Surveillance of artemether-lumefantrine associated Plasmodium falciparum multidrug resistance protein-1 gene polymorphisms in Tanzania.

BACKGROUND: Resistance to anti-malarials is a major public health problem worldwide. After deployment of artemisinin-based combination therapy (ACT) there have been reports of reduced sensitivity to ACT by malaria parasites in South-East Asia. In Tanzania, artemether-lumefantrine (ALu) is the recommended first-line drug in treatment of uncomplicated malaria. This study surveyed the distribution of the Plasmodium falciparum multidrug resistance protein-1 single nucleotide polymorphisms (SNPs) associated with increased parasite tolerance to ALu, in Tanzania. METHODS: A total of 687 Plasmodium falciparum positive dried blood spots on filter paper and rapid diagnostic test strips collected by finger pricks from patients attending health facilities in six regions of Tanzania mainland between June 2010 and August 2011 were used. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique was used to detect Pfmdr1 SNPs N86Y, Y184F and D1246Y. RESULTS: There were variations in the distribution of Pfmdr1 polymorphisms among regions. Tanga region had exceptionally high prevalence of mutant alleles, while Mbeya had the highest prevalence of wild type alleles. The haplotype YFY was exclusively most prevalent in Tanga (29.6%) whereas the NYD haplotype was the most prevalent in all other regions. Excluding Tanga and Mbeya, four, most common Pfmdr1 haplotypes did not vary between the remaining four regions (χ² = 2.3, p = 0.512). The NFD haplotype was the second most prevalent haplotype in all regions, ranging from 17% - 26%. CONCLUSION: This is the first country-wide survey on Pfmdr1 mutations associated with ACT resistance. Distribution of individual Pfmdr1 mutations at codons 86, 184 and 1246 varies throughout Tanzanian regions. There is a general homogeneity in distribution of common Pfmdr1 haplotypes reflecting strict implementation of ALu policy in Tanzania with overall prevalence of NFD haplotype ranging from 17 to 26% among other haplotypes. With continuation of ALu as first-line drug this haplotype is expected to keep rising, thus there is need for continued pharmacovigilance studies to monitor any delayed parasite clearance by the drug

Human African Trypanosomiasis and challenges to its control in Urambo, Kasulu and Kibondo Districts, western Tanzania

A study was carried out to determine the prevalence and management of Human African Trypanosomiasis (HAT) in Urambo, Kasulu and Kibondo districts of western Tanzania. Parasitological surveys for trypanosome and other blood parasites were conducted in selected villages. Interviews with health workers were conducted to explore facility capacity to diagnose and manage HAT. Community knowledge on tsetse and availability of trypanocidal drugs was explored. Results showed that, although health facility records showed HAT is an important public health problem in the three districts, typanosomes were found in 0.6% of the examined individuals in Urambo district only. Malaria parasites with a prevalence of 12.1%, 19.7% and 9.7%, in Urambo, Kibondo and Kasulu, respectively were detected in blood samples from the same individuals examined for trypanosomes. There was poor capacity for most of the health facilities in the diagnosis, treatment and control of HAT. In both districts, communities were knowledgeable of the tsetse identity (82.4%) and had experienced tsetse bites (94%). The majority (91.4%) of the community members knew that they were at risk of acquiring HAT. However, only 29% of the respondents knew that anti-trypanocidal drugs were readily available free of charge from health care facilities. Late treatment seeking behaviour was common in Kasulu and Urambo districts. In conclusion, health facilities in western Tanzania are faced with problems of poor capacity to diagnose and manage HAT and that treatment seeking behaviour among the communities at risk is poor. Efforts should be made to strengthen the capacity of the health facility to handle HAT cases and health education to the population at risk. Keywords: Human African Trypanosomiasis, diagnosis, control, TanzaniaTanzania Health Research Bulletin Vol. 8 (2) 2006: pp. 80-8

Repurposing NGO data for better research outcomes: A scoping review of the use and secondary analysis of NGO data in health policy and systems research

Background Non-government organisations (NGOs) collect and generate vast amounts of potentially rich data, most of which are not used for research purposes. Secondary analysis of NGO data (their use and analysis in a study for which they were not originally collected) presents an important but largely unrealised opportunity to provide new research insights in critical areas including the evaluation of health policy and programmes. Methods A scoping review of the published literature was performed to identify the extent to which secondary analysis of NGO data has been used in health policy and systems research (HPSR). A tiered analytic approach provided a comprehensive overview and descriptive analyses of the studies which: 1) used data produced or collected by or about NGOs; 2) performed secondary analysis of the NGO data (beyond use of an NGO report as a supporting reference); 3) used NGO-collected clinical data. Results Of the 156 studies which performed secondary analysis of NGO-produced or collected data, 64% (n=100) used NGO-produced reports (e.g. to critique NGO activities and as a contextual reference) and 8% (n=13) analysed NGO-collected clinical data.. Of the studies, 55% investigated service delivery research topics, with 48% undertaken in developing countries and 17% in both developing and developed. NGO-collected clinical data enabled HPSR within marginalised groups (e.g. migrants, people in conflict-affected areas), with some limitations such as inconsistencies and missing data. Conclusion We found evidence that NGO-collected and produced data are most commonly perceived as a source of supporting evidence for HPSR and not as primary source data. However, these data can facilitate research in under-researched marginalised groups and in contexts that are hard to reach by academics, such as conflict-affected areas. NGO–academic collaboration could help address issues of NGO data quality to facilitate their more widespread use in research. Their use could enable relevant and timely research in the areas of health policy, programme evaluation and advocacy to improve health and reduce health inequalities, especially in marginalised groups and developing countries

Analyses of human vaccine-specific circulating and bone marrow-resident B cell populations reveal benefit of delayed vaccine booster dosing with blood-stage malaria antigens

We have previously reported primary endpoints of a clinical trial testing two vaccine platforms for the delivery of Plasmodium vivax malaria DBPRII: viral vectors (ChAd63, MVA), and protein/adjuvant (PvDBPII with 50µg Matrix-M™ adjuvant). Delayed boosting was necessitated due to trial halts during the pandemic and provides an opportunity to investigate the impact of dosing regimens. Here, using flow cytometry – including agnostic definition of B cell populations with the clustering tool CITRUS – we report enhanced induction of DBPRII-specific plasma cell and memory B cell responses in protein/adjuvant versus viral vector vaccinees. Within protein/adjuvant groups, delayed boosting further improved B cell immunogenicity compared to a monthly boosting regimen. Consistent with this, delayed boosting also drove more durable anti-DBPRII serum IgG. In an independent vaccine clinical trial with the P. falciparum malaria RH5.1 protein/adjuvant (50µg Matrix-M™) vaccine candidate, we similarly observed enhanced circulating B cell responses in vaccinees receiving a delayed final booster. Notably, a higher frequency of vaccine-specific (putatively long-lived) plasma cells was detected in the bone marrow of these delayed boosting vaccinees by ELISPOT and correlated strongly with serum IgG. Finally, following controlled human malaria infection with P. vivax parasites in the DBPRII trial, in vivo growth inhibition was observed to correlate with DBPRII-specific B cell and serum IgG responses. In contrast, the CD4+ and CD8+ T cell responses were impacted by vaccine platform but not dosing regimen and did not correlate with in vivo growth inhibition in a challenge model. Taken together, our DBPRII and RH5 data suggest an opportunity for protein/adjuvant dosing regimen optimisation in the context of rational vaccine development against pathogens where protection is antibody-mediated

Thermal Mechanical Property Enhancement with Silicon Carbide Ceramic Filled Composites for Industrial Applications

Epoxy composites with glass fiber reinforcement can be found in the automotive and aerospace industries. In this study, the properties of the epoxy matrix were enhanced by processing composites filled with ceramic particles of silicon carbide (SiC). At first, SiC-filled E-glass fiber-reinforced epoxy composites/sandwich structures were processed using the hand layup technique. Next, processed composites were characterized using a tensile tester and an Izod impact tester to determine the best mixing ratio of ceramic-embedded epoxy composites. The highest mechanical properties were obtained according to ASTM D638 and D256 standards. Next, Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), X-ray diffraction analysis (XRD), analysis of differential scanning calorimetry (DSC), and thermogravimetric analysis (TGA) were carried out respectively to find out the presence of functional groups, surface morphology, crystallographic structure, glass transition temperature (Tg) and thermal/material stability of processed composites. In the end, the study elaborates that the mechanical properties of epoxy matrix composites were improved by the addition of SiC ceramic fillers, and among processed composites, 10% SiCE composite carried the highest properties, including the Tg value of 62.8 °C, 69.87 MPa for tensile strength and 57.12 kJ m−1 for impact strength

Thermal Mechanical Property Enhancement with Silicon Carbide Ceramic Filled Composites for Industrial Applications

Epoxy composites with glass fiber reinforcement can be found in the automotive and aerospace industries. In this study, the properties of the epoxy matrix were enhanced by processing composites filled with ceramic particles of silicon carbide (SiC). At first, SiC-filled E-glass fiber-reinforced epoxy composites/sandwich structures were processed using the hand layup technique. Next, processed composites were characterized using a tensile tester and an Izod impact tester to determine the best mixing ratio of ceramic-embedded epoxy composites. The highest mechanical properties were obtained according to ASTM D638 and D256 standards. Next, Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), X-ray diffraction analysis (XRD), analysis of differential scanning calorimetry (DSC), and thermogravimetric analysis (TGA) were carried out respectively to find out the presence of functional groups, surface morphology, crystallographic structure, glass transition temperature (Tg) and thermal/material stability of processed composites. In the end, the study elaborates that the mechanical properties of epoxy matrix composites were improved by the addition of SiC ceramic fillers, and among processed composites, 10% SiCE composite carried the highest properties, including the Tg value of 62.8 °C, 69.87 MPa for tensile strength and 57.12 kJ m−1 for impact strength

Magnitude and risk factors of non-communicable diseases among people living with HIV in Tanzania: a cross sectional study from Mbeya and Dar es Salaam regions

Background: HIV and Non communicable diseases (NCDs) are major problem of public health importance in developing countries. This study was conducted to explore and establish information on the magnitude, distribution of NCDs risk factors among people living with HIV (PLWHIV) which is scarce in Tanzania. Method: A cross sectional study was conducted to PLWHIV from 12 care and treatment clinics in Dar es Salaam and Mbeya regions from October 2011 to February 2012. Data on demographic characteristics, NCD risk factors including behavioral, biochemical tests and physical measurements was collected from PLWHIV. Results: Of 754 PLWHIV recruited, 671(89.0%) consented to participate in the study and 354/671(52.8%) were on antiretroviral therapy (ART). The following NCD risk factors: raised blood levels of low density lipoprotein (61.3% vs 38.7%, p 40 years (63.3% vs 36.7%, p 40 years (AOR = 2.52, 95% CI 1.37-4.63), abnormal waist circumference (AOR = 2.37 95% CI 1.13-5.00), overweight/obesity (AOR = 2.71, 95% CI 1.26-5.84) and male sex (AOR = 1.17, 1.02-4.20) were the predictors of hypertension among patients on ART while raised TC (AOR = 1.47 (1.01-2.21) and being aged >40 years (AOR = 3.42, 95% CI 2.06-5.70) were predictors for hypertension among ART naïve patients. Conclusion: This study has revealed that the magnitude of NCD risk factors is significantly higher among PLWHIV on ART than those not on ART. Initiating and strengthening of interventions for minimizing preventable NCD risks should be considered when initiating ART among PLWHIV. Regular monitoring of NCD risk factors is of paramount importance among ART patients