National Non-Communicable Diseases Conferences- A Platform to Inform Policies and Practices in Tanzania

Background: Non-communicable diseases (NCDs) arise from diverse risk factors with differences in the contexts and variabilities in regions and countries. Addressing such a complex challenge requires local evidence. Tanzania has been convening stakeholders every year to disseminate and discuss scientific evidence, policies, and implementation gaps, to inform policy makers in NCDs responses. This paper documents these dissemination efforts and how they have influenced NCDs response and landscape in Tanzania and the region. Methods: Desk review was conducted through available MOH and conference organizers’ documents. It had both quantitative and qualitative data. The review included reports of the four NCDs conferences, conference organization, and conduct processes. In addition, themes of the conferences, submitted abstracts, and presentations were reviewed. Narrative synthesis was conducted to address the objectives. Recommendations emanated from the conference and policy uptake were reviewed and discussed to determine the impact of the dissemination. Findings: Since 2019, four theme-specific conferences were organized. This report includes evidence from four conferences. The conferences convened researchers and scientists from research and training institutions, implementers, government agencies, and legislators in Tanzania and other countries within and outside Africa. Four hundred and thirty-five abstracts were presented covering 14 sub-themes on health system improvements, financing, governance, prevention intervention, and the role of innovation and technology. The conferences have had a positive effect on governments’ response to NCDs, including health care financing, NCDs research agenda, and universal health coverage. Conclusion: The National NCDs conferences have provided suitable platforms where stakeholders can share, discuss, and recommend vital strategies for addressing the burden of NCDs through informing policies and practices. Ensuring the engagement of the right stakeholders, as well as the uptake and utilization of the recommendations from these platforms, remains crucial for addressing the observed epidemiological transition in Tanzania and other countries with similar contexts

Non-communicable Diseases Week: Best Practices in Addressing the NCDs Burden from Tanzania

Background: Five million people die every year from non-communicable diseases (NCDs) globally. In Tanzania, more than two-thirds of deaths are NCD-related. The country is investing in preventive and advocacy activities as well as interventions to reduce the burden. Of particular interest, the Ministry of Health (MoH) commemorates NCDs’ week using a multisectoral and multi-stakeholders’ approach. This paper highlights activities conducted during NCDs week with the aim of sharing lessons for other countries with similar context and burdens. Methods: A thorough review of official reports and the national strategic plans for NCDs was done including the 2020 and 2021 National NCDs’ week reports, the National Strategic Plan for NCDs 2015–2020, and the National NCDs agenda. Findings: NCDs week is commemorated annually throughout the country involving the five key activities. First, community awareness and participation are encouraged through media engagement and community-based preventive and advocacy activities. Second, physical activities and sports festivals are implemented with a focus on developing and renovating infrastructures for sports and recreation. Third, health education is provided in schools to promote healthy behaviors for secondary school adolescents in transition to adulthood. Fourth, health service provision and exhibitions are conducted involving screening for hypertension, diabetes, obesity, alcohol use, and physical activities. The targeted screening of NCDs identified 10% of individuals with at least one NCD in 2020. In 2021, a third of all screened individuals were newly diagnosed with hypertension, and 3% were found to have raised blood glucose levels. Fifth, the national NCDs scientific conferences conducted within the NCDs week provide an avenue for stakeholders to discuss scientific evidence related to NCDs and recommend strategies to mitigate NCDs burden. Conclusion: The initiation of NCDs week has been a cornerstone in advocating for NCDs control and prevention in the country. It has created awareness on NCDs, encourage healthy lifestyles and regular screening for NCDs. The multi-stakeholder and multi-sectoral approaches have made the implementation of the mentioned activities feasible and impactful. This has set an example for the united efforts toward NCD control and prevention at national, regional, and global platforms while considering contextual factors during adoption and implementation

No evidence of SARS‐CoV‐2 transmission through transfusion of human blood products: A systematic review

Abstract The presence of viral nucleic material in the circulation poses a theoretical risk of transmission through transfusion. However, little is known about the possibility of the actual transmission through transfusion or transplantation of blood products. A PROSPERO registered systematic review pooled evidence from PubMed/MEDLINE, Google Scholar and CINAHL. The search included studies on severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) transmission through human blood products. In total 537 studies were extracted, and only eight articles (1.5%) were eligible for the final analysis. A total of 14 patients received blood products from coronavirus disease‐2019 (COVID‐19) virus‐positive donors, and six (42.9%) tested negative for COVID‐19 RT‐PCR for up to 14 days post‐transfusion/transplantation. There were no documented clinical details on the COVID‐19 test for eight (57.1%) blood products recipients. Of the eight patients, none of them developed any COVID‐19‐related symptoms. In conclusion, there is limited evidence of transfusion transmission of SARS‐CoV‐2 via human blood products. Consolidation of further evidence, as it emerges, is warranted

Epidemiology and treatment outcomes of recurrent tuberculosis in Tanzania from 2018 to 2021 using the National TB dataset.

BackgroundPatients with recurrent TB have an increased risk of higher mortality, lower success rate, and a relatively feeble likelihood of treatment completion than those with new-onset TB. This study aimed to assess the epidemiology of recurrent TB in Tanzania; specifically, we aim to determine the prevalence of TB recurrence and factors associated with unfavourable treatment outcomes among patients with recurrent TB in Tanzania from 2018 to 2021.MethodsIn this cross-sectional study, we utilized Tanzania's routinely collected national TB program data. The study involved a cohort of TB patients over a fixed treatment period registered in the TB and Leprosy case-based District Health Information System (DHIS2-ETL) database from 2018 to 2021 in Tanzania. We included patients' sociodemographic and clinical factors, facility characteristics, and TB treatment outcomes. We conducted bivariate analysis and multivariable multi-level mixed effects logistic regression of factors associated with TB recurrence and TB treatment outcomes to account for the correlations at the facility level. A purposeful selection method was used; the multivariable model included apriori selected variables (Age, Sex, and HIV status) and variables with a p-value FindingsA total of 319,717 participants were included in the study; the majority were adults aged 25-49 (44.2%, n = 141,193) and above 50 years (31.6%, n = 101,039). About two-thirds were male (60.4%, n = 192,986), and more than one-fifth of participants (22.8%, n = 72,396) were HIV positive. Nearly two in every hundred TB patients had a recurrent TB episode (2.0%, n = 6,723). About 10% of patients with recurrent TB had unfavourable treatment outcomes (9.6%, n = 519). The odds of poor treatment outcomes were two-fold higher for participants receiving treatment at the central (aOR = 2.24; 95% CI 1.33-3.78) and coastal zones (aOR = 2.20; 95% CI 1.40-3.47) than the northern zone. HIV-positive participants had 62% extra odds of unfavourable treatment outcomes compared to their HIV-negative counterparts (aOR = 1.62; 95% CI 1.25-2.11). Bacteriological TB diagnosis (aOR = 1.39; 95% CI 1.02-1.90) was associated with a 39% additional risk of unfavourable treatment outcomes as compared to clinical TB diagnosis. Compared to community-based DOT, patients who received DOT at the facility had 1.39 times the odds of poor treatment outcomes (aOR = 1.39; 95%CI 1.04-1.85).ConclusionTB recurrence in Tanzania accounts for 2% of all TB cases, and it is associated with poor treatment outcomes. Unfavourable treatment outcomes were recorded in 10% of patients with recurrent TB. Poor TB treatment outcome was associated with HIV-positive status, facility-based DOT, bacteriologically confirmed TB and receiving treatment at the hospital level, differing among regions. We recommend post-treatment follow-up for patients with recurrent TB, especially those coinfected with HIV. We also propose close follow-up for patients treated at the hospital facility level and strengthening primary health facilities in TB detection and management to facilitate early treatment initiation

Towards sustainable emergence transportation system for maternal and new born: Lessons from the m-mama innovative pilot program in Shinyanga, Tanzania

Maternal mortality comprises about 10% of all deaths among women of reproductive age (15–49 years). More than 90% of such deaths occur in low- and middle-income countries (LMIC). In this study, we aimed to document lessons learnt and best practices toward sustainability of the m-mama program for reducing maternal and newborn mortality in Tanzania. We conducted a qualitative study from February to March 2022 in Kahama and Kishapu district councils of Shinyanga region. A total of 20 Key Informant Interviews (KII) and four Focused Group Discussions (FGDs) were conducted among key stakeholders. The participants included implementing partners and beneficiaries, Community Care groups (CCGs) facilitators, health facility staff, drivers and dispatchers. We gathered data on their experience with the program, services offered, and recommendations to improve program sustainability. We based the discussion of our findings on the integrated sustainability framework (ISF). Thematic analysis was conducted to summarize the results. To ensure the sustainability of the program, these were recommended. First, active involvement of the government to complement community efforts, through the provision and maintenance of resources including a timely and inclusive budget, dedicated staff, infrastructure development and maintenance. Secondly, support from different stakeholders through a well-coordinated partnership with the government and local facilities. Third, continued capacity building for implementers, health care workers (HCWs) and community health workers (CHWs) and community awareness to increase program trust and services utilization. Dissemination and sharing of evidence and lesson learnt from successful program activities and close monitoring of implemented activities is necessary to ensure smooth, well-coordinated delivery of proposed strategies. Considering the temporality of the external funding, for successful implementation of the program, we propose a package of three key actions; first, strengthening government ownership and engagement at an earlier stage, secondly, promoting community awareness and commitment and lastly, maintaining a well-coordinated multi-stakeholder’ involvement during program implementation

Towards sustainable emergence transportation system for maternal and new born: Lessons from the m-mama innovative pilot program in Shinyanga, Tanzania.

Maternal mortality comprises about 10% of all deaths among women of reproductive age (15-49 years). More than 90% of such deaths occur in low- and middle-income countries (LMIC). In this study, we aimed to document lessons learnt and best practices toward sustainability of the m-mama program for reducing maternal and newborn mortality in Tanzania. We conducted a qualitative study from February to March 2022 in Kahama and Kishapu district councils of Shinyanga region. A total of 20 Key Informant Interviews (KII) and four Focused Group Discussions (FGDs) were conducted among key stakeholders. The participants included implementing partners and beneficiaries, Community Care groups (CCGs) facilitators, health facility staff, drivers and dispatchers. We gathered data on their experience with the program, services offered, and recommendations to improve program sustainability. We based the discussion of our findings on the integrated sustainability framework (ISF). Thematic analysis was conducted to summarize the results. To ensure the sustainability of the program, these were recommended. First, active involvement of the government to complement community efforts, through the provision and maintenance of resources including a timely and inclusive budget, dedicated staff, infrastructure development and maintenance. Secondly, support from different stakeholders through a well-coordinated partnership with the government and local facilities. Third, continued capacity building for implementers, health care workers (HCWs) and community health workers (CHWs) and community awareness to increase program trust and services utilization. Dissemination and sharing of evidence and lesson learnt from successful program activities and close monitoring of implemented activities is necessary to ensure smooth, well-coordinated delivery of proposed strategies. Considering the temporality of the external funding, for successful implementation of the program, we propose a package of three key actions; first, strengthening government ownership and engagement at an earlier stage, secondly, promoting community awareness and commitment and lastly, maintaining a well-coordinated multi-stakeholder' involvement during program implementation

Bivariate analysis of factors associated with TB recurrence in Tanzania from 2018 to 2021.

Bivariate analysis of factors associated with TB recurrence in Tanzania from 2018 to 2021.</p

Factors associated with TB recurrence in Tanzania, from 2018 to 2021 (N = 273,807).

Factors associated with TB recurrence in Tanzania, from 2018 to 2021 (N = 273,807).</p

Socio-demographic and facility-level characteristics of patients diagnosed with TB in Tanzania from 2018 to 2021 (N = 319,720).

Socio-demographic and facility-level characteristics of patients diagnosed with TB in Tanzania from 2018 to 2021 (N = 319,720).</p

Efforts to Address the Burden of Non-Communicable Diseases Need Local Evidence and Shared Lessons from High-Burden Countries.

The burden of non-communicable diseases (NCD) is increasing at an unprecedented rate globally [1,2]. The surge in recent years strains the already weakened health system in low and middle-income countries (LMICs). Such epidemiological transition in most resource-constrained countries occurs under the constrained health system struggling to contain the persistent burden of communicable diseases [3,4] deaths arising from LMICs, calling for immediate locally driven interventions, but with informed policies and intervention to counteract the drivers of such burden. Although the standard drivers for NCDs are globally known, namely, tobacco use, physical inactivity, the harmful use of alcohol, and unhealthy diets [5]. These risk factors vary from one country and region to another [6,7]. Therefore, the globally and World Health Organization’s (WHO) recognized best buys may not be adequate if not tailored to the locally determined risk factors, local epidemiology, context, and matching the available resources. These differences and lack of comprehensive knowledge of NCD’s risk factors call for country-led research to understand the local epidemiology, use evidence-based interventions, and apply multi-stakeholder approaches to address such a multi-faceted burden [8,9]. Countries need ownership and use of local resources, adequate healthcare financing for chronic diseases, and community-based initiatives that work within the same contexts to ensure sustainability [10,11]. This series presents efforts by countries facing epidemiological transition with the surge of NCDs amid the persistent burden of communicable diseases [12,13,14,15]. The majority of these countries are in low and middle-income brackets [16,17,18,19]. Such countries are making various efforts to contain the unprecedented burden, drawing several lessons from one another in reaching epidemiological control. Some of the initiatives presented in this series are unique and can be adopted with modifications to suit other countries or regions with similar contexts. Uniquely, three of the papers presented in this series are from Tanzania. The country has a persistent burden of traditional communicable diseases such as HIV at a national prevalence of 4.7% [20], Malaria at a national prevalence of 9% [21], and tuberculosis with an incidence rate of 222 per 100000 of the population [22], maternal and child health challenges with maternal mortality 524 deaths per 100000 [23]. Under such heavy burden of communicable diseases, Tanzania is facing a fact growing burden of NCDs, accounting for 41% of the Disability Adjusted Life Years (DALYs) [24], and NCDs alone accounting for more than 31–34% of premature deaths [25,26]. The burden of NCDs aligns with nutritional, economic, and demographical transitions [27]. Whereas the common risk factors such as unhealthy dietary habits, overweight and obesity, tobacco intake, and excessive alcohol consumption are associated with the big four NCDs in the country, namely: cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes; they account for only 40% of the known risk factors [24]. Furthermore, the burdens of other NCDs, such as road traffic injuries, mental health disorders, and congenital conditions, are also rising and equally demand immediate attention. The confluence of the previous and persistent burden of childhood under nutrition in Tanzania [28,29] may also attribute to the unknown risk factors found elsewhere [30,31]. The high burden of maternal under-nutrition [32] may be behind poor birth outcomes, such as low birth weight, which may in turn explain the rising NCD burden in terms of morbidity and mortality in the country [33]. Understanding the local contextual factors driving the NCDs burden is therefore crucial for any meaningful success. Strengthening the health system has been a hallmark in efforts to address the local burden in Tanzania [24]. The Government of Tanzania, through the Ministry of Health (MoH), has been working with the Tanzania Non-communicable Diseases Alliance (TANCDA) and Tanzania Diabetes Association (TDA), and other national and international organizations with interest in NCDs, pioneered the development of the National Strategic Plan for NCDs launched in 2009 [34]. The collaboration between government and non-government stakeholders resulted in the development of the National NCDs Control and Prevention Program in 2019 to coordinate the national preventive, curative, and rehabilitative efforts and align the stakeholders [35]. Although the burden is still rising on all NCDs in Tanzania [36], the country is on the right track in NCDs response [37]. Tanzania is far away from having a transformative and resilient health system to cope with the rising cost of health care from such chronic conditions [38,39,40]. The strategies’ implementation and stakeholder collaboration should also emphasize prevention and control measures. The focus on NCD prevention and control heralds the start of a new era in providing affordable health services while maintaining equity and quality health services for those affected by chronic diseases and disabilities for the rest of their lives [40,41]. Through the coordinated efforts, the national NCDs Control and Prevention Program, the national NCDs week was inaugurated to commemorate various efforts addressing the NCDs burden in the country. In this particular week, the MoH coordinates the national NCDs conference serving as a platform to convene scientists in Tanzania and beyond to discuss the burden and national response and innovations to address the new challenges. The NCDs week has advocacy activities, school health promotion, physical activities, and NCDs screening. The week attracts national and civil organizations leaders, a sign of commitment to addressing the burden of NCDs. As explained in these papers, such efforts may inform other countries with similar burdens or contexts in settin