Antibiotics prescription practices for provisional malaria cases in three hospitals in Moshi, northern Tanzania

Background: Irrational antibiotic use is an important factor for development and spread of resistance to currently used antibiotics. This study was carried out to assess antibiotic prescribing practices among cases diagnosed as malaria at three hospitals in Moshi Municipality in northern Tanzania.Methods: This was a cross sectional, retrospective study that included patients files from Kilimanjaro Christian Medical Centre (KCMC), Mawenzi Regional Hospital and St Joseph Hospital. Patient files whose primary provisional diagnosis was malaria were analysed using a convenient sampling method. Variables of interest were the types of medications prescribed, whether or not a laboratory test was requested and treatment was initiated before laboratory reports.Results: A total of 250 patients’ files were included in the analysis (KCMC=62.8%; Mawenzi=23.2%; St. Joseph=14.0%). In 232 (92.8%) prescriptions made in the three hospitals, laboratory tests were requested to confirm diagnoses. Among laboratory tests requested, 89.2% were blood slides for microscopic detection of malaria parasites, 3.01% malaria rapid diagnostic tests and 3.01% other tests. The majority of prescriptions across all three hospitals (KCMC=86.4%; Mawenzi=91.4%; St. Joseph= 72.4%; X2=7.787). Clinicians at Mawenzi were more likely to start treatment before laboratory findings than their counterparts at KCMC and St Joseph hospitals (X2=7.787, p≤0.05). A significantly higher number of prescriptions made before laboratory findings were observed at KCMC than Mawenzi and St. Joseph hospitals (X2=7.787, p<0.05). Prescriptions from KCMC were more likely to include at least one type of antibiotic than in the other two facilities. Over one third (KCMC=34.0%; St. Joseph=42.1%; Mawenzi=38.1%) of the prescriptions made contained at least one type of an antibiotic. There was a strong association between health facilities and antibiotics prescription in which KCMC prescribed antibiotics at the highest rate while Mawenzi Regional Hospital prescribed antibiotics at the lowest rates (X2=29.234, p<0.001).Conclusion: Antibiotics are prescribed at a high rate among provisionally diagnosed malaria cases before availability of laboratory results. Efforts should be made to improve laboratory services in terms of trained personnel and equipment to reduce irrational use of antibiotics in provisionally diagnosed malaria cases

A rapid ethnographic appraisal of community concepts of and responses to joint pain in Kilimanjaro, Tanzania

Introduction: Musculoskeletal disorders, experienced as joint pain, are a significant global health problem, but little is known about how joint pain is categorised and understood in Tanzania. Understanding existing conceptualisations of and responses to joint pain is important to ensure both research and interventions are equitable and avoid biomedical imposition. Methods: Rapid ethnographic appraisal was conducted in a peri-urban and rural community in Kilimanjaro, documenting language used to describe joint pain, ideas about causes, understandings of who experiences such pain, the impacts pain has and how people respond to it. We conducted 66 interviews with: community leaders, traditional healers, community members, pharmacists. Photographs were taken and included in fieldnotes notes to supplement the interview data and develop thick descriptions. Data were analysed by constant comparison using QDA Miner software. Results: Across the sample, dominant concepts of joint pain were named as ugonjwa wa baridi - cold disease; ugonjwa wa uzee – old age disease; rimatizim – disease of the joints; and gauti – gout. Causes mentioned included exposure to the cold, old age, alcohol and red meat consumption, witchcraft, demons, and injuries/falls. Age, gender and occupation were seen as important factors for developing joint pain. Perceived impacts of joint pain included loss of mobility, economic and family problems, developing new health conditions, death, reduction in sexual functioning, and negative self-perceptions. Responses to joint pain blended biomedical treatments, herbal remedies, consultations with traditional healers and religious ritual. Conclusions: Conceptualizations of and responses to joint pain in the two communities were syncretic, mixing folk and biomedical practices. Narratives about who is affected by joint pain mirror emerging epidemiological findings, suggesting a strong ‘lay epidemiology’ in these communities. Anthropological methods can support the decolonisation of global health by de-centering the imposition of English-language biomedicine and pursuing synthetic, dignified languages of care

Participatory Evaluation of Resilient Potato Varieties in Climate-Smart Villages of Lushoto in Tanzania

This three-year study conducted by the International Potato Centre (CIP) in collaboration with Selian Agricultural Research Institute (SARI) was based on demand by Lushoto farmers through the CGIAR Research Program on Climate Change, Agriculture and Food Security (CCAFS). This participatory action research (PAR) was aimed at developing more resilient potato varieties that can grow in both long and short rainy seasons and give higher yields. The approach involved training-of-trainers (ToT) and participatory varietal selection (PVS) experiments. The ToT comprised five training events using modules. Three training events were done in the long rainy season and two in the subsequent short rainy season. The topics covered in the first round of training were on integrated crop management, from land preparation to seed storage. The second round of training was participant-driven whereby topics emerged from the first training. A total of twenty-one participants representing farmers, extension services and local non-governmental organizations were trained. The training was supported by field experiments using the CIP Mother and Baby Trials model. The trials were carried out in five villages: Kwesine, Boheloi, Maringo, Kwekitui and Milungui. Experimental materials comprised six advanced and heat tolerant clones from CIP (CIP390478.9, CIP388767.1, CIP392797.22, CIP300055.32, CIP398208.29 and CIP397073.7), two local varieties (Kidinya and Obama), an improved variety recently registered in Tanzania (Asante) and a popular farmer’s variety but registered in Kenya (Shangii). A cross-analysis of field and culinary data combining quantitative and qualitative assessments from the three seasons of field evaluations showed a certain consistency in the high yielding ability and acceptability of four genotypes, namely Asante, Shangii, CIP392797.22 and CIP398208.29. The two clones were then named by farmers and proposed for official release while Shangii was proposed for registration for commercial use

What the World Happiness Report doesn’t see: The sociocultural contours of wellbeing in northern Tanzania

This paper presents a mixed methods approach to understanding wellbeing in the Kilimanjaro region of northern Tanzania—a country consistently ranked by the World Happiness Report as one of the least happy in the world.  A primary objective is to demonstrate how qualitative data offering bottom-up perspectives on wellbeing offer a necessary complement to quantitative self-report measures, allowing for more nuanced cultural understandings of lived experience and wellbeing that recognize diversity both globally and locally. The research contextualized responses to standardized life evaluations (including the Cantril ladder question used by the World Happiness Report) through observations and interviews along with culturally sensitive measures of emotional experience.  Findings show Kilimanjaro to have more positive life evaluations than Tanzania as a whole, and significant within-region demographic variation driven particularly by lower levels of wellbeing for nonprofessional women compared with nonprofessional men and professionals.  In part because such demographic groups were often unfamiliar with standardized self-report measures, it was only through interviews, case studies, and culturally sensitive reports of emotional experience that we were able to recognize the diverse and nuanced life circumstances which individuals and groups were navigating and how those circumstances interacted with wellbeing.  Drawing on the example of nonprofessional women for illustration, we describe how key sociocultural factors – particularly, family stability, parenting circumstances, social relationships, and meeting life course expectations -- intersect with economic realities to create varied experiences of wellbeing. The complex picture of locally understood wellbeing that emerged from this research presents an alternative picture to global perspectives reliant on survey self-reports. It serves as a reminder of the importance of methodological choices in global wellbeing research and urges the addition of local perspectives and paradigms to inform policy and practice

Unlocking the health system barriers to maximise the uptake and utilisation of molecular diagnostics in low- and middle- income country setting

The study was funded by the European and Developing Countries Clinical Trials Partnership (EDCTP), grant TWENDE-EDCTP-CSA-2014-283.Background : Early access to diagnosis is crucial for effective management of any disease including tuberculosis (TB). We investigated the barriers and opportunities to maximise uptake and utilisation of molecular diagnostics in routine healthcare settings. Methods : Using the implementation of World Health Organisation approved TB diagnostics, Xpert MTB/RIF and Line Probe Assay (LPA) as a benchmark we evaluated the barriers and how they could be unlocked to maximise uptake and utilisation of molecular diagnostics. Results : Health officers representing 190 districts/counties participated in the survey across Kenya, Tanzania and Uganda. The survey findings were corroborated by 145 healthcare facility (HCF) audits and 11 policymaker engagement workshops. Xpert MTB/RIF coverage was 66%, falling behind microscopy and clinical diagnosis by 33% and 1% respectively. Stratified by HCF type, Xpert MTB/RIF implementation was 56%, 96% and 95% at district-, regional- and national referral- hospital levels. LPA coverage was 4%, 3% below culture across the three countries. Out of 111 HCFs with Xpert MTB/RIF, 37 (33%) utilised it to full capacity, performing ≥8 tests per day of which 51% of these were level five (zonal consultant and national referral) HCFs. Likewise, 75% of LPA was available at level five HCFs. Underutilisation of Xpert MTB/RIF and LPA was mainly attributed to inadequate- utilities, 26% and human resource, 22%. Underfinancing was the main reason underlying failure to acquire molecular diagnostics. Second to underfinancing was lack of awareness with 33% healthcare administrators and 49% practitioners were unaware of LPA as TB diagnostic. Creation of a health tax and decentralising its management was proposed by policymakers as a booster of domestic financing needed to increase access to diagnostics. Conclusion : Our findings suggest higher uptake and utilisation of molecular diagnostics at tertiary level HCFs contrary to the WHO recommendation. Country-led solutions are crucial for unlocking barriers to increase access to diagnostics.Publisher PDFPeer reviewe

Measuring adherence to antiretroviral therapy in northern Tanzania: feasibility and acceptability of the Medication Event Monitoring System

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Landscape-scale variability of soil health indicators: Effects of cultivation on soil organic carbon in the Usambara Mountains of Tanzania

During the Phase I of the CCAFS project we conducted a systematic land and soil health assessment in Lushoto District in November 2012. These data were used to inform climate-smart agricultural interventions for the IFAD project as well as to parameterize DSSAT crop models for maize and beans. The land and soil health assessment that was carried out using the Land Degradation Surveillance Framework (LDSF). These data were also used to assess the effect of cultivation on soil organic carbon dynamics across the landscape. Finally, these data provide a biophysical assessment for the Lushoto CCAFS Climate Smart Village