Factors associated with partners elicitation during HIV Index client´s testing in Dar es Salaam Region, Tanzania

Introduction: Identifying people exposed to HIV is critical towards achieving the UNAIDS 90-90-90 goals for HIV epidemic control. The first 90 in Tanzania is at 53% and yet factors for partner's elicitation to HIV care providers are poorly understood. The objective of this study was to determine predictors of partner's elicitation among index HIV positive clients. Methods: We conducted a cross-sectional study from January to March 2019 among HIV positive clients diagnosed within the previous 12 months within HIV care and treatment centers in Dar-es Salaam. A structured questionnaire was used to collect the indexes' partner such as including name, type and status of relationship, and location. Participants were asked to choose the preferred approach to notify partners. Using modified Poisson regression estimate prevalence ratios predictors were determined for variables at p< to 0.05. Results: A total of 438 HIV index clients, mean age 37yrs ±11 SD were identified. Of these, 243 (55.5%) provided partners information to HIV Testing and Care (HTC) provider. Predictors for partner elicitation were awareness of notification methods aPR 3.80, 95%CI 2.11-7.01; having privacy at initial HTC visit aPR 3.20 95%CI 1.30-7.40; awareness of partner's HIV status aPR 1.16, 95%CI 1.03-1.30 and having no fear of rejection by partner aPR1.52, 95%CI 1.23-1.88. However, being a female HIV index client was significantly associated with decreased likelihood of partner's elicitation aPR 0.87, 95% CI 0.80-0.95. Conclusion: There is a low elicitation rate of exposed partners by index clients. Awareness of notification approaches, confidentiality, having no fear of rejection by partner, and privacy during HTC services contribute to high partner elicitation. Promotion of community awareness on partner's notification approaches and HIV transmission dynamics, and provision of additional support networks for women improve elicitation outcomes are recommended

Knowledge of obstetric danger signs among recently-delivered women in Chamwino district, Tanzania: a cross-sectional study

Abstract Background Low knowledge of danger signs has been shown to delay seeking obstetric care which leads to high maternal mortality and morbidity worldwide. In Tanzania about half of pregnant women are informed about obstetric danger signs during antenatal care, but the proportion of those who have full knowledge of these obstetric danger signs is not known. This study assessed the knowledge of obstetric danger signs and its associated factors among recently-delivered women in Chamwino District, Tanzania. Methods A community-based cross-sectional study was conducted in January 2014 in Chamwino District, Tanzania. A woman was considered knowledgeable if she spontaneously mentioned at least five danger signs in any of the three phases of childbirth (pregnancy, childbirth and postpartum) with at least one in each phase. Multistage cluster sampling was used to recruit study participants. Descriptive and bivariate analyses were conducted. Multivariable logistic regression analyses were performed to control for confounding and other important covariates. Results A total of 428 women were interviewed. The median age (IQR) was 26.5 (22–33) years. Only 25.2% of respondents were knowledgeable about obstetric danger signs during pregnancy, childbirth/labour and postpartum. Significant explanatory variables of being knowledgeable about obstetric danger signs were found to be maternal education (AOR = 1.96; 95% CI: 1.01, 3.82), maternal occupation (AOR = 2.23; 95% CI; 1.10, 4.52), spouse occupation (AOR = 2.10; 95% CI: 1.02, 4.32) and counseling on danger signs (AOR = 3.42; 95% CI: 1.36, 8.62) after controlling for the clustering effect, confounding and important covariates. Conclusion A low proportion of women was found to be knowledgeable about obstetric danger signs in Chamwino district. Therefore, we recommend the Ministry of Health to design and distribute the maternal health booklets that highlight the obstetric danger signs, and encourage antenatal care providers and community health workers to provide frequent health education about these danger signs for every pregnant woman in order to increase their level of knowledge about obstetric danger signs

Addressing the workforce capacity for public health surveillance through field epidemiology and laboratory training program: the need for balanced enhanced skill mix and distribution, a case study from Tanzania

Introduction: skill mix refers to the range of professional development and competencies, skills and experiences of staff within a particular working environment that link with specific outcome while responding to client needs. A balanced skill-mix and distribution of core human resources is important to strengthen decision-making process and rapid responses. We analysed graduates´ information of the Tanzania Field Epidemiology and Laboratory Training Program (TFELTP) between 2008-2016, distribution of skill-mix and the surveillance workforce-gaps within regions. Methods: trainees´ data of nine cohorts enrolled between 2008 and 2016 were extracted from the program database. Distribution by sex, region and cadres/profession was carried out. An indicator to determine enhanced-skill mix was established based on the presence of a clinician, nurse, laboratory scientist and environmental health officer. A complete enhanced skill-mix was considered when all four were available and have received FELTP training. Results: the TFELTP has trained 113 trainees (male=71.7%), originated from 17 regions of Tanzania Mainland (65.4% of all) and Zanzibar. Clinicians (34.5%) and laboratory scientists (38.1%) accounted for the most recruits, however, the former were widely spread in regions (83% vs. 56%). Environmental health officers (17.7%) were available in 39% of regions. The nursing profession, predominantly lacking (6.2%) was available in 22% of regions. Only two regions (11.7%) among 17 covered by TFELTP presented complete skill-mix, representing 7.7% of Tanzanian regions. Seven regions (41%) had an average of one trainee. Conclusion: the TFELTP is yet to reach the required skill-mix in many regions within the country. The slow fill-rate for competent and key workforce cadres might impede effective response. Strategies to increase program awareness at subnational levels is needed to improve performance of surveillance and response system in Tanzania

Phenotypic and genetic characterization of vibrio cholerae O1 isolated from various regions of Kenya between 2007 and 2010

Introduction: Cholera, a disease caused by Vibrio cholerae O1 and O139 remains an important public health problem globally. In the last decade, Kenya has experienced a steady increase of cholera cases. In 2009 alone, 11,769 cases were reported to the Ministry of Public Health and Sanitation. This study sought to describe the phenotypic characteristics of the isolated V. cholerae isolates.Methods: This was a laboratory based cross-sectional study that involved isolates from different cholera outbreaks. Seventy six Vibrio cholerae O1 strains from different geographical areas were used to  represent 2007 to 2010 cholera epidemics in Kenya, and were characterized by serotyping, biotyping, polymerase chain r(PCR), pulsed-field gel electrophoresis (PFGE) and ribotyping along with antimicrobial susceptibility testing. Results: Seventy six Vibrio cholerae O1 strains from different geographical areas were used to represent 2007 to 2010 cholera epidemics in Kenya. Serotype Inaba was dominant (88.2%) compared to Ogawa.  The isolates showed varying levels of antibiotic resistance ranging from 100% susceptible to tetracycline, doxycycline, ofloxacin, azithromycin, norfloxacin and ceftriaxone to 100% resistant to furazolidone, trimethoprim-sulfamethoxazole, polymyxin-B and streptomycin. The isolates were positive for ctxA, tcpA (El Tor), rtxC genes and were biotype El Tor variant harboring classical ctxB gene. All the isolates were classified as cholera toxin (CT) genotype 1 as they had mutation in the ctxB at positions 39 and 68. All the isolates had genetically similar NotI PFGE and BglI ribotype patterns. The absence of any observed variation is consistent with a clonal origin for all of the isolates. Conclusion: Kenya experienced cholera numerous outbreak from 2007-2010. The clinical Vibrio cholerae O1 isolates from the recent cholera epidemic were serotypes Inaba and Ogawa, Inaba being the  predominant serotype. The Vibrio cholerae O1 strains were biotype El Tor variants that produce cholera toxin B (ctx B) of the classical type and were positive for ctxA, tcpA El Tor and rtxC genes.Key words: Cholera, characterization, Kenya, serotype, epidemics, pulsed-field gel electrophoresis

Projector augmented-wave approach to density-functional perturbation theory

The density-functional theory total energy within the projector-augmented wave formalism is expressed in a form suitable for application of the variation-perturbation formalism. We derive the corresponding expressions up to the third order. The much deeper complexity of the projector-augmented wave formalism, compared to the norm-conserving pseudopotential case, implies the introduction of several new notations. However, the structure of the resulting formalism is quite similar, and should be as useful, accurate, and widely applicable

Phylogeny of Kenyan strains showing the two subclades.

<p>Phylogeny of Kenyan strains showing the two subclades.</p

Global and seventh pandemic phylogeny.

<p>1a, a maximum likelihood phylogenetic tree of <i>V</i>. <i>cholerae</i> based on the SNP differences within the core genome. The 6 major O1 clinical groups are shown in this tree with the 7^th pandemic El Tor in blue, classical lineage in green and other colours are match the colours of strains in Table S2. In red are the environmental non O1/O139 strains from Kenya. The date range on the wave 3 node is the BEAST estimated time when the seventh pandemic wave 3 cholera entered Kenya. 1b, a maximum likelihood phylogenetic tree of the 7th pandemic lineage of <i>V</i>. <i>cholerae</i> based on the SNP differences across the whole core genome, excluding likely recombination events. The pre-7th pandemic isolate M66 was used as an outgroup to root the tree. Blue, green and red branches and the clade cartoon represent wave 1, 2, 3 and Kenyan clade respectively. 1c, a maximum likelihood phylogenetic sub-tree showing the position of Kenyan sporadic or travel linked clustering with south Asian strains. All the scales are given as the number of substitutions per variable site.</p