and during the early spring breeding season;Secondly, the activity of 3 chemotherapeutics was evaluated against rabies virus in vitro. Amantadine HCl, ribavirin and rifampin were found effective when used in the first 8-12 hr after infection. Also, these drugs were effective when used continuously for 24-36 hr, with ribavirin showing a wider range of active concentrations than amantadine HCl, which in turn showed wider range than rifampin. Amantadine HCl, and rifampin were more toxic to cell cultures at higher concentrations

A ten year review of the sickle cell program in Muhimbili National Hospital, Tanzania.

BACKGROUND: Africa has the highest burden of Sickle cell disease (SCD) but there are few large, systematic studies providing reliable descriptions of the disease spectrum. Tanzania, with 11,000 SCD births annually, established the Muhimbili Sickle Cell program aiming to improve understanding of SCD in Africa. We report the profile of SCD seen in the first 10 years at Muhimbili National Hospital (MNH). METHODS: Individuals seen at MNH known or suspected to have SCD were enrolled at clinic and laboratory testing for SCD, haematological and biochemical analyses done. Ethnicity was self-reported. Clinical and laboratory features of SCD were documented. Comparison was made with non-SCD population as well as within 3 different age groups (< 5, 5-17 and ≥ 18 years) within the SCD population. RESULTS: From 2004 to 2013, 6397 individuals, 3751 (58.6%) SCD patients, were enrolled, the majority (47.4%) in age group 5-17 years. There was variation in the geographical distribution of SCD. Individuals with SCD compared to non-SCD, had significantly lower blood pressure and peripheral oxygen saturation (SpO2). SCD patients had higher prevalence of severe anemia, jaundice and desaturation (SpO2 < 95%) as well as higher levels of reticulocytes, white blood cells, platelets and fetal hemoglobin. The main causes of hospitalization for SCD within a 12-month period preceding enrolment were pain (adults), and fever and severe anemia (children). When clinical and laboratory features were compared in SCD within 3 age groups, there was a progressive decrease in the prevalence of splenic enlargement and an increase in prevalence of jaundice. Furthermore, there were significant differences with monotonic trends across age groups in SpO2, hematological and biochemical parameters. CONCLUSION: This report confirms that the wide spectrum of clinical expression of SCD observed elsewhere is also present in Tanzania, with non-uniform geographical distribution across the country. Age-specific analysis is consistent with different disease-patterns across the lifespan

Enhanced REC collaborative review through videoconferencing

As international collaborative health research activities increase, building research ethics committees (REC) infrastructure and capacity in lowand middle-income countries for efficient and thorough review of research protocols becomes more critical, especially in sub-Saharan Africa. International investigators may face multiple challenges when conducting research in these settings, an important one being the length of time involved in securing REC review and approval. We discuss an approach to the problem that involved organisation of ‘rapid review’ REC sub-committees who met via video-conference for collaborative review of research protocols

Enhanced REC collaborative review through videoconferencing

As international collaborative health research activities increase, building research ethics committees (REC) infrastructure and capacity in lowand middle-income countries for efficient and thorough review of research protocols becomes more critical, especially in sub-Saharan Africa. International investigators may face multiple challenges when conducting research in these settings, an important one being the length of time involved in securing REC review and approval. We discuss an approach to the problem that involved organisation of ‘rapid review’ REC sub-committees who met via video-conference for collaborative review of research protocols

A Retrospective Study of Patients with Castrate Resistant Prostate Cancer at Muhimbili National Hospital, Tanzania

Background: Prostate cancer (PC) is a common health problem among men globally with high incidence and mortality. The mortality following PC is associated with advanced disease progressing to castrate resistance following androgen ablation therapies. While advances to addresscastrate resistant prostatic cancer (CRPC) have shown good results, the burden of castrate resistant cancer in Tanzania has remained unknown hence our patients cannot benefit from such advances. This study therefore aimed to determine the magnitude and clinical presentation among patients with a diagnosis of castrate resistant cancer at Muhimbili National Hospital in 2018-2019. Methods: This was a retrospective descriptive hospital based study carried out at Muhimbili National Hospital. Patients who were treated with androgen blockade, had evidence of attainment of castrate levels of testosterone with a diagnosis of castrate resistant prostate cancer were identified. Information regarding primary prostatic cancer treatment, clinical disease progression symptoms, and age of the patients were collected. Descriptive statistics were prepared and summarized as tables and figures. Results: We recruited 293 patients with prostate cancer treated by androgen deprivation therapy. Bilateral orchiectomy was the most common treatment modality offered for advanced PC. Castrate levels of testosterone were achieved in 189 (95.5%) of the patients who had testosterone levels checked. Ninety-Six (50.8%) had met the criteria for diagnosis of castrate resistant prostate cancer with mean age of 71.23±4.2 years. Patients presented with lower urinary tract symptoms and metastatic features. Most of the patients had a poorly differentiated histology with prostate specific antigen (PSA) over 100ng/l. Only 13.5% of the patients had spine magnetic resonance imaging (MRI) for their work up. Conclusion and recommendation: Half of patients treated for advanced PC at MNH will progress to castrate resistance following androgen deprivation therapy. More studies are needed to understand the predictors of CRPC and related treatment strategies. Key words: Castrate Resistant Prostate cancer, androgen deprivation therapy, advanced prostate cance