Quantifying the burden of rhodesiense sleeping sickness in Urambo district, Tanzania

Sleeping sickness (human African trypanosomiasis - HAT) is a disease transmitted by tsetse flies and is always fatal if left untreated. The disease occurs in foci affecting poor communities with limited access to health service provision and as such the disease is often left undiagnosed, mistaken for more common afflictions. Even if diagnosed, sleeping sickness is costly to treat, both for health services and patients and their families in terms of costs of diagnosis, transport, hospital care, and the prolonged period of convalescence. Here we estimate the health burden of the acute form T. b. rhodesiense sleeping sickness in Urambo District, Tanzania in terms of Disability Adjusted Life Years (DALYs), the yardstick commonly used by policy makers to prioritize disease management practices, representing a year of healthy life lost to disease. In this single district, the burden of the disease over one year was estimated at 979 DALYs and the estimated monetary costs to health services for the 143 treated patients at US$11,841 and to the patients themselves at US$ 3,673 for direct medical costs and US$ 9,781 for indirect non-medical costs. Sleeping sickness thus places a considerable burden on the affected rural communities and health services

Estimating the economic and social consequences for patients diagnosed with human African trypanosomiasis in Muchinga, Lusaka and Eastern Provinces of Zambia (2004-2014)

Abstract Background Acute human African trypanosomiasis (rHAT) caused by Trypanosoma brucei rhodesiense is associated with high mortality and is fatal if left untreated. Only a few studies have examined the psychological, social and economic impacts of rHAT. In this study, mixed qualitative and quantitative research methods were used to evaluate the socio-economic impacts of rHAT in Mambwe, Rufunsa, Mpika and Chama Districts of Zambia. Methods Individuals diagnosed with rHAT from 2004 to 2014 were traced using hospital records and discussions with communities. Either they, or their families, were interviewed using a structured questionnaire and focus group discussions were conducted with affected communities. The burden of the disease was investigated using disability adjusted life years (DALYs), with and without discounting and age-weighting. The impact of long-term disabilities on the rHAT burden was also investigated. Results Sixty four cases were identified in the study. The majority were identified in second stage, and the mortality rate was high (12.5%). The total number of DALYs was 285 without discounting or age-weighting. When long-term disabilities were included this estimate increased by 50% to 462. The proportion of years lived with disability (YLD) increased from 6.4% to 37% of the undiscounted and un-age-weighted DALY total. When a more active surveillance method was applied in 2013–2014 the cases identified increased dramatically, suggesting a high level of under-reporting. Similarly, the proportion of females increased substantially, indicating that passive surveillance may be especially failing this group. An average of 4.9 months of productive time was lost per patient as a consequence of infection. The health consequences included pain, amnesia and physical disability. The social consequences included stigma, dropping out of education, loss of friends and self-esteem. Results obtained from focus group discussions revealed misconceptions among community members which could be attributed to lack of knowledge about rHAT. Conclusions The social and economic impact of rHAT on rural households and communities is substantial. Improved surveillance and strengthening of local medical services are needed for early and accurate diagnosis. Disease prevention should be prioritised in communities at risk of rHAT, and interventions put in place to prevent zoonotic disease spill over from domestic animals and wildlife. Supportive measures to mitigate the long-term effects of disability due to rHAT are needed

Assessing the effect of insecticide-treated cattle on tsetse abundance and trypanosome transmission at the wildlife-livestock interface in Serengeti, Tanzania

In the absence of national control programmes against Rhodesian human African trypanosomiasis, farmer-led treatment of cattle with pyrethroid-based insecticides may be an effective strategy for foci at the edges of wildlife areas, but there is limited evidence to support this. We combined data on insecticide use by farmers, tsetse abundance and trypanosome prevalence, with mathematical models, to quantify the likely impact of insecticide-treated cattle. Sixteen percent of farmers reported treating cattle with a pyrethroid, and chemical analysis indicated 18% of individual cattle had been treated, in the previous week. Treatment of cattle was estimated to increase daily mortality of tsetse by 5–14%. Trypanosome prevalence in tsetse, predominantly from wildlife areas, was 1.25% for T. brucei s.l. and 0.03% for T. b. rhodesiense. For 750 cattle sampled from 48 herds, 2.3% were PCR positive for T. brucei s.l. and none for T. b. rhodesiense. Using mathematical models, we estimated there was 8–29% increase in mortality of tsetse in farming areas and this increase can explain the relatively low prevalence of T. brucei s.l. in cattle. Farmer-led treatment of cattle with pyrethroids is likely, in part, to be limiting the spill-over of human-infective trypanosomes from wildlife areas

Results of CSEE 2022

Results of Certificate of Secondary Education Examination (CSEE) of year 2022 for public schoolsSNSchools Name SexDiv IDiv IIDiv IIIDiv IVDiv 0BioChemPhyMathPhy & MathPCM/TotalTotalPassAllPassAllPassPassAll PassPCBF & M1ForestF03101003048141014011410143263M28145244542415243624251202HayomboF0544510349994754464121M188192128131313871367573IdudaF0394512477772672169103M0381762877738732344IganzoF52017864753130181529181412132245M14171654126835343026333026261135IhangaF0101054163521192100210090166M04940232711811331131766IlombaF4222514145865449546165468237407M1092791338549474918264913161707IsyesyeF11519597701914818811101190M417183911632314128191288898IteziF2262

Safety and efficacy of the 10-day melarsoprol schedule for the treatment of second stage rhodesiense sleeping sickness

OBJECTIVE: Assessment of the safety and efficacy of a 10-day melarsoprol schedule in second stage T.b. rhodesiense patients and the effect of suramin-pretreatment on the incidence of encephalopathic syndrome (ES) during melarsoprol therapy. DESIGN: Sequential conduct of a proof-of-concept trial (n = 60) and a utilization study (n = 78) using historic controls as comparator. SETTING: Two trial centres in the T.b. rhodesiense endemic regions of Tanzania and Uganda. PARTICIPANTS: Consenting patients with confirmed second stage disease and a minimum age of 6 years were eligible for participation. Unconscious and pregnant patients were excluded. MAIN OUTCOME MEASURES: The primary outcome measures were safety and efficacy at end of treatment. The secondary outcome measure was efficacy during follow-up after 3, 6 and 12 months. RESULTS: The incidence of ES in the trial population was 11.2% (CI 5-17%) and 13% (CI 9-17%) in the historic data. The respective case fatality rates were 8.4% (CI 3-13.8%) and 9.3% (CI 6-12.6%). All patients discharged alive were free of parasites at end of treatment. Twelve months after discharge, 96% of patients were clinically cured. The mean hospitalization time was reduced from 29 to 13 days (p>0.0001) per patient. CONCLUSIONS: The 10-day melarsoprol schedule does not expose patients to a higher risk of ES or death than does treatment according to national schedules in current use. The efficacy of the 10-day melarsoprol schedule was highly satisfactory. No benefit could be attributed to the suramin pre-treatment. TRIAL REGISTRATION: Current Controlled Trials ISRCTN4053788

Nitrate pollution of Neogene alluvium aquifer in Morogoro municipality, Tanzania

Concern over nitrate pollution of groundwater in integrated water quality management has been growing recently. The levels of nitrate in wells from septic tanks and urban agriculture with nitrogen fertilizers application may increase the potential groundwater pollution by nitrate. The purpose of this study was to determine the concentrations and spatial distribution of nitrate (NO3 -) in groundwater in Morogoro municipality. Groundwater samples were collected from 20 wells during wet season period in March-April 2010 in 6 wards namely Kihonda, Mji Mpya, Mafisa, Saba Saba, Boma and Kilakala. The spectrophotometer was used to measure the NO3 - concentration in water samples. The minimum and maximum nitrate levels were 1.4 and 32.5 mg/L respectively in the wards studied with an average of 7.76 mg/L. These results showed that all of the groundwater samples have NO3 - concentration below the Tanzania Bureau of Standards upper limit value and World Health Organization guideline of 75 mg/l and 50 mg/l respectively. Also, the level of nitrate concentration tends to decrease with depth for most of the places due to the anoxic condition that is available at the higher depth which facilitates the utilization of nitrate by anaerobic microorganisms

Comparative detection of trypanosomal DNA by loop mediated isotherma amplification and PCR from FTA cards spotted with patient blood

We analyzed DNA eluted from FTA (Flinders Technology Associates) cards spotted with blood from Human African Trypanosomiasis (HAT) patients admitted at Lwala Hospital, Eastern Uganda, and Kaliua Health Centre in northwestern Tanzania. The aim was to evaluate Loop mediated isothermal Amplification (LAMP) for detection of trypanosomal DNA in clinical samples, and to characterize the infecting trypanosomes to sub-species level. LAMP targeting the Trypanozoon conserved Random Inserted Mobile Element (RIME) and that for the SRA were performed. For comparison, PCR for the Serum Resistance Associated (SRA) gene specific for T. b. rhodesiense and that to amplify the T. b. gambiense specific surface glycoprotein (TgSGP) were done. Out of 128 samples analyzed, SRA-PCR was positive in 101 (78.9% sensitivity; 95% Confidence Interval, CI of 71.1-85.1%), the SRA-LAMP positive in 120 (93.8%, 95% CI= 88.2-96.8%), while RIME-LAMP revealed signals in 122 (95.3%; 95% CI=90.2-97.8%). RIME- and SRA-LAMP were each significantly more sensitive than SRA-PCR (P=0.000 and P=0.001 respectively, Fisher's exact test). There was poor agreement with SRA-PCR, yielding Kappa values of 0.31 and 0.40 respectively. Agreement between SRA-LAMP and RIME-LAMP was almost perfect (Kappa= 0.85; 95% CI=0.64-1). All the 128 field samples were negative for the TgSGP-PCR. Blood spots from 3 T. b. gambiense HAT cases from NW Uganda were positive by TgSGP-PCR and RIME-LAMP. PCR took 5 times longer to execute than LAMP. LAMP may be useful to monitor for emerging HAT foci, or test travellers returning from endemic countries. It should be evaluated in a case-control study to determine its utility as a HAT diagnosti