Activating Equitable Engagement: from research to policy (and back again): a report on dissemination activities for 'NIHR Global Health Research Group on estimating the prevalence, quality of life, economic and societal impact of arthritis in Tanzania'

This report details the dissemination outputs, stakeholder engagement events (herein referred to as ‘Engagement Activities’) and their underlying principles conducted by the NIHR Funded Project: NIHR Global Health Research Group on estimating the prevalence, quality of life, economic and societal impact of arthritis in Tanzania. Engagement activities were designed acknowledging that inequalities and injustices are writ large in the field of Global Health. Just as social, economic, political, racial and gendered inequalities impact individuals’ health experiences, we also recognise that these same inequalities can be reproduced and reinforced by institutions, organisations and (most pertinent to us) research groups purporting to tackle health issues (Büyüm et al. 2020). Engagement activities were therefore designed from a commitment to make Global Health more equitable, with the following interrelated principles underpinning all engagement efforts: i) the ethics of dissemination ii) valuing knowledges iii) decentering western voices iv) nurturing equitable relationships. As such, we paid close attention not only to what we did but how we did it, striving towards a goal of activating equitable engagement

Estimating the prevalence and predictors of musculoskeletal disorders in Tanzania: a cross-sectional pilot study

\ua9 2024, African Field Epidemiology Network. All rights reserved.Introduction: musculoskeletal (MSK) disorders account for approximately 20% of all years lived with disability worldwide however studies of MSK disorders in Africa are scarce. This pilot study aimed to estimate the community-based prevalence of MSK disorders, identify predictors, and assess the associated disability in a Tanzanian population. Methods: a cross-sectional study was conducted in one village in the Kilimanjaro region from March to June 2019. The Gait, Arms, Legs, Spine (GALS) or paediatric GALS (pGALS) examinations were used during household and school visits. Individuals positive in GALS/pGALS screening were assessed by the regional examination of the musculoskeletal system (REMS) and Modified Health Assessment Questionnaire (MHAQ). Results: among the 1,172 individuals enrolled in households, 95 (8.1%, 95% CI: 6.6-9.8) showed signs of MSK disorders using the GALS/pGALS examination and 37 (3.2%, 95% CI: 2.2-4.3) using the REMS. Among 682 schools enrolled children, seven showed signs of MSK disorders using the GALS/pGALS examination (1.0%, 95% CI: 0.4-2.1) and three using the REMS (0.4%, 95% CI: 0.0-1.3). In the household-enrolled adult population, female gender and increasing age were associated with GALS and REMS-positive findings. Among GALS-positive adults, increasing age was associated with REMS-positive status and increasing MHAQ score. Conclusion: this Tanzanian study demonstrates a prevalence of MSK disorders and identifies predictors of MSK disorders comparable to those seen globally. These findings can inform the development of rheumatology services and interventions in Tanzania and the design of future investigations of the determinants of MSK disorders, and their impacts on health, livelihoods, and well-being

Using Nylon Strips to Dispense Mosquito Attractants for Sampling the Malaria Vector <I>Anopheles gambiae</I> s.s.

Synthetic versions of human derived kairomones can be used as baits when trapping host seeking mosquitoes. The effectiveness of these lures depends not only on their attractiveness to the mosquitoes, but also on the medium from which they are dispensed. We report oil the development and evaluation of nylon strips as a method of dispensing odorants attractive to the malaria vector, Anopheles gambiae s.s. (Giles). When a synthetic blend of attractants was dispensed using this method, significantly more mosquitoes were trapped than when two previous methods, open glass vials or low density polyethylene sachets were used. We conclude that the nylon strips are suitable for dispensing odorants in mosquito trapping operations and can be adopted for use in rural and remote areas. The nylon material required is cheap and widely available and the strips can be prepared,without specialized equipment or electricity

Fusion of plectasin derivative NZ2114 with hydrophilic random coil polypeptide : Recombinant production in Pichia pastoris and antimicrobial activity against clinical strain MRSA

One of the roadblocks towards the practical use of antimicrobial peptides for medical use is their relatively high cost when synthesized chemically. Effective recombinant production has only been successful in some cases, such as the previously reported production in Pichia pastoris of the antimicrobial plectasin derivative peptide NZ2114. The same production host has also been used extensively to produce so-called protein-polymers: sequences that consist of repetitions of simple amino acid motifs found in structural proteins such as collagen and elastin, and that can be designed to self-assemble in micelles, fibers and hydrogels. With the eventual goal of producing recombinant biomaterials such as antimicrobial protein polymer, we here explore the secreted production in Pichia pastoris of a fusion of NZ2114 with a hydrophilic random coil protein polymer Cp 4. The intact NZ2114- Cp 4 fusion copolymer was produced with a yield of purified protein in the order of 1 g L−1 supernatant. We find that purified NZ2114-Cp 4 has an activity against clinical strain MRSA, but very much lower than activity of chemically synthesized NZ2114. We conclude that possibly, the activity of NZ2114 is impaired by the C-terminal attachment to the protein polymer chain, but other reasons for the low activity cannot yet be excluded either.</p

Evidencing the clinical and economic burden of musculoskeletal disorders in Tanzania: Paving the way for urgent rheumatology service development

No abstract availabl

Taxis assays measure directional movement of mosquitoes to olfactory cues.

BACKGROUND: Malaria control methods targeting indoor-biting mosquitoes have limited impact on vectors that feed and rest outdoors. Exploiting mosquito olfactory behaviour to reduce blood-feeding outdoors might be a sustainable approach to complement existing control strategies. Methodologies that can objectively quantify responses to odour under realistic field conditions and allow high-throughput screening of many compounds are required for development of effective odour-based control strategies. METHODS: The olfactory responses of laboratory-reared Anopheles gambiae in a semi-field tunnel and A. arabiensis females in an outdoor field setting to three stimuli, namely whole human odour, a synthetic blend of carboxylic acids plus carbon dioxide and CO(2) alone at four distances up to 100 metres were measured in two experiments using three-chambered taxis boxes that allow mosquito responses to natural or experimentally-introduced odour cues to be quantified. RESULTS: Taxis box assays could detect both activation of flight and directional mosquito movement. Significantly more (6-18%) A. arabiensis mosquitoes were attracted to natural human odour in the field up to 30 metres compared to controls, and blended synthetic human odours attracted 20% more A. gambiae in the semi-field tunnel up to 70 metres. Whereas CO(2) elicited no response in A. arabiensis in the open field, it was attractive to A. gambiae up to 50 metres (65% attraction compared to 36% in controls). CONCLUSIONS: We have developed a simple reproducible system to allow for the comparison of compounds that are active over medium- to long-ranges in semi-field or full-field environments. Knowing the natural range of attraction of anopheline mosquitoes to potential blood sources has substantial implications for the design of malaria control strategies, and adds to the understanding of olfactory behaviour in mosquitoes. This experimental strategy could also be extended from malaria vectors to other motile arthropods of medical, veterinary and agricultural significance

Estimating the Quality-of-Life Impact of Musculoskeletal Disorders in Tanzania: Results from a Cross-Sectional Community-Based Survey

Background Sub Saharan Africa is currently facing a preventable crisis caused by rapid rise in people developing non communicable diseases (NCDs). This brings not only clinical but economic, societal and quality-of-life impacts on people’s day-to-day life. Yet, plans to reduce NCDs often overlook the impact of Musculoskeletal (MSK) disorders. Arthritis is one of the commonest MSK disorders, is a leading cause of disability, causing significant absence from work, and incurs substantial medical costs globally. Measuring the quality-of-life impact of these diseases is urgently needed to inform policy. Our study has directly measured and valued the quality-of-life impact of MSK in Tanzania. Methods A cross-sectional community-based survey was undertaken between January–Sept 2021 in the Kilimanjaro region of Tanzania. Clinical screening tools, including the Gait Arms Legs Spine (GALS) and Regional Examination of the Musculoskeletal system (REMS) tools were used for identifying MSK disorders. Two-stage cluster sampling was used to administer health-related quality of life (HRQoL) questionnaires using the Swahili version of the preference-based tool EuroQol EQ-5D-5L and CHU9D, for a sample of all residents (aged over 5 years old) in selected households (N = over 2,500). To establish a reference population account of these measures, a longer questionnaire went to those who had arthritis and who were matched on age and gender (~1:3), n=153 REMS+ and n=441 controls. Thus, responses from participants screening positive with MSK were directly compared to a matched control group in a bid to establish the magnitude of impact. Ethiopia, Uganda, Zimbabwe and UK tariffs were used for conversion to utilities (Tanzania has no tariff). Regression based analysis were undertaken to estimate differences in utility scores between those presenting as REMS+/-. Other explanatory variables included age, occupation, marital status, gender, religion, education. Results The survey revealed a statistically significant reduction in quality-of-life, on average 20%, for those who are REMS+ (slightly less for GALS+). Population norms (~0.90 utility) are in line with HRQoL values from other countries for the average age of our dataset at 30 – 40 years old but those presenting with a positive diagnosis had a significant reduction in health-related utility of ~0.12 to 0.22 depending on what country tariff was used. The attribute ‘pain/discomfort’ was a major contributor to this reduction in HRQoL. Conclusion A good quality of life refers to a person’s ability to look after themselves, get around their community, participate in their usual activities, and avoid pain and distress. Results show that those with MSK for all quality-of-life dimensions had lower utility scores than controls. This is the first study to quantify the significant burden of MSK on health in Kilimanjaro, and likely wider Tanzania. With such a baseline figure, we know that any future interventions aimed at alleviating symptoms including pain or, indeed, any preventive interventions will likely improve this quality-of-life profile. Our findings provide initial evidence to justify the need to plan effective and cost-effective interventions for the prevention and management of MSK in Tanzania, as well as ensure adequate service provision including training of rheumatology sub specialists