Non communicable diseases in Tanzania: a call for urgent action

Globally there is evidence of the growing burden of Non Communicable diseases (NCDs) especially in developing countries including Tanzania. This paper summarises the review of published papers on the magnitude of Non Communicable Diseases in the country. Current opportunities for management and control of NCDs are also explored. In this review diseases such as diabetes and hypertension have been shown to have increased over the years. Prevalence of risk factors such as obesity, dyslipidemia and smoking has been shown to be high with clear gender and urban rural differences. Generally there is paucity of national representative data on the burden of risk factors and prevalence of non-communicable diseases. The main risk factors for NCDs namely smoking, alcohol intake, unhealthy diet and low physical activity are prevalent in both rural and urban communities. The socio-demographic and economic transition has a big role in the current rise of non-communicable diseases in Tanzania. There are initiatives to control the burden of non-communicable diseases in the country. However there is need to focus more on primary prevention at population level targeting interventions to reduce exposure to tobacco, reduce alcohol intake, reduce salt intake, promote healthy diets and physical activity. For the prevention and control of NCDs, there needs to be a continuum from primary to tertiary prevention and a scope of interventions from the community level up to the national level. Community-based interventions are needed targeting the risk factors for primary prevention. In addition, secondary prevention measures are needed targeting those at high risk to ensure that they are identified early through a high risk targeted screening for early identification and appropriate care. Effective policies are needed to support such interventions

Clinical manifestations and outcomes of severe malaria among children admitted to Rungwe and Kyela district hospitals in south-western Tanzania

Malaria remains as an important public health and a major cause of childhood death and paediatric hospital admission in sub-Saharan Africa. This prospective hospital based cross sectional study was conducted from April 2007 to April 2008. The main objective was to assess clinical manifestations and outcomes of severe malaria in children admitted to district hospital in Rungwe and Kyela in south-western Tanzania. A total of 1371 children were selected as screening group of which 409 (29.8%) were tested positive for malaria. Mean age of the children was 2.7 (95%CI= 2.5, 2.8) years and the majority (86%) were under five years of age. The proportion of children severe malaria in Rungwe was significantly higher than that of Kyela by 21.3% (P=0.002). The common symptoms of severe malaria during admission were convulsions (50.9%) compensated shock (30.6%), prostration (29.1%) and symptomatic severe anaemia (14.9%). The case fatality rate (CFR) was 4.6% and the cure rate (CR) was 95.4%. Children with suspected severe acidosis and symptomatic severe anemia were 4.8 (95%CI=1.6, 14.6) and 5.5 (95%CI 1.1, 28.2), respectively, more likely to die compared to those without these symptoms. The proportion of deaths among children presenting ≥5 symptoms was 32.1% higher than among those presenting one symptom (OR =0.50, 95%CI 0.125-2.000; P=0.000). Convulsions and compensated shock were the leading symptoms at admission. Suspected severe acidosis and symptomatic severe anemia were the predictors of mortality for children. In order to reduce mortality among admitted children with severe malaria there is a need for health providers to deploy strategic management of fatal prognostic factors. In conclusion, convulsion and compensated shock were the leading symptoms among children at admission and that suspected severe acidosis and symptomatic severe anemia were the predictors of mortality. It is therefore important to emphasis early diagnosis and prompt treatment of severe cases of malaria to minimize mortality among children

Knowledge and Perceptions about Tuberculosis in Agropastoral Communities in Northern Tanzania: A Cross-Sectional Study

Aim: To determine knowledge and perceptions about tuberculosis in agropastoral communities in Northern Tanzania. Study Design: This was a cross sectional study on habits and attitudes to tuberculosis. Methods: The study was conducted between June 2011 and May 2012.We enrolled tuberculosis patients registered at Mount Meru Hospital in Arusha municipal, Enduleni Hospital in Ngorongoro district, and Haydom Lutheran Hospital in Mbulu district. In addition we selected for comparison some of their household relatives and individuals from the neighborhood. Data was collected using a structured questionnaire. Knowledge about tuberculosis was assessed by questions concerning causes, symptoms, modes of transmission and prevention and treatment. Key variables for assessment of perception on tuberculosis included: individuals considered most at risk, and misconceptions. Results: We recruited 164 respondents of whom 25% were confirmed tuberculosis patients, 41.5% relatives of the patients and 33.5% neighbors. Females constituted 48.8% of all respondents. Of all the participants, only two of the neighbors had never heard about tuberculosis in their life time. Even though 99% had heard about tuberculosis, specific knowledge on causes, prevention and treatment was poor. A total of 67.7% thought that transmission of tuberculosis occurs during sexual intercourse. Respondents thought that risk from tuberculosis was higher among adults (68.9%), alcohol users (39.6%), smoking (26.8%), consumption of raw animal products (6.1%) and childhood (23.2%). Conclusion: Our study shows that study participants had heard about tuberculosis but specific knowledge was low. Misconceptions surrounding causes, transmission, prevention and treatment of the disease were common. Selection of appropriate channels for public health education and awareness programmes targeting knowledge about prevention and control of tuberculosis in agropastoral communities may improve this situation.publishedVersio

Prevalence and Correlates of Cardio-Metabolic Risk Factors Among Regular Street Food Consumers in Dar es Salaam, Tanzania

Background: Regular street food consumers (RSFCs) in Africa are at an increased risk of unhealthy eating practices, which have been associated with intermediate risk factors of cardio-metabolic diseases. However, knowledge of the magnitude and correlates of these risk factors is limited in Tanzania. This study aimed to fill this gap using data collected from RSFCs in Dar es Salaam, the largest city in Tanzania. Methodology: A cross-sectional study was carried out among 560 RSFCs in three districts of Dar es Salaam between July and September 2018. Information on socio-economic factors and demographics, behavioral risks, anthropometric and biochemical indicators was collected. Adjusted odds ratios (OR) and prevalence ratio (PR) with corresponding 95% confidence intervals (CI) were estimated using multivariable binary logistic and modified Poisson regression models, respectively. Results: On average, participants consumed 11 street food meals/week. The prevalence (95% CI) of cardio-metabolic risk factors was 63.9% (60.6– 69.9%) for overweight/obesity, 42.5% (38.3– 46.9%) for raised blood pressure, 13.5% (10.9– 16.8%) for raised triglycerides and 6.6% (4.9– 9.3%) for raised glucose levels. The correlates of overweight/obesity were female vs male sex (APR=1.3; 95% CI 1.2– 1.5), age of 41– 64 vs 25– 40 years (APR=1.4; 95% CI 1.2– 1.6), high vs low income (APR=1.2; 95% CI 1.04– 1.3), being married/cohabiting vs other (APR=1.2; 95% CI 1.01– 1.4) and family history of diabetes vs no family history (APR=1.2; 95% CI 1.01– 1.3). Age 41– 64 vs 25– 40 years, was the only significant factor associated with raised blood pressure APR (95% CI) 2.2 (1.7– 2.9) and raised glucose AOR (95% CI) 3.9 (1.5– 10.5). Conclusion: Our study revealed that RSFCs are at risk of cardio-metabolic health problems, especially women, middle-aged people and those with higher incomes. Transdisciplinary studies to understand the drivers of street food consumption are needed in order to inform interventions to mitigate the risk of developing cardio-metabolic diseases. These interventions should target both street food vendors and their consumers. Keywords: street food consumers, cardio-metabolic risks, cardio-metabolic correlates, Tanzani

Housing infrastructure: contemporary issues in timber adoption

Scotland currently has 76·7% of all implemented timber-framed buildings in the UK housing market. England’s figure is 16%. The English contribution is considered relatively low given its demand for more sustainable, low-cost social housing. The aim of this study is to investigate potential contemporary barriers to the adoption of timber as a primary structural material in residential housing developments in England. The research methodology is quantitative and findings revealed that a combination of economic, cultural and psychological issues rather than technical and durability performance are responsible. These are fundamentally due to lack of education regarding the use of timber, erroneously perceived increased maintenance costs of timber housing, developers’ influence and monopoly over timber technology, uncertainty in property resale value and the recent overall lack of confidence in timber technology. It is recommended that improved training comprising compulsory basic timber technology and sustainable construction is adopted as a formal prerequisite for the attainment of relevant qualifications within the built environment, civil engineering and architecture. To this end, the benefits of sustainable construction, specifically, timber, in housing should be introduced even at the pre-university level, within schools and colleges. Also recommended are public awareness campaigns through relevant institutions, in the public and private sectors and among construction professionals, of the merits and misconceptions surrounding timber technology.N/

Community-based HIV services during Differentiated Service Delivery Models: a cross-sectional survey from nine regions in Tanzania

Introduction: To combat the HIV epidemic and reach the 90-90-90 goals, community-based HIV/AIDS services (CHBS) plays a great role. However, how well CHBS works in the era of adopting differentiated service delivery models for care and treatment has not been adequately evaluated. We hence assessed CBHS programs implemented by various partners with a focus on the coverage; program needs; linkage and referral process; consistent use of guidelines and training curricula and challenges faced by providers and clients. Methods: It was a cross-sectional study conducted in July 2020 in 9 regions using both quantitative and qualitative methods. Quantitative data were analyzed using STATA version 12 and qualitative data were managed using Thematic Content Analysis. Results: 26 implementing partners were offering CBHS in biomedical, behavioral, and structural areas. Their focus was on PLHIV, orphans, and key and vulnerable populations. The majority of PLHIV had a positive perception of different CBHS. Key factors in the perceived effectiveness of community HIV services were the consistent use and availability of guidelines and training curricula, standard operating procedures, and readiness of essential commodities and supplies. Out of 1391 PLHIV who were involved, 67.4% and 25.0% were tested at the health facility and communities respectively. About 69.8% were referred after confirming their seropositivity and forms were not given to about 57.5% when referred from health facilities to communities for CBHS. There was a deficit of 45% in health workers across different cadres, a deficit in all categories of supplies and equipment example the HIV test kit by 53.8%. Challenges for CBHS included financial hindrances, HIV-related stigma, and discrimination, distance to health facilities, and poor incentives for community health workers. Conclusion: it is important to address HIV-related stigma hence accelerating efforts to limit the spread of the HIV epidemic in the respective communities

Prevalence of asymptomatic malaria infections in selected military camps in Tanzania

Background: Despite a decrease in malaria burden reported between 2000 and 2015, an increasing trend of malaria transmission has been recently reported in some endemic countries including Tanzania. Periodic monitoring to identify pocket areas for asymptomatic Plasmodium falciparum infection   is vital for malaria elimination efforts. The objective of this study was to determine prevalence of asymptomatic malaria infections among military recruits in selected camps in Tanzania. Methods: A cross-sectional study was conducted in 2015 at four military camps (Bulombora, Mgambo, Ruvu, and Rwamkoma) of National Service located in regions with varying malaria endemicity in Tanzania.  Finger prick blood samples collected from asymptomatic military recruits who had been at the camps for over two months were simultaneously tested using microscopy and malaria rapid diagnostic tests (mRDTs) to detect malaria parasite infections. Results: Malaria parasite prevalence among asymptomatic recruits was 20.3% and 19.4% by microscopy and mRDT respectively. There was moderate agreement (Kappa=0.724) between microscopy and mRDT test results. A significant difference (p<0.001) of malaria parasite prevalence among the four study camps was observed; ranging from 1.9% in Bulombora to 39.4% in Rwamkoma. The geometric mean parasite density was 11,053 asexual parasites/µl and most recruits (56.8%) had 200 to 1999 asexual parasites/µl. P. falciparum was the predominant (99.2%) malaria parasite species. Conclusion: Our study found high prevalence of asymptomatic malaria infections among military recruits in the selected camps, and this varied from one camp to another. The study has highlighted that public residence institutions such as military camps can be potential hotspots for malaria infection and therefore should not be skipped in routine national malaria surveillance system for monitoring trends of infection

Supply chain management of laboratory supportive services and its potential implications on the quality of HIV diagnostic services in Tanzania

Background: Reliable supply of laboratory supportive services contributes significantly to the quality of HIV diagnostic services. This study assessed the status of supply chain management of laboratory supportive services and its potential implications on the quality of HIV diagnostic services in selected districts of Tanzania.Methods: The study was conducted in 39 health facilities (HFs) from eight districts in four regions of Tanzania, namely Iringa, Mtwara, Tabora and Tanga. Facilities with care and treatment centres for HIV/AIDS patients were purposively selected for the study. The study utilized a quantitative method of data collection. A questionnaire was administered to heads of laboratories to obtain information on laboratory supply chain management.Results:  A total of 39 health facilities (HF) were included in the study. This included 23 public and 16 private facilities. In 82% of the HFs, ordering of supplies was performed by the laboratory departments. The information commonly used to forecast requirements of the laboratories included the number of tests done (74.4%; n=29), current stock levels (69.2%; n=27), average monthly consumption (64.1%, n=25) and minimum and maximum stock levels (10.2%, n=4). Emergency orders were significantly common in public than private facilities (73.9% vs. 56.3%, p=0.004).  Delivery of ordered supplies took 1 to 180 days with a significantly longer period for public than private facilities (32.5 vs. 13.1 days, p=0.044). Most of the public HFs ordered supplies from diverse sources compared to private facilities (68.2% vs. 31.8%).Conclusion: There was a weak inventory management system and delays in delivery of supplies in the majority of HFs, which are likely to impede quality of HIV care and treatment. Strengthening capacity for data management and ensure constant supply will potentially improve the quality of HIV diagnostic services

HIV treatment outcomes and their associated factors among adolescents and youth living with HIV in Tanzania

Introduction:  Despite improvements in access to Ante-Retroviral therapy in Tanzania, low ART initiation rate, low retention rate, lower viral load suppression, high loss to follow up and death rate among adolescents and youth living with HIV remain a challenge.  This study was conducted to identify factors affecting HIV treatment outcomes among adolescents and youths. Methods: A cross-sectional study was done in seven regions in Tanzania. A total of 1124 in and out of school ALYHIV were interviewed using a semi-structured questionnaire. Results: A total of 1120(99.6%) participants were on ART. Of those who were on ART, 606 (53.9%) participants had advanced HIV disease, 423(37.6 %) had switched to the second line of ART and 1761(7.7%) had a virological failure. After adjusting for confounders, death of both parents (APR= 1.3, 95%CI: 1.01-1.8); regions with high HIV prevalence (APR= 1.7, 95%CI: 1.2-2.3) and taking ARVs for three years and less (APR= 2.2, 95%CI: 1.4-3.6) were associated to have advanced HIV. Additionally, HIV regional prevalence level, level of perception, adherence status, ARV storage and supervision of ART use were independently associated with Virological failure.    Conclusion: This study has shown that despite an almost universal utilization of ART among adolescents and youth living with HIV unfavourable clinical ART outcomes such as advanced HIV disease, virological failure and ART switch to the second line remain a challenge, particularly among males and adolescents. Various factors at individual, community and health facility levels contribute to unfavorable ART clinical outcomes among AYLHIV. Therefore, an all-inclusive multidimensional and multi- stakeholders’ approach is needed to ensure the availability of sustainable, effective and quality care and treatment services prioritizing AYLHIV.&nbsp