The epidemiology of human brucellosis in the context of zoonotic diseases in Tanzania

The aims of the study were to determine the seroprevalence and incidence of human brucellosis in Arusha and Manyara regions, risk factors for human brucellosis, health-seeking behavior and clinical features of human brucellosis cases and to evaluate different diagnostic tests for brucellosis. Other objectives included determination of the knowledge of medical practitioners relevant for diagnosis of zoonoses and estimation of the burden of disease caused by human brucellosis in Tanzania.From cross-sectional studies, the Brucella seroprevalence in humans was 4.8% when determined by assays in the field and 6.4 % at the Sokoine University of Agriculture (SUA) based on the Rose Bengal Plate Test (RBPT). Based on the competitive ELISA (c-ELISA) test conducted at the Veterinary Laboratory Agencies (VLA) the seroprevalence of brucellosis was 7.7%. The majority of RBPT positive individuals were asymptomatic. Most of the c-ELISA positive individuals were above 15 years of age with the age group 16-30 years having the highest number of seropositive individuals. There was a significant association between the seroprevalence of brucellosis in humans and the seroprevalence of brucellosis in goats at the district level.Prospective hospital studies indicated that the incidence of brucellosis was 11.2 cases/100,000 people per annum. Joint pain, headache, backache, fever and fatigue were the main clinical features described by the confirmed (c-ELISA positive) patients, but these were also most commonly reported by the c-ELISA negative patients initially suspected as having brucellosis. Patients with brucellosis delayed going to hospital with a median delay time of 90 days. Distance to the hospital, keeping animals and knowledge of brucellosis were significantly associated with patient delay to present to hospital. More cases of brucellosis were recorded in hospitals located in pastoral areas and brucellosis was more common among people engaging in business.Brucellosis was associated with assisting an aborting animal. It was shown that the closer the distance between households, the higher the risk of brucellosis. People who were of Christian religion were found to have a higher risk of disease compared to other religions.The sensitivity and specificity of the RBPT in the cross-sectional survey were 39.4% and 98.8% respectively, at the SUA laboratory 38.7% and 96.8% respectively and at the hospitals 44.3% and 89.5% respectively. The sensitivities and specificities of the diagnostic tests for brucellosis at the hospitals were also low. There was a poor agreement between the RBPT performed at SUA, the RBPT performed in crosssectional survey and the tests performed at the hospitals.Medical practitioners in rural hospitals had poorer knowledge of most zoonoses when compared to the practitioners in urban hospitals, including transmission of sleeping sickness, clinical presentations of anthrax and rabies in humans. In both areas practitioners had poor knowledge of echinococcosis transmission to humans, clinical features of echinococcosis in humans, and diagnosis of bovine tuberculosis in humans.Brucellosis contributed to an estimated 3,644 -3,708 Disability Adjusted Life Years (DALY) burden in Tanzania based on data collected from hospitals while data from the community resulted in an estimated 92,080 - 121,550 DALY burden in Tanzania. The majority of cases continued to have brucellosis clinical features for a period of over two years, and out of these, five days spent as inpatients. Households used a mean total of US $90.65 (92, 826 TShs.) to care for a single case of brucellosis per year and each health provider used a mean total of US$ 858 (878,592 TShs.) per year to care for cases of brucellosis.Brucellosis contributes to poverty and suffering particularly to the poor in the rural areas of Tanzania and yet it is neglected. There is a need for increased health education on risk factors for transmission of brucellosis to humans and the importance of going to hospital at an early stage of the disease. More efforts also need to be directed towards improving the diagnosis and treatment of brucellosis to reduce prolonged human suffering from brucellosis. This should include the adoption of standardized diagnostic and treatment protocols. Restructuring and updating of disease recording systems and diagnostic laboratories so that they diagnose and hence capture zoonoses such as brucellosis should be implemented. Efforts should be made to equip practitioners with adequate knowledge relevant for identification of zoonoses

'They have ears but they cannot hear' : listening and talking as HIV prevention : a new approach to HIV and AIDS campaigns at three of the universities in KwaZulu-Natal.

Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2008.Sexuality is made relevant in the way language is used as a matter of the identity of a group or individuals. Sex, for human beings, is not merely instinctive behaviour. It is meaningful-cultural behaviour and as such is semiotically loaded with meaning. Listening and talking about sex highlights conventions, taken-for-granted assumptions about the way things have to be done. Language as the most powerful representational system shapes our understanding of what we do and how we do them in relation to sex. Our understanding of sexual scripts about the sexuality of a particular group of people is through language as a signifying practice. The study of listening and talking is not merely an investigation of how sex is talked about, but how respondents enact sexuality and sexual identity vis-à-vis its linguistically loaded forms of representations in a variety of discourse genres. Representation and its inherent process of signification draws on lived experiences and the daily talk of people in interaction. A theoretical perspective is presented not as a model to be tested, but as testimony to the rich literature on the nature and function of language as a political arena, semiotically loaded with meanings that are taken for granted. It is concluded that the appropriation of cultural myths is encoded in language and as such language is a legitimate area of inquiry especially in understanding sexual scripts in the context HIV/AIDS. The study engages reported high risk sexual encounters such as multiple and concurrent partnerships, as well as unsafe sex practices which have been identified in literature as fanning the embers of the epidemic. Ideologies influencing developing communication campaigns in light of these discourses become a serious challenge as the conventional basis for such campaigns is in socio-cognitive theories, few of which can be assumed to apply with regard to the discursive representations of sexual practices and the inherent risks. Drawing on a cross-sectional survey of 1400 students on seven campuses, conceptually triangulated via focused-ethnography, listening analysis and discourse analysis, this research examines perceptions, interpretations, attitudes, and practices of sexuality and HIV/AIDS. The research is a multi-method and inter-disciplinary approach located within cultural studies to interrogate the gap between knowledge, attitudes, beliefs and behaviour modification in the light of the HIV/AIDS epidemic. This research discusses these findings and offers a critical appraisal of sexual behaviour in the context of ABC (Abstain, Be faithful, Condomise) as ideologically encoded in cultural and relational myths. I found that students are sexually active with reported multiple and concurrent sexual partnerships. Postgraduate students were less likely to report having had used a condom at their last coital encounter compared with the often younger undergraduate students. Condom use continues to be a norm in the universities surveyed. This is truer for students who reported multiple sexual partnerships. Amongst the dominant scripts that came out in the ethnographic inquiry are: sex as uncontrollable biological drive; females are responsible for safe sex practices; strong social scripts elevate male sexual prowess and show disdain for female affirmative sexualities, risk is discounted using a form of post modern fatalism (resistance to regulation); and physical status, based on appearance of a possible partner, is used to select ‘sexually safe’ partners. I have concluded that a deeper understanding of the cultural and sexual scripts obtained from students is critical for appropriate design and implementation of interventions aimed at stemming the tide of the HIV epidemic. I have also demonstrated that interventions that only emphasise the rational dimensions of human behaviour are more likely to miss their target audience as sex is more than a choice of Cartesian rationality (linear choice)

Seroprevalence and risk factors for human brucellosis in agro-pastoral areas in Tanzania

Background: Brucellosis is an endemic zoonosis in Tanzania. This study was conducted to investigate the seroprevalence of human brucellosis and its risk factors in agro-pastoral areas in Morogoro Region, Tanzania. Methods: Questionnaire survey and blood sampling were conducted from January to February 2018 at four villages. Anyone living in the villages and wished to participate were involved. Competitive ELISA was used for diagnosis. Risk factor analysis for sero-positivity in human and analysis for the association of sero-positivity between cattle and human within each farm were conducted, using the data of farm-level bovine brucellosis status from our bovine brucellosis research performed in 2016. Results: The seroprevalence was 33.3% (44/132). In univariable analysis, the Maasai were significantly more sero-positive (56.5%) than other tribes (28.4%) (OR = 3.23, 95% CI: 1.28–8.41). Drinking raw milk was a risk factor in both univariable and multivariable analyses (OR = 3.97, 95% CI: 1.61–10.20). A negative association between sero-positivity in cattle and human within each farm was found (p<0.01). The Maasai performed more risk-taking behaviours for human infection than other tribes: drinking raw milk (p<0.01) or blood (p<0.01) and helping delivery of cattle with bare hands (p=0.03). Conclusions: The Maasai were at high risk of human brucellosis. More detailed survey and educational interventions are urgently needed

Plant Fetish: A Creative Challenge to Mental Health Stigma

People of BAMME (Black, Asian, Minority, and Migrant ethnic) heritage in the UK experience various anomalies when engaging with mental health services. Typically concentrated at secondary and secure levels of care, these discrepant experiences interact with a reticence to uptake mental health support at the primary care level. Official, national anti-stigma campaigns often reproduce messages that do not connect with BAMME communities, raising questions about how best to challenge stigma in this context. This research paper describes a case study of an alternative means to address stigma, drawing from a dramatic comedy performance, Plant Fetish, written and performed by an artist who carries a diagnosis of complex post-traumatic stress disorder (Complex PTSD). The study comprised of an individual interview with the artist, audience feedback, and a group discussion conducted after the show. Data were subject to interpretative phenomenological analysis. Findings are discussed in relation to the importance of using creativity to increase public awareness of mental health and inform efforts to reduce stigma. We conclude that such approaches show promise and merit further exploration in a context of growing discursive interest in mental health amidst acknowledged deficiencies of contemporary anti-stigma efforts, especially as they apply to BAMME people, their families, and their communities

Integrating serological and genetic data to quantify cross-species transmission: brucellosis as a case study

Epidemiological data are often fragmented, partial, and/or ambiguous and unable to yield the desired level of understanding of infectious disease dynamics to adequately inform control measures. Here, we show how the information contained in widely available serology data can be enhanced by integration with less common type-specific data, to improve the understanding of the transmission dynamics of complex multi-species pathogens and host communities. Using brucellosis in Northern Tanzania as a case-study, we developed a latent process model based on serology data obtained from the field, to reconstruct Brucella transmission dynamics. We were able to identify sheep and goats as a more likely source of human and animal infection than cattle; however, the highly cross-reactive nature of Brucella spp. meant that it was not possible to determine which Brucella species (B. abortus or B. melitensis) is responsible for human infection. We extended our model to integrate simulated serology and typing data, and show that although serology alone can identify the host source of human infection under certain restrictive conditions, the integration of even small amounts (5%) of typing data can improve understanding of complex epidemiological dynamics. We show that data integration will often be essential when more than one pathogen is present and when the distinction between exposed and infectious individuals is not clear from serology data. With increasing epidemiological complexity, serology data become less informative. However, we show how this weakness can be mitigated by integrating such data with typing data, thereby enhancing the inference from these data and improving understanding of the underlying dynamics

Prevalence of brucellosis in the human, livestock and wildlife interface areas of Serengeti National Park, Tanzania.

This research article published by AOSIS, 2016Between 2005 and 2006, a cross-sectional survey was carried out in domestic ruminants in agropastoral communities of Serengeti district, Tanzania to determine the seroprevalence of brucellosis in domestic-wildlife interface villages. Both the Rose Bengal Plate Test (RBPT) and Competitive Enzyme Linked-immunosorbent Assay (c-ELISA) were used to analyse 82 human and 413 livestock sera from four randomly selected villages located along game reserve areas of Serengeti National Park. Although both cattle (288) and small ruminants (125) were screened, seropositivity was detected only in cattle. The overall seroprevalence based on c-ELISA as a confirmatory test was 5.6%. In cattle both age and sex were not statistically associated with brucellosis seropositivity (P = 0.63; 95% CI = 0.03, 0.8 and 0.33; 95% CI = 0.6, 3.7, respectively). Overall herd level seropositivity was 46.7% (n = 7), ranging from 25% to 66.7% (n = 4-10). Each village had at least one brucellosis seropositive herd. None of the 82 humans tested with both RBPT and c-ELISA were seropositive. Detecting Brucella infection in cattle in such areas warrants further investigation to establish the circulating strains for eventual appropriate control interventions in domestic animals

CIHR canadian HIV trials network HIV workshop: ethical research through community participation and strengthening scientific validity

The CIHR canadian HIV trials network mandate includes strengthening capacity to conduct and apply clinical research through training and mentoring initiatives of HIV researchers by building strong networks and  partnerships on the African continent. At the17th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA), the CTN facilitated a two-day workshop to address ethical issues in the conduct of HIV research, and career enhancing strategies for young African HIV researchers. Conference attendees were allowed to attend whichever session was of interest to them. We report on the topics covered, readings shared and participants’ evaluation of the workshop. The scientific aspects of ethical research in HIV and career enhancement strategies are relevant issues to conference attendees.Key words: Capacity building, ethics, HIV research, South Afric

Creativity out of chaos

Creativity is said to be highly desired in post-modern and post-industrial organizations Creativity and anarchy on the one hand, and managerialism, on the other, can be seen as different forms of knowledge, two opposed ideals. In many organizational as well as societal reforms we currently observe it is the managerialist ideal that wins over the anarchic. In this paper, we wonder if people fear anarchy? We reflect on the possible reasons for the fear, and we also try to explain why we believe that anarchic organizing should not be avoided or feared

After-action review of rabies and anthrax outbreaks multisectoral response in Tanzania, challenges and lessons

After-action review uses experiences gained from past events to adopt best practices, thereby improving future interventions. In December 2016 and late 2018, the government of Tanzania with support from partners responded to anthrax and rabies outbreaks in Arusha and Morogoro regions respectively. The One Health Coordination Desk (OHCD) of the Prime Minister’s Office (PMO) later coordinated after-action reviews to review the multi-sectoral preparedness and response to the outbreaks. To establish and describe actions undertaken by the multi-sectoral investigation and response teams during planning and deployment, execution of field activities, and outbreak investigation and response, system best practices and deficiencies. These were cross-sectional surveys. Semi-structured, open and closed-ended questionnaire and focus group discussions were administered to collect information from responders at the national and subnational levels. It was found that the surveillance and response systems were weak at community level, lack of enforcement of public health laws including vaccination of livestock and domestic animals and joint preparedness efforts were generally undermined by differential disease surveillance capacities among sectors. Lack of resources in particular funds for supplies, transport and deployment of response teams contributed to many shortfalls. The findings underpin the importance of after-action reviews in identifying critical areas for improvement in multi-sectoral prevention and control of disease outbreaks. Main sectors under the coordination of the OHCD should include after action reviews in their plans and budget it as a tool to continuously assess and improve multi-sectoral preparedness and response to public health emergencies

Quantifying Risk Factors for Human Brucellosis in Rural Northern Tanzania

Brucellosis is a zoonosis of veterinary, public health and economic significance in most developing countries. Human brucellosis is a severely debilitating disease that requires prolonged treatment with a combination of antibiotics. The disease can result in permanent and disabling sequel, and results in considerable medical expenses in addition to loss of income due to loss of working hours. A study was conducted in Northern Tanzania to determine the risk factors for transmission of brucellosis to humans in Tanzania. This was a matched case-control study. Any patient with a positive result by a competitive ELISA (c-ELISA) test for brucellosis, and presenting to selected hospitals with at least two clinical features suggestive of brucellosis such as headache, recurrent or continuous fever, sweating, joint pain, joint swelling, general body malaise or backache, was defined as a case. For every case in a district, a corresponding control was traced and matched by sex using multistage cluster sampling. Other criteria for inclusion as a control included a negative c-ELISA test result and that the matched individual would present to hospital if falls sick. Multivariable analysis showed that brucellosis was associated with assisted parturition during abortion in cattle, sheep or goat. It was shown that individuals living in close proximity to other households had a higher risk of brucellosis. People who were of Christian religion were found to have a higher risk of brucellosis compared to other religions. The study concludes that assisting an aborting animal, proximity to neighborhoods, and Christianity were associated with brucellosis infection. There was no association between human brucellosis and Human Immunodeficiency Virus (HIV) serostatus. Protecting humans against contact with fluids and tissues during assisted parturition of livestock may be an important means of reducing the risk of transferring brucellosis from livestock to humans. These can be achieved through health education to the communities where brucellosis is common