Water, sanitation and hygiene (WASH) in schools: results from a process evaluation of the National Sanitation Campaign in Tanzania

This study assesses the intermediate outcomes of the Tanzania National Sanitation Campaign (NSC) for schools. A cross-sectional study was designed as part of a process evaluation of the NSC in Tanzania on 70 primary schools and 54 regional and district education officers. Data was collected between August and December 2014 using questionaires, key informant interviews, and desk studies. The results showed that only 50% of schools met the Tanzania guideline of 50 boys per drop hole, while 43% met the guideline of 40 girls per drop hole. In addition, 53% of schools had a reliable water supply, 43% had some functional handwashing stations, but only 29% and 19% had water and soap available at the stations, respectively. Overall, the implementation of the NSC in schools was found to be effective, though poor planning and coordination, inadequate funding, and low technical capacity were identified as barriers to achieve the intended objectives. The study recommends stronger and coordinated stakeholder partnerships with clearly defined roles including cost sharing. Government and other stakeholders should also consider the impact of increasing funding for both software and hardware components to improve the enabling environment, and to develop a standardised monitoring mechanism for sustainable school water, sanitation and hygiene.</jats:p

Users' and health service providers' perception on quality of laboratory malaria diagnosis in Tanzania

<p>Abstract</p> <p>Background</p> <p>Correct diagnosis of malaria is crucial for proper treatment of patients and surveillance of the disease. However, laboratory diagnosis of malaria in Tanzania is constrained by inadequate infrastructure, consumables and insufficient skilled personnel. Furthermore, the perceptions and attitude of health service providers (laboratory personnel and clinicians) and users (patients/care-takers) on the quality of laboratory services also present a significant challenge in the utilization of the available services. This study was conducted to assess perceptions of users and health-care providers on the quality and utilization of laboratory malaria diagnostic services in six districts from three regions in Tanzania.</p> <p>Methods</p> <p>Questionnaires were used to collect information from laboratory personnel, clinicians and patients or care-takers.</p> <p>Results</p> <p>A total of 63 laboratory personnel, 61 clinicians and 753 patients/care-takers were interviewed. Forty-six (73%) laboratory personnel claimed to be overworked, poorly motivated and that their laboratories were under-equipped. About 19% (N = 12) of the laboratory personnel were lacking professional qualification. Thirty-seven clinicians (60.7%) always requested for blood smear examination to confirm malaria. Only twenty five (41.0%) clinicians considered malaria microscopy results from their respective laboratories to be reliable. Forty-five (73.8%) clinicians reported to have been satisfied with malaria diagnostic services provided by their respective laboratories. Majority (90.2%, N = 679) of the patients or care-takers were satisfied with the laboratory services.</p> <p>Conclusion</p> <p>The findings show that laboratory personnel were not satisfied with the prevailing working conditions, which were reported to undermine laboratory performance. It was evident that there was no standard criteria for ordering malaria laboratory tests and test results were under-utilized. Majority of the clinicians and patients or care-takers were comfortable with the overall performance of laboratories, but laboratory results were having less impact on patient management.</p

Comparative performance of three experimental hut designs for measuring malaria vector responses to insecticides in Tanzania.

BACKGROUND: Experimental huts are simplified, standardized representations of human habitations that provide model systems to evaluate insecticides used in indoor residual spray (IRS) and long-lasting insecticidal nets (LLINs) to kill disease vectors. Hut volume, construction materials and size of entry points impact mosquito entry and exposure to insecticides. The performance of three standard experimental hut designs was compared to evaluate insecticide used in LLINs. METHODS: Field studies were conducted at the World Health Organization Pesticide Evaluation Scheme (WHOPES) testing site in Muheza, Tanzania. Three East African huts, three West African huts, and three Ifakara huts were compared using Olyset(®) and Permanet 2.0(®) versus untreated nets as a control. Outcomes measured were mortality, induced exophily (exit rate), blood feeding inhibition and deterrence (entry rate). Data were analysed using linear mixed effect regression and Bland-Altman comparison of paired differences. RESULTS: A total of 613 mosquitoes were collected in 36 nights, of which 13.5% were Anopheles gambiae sensu lato, 21% Anopheles funestus sensu stricto, 38% Mansonia species and 28% Culex species. Ifakara huts caught three times more mosquitoes than the East African and West African huts, while the West African huts caught significantly fewer mosquitoes than the other hut types. Mosquito densities were low, very little mosquito exit was measured in any of the huts with no measurable exophily caused by the use of either Olyset or Permanet. When the huts were directly compared, the West African huts measured greater exophily than other huts. As unholed nets were used in the experiments and few mosquitoes were captured, it was not possible to measure difference in feeding success either between treatments or hut types. In each of the hut types there was increased mortality when Permanet or Olyset were present inside the huts compared to the control, however this did not vary between the hut types. CONCLUSIONS: Both East African and Ifakara huts performed in a similar way although Ifakara huts allowed more mosquitoes to enter, increasing data power. The work convincingly demonstrates that the East African huts and Ifakara huts collect substantially more mosquitoes than the West African huts

Longitudinal evaluation of Ocimum and other plants effects on the feeding behavioral response of mosquitoes (Diptera: Culicidae) in the field in Tanzania

<p>Abstract</p> <p>Background</p> <p>The use of repellent materials from plants against nuisance insects is common with great potential to compliment existing malaria control programmes and this requires evaluation in the field. Ocimum plant species, <it>Ocimum suave </it>(Willd) and <it>O. kilimandscharicum </it>(Guerke) materials and their essential oils extracted by steam distillation were evaluated in the field and experimental huts for repellence, exophily and feeding inhibition effects against three mosquito species, <it>Anopheles arabiensis </it>(Patton), <it>An. gambiae </it>ss (Giles) and <it>Culex quinquefasciatus </it>(Say). The protective effect of essential oils from Ocimum plants were compared with N, N-diethly-3- methylbenzamide (DEET), a standard synthetic repellent. Also, the protective effect of fumigation by burning of repellent plants; <it>Ocimum suave, Ocimum kilimandscharicum</it>, <it>Azadirachta indica</it>, <it>Eucalyptus globules </it>and <it>Lantana camara </it>were tested in experimental huts and selected local houses.</p> <p>Results</p> <p>In the field, protection by Ocimum plants from mosquito bites was high and there was small variation among different mosquito species. Protection efficiency was 93.4%, 91.98% and 89.75% for <it>An. arabiensis </it>while for <it>Cx</it>. <it>quinquefaciatus </it>it was 91.30%, 88.65% and 90.50% for DEET, <it>Ocimum suave </it>and <it>O. kilimandscharicum </it>respectively. In the experimental hut, deterrence induced by burning of Ocimum and other plants ranged from 73.1.0% to 81.9% for <it>An. arabiensis </it>and 56.5% to 67.8% for <it>Cx. quinquefaciatus</it>, while feeding inhibition was 61.1% to 100% for <it>An. arabiensis </it>and 50% to 100% for <it>Cx. quinquefaciatus</it>. Evaluations under field conditions confirmed high protective efficacy, enhanced feeding inhibition and house entry inhibition (Deterrence).</p> <p>Conclusion</p> <p>This study shows the potential of <it>Ocimum suave and Ocimum kilimandscharicum </it>crude extracts and whole plants of <it>Ocimum suave, Ocimum kilimandscharicum</it>, <it>Azadirachta indica</it>, <it>Eucalyptus globules and Lantana camara </it>for use in protecting against human biting while the burning of plants reduces significantly the indoor resting mosquitoes.</p

Colonization and Authentication of the Pyrethroid-Resistant Anopheles gambiae s.s. Muleba-Kis Strain; an Important Test System for Laboratory Screening of New Insecticides.

BACKGROUND: The emergence and spread of insecticide resistance in malaria vectors to major classes of insecticides call for urgent innovation and application of insecticides with novel modes of action. When evaluating new insecticides for public health, potential candidates need to be screened against both susceptible and resistant mosquitoes to determine efficacy and to identify potential cross-resistance to insecticides currently used for mosquito control. The challenges and lessons learned from establishing, maintaining, and authenticating the pyrethroid-resistant An. gambiae s.s. Muleba-Kis strain at the KCMUCo-PAMVERC Test Facility are described in this paper. METHODS: Male mosquitoes from the F1 generation of wild-pyrethroid resistant mosquitoes were cross-bred with susceptible female An. gambiae s.s. Kisumu laboratory strain followed by larval selection using a pyrethroid insecticide solution. Periodic screening for phenotypic and genotypic resistance was done. WHO susceptibility tests and bottle bioassays were used to assess the phenotypic resistance, while Taqman™ assays were used to screen for known target-site resistance alleles (kdr and ace-1). Additionally, the strains were periodically assessed for quality control by monitoring adult weight and wing length. RESULTS: By out-crossing the wild mosquitoes with an established lab strain, a successful resistant insectary colony was established. Intermittent selection pressure using alphacypermethrin has maintained high kdr mutation (leucine-serine) frequencies in the selected colony. There was consistency in the wing length and weight measurements from the year 2016 to 2020, with the exception that one out of four years was significantly different. Mean annual wing length varied between 0.0142-0.0028 mm compared to values obtained in 2016, except in 2019 where it varied by 0.0901 mm. Weight only varied by approximately 0.001 g across four years, except in 2017 where it differed by 0.005 g. Routine phenotypic characterization on Muleba-Kis against pyrethroids using the WHO susceptibility test indicated high susceptibility when type I pyrethroids were used compared to type II pyrethroids. Dynamics on susceptibility status also depended on the lapse time when the selection was last done. CONCLUSIONS: This study described the procedure for introducing, colonizing, and maintaining a resistant An. gambiae s.s. strain in the laboratory with leucine to serine substitution kdr allele which reflects the features of the wild-resistant population in East Africa. Challenges in colonizing a wild-resistant mosquito strain were overcome by out-crossing between mosquito strains of desired traits followed by intermittent insecticide selection at the larval stage to select for the resistant phenotype

Longitudinal evaluation of Ocimum and other plants effects on the feeding behavioral response of mosquitoes (Diptera: Culicidae) in the field in Tanzania

<p>Abstract</p> <p>Background</p> <p>The use of repellent materials from plants against nuisance insects is common with great potential to compliment existing malaria control programmes and this requires evaluation in the field. Ocimum plant species, <it>Ocimum suave </it>(Willd) and <it>O. kilimandscharicum </it>(Guerke) materials and their essential oils extracted by steam distillation were evaluated in the field and experimental huts for repellence, exophily and feeding inhibition effects against three mosquito species, <it>Anopheles arabiensis </it>(Patton), <it>An. gambiae </it>ss (Giles) and <it>Culex quinquefasciatus </it>(Say). The protective effect of essential oils from Ocimum plants were compared with N, N-diethly-3- methylbenzamide (DEET), a standard synthetic repellent. Also, the protective effect of fumigation by burning of repellent plants; <it>Ocimum suave, Ocimum kilimandscharicum</it>, <it>Azadirachta indica</it>, <it>Eucalyptus globules </it>and <it>Lantana camara </it>were tested in experimental huts and selected local houses.</p> <p>Results</p> <p>In the field, protection by Ocimum plants from mosquito bites was high and there was small variation among different mosquito species. Protection efficiency was 93.4%, 91.98% and 89.75% for <it>An. arabiensis </it>while for <it>Cx</it>. <it>quinquefaciatus </it>it was 91.30%, 88.65% and 90.50% for DEET, <it>Ocimum suave </it>and <it>O. kilimandscharicum </it>respectively. In the experimental hut, deterrence induced by burning of Ocimum and other plants ranged from 73.1.0% to 81.9% for <it>An. arabiensis </it>and 56.5% to 67.8% for <it>Cx. quinquefaciatus</it>, while feeding inhibition was 61.1% to 100% for <it>An. arabiensis </it>and 50% to 100% for <it>Cx. quinquefaciatus</it>. Evaluations under field conditions confirmed high protective efficacy, enhanced feeding inhibition and house entry inhibition (Deterrence).</p> <p>Conclusion</p> <p>This study shows the potential of <it>Ocimum suave and Ocimum kilimandscharicum </it>crude extracts and whole plants of <it>Ocimum suave, Ocimum kilimandscharicum</it>, <it>Azadirachta indica</it>, <it>Eucalyptus globules and Lantana camara </it>for use in protecting against human biting while the burning of plants reduces significantly the indoor resting mosquitoes.</p

Laboratory and semi-field efficacy evaluation of permethrin-piperonyl butoxide treated blankets against pyrethroid-resistant malaria vectors.

To control pyrethroid-resistant malaria vectors, Indoor Residual Spraying (IRS) and Long-Lasting Insecticidal Nets (LLINs) that include additional ingredients to pyrethroid are being developed. Same progress needs to be made to the pyrethroid-treated blankets, which are more compatible with shelter structures found in emergency settings such as displaced populations. In the current study, efficacy of blankets treated with permethrin and piperonyl butoxide (PBO) was evaluated against pyrethroid-resistant Anopheles gambiae sensu stricto. Efficacy was compared with that of Olyset LLIN, Olyset Plus LLIN and untreated blanket in terms of mortality and blood-feeding inhibition against pyrethroid-resistant Anopheles gambiae mosquitoes. The current study indicates that, in emergency shelters such as migrant and refugee camps where LLINs cannot be used, PBO-permethrin blankets may provide protection against resistant mosquitoes if widely used. No side effects related to the use of the treated blankets were reported from the participants. These results need validation in a large-scale field trial to assess the epidemiological impact of the intervention, durability and acceptability of this new vector control strategy for malaria vector control

Ethnobotanical study of some of mosquito repellent plants in north-eastern Tanzania

The use of plant repellents against nuisance biting insects is common and its potential for malaria vector control requires evaluation in areas with different level of malaria endemicity. The essential oils of Ocimum suave and Ocimum kilimandscharicum were evaluated against malaria vectors in north-eastern Tanzania. An ethnobotanical study was conducted at Moshi in Kilimanjaro region north-eastern Tanzania, through interviews, to investigate the range of species of plants used as insect repellents. Also, bioassays were used to evaluate the protective potential of selected plants extracts against mosquitoes. The plant species mostly used as repellent at night are: fresh or smoke of the leaves of O. suave and O. kilimandscharicum (Lamiaceae), Azadirachta indica (Meliaceae), Eucalyptus globules (Myrtaceae) and Lantana camara (Verbenaceae). The most popular repellents were O. kilimandscharicum (OK) and O. suave (OS) used by 67% out of 120 households interviewed. Bioassay of essential oils of the two Ocimum plants was compared with citronella and DEET to study the repellence and feeding inhibition of untreated and treated arms of volunteers. Using filter papers impregnated with Ocimum extracts, knockdown effects and mortality was investigated on malaria mosquito Anopheles arabiensis and Anopheles gambiae, including a nuisance mosquito, Culex quinquefasciatus. High biting protection (83% to 91%) and feeding inhibition (71.2% to 92.5%) was observed against three species of mosquitoes. Likewise the extracts of Ocimum plants induced KD90 of longer time in mosquitoes than citronella, a standard botanical repellent. Mortality induced by standard dosage of 30 mg/m2 on filter papers, scored after 24 hours was 47.3% for OK and 57% for OS, compared with 67.7% for citronella. The use of whole plants and their products as insect repellents is common among village communities of north-eastern Tanzania and the results indicate that the use of O. suave and O. kilimandscharicum as a repellent would be beneficial in reducing vector biting. The widespread use of this approach has a potential to complement other control measures

Smear positive pulmonary tuberculosis among HIV patients receiving Highly Active Antiretroviral Therapy in Dar es Salaam, Tanzania

Globally, tuberculosis-HIV co-infections are on the increase. In 2007, 15% (1.37 million) of the tuberculosis cases were HIV-positive tuberculosis (TB). This cross-sectional study was conducted in February 2009 to assess the effect of the level of CD4 lymphocyte counts on the development of smear positive pulmonary TB (PTB) among HIV patients before and after initiation of highly active antiretroviral therapy (HAART). A total of 155 HIV patients who were on HAART programme were enrolled and out of these 42 (27.1%) were smear positive PTB. Of the 42 PTB patients, 38 (90.5%) were also infected with HIV and were already at initiation of HAART. There was no association between the development of smear positive PTB and socio-demographic characteristics among HIV patients before and after HAART initiation (P>0.05). A larger proportion of HIV+PTB patients diagnosed before and after HAART initiation was found with CD4 lymphocyte count <200cells/µl. However, the difference was not statistically significant (P=0.092). Among HIV patients who were diagnosed to be smear positive PTB after HAART initiation, their CD4 lymphocyte counts at time of TB diagnosis was lower than their CD4 lymphocyte counts at time of HAART initiation. The four patients diagnosed with PTB after HAART initiation had mean CD4 lymphocyte counts at HAART initiation not statistically different from that at TB diagnosis (t=0.715, P=0.526).The median time period within which the diagnosis of smear positive PTB was made after HAART initiation was 22 weeksand the mean time was 66.75 weeks. These findings provide evidence that development of smear positive PTB after HAART initiation may occur at any level of CD4 lymphocyte count (P<0.05). This study was limited by the relatively small sample size, we therefore recommend more studies involving a larger sample size in order to estimate more accurately the effect of both level of CD4 lymphocyte count and HAART on the development of smear positive PTB among HIV patients on treatment