Urogenital schistosomiasis knowledge, attitudes and practices among the community members in Lindi, Tanzania: A qualitative study

Background: Urogenital schistosomiasis caused by Schistosoma haematobium (S. haematobium), remains a public health problem in Lindi region. Despite twelve rounds of praziquantel preventive chemotherapy. There is a scarcity of information on the factors perpetuating the transmission of S. haematobium in Lindi. Therefore, this study aimed to explore the urogenital schistosomiasis knowledge, attitudes, and practices among the community members in Mtama district in the Lindi region of Tanzania.Methodology: A cross-sectional study employing a qualitative approach was conducted in Mtama, Lindi in May 2021. The respondents were purposively sampled, and a total of 6 Focus Group Discussions (FGDs), 2 in each village were conducted. The FGDs were audio-recorded, transcribed verbatim, and analysed thematically to identify emerging themes.Results: Majority of respondents were aware of the endemicity of S. haematobium and the ongoing distribution of praziquantel preventive chemotherapy. Respondents had inadequate knowledge of the disease causation and the role of snails in disease transmission. Also, misconception on the modes of disease transmission was observed. Respondents had undesirable attitudes. They were against regular screening of urogenital schistosomiasis and were into the use of traditional ways of treatment to dodge screening and treatment costs. Respondents exhibited inappropriate water, sanitation, and hygienic practices (WaSH), thus perpetuating disease transmission.Conclusion: Despite the community being aware and knowledgeable of urogenital schistosomiasis, there is inadequate understanding of how the disease is transmitted, the roles of snails in S. haematobium transmission, coupled with undesirable attitudes and inappropriate practices. These potentially compromise the ongoing Government efforts to control the disease in Lindi region. Therefore, there is need to initiate a community-based health education programme targeting behaviour change

Evidence of continued transmission of Wuchereria bancrofti and associated factors despite nine rounds of ivermectin and albendazole mass drug administration in Rufiji district, Tanzania

Background: In most sub-Saharan Africa, the National Lymphatic Filariasis Elimination Programme (NLFEP) is based on annual mass drug administration (MDA) with ivermectin and albendazole. In order to interrupt transmission, 4–6 rounds of MDA are required with at least 60–70% minimum effective coverage. Children born since the introduction of the MDA programme are recommended for assessing the interruption of transmission. The objective of this study was lymphatic filariasis transmission status after nine rounds of MDA in Rufiji district, Tanzania.Methods: This cross sectional survey involved 270 heads of household. Parents or guardians were interviewed on behalf of the schoolchildren about their participation in MDA programme. Status of LF prevalence was assessed by measuring Wuchereria bancrofti circulating filarial antigens (CFA) in blood samples from standard one school children (6 – 9 years)   using immunochromatographic test cards.Results: A total of 413 standard one schoolchildren were tested for CFA; 59 (14.3%) had CFA. Two thirds (66.8%) of the children did not participate in 2011 MDA round. Prevalence of CFA was significantly lower in younger (6.4%) than older children (40.4%) (p<0.05). Participation in the last (2011) MDA did not significantly change the prevalence W. bancrofti CFA (χ2 = 0.723, p=0.4). The recorded MDA coverage for 5 years including 2011 was above the 60–70 % minimum effective coverage. The community reported coverage was 40.4% for last MDA (2011), for previous MDAs was 53.0%; being far below the minimum effective coverage. Though the large majority (97.0%) of households had heard of LF, only about half (57.0%) knew it was transmitted by mosquitoes. Less than a half (43.6%) of households were aware of the adverse effects of LF, therefore motivated to participate in MDA.Conclusion: The findings indicate that LF transmission has continued in Rufiji district despite nine rounds of MDA. Low compliance to MDAs due to community and programmatic factors were responsible for the continued LF transmission. Detailed entomological studies are required to establish LF transmission dynamics and the programmatic factors associated with MDA implementation in the area

APPRAISAL ON THE PREVALENCE OF MALARIA AND ANAEMIA IN PREGNANCY AND FACTORS INFLUENCING UPTAKE OF INTERMITTENT PREVENTIVE THERAPY WITH SULFADOXINE-PYRIMETHAMINE IN KIBAHA DISTRICT, TANZANIA.

Objective: To appraise the prevalence of malaria and anaemia in antenatal mothers; and explore the factors influencing coverage of intermittent preventive treatment (IPT) with sulfadoxine-pyrimethamine (SP) under operational conditions in the national programme for malaria control in pregnancy. Design: Descriptive cross-sectional survey. Setting: The reproductive and child health clinic in Kibaha district hospital, Tanzania Subjects: Pregnant mothers on routine antenatal visits Main outcome measures: Prevalence of malaria (peripheral parasitaemia) and anaemia, coverage of IPT with SP and the factors influencing coverage. Results: A total of 395 mothers were recruited; 27.3% had malaria. Moderate anaemia i.e. haemoglobin (Hb) level 8.0 - 10.9 g/dl was detected in 56.7% of mothers; 34.2% had severe anaemia (Hb 8.0 g/dl was strongly associated with negative parasitaemia while Hb < 8.0 g/dl was strongly associated with positive parasitaemia. About a third (40.0%) of the mothers did not receive SP for IPT because of unavailability. Of those receiving, about a third (40.0%) did not swallow the tablets at the clinic because of empty stomach and sharing of water cups. Majority (90.1%) were aware that SP was the drug for IPT and 77.2% held the perception that IPT with SP has health benefits; however, 70.0% were not aware on the timing for IPT. Conclusion: Severe malarial anaemia is still a health problem in pregnancy, conceivably due to low coverage of IPT with SP because of erratic availability of SP. There is a major gap on appropriate timing for IPT with SP that should be corrected

Impact of praziquantel mass drug administration campaign on prevalence and intensity of Schistosoma haemamtobium among schoolchildren in Bahi district, Tanzania

As part of the Tanzania National Schistosomiasis Control Programme, Bahi district in central Tanzania, received two annual rounds of praziquantel mass drug administration (MDA) to control urinary schistosomiasis in schoolchildren. The objectives of this study were to assess the impact of the two rounds of MDA on prevalence and intensity of Schistosoma haemamtobium and the impact of MDA campaigns on knowledge of urinary schistosomiasis, safe water use and contact with potentially unsafe water bodies. A quantitative crosssectional study was carried out among schoolchildren in March and April, 2013. A structured questionnaire was used to collect information on MDA uptake, knowledge of schistosomiasis, sources of water for domestic and other uses. Urine samples were collected from each pupil to examine prevalence and intensity of S. haematobium. Transmission of schistosomiasis was assessed by sampling Bulinus spp snails for cercarial shedding. Uptake of MDA was 39.5% in 2011 and 43.6% in 2012. Prevalence of S. haematobium significantly dropped by 50.0% from 26% in 2011 to 15% in 2012 (p = 0.000). Prevalence of S. haematobium was significantly low in MDA participating (3.1%) than non-participating (28.5%) schoolchildren (p = 0.000). MDA campaigns had significant impact on knowledge of the disease (p = 0.02) and borderline impact on safe water use (p = 0.04) but had no impact on avoidance of contact with unsafe water bodies (p = 0.06). Bulinus spp. snails were found shedding schistosome cercariae indicating environmental contamination with viable S. haematobium eggs. In conclusion, though MDA significantly reduced prevalence of S. haematobium, uptake was below 50.0% and below the World Health Assembly resolution 54.19 target of 75.0% for 2010. Non-participation in MDA was the likely source of S. haematobium eggs in the environment hence the observed 15.0% prevalence of S. haematobium infection; and cercarial shedding Bulinus spp. snails indicating continuity of transmission hence the need for further health promotion campaigns

Impact of praziquantel mass drug administration campaign on prevalence and intensity of Schistosoma haemamtobium among schoolchildren in Bahi district, Tanzania

As part of the Tanzania National Schistosomiasis Control Programme, Bahi district in central Tanzania, received two annual rounds of praziquantel mass drug administration (MDA) to control urinary schistosomiasis in schoolchildren. The objectives of this study were to assess the impact of the two rounds of MDA on prevalence and intensity of Schistosoma haemamtobium and the impact of MDA campaigns on knowledge of urinary schistosomiasis, safe water use and contact with potentially unsafe water bodies. A quantitative crosssectional study was carried out among schoolchildren in March and April, 2013. A structured questionnaire was used to collect information on MDA uptake, knowledge of schistosomiasis, sources of water for domestic and other uses. Urine samples were collected from each pupil to examine prevalence and intensity of S. haematobium. Transmission of schistosomiasis was assessed by sampling Bulinus spp snails for cercarial shedding. Uptake of MDA was 39.5% in 2011 and 43.6% in 2012. Prevalence of S. haematobium significantly dropped by 50.0% from 26% in 2011 to 15% in 2012 (p = 0.000). Prevalence of S. haematobium was significantly low in MDA participating (3.1%) than non-participating (28.5%) schoolchildren (p = 0.000). MDA campaigns had significant impact on knowledge of the disease (p = 0.02) and borderline impact on safe water use (p = 0.04) but had no impact on avoidance of contact with unsafe water bodies (p = 0.06). Bulinus spp. snails were found shedding schistosome cercariae indicating environmental contamination with viable S. haematobium eggs. In conclusion, though MDA significantly reduced prevalence of S. haematobium, uptake was below 50.0% and below the World Health Assembly resolution 54.19 target of 75.0% for 2010. Non-participation in MDA was the likely source of S. haematobium eggs in the environment hence the observed 15.0% prevalence of S. haematobium infection; and cercarial shedding Bulinus spp. snails indicating continuity of transmission hence the need for further health promotion campaigns

Accuracy of clinical diagnosis and malaria rapid diagnostic test and its influence on the management of children with fever under reduced malaria burden in Misungwi district, Mwanza Tanzania

Introduction: malaria diagnosis is known to be non-specific because of the overlap of symptoms of malaria with other infectious diseases that is made worse with declining malaria burden. Though the use of malaria rapid diagnostic test (mRDT) for malaria confirmation has universally been adopted, malaria decline may alter performance of mRDT. This study examined accuracy of clinical diagnosis and mRDT and its influence on prescription for febrile underfives. Methods: a cross-sectional study of 600 underfives was carried out in 6 randomly selected health facilities in Misungwi district, Mwanza; from November - December 2014. Consecutive underfives with a fever consultation were recruited: for each fever and the clinical diagnosis entertained were recorded. Parasitological confirmation of malaria was done by mRDT and microscopic examination of finger prick blood samples. Treatment was based on mRDT results, drugs prescribed recorded. Accuracy of clinical diagnosis and mRDT in predicting malaria was assessed by performance indices against microscopy. Antimalarial and antibiotics prescriptions were assessed against parasitological findings. Results: clinically, 37.2% had malaria; 32.8% were mRDTpositive and 17.0% microscopically positive. Sensitivity of clinical diagnosis was very high (97.0% [95%CI: 91.0-99.2]); specificity 66.7% [95%CI: 62.3-70.8], and positive predictive value 37.4% (95%CI: 31.6-43.5). Sensitivity of mRDTwas very high (99.0% [95%CI: 93.9-99.9]), specificity (80.7% [95%CI: 76.9-84.0]), positive predictive value 51.3% [95% CI: 44.1-58.4]) and negative predictive 99.75% [95%CI: 99.4-100.0]. Those receiving antimalarial prescription, 75.0% were mRDT positive; 39.4% microscopically positive. Those receiving antibiotic, 78.8% were mRDT negative; 90.1% microscopically negative. Conclusion: decline in malaria lowered specificity of mRDT to &lt; 95% against WHO recommendation. Though adherence to mRDT results was high, there was over prescription of antibiotics.The Pan African Medical Journal 2016;2

Lymphatic filariasis elimination efforts in Rufiji, southeastern Tanzania: decline in circulating filarial antigen prevalence in young school children after twelve rounds of mass drug administration and utilization of long-lasting insecticide-treated nets

Background: Lymphatic filariasis (LF) is a parasitic infection transmitted by mosquito vectors, and in Sub-Saharan Africa it is caused by the nematode Wuchereria bancrofti. The disease has been targeted for global elimination with the annual mass drug administration (MDA) strategy. Vector control is known to play an important complementary role to MDA in reducing the transmission of LF. The effects of an MDA and insecticide-treated net intervention implemented in an endemic area of southeastern Tanzania are reported here. Methods: A cross-sectional study assessing W. bancrofti circulating filarial antigen (CFA) was conducted in five primary schools in five different villages. Standard one pupils aged 6–9 years were screened for CFA using immunochromatographic test cards (ICT), with a total of 413 screened in 2012 and 659 in 2015. Just after CFA testing, the children were interviewed on their participation in the MDA campaign. Moreover, 246 heads of households in 2012 and 868 in 2015 were interviewed on their participation in MDA and utilization of long-lasting insecticide-treated nets (LLINs). Results: The prevalence of CFA for the 413 children tested in 2012 was 14.3%, while it was 0.0% for the 659 children tested in 2015. The Tanzanian National Lymphatic Filariasis Elimination Programme reported annual treatment coverage for Rufiji District ranging from 54.3% to 94.0% during the years 2002–2014. The surveyed treatment was 51.6% in 2011 and 57.4% in 2014. With regard to LLINs, possession and utilization increased from 63.4% and 59.2%, respectively, in 2012, to 92.5% and 75.4%, respectively, in 2015. Conclusions: The findings suggest that 12 rounds of MDA complemented with vector control through the use of insecticide-treated nets resulted in a marked reduction in W. bancrofti CFA in young school children