Prevalence of undernutrition and risk factors of severe undernutrition among children admitted to Bugando Medical Centre in Mwanza, Tanzania

BACKGROUND: Malnutrition is a major public health problem in developing countries including Tanzania, contributing up to 50 % of under-five mortality. East Africa region was among the three United Nations (UN) subregions with the highest prevalence of stunting in 2011. In resource limited countries, the available little resources in hospitals are likely to be used focusing the primary clinical problem that led to admission of children leaving moderate and mild malnutrion unattended. This work was conducted to determine the prevalence of under-nutrition and risk factors associated with severe malnutrition among undernourished children aged 6–60 months admitted to Bugando Medical Centre (BMC) paediatric wards. METHOD: This was a hospital-based cross sectional study where by 720 children were screened in order to determine their nutritional status. Data were collected through measurement of weight/length or height, mid upper arm circumference (MUAC) and interpretation was done using Z-score (mild malnutrition ≤1SD, moderate malnutrition ≤2SD and severe malnutrition ≤3SD). The socio-demographic data were obtained using a questionnaire that was completed by interviewing children’s parents/caregiver. RESULTS: Out of 720 screened children, 402 (55.8 %) were undernourished. Severe malnutrition was found in 178 (24.7 %) children and among these 97 (54.5 %) had marasmus. Risk factors associated with severe malnutrition were children with age less than 2 years, lack of vaccination, taking unbalanced diet, low maternal education and single parent, with p-value (<0.001, < 0.001, <0.001, 0.02, < 0.001) respectively. CONCLUSION: This study show a high prevalence of malnutrition in hospitalized children and the majority was marasmic. The risk factors associated with severe malnutrition were described. We recommend improving the screening for undernutrition in all admitted patients so that proper management of this problem can be done concurrently with the primary clinical disease that led to admission

Networks among agricultural stakeholders in the southwestern highlands of Uganda

The aim of this study was to explore the interactions that exist among agricultural stakeholders in the southwestern highlands of Uganda as a way of identifying opportunities and gaps for operation of Innovation Platforms (IPs) under the proof of concept of Integrated Agricultural Research for Development (IAR4D) research project. The specific objectives were to (i) characterize the agricultural stakeholders in the study sites (ii) determine the nature, diversity and relative importance of horizontal and vertical networks that exist among stakeholders in the Southwestern Highlands of Uganda. Data were collected from both stakeholder analysis and household interviews in Kabale and Kisoro Districts. Results show that extension staff, local governments and farmer groups accounted for approximately 75% of all categories of stakeholders in the area. Most of these organizations started after 10 to 15 years ago following the return of relative political stability in Uganda. Generally, stakeholder interactions in site with limited ARD intervention are more limited compared to their high-intervention counterparts. Sites with “good” market access have more institutions operating there but majority are isolated from each other. At household level, an individual household has networks with approximately two different organizations most of which are farmer groups or credit associations. The greatest proportion of horizontal networks that a household has is with fellow farmers. In order to make the value chain complete, establishment of IPs should pay special attention to including the private sector such as input and produce dealers. Facilitating IP actors to identify critical challenges and opportunities, and effectively articulate them will ensure cohesion. It is also critical to periodically monitor and evaluate stakeholders in terms of the quality of the networks to minimize conflict situations

Epidemiology of Malaria in an Area Prepared for Clinical Trials in Korogwe, North-eastern Tanzania.

Site preparation is a pre-requesite in conducting malaria vaccines trials. This study was conducted in 12 villages to determine malariometric indices and associated risk factors, during long and short rainy seasons, in an area with varying malaria transmission intensities in Korogwe district, Tanzania. Four villages had passive case detection (PCD) of fever system using village health workers. Four malariometric cross-sectional surveys were conducted between November 2005 and May 2007 among individuals aged 0-19 years, living in lowland urban, lowland rural and highland strata. A total of 10,766 blood samples were collected for malaria parasite diagnosis and anaemia estimation. Blood smears were stained with Giemsa while haemoglobin level was measured by HaemoCue. Socio-economic data were collected between Jan-Apr 2006. Adjusting for the effect of age, the risk of Plasmodium falciparum parasitaemia was significantly lower in both lowland urban, (OR = 0.26; 95%CI: 0.23-0.29, p < 0.001) and highlands, (OR = 0.21; 95%CI: 0.17-0.25, p < 0.001) compared to lowland rural. Individuals aged 6-9 years in the lowland rural and 4-19 years in both lowland urban and highlands had the highest parasite prevalence, whilst children below five years in all strata had the highest parasite density. Prevalence of splenomegaly and gametocyte were also lower in both lowland urban and highlands than in lowland rural. Anaemia (Hb <11 g/dl) prevalence was lowest in the lowland urban. Availability of PCD and higher socio-economic status (SES) were associated with reduced malaria and anaemia prevalence. Higher SES and use of bed nets in the lowland urban could be the important factors for low malaria infections in this stratum. Results obtained here were used together with those from PCD and DSS in selecting a village for Phase 1b MSP3 vaccine trial, which was conducted in the study area in year 2008

Relationship Between Non-Hodgkin's Lymphoma and Blood Levels of Epstein-Barr Virus in Children in North-Western Tanzania: A Case Control Study.

Non-Hodgkin's Lymphomas (NHL) are common in African children, with endemic Burkitt's lymphoma (BL) being the most common subtype. While the role of Epstein-Barr Virus (EBV) in endemic BL is known, no data are available about clinical presentations of NHL subtypes and their relationship to Human Immunodeficiency Virus (HIV) infection and Epstein Barr Virus (EBV) load in peripheral blood of children in north-western, Tanzania. A matched case control study of NHL subtypes was performed in children under 15 years of age and their respective controls admitted to Bugando Medical Centre, Sengerema and Shirati district designated hospitals in north-western, Tanzania, between September 2010 and April 2011. Peripheral blood samples were collected on Whatman 903 filter papers and EBV DNA levels were estimated by multiplex real-time PCR. Clinical and laboratory data were collected using a structured data collection tool and analysed using chi-square, Fisher and Wilcoxon rank sum tests where appropriate. The association between NHL and detection of EBV in peripheral blood was assessed using conditional logistic regression model and presented as odds ratios (OR) and 95% confidence intervals (CI). A total of 35 NHL cases and 70 controls matched for age and sex were enrolled. Of NHLs, 32 had BL with equal distribution between jaw and abdominal tumour, 2 had large B cell lymphoma (DLBCL) and 1 had NHL-not otherwise specified (NHL-NOS). Central nervous system (CNS) presentation occurred only in 1 BL patient; 19 NHLs had stage I and II of disease. Only 1 NHL was found to be HIV-seropositive. Twenty-one of 35 (60%) NHL and 21 of 70 (30%) controls had detectable EBV in peripheral blood (OR = 4.77, 95% CI 1.71 - 13.33, p = 0.003). In addition, levels of EBV in blood were significantly higher in NHL cases than in controls (p = 0.024). BL is the most common childhood NHL subtype in north-western Tanzania. NHLs are not associated with HIV infection, but are strongly associated with EBV load in peripheral blood. The findings suggest that high levels of EBV in blood might have diagnostic and prognostic relevance in African children

ADOPTION OF SOIL CONSERVATION THROUGH COLLECTIVE ACTIONS IN SOUTHWESTERN UGANDA

In developing countries, access to and use of renewable natural resources are essential for rural livelihoods to thrive. Hence, cooperation in the management of natural resources is increasingly an important strategy that can enhance long-term socio-ecological resilience. In most cases, collective actions have widely been recognised as an alternative institutional arrangement to centralised governance for the management of natural resources, but their success largely depends on factors that are specific to localities where they are implemented. In this study, factors that influence adoption and extent of adoption of natural resource conservation activities were identified using two case studies: Bubaare and Bufundi Innovation Platforms in Uganda. The drivers of adoption of community natural resource management strategies are analysed using an Ordered Logit Model while extent of adoption is analysed using a truncated regression model. The education level of a household head, membership in collective action group, and perception of plot slope and relevance of bye-laws were factors associated with likelihood of adoption. Value of livestock, membership in collective action group, access to credit and off-farm income were found to positively influence the level of investment. Thus, collective action increases opportunities for adoption; hence farmers should be supported to work collectively.Dans les pays en voie de d\ue9veloppement, l\u2019acc\ue8s et l\u2019utilisation des ressources naturelles sont essentiels pour la suivie en mileu rural et pour y prosp\ue9rer. Ainsi, la coop\ue9ration dans la gestion des ressources naturelles est de plus en plus une strat\ue9gie importante qui peut am\ue9liorer \ue0 long terme la coh\ue9sion socio-\ue9cologique. Dans beaucoup de cas; les actions collectives ont \ue9t\ue9 largement reconnues comme une alternative d\u2019organisation institutionnelle pour centraliser la gouvernance de la gestion des ressources naturelles, mais leur succ\ue8s d\ue9pend largement des facteurs qui sont sp\ue9cifiques aux milieux o\uf9 elles sont mise en oeuvre. Dans cette \ue9tude, les facteus qui influencent l\u2019adoption et le degr\ue9 d\u2019adoption des activit\ue9s de conservation des ressources naturelles \ue9taient identifi\ue9s en utilisant deux cas d\u2019\ue9tude: Les Plate-formes d\u2019Innovation de Bubaare et Bufundi en Ouganda. Les forces motrices d\u2019adoption des strategies de gestion des ressources naturelles communautaires sont analys\ue9es en utilsant un mod\ue8le Logit Ordonn\ue9 tandis que le degr\ue9 d\u2019adoption est analys\ue9 en utilisant un mod\ue8le de r\ue9gression tronqu\ue9. Le niveau d\u2019\ue9ducation du chef de m\ue9nage, l\u2019appartenance au groupe d\u2019action collective, et la perception de la pente de la parcelle et limportance des arr\ueat\ue9s \ue9taient les facteurs associ\ue9s au taux d\u2019adoption. La value du b\ue9tail, l\u2019appartenance au groupe d\u2019action collective, l\u2019acc\ue8s au cr\ue9dit et le revenu non- agricole \ue9taient les facteurs qui influencent positivement le niveau d\u2019investissement. Donc, les actions collectives augmentent les opportunit\ue9s pour l\u2019adoption; ainsi les producteurs devraient \ueatre encourag\ue9s \ue0 travailler de fa\ue7con collective

Efficacy of artemether-lumefantrine in treatment of malaria among under-fives and prevalence of drug resistance markers in Igombe-Mwanza, north-western Tanzania

\ud \ud Drug resistance to anti-malarials is a major public health problem worldwide. This study aimed at establishing the efficacy of artemether-lumefantrine (ACT) in Igombe-Mwanza, north-western Tanzania after a few years of ACT use, and establish the prevalence of mutations in key targets for artemisinin, chloroquine and sulphadoxine/pyrimetamine (SP) drugs. A prospective single cohort study was conducted at Igombe health centre using artemether-lumefantrine combination therapy between February 2010 and March 2011. The follow-up period was 28 days and outcome measures were according to WHO guidelines. Blood was collected on Whatman filter paper for DNA analysis. DNA extraction was done using TRIS-EDTA method, and mutations in Pfcrt, Pfmdr1, Pfdhfr, Pfdhps and Pfatp6 were detected using PCR-RFLP methods established previously. A total of 103 patients completed the 28 days follow-up. The mean haemoglobin was 8.9 g/dl (range 5.0 to 14.5 g/dl) and mean parasite density was 5,608 parasites/μl. Average parasite clearance time was 34.7 hours and all patients cleared the parasites by day 3. There was no early treatment failure in this study. Late clinical failure was seen in three (2.9%) patients and late parasitological failure (LPF) was seen in two (1.9%). PCR-corrected LPF was 1% and adequate clinical and parasitological response was 96%. The majority of parasites have wild type alleles on pfcrt 76 and pfmdr1 86 positions being 87.8% and 93.7% respectively. Mutant parasites predominated at pfdhfr gene at the main three positions 108, 51 and 59 with prevalence of 94.8%, 75.3% and 82.5% respectively. Post-treatment parasites had more wild types of pfdhps at position 437 and 540 than pre-treatment parasites. No mutation was seen in pfatp6 769 in re-infecting or recrudescing parasites. The efficacy of artemether-lumefantrine for treatment of uncomplicated malaria is still high in the study area although the rate of re-infection is higher than previously reported. Parasite clearance after 48 hours was lower compared to previous studies. The prevalence of wild type allele pfcrt 76 K and pfmdr1 86 N was high in the study area while markers for SP resistance is still high. Artemether-lumefantrine may be selecting for wild type alleles on both positions (437 and 540) of pfdhps

Progress of Trachoma Mapping in Mainland Tanzania: Results of Baseline Surveys from 2012 to 2014.

PURPOSE: Following surveys in 2004-2006 in 50 high-risk districts of mainland Tanzania, trachoma was still suspected to be widespread elsewhere. We report on baseline surveys undertaken from 2012 to 2014. METHODS: A total of 31 districts were surveyed. In 2012 and 2013, 12 at-risk districts were selected based on proximity to known trachoma endemic districts, while in 2014, trachoma rapid assessments were undertaken, and 19 of 55 districts prioritized for baseline surveys. A multi-stage cluster random sampling methodology was applied whereby 20 villages (clusters) and 36 households per cluster were surveyed. Eligible participants, children aged 1-9 years and people aged 15 years and older, were examined for trachoma using the World Health Organization simplified grading system. RESULTS: A total of 23,171 households were surveyed and 104,959 participants (92.3% of those enumerated) examined for trachoma signs. A total of 44,511 children aged 1-9 years and 65,255 people aged 15 years and older were examined for trachomatous inflammation-follicular (TF) and trichiasis, respectively. Prevalence of TF varied by district, ranging from 0.0% (95% confidence interval, CI 0.0-0.1%) in Mbinga to 11.8% (95% CI 6.8-16.5%) in Chunya. Trichiasis prevalence was lowest in Urambo (0.03%, 95% CI 0.00-0.24%) and highest in Kibaha (1.08%, 95% CI 0.74-1.43%). CONCLUSION: Only three districts qualified for mass drug administration with azithromycin. Trichiasis is still a public health problem in many districts, thus community-based trichiasis surgery should be considered to prevent blindness due to trachoma. These findings will facilitate achievement of trachoma elimination objectives

Using rapid diagnostic tests as source of malaria parasite DNA for molecular analyses in the era of declining malaria prevalence

BACKGROUND: Malaria prevalence has recently declined markedly in many parts of Tanzania and other sub-Saharan African countries due to scaling-up of control interventions including more efficient treatment regimens (e.g. artemisinin-based combination therapy) and insecticide-treated bed nets. Although continued molecular surveillance of malaria parasites is important to early identify emerging anti-malarial drug resistance, it is becoming increasingly difficult to obtain parasite samples from ongoing studies, such as routine drug efficacy trials. To explore other sources of parasite DNA, this study was conducted to examine if sufficient DNA could be successfully extracted from malaria rapid diagnostic tests (RDTs), used and collected as part of routine case management services in health facilities, and thus forming the basis for molecular analyses, surveillance and quality control (QC) testing of RDTs. METHODS: One hyper-parasitaemic blood sample (131,260 asexual parasites/μl) was serially diluted in triplicates with whole blood and blotted on RDTs. DNA was extracted from the RDT dilution series, either immediately or after storage for one month at room temperature. The extracted DNA was amplified using a nested PCR method for Plasmodium species detection. Additionally, 165 archived RDTs obtained from ongoing malaria studies were analysed to determine the amplification success and test applicability of RDT for QC testing. RESULTS: DNA was successfully extracted and amplified from the three sets of RDT dilution series and the minimum detection limit of PCR was <1 asexual parasite/μl. DNA was also successfully amplified from (1) 70/71 (98.6%) archived positive RDTs (RDTs and microscopy positive) (2) 52/63 (82.5%) false negative RDTs (negative by RDTs but positive by microscopy) and (3) 4/24 (16.7%) false positive RDTs (positive by RDTs but negative by microscopy). Finally, 7(100%) negative RDTs (negative by RDTs and microscopy) were also negative by PCR. CONCLUSION: This study showed that DNA extracted from archived RDTs can be successfully amplified by PCR and used for detection of malaria parasites. Since Tanzania is planning to introduce RDTs in all health facilities (and possibly also at community level), availability of archived RDTs will provide an alternative source of DNA for genetic studies such as continued surveillance of parasite resistance to anti-malarial drugs. The DNA obtained from RDTs can also be used for QC testing by detecting malaria parasites using PCR in places without facilities for microscopy

Implementation research of a cluster randomized trial evaluating the implementation and effectiveness of intermittent preventive treatment for malaria using dihydroartemisinin-piperaquine on reducing malaria burden in school-aged children in Tanzania: methodology, challenges, and mitigation

BACKGROUND: It has been more than 20 years since the malaria epidemiologic shift to school-aged children was noted. In the meantime, school-aged children (5-15 years) have become increasingly more vulnerable with asymptomatic malaria prevalence reaching up to 70%, making them reservoirs for subsequent transmission of malaria in the endemic communities. Intermittent Preventive Treatment of malaria in schoolchildren (IPTsc) has proven to be an effective tool to shrink this reservoir. As of 3(rd) June 2022, the World Health Organization recommends IPTsc in moderate and high endemic areas. Even so, for decision-makers, the adoption of scientific research recommendations has been stifled by real-world implementation challenges. This study presents methodology, challenges faced, and mitigations used in the evaluation of the implementation of IPTsc using dihydroartemisinin-piperaquine (DP) in three councils (Handeni District Council (DC), Handeni Town Council (TC) and Kilindi DC) of Tanga Region, Tanzania so as to understand the operational feasibility and effectiveness of IPTsc on malaria parasitaemia and clinical malaria incidence. METHODS: The study deployed an effectiveness-implementation hybrid design to assess feasibility and effectiveness of IPTsc using DP, the interventional drug, against standard of care (control). Wards in the three study councils were the randomization unit (clusters). Each ward was randomized to implement IPTsc or not (control). In all wards in the IPTsc arm, DP was given to schoolchildren three times a year in four-month intervals. In each council, 24 randomly selected wards (12 per study arm, one school per ward) were chosen as representatives for intervention impact evaluation. Mixed design methods were used to assess the feasibility and acceptability of implementing IPTsc as part of a more comprehensive health package for schoolchildren. The study reimagined an existing school health programme for Neglected Tropical Diseases (NTD) control include IPTsc implementation. RESULTS: The study shows IPTsc can feasibly be implemented by integrating it into existing school health and education systems, paving the way for sustainable programme adoption in a cost-effective manner. CONCLUSIONS: Through this article other interested countries may realise a feasible plan for IPTsc implementation. Mitigation to any challenge can be customized based on local circumstances without jeopardising the gains expected from an IPTsc programme. Trial registration clinicaltrials.gov, NCT04245033. Registered 28 January 2020, https://clinicaltrials.gov/ct2/show/NCT04245033

Selecting sites to prove the concept of IAR4D in the Lake Kivu Pilot Learning Site

Selecting sites is an essential step in enabling the assessment of the impact of Integrated Agricultural Research for Development (IAR4D) in the Lake Kivu Pilot Learning Site. This paper reports on the process of identifying distinct administrative territories (sites) in which to establish innovation platforms and to monitor similar communities that are experiencing alternative agricultural research for development interventions. We show how the research design for the Sub- Saharan Africa Challenge Programme (SSACP) has been modified to take into account the key conditioning factors of the LKPLS without relinquishing robustness. A key change is the explicit incorporation of accessibility to multiple markets. Candidate sites were stratified according to the national political context, followed by good and poor accessibility to markets and finally according to security considerations and agro-ecology. Randomisation was carried out at all levels, although the need for paired counterfactual sites required the diagnosis of conditioning factors at the site level. Potential sites were characterised in terms of existing or recent agricultural research initiatives, as well as local factors that would have a direct effect on the success of interventions seeking to improve productivity, ameliorate the degradation of natural resources and enhance incomes through better links to markets. Fourteen sites were selected during the initial phase, and a further ten sites were added one year afterwards due to the need for more innovation platforms to test IAR4D. The site selection was successful in pairing action and counterfactual sites in terms of the baseline socioeconomic conditions of farming households. The unavoidable proximity of action and counterfactual sites, however, allows the possibility of spill-over effects and could reduce the measurable impact of IAR4D