Focus on Mainland Tanzania:(Progress & Impact Series)

Tanzania's National Malaria Control Programme (NMCP) has provided strong, stable leadership in coordinating malaria control activities since 1995. Because of continuity and focus on programme implementation, both the number of partners and resources have been growing, most notably over the last seven years. Between 2003 and 2010, about US$ 450 million in external funding was allocated to scale up the malaria control programme. These increasing contributions have been used to deliver preventive and curative services. 18 562 571 insecticide-treated mosquito nets (ITNs) were distributed between 2007 and 2010 through mass campaigns and the national voucher scheme. Indoor residual spraying (IRS) began in 2007 and had expanded to cover 94% of the targeted structures in 18 districts by March 2011.Rapid diagnostic tests (RDTs) and artemisininbased combination therapies (ACTs) have been deployed to reach half of the population so far, and health workers have been trained in using them. Efforts have also been made to make these new treatments available in the private sector, where up to 40% of the rural population seek care for fever. This deployment of interventions has resulted in improved coverage. 63% of households owned at least one ITN in 2010, compared with 23% in 2004–2005. 64% of all children under five and 56% of all pregnant women nationwide used an ITN the night before the 2010 survey—a more than twofold increase since 2007. In addition, between 2001 and 2006, Tanzania changed its recommended antimalarial drug from chloroquine to sulfadoxine-pyrimethamine (SP) to ACTs, thereby providing access to more effective antimalarials. Because of good coverage results, the Tanzanian government has been able to reduce disease burden and save lives. In the Ifakara surveillance area, the prevalence of parasitaemia in children under five was reduced by more than 5-fold, from 25% in 2004–2005 to less than 5% in 2010. Nationally, severe childhood anaemia was halved, dropping from 11% in 2004–2005 to 5.5% in 2010. All-cause under-five child mortality fell by 45% between 1999 and 2010—from 148 deaths per 1000 live births in 1999 to 81 per 1000 live births in 2010. According to the Lives Saved Tool (LiST estimation model), the lives of 63 000 children under five have been saved by malaria control interventions since 1999. Tanzania's improved malaria and health indicators are all signs that malaria control efforts are working and delivering results. Consideration of other factors that might explain the declines in all-cause under-five mortality leads to the conclusion that the improvement in child health is due in large part to malaria control efforts. The country is also achieving equitable impact on major mortality and malaria coverage indicators. With demonstrated ability to deliver and achieve impact on child survival, Tanzania has articulated even more ambitious malaria control goals: universal ITN coverage, IRS in half of the country, and enhanced diagnosis and ACT treatment of all malaria cases. This will require increased funding and a strengthened health infrastructure. If challenges of resource mobilization, boosting the work force, and strengthening the health system can be met, Tanzania will have paved the way towards unprecedented public health achievements and protection of its population against a major scourge.\u

Covid-19 in Africa: Exploring the Factors that Predict Public Acceptance & Use of the Covid-19 Vaccine in Sub-Saharan Africa

The Covid-19 pandemic has resulted in many unprecedented mortality and fatalities globally. To address the negative effects of the pandemic on the general public and nations, the Covid-19 vaccine was developed and rolled out globally. However, historical evidence suggests that Africans initially struggle to accept and use vaccines because of misconceptions and ignorance and the Covid-19 vaccine might not be an exception. This study identifies the various factors that influence citizens' acceptance and use of the Covid-19 vaccine in Africa, specifically Sub-Saharan Africa using a chi-square analysis of 3000 respondents from six countries. Results from our analysis suggest that vaccine specific issues such as safety, effectiveness, availability, delivery methods, and other factors strongly correlate with acceptance and use of the Covid-19 vaccine. The findings of this study have serious implications for both theory and practice in Africa and globally

Philippine-Pop as Potential Catalyst: Filipino Fans’ Perception as a Basis for Tourism Promotion

Philippine Pop, or P-Pop, is a recent phenomenon similar to the well-known Korean Pop groups, showcasing the talents of the country's artists. The study investigates the various factors and effects of P-pop as a potential catalyst to the perception of Filipino fans. This quantitative study utilized a descriptive research design with four hundred (400) P-pop fans aged 18 and above as the respondents. The findings revealed that destination, transportation, food and beverage, and culture are highly observed in the content of P-pop, according to the Filipino fans. Therefore, it provides representation and exposure to the Philippines’ local destination, transportation, food and beverage, and culture through its content, which is a way to give awareness and influence its viewers, including the fans and the general public. This study also showed that there is a significant relationship between factors such as P-pop’s content, popularity, cultural promotion, tourism promotion, and travel motivation, in which all factors play an important role in promoting the tourism industry. It was concluded that P-pop is a potential catalyst for promoting the tourism industry of the Philippines as it can contribute to increasing the travel motivation of Filipino fans. Moreover, this pioneering study aims to open the opportunity for continuous research as it highlights the promotion of the tourism industry by utilizing the strength of the Philippine culture. With the increasing popularity of P-pop, both locally and internationally, this new method of promoting tourism through idol groups can pave the way for the Philippine tourism industry to boom

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research