The population biology and epidemiology of schistosome and geohelminth infections among schoolchildren in Tanzania

A study of helminth infections was undertaken among 3244 schoolchildren from 28 schools in Morogoro Rural District, Tanzania. Schistosoma haematobium was the most common infection, followed by hookworms, Ascaris lumbricoides, S. mansoni, and Trichuris trichiura. Infection prevalence of each species varied among schools and age groups, but not between sexes. There was no relationship between the prevalences of different infections among schools, except for a strong negative correlation between the prevalence of hookworm and S. mansoni infections. Within each age group, there was little excess overlap in the distribution of each infection; thus the number of multiple infections was low whereas the number of individuals harbouring at least one infection was relatively high. More children than expected carried infections of A. lumbricoides and S. mansoni, and the clustering effect increased with age. Only 2 schools had high overall infection prevalences of both geohelminths and schistosomes. Logistic regression analysis of morbidity and parasitological data indicated that individuals with multiple species infections were not at increased risk of morbidity (on a multiplicative scale) compared to individuals with single species infections. This was attributed in part to the low egg counts observed for each parasite species. The results implied little interaction between schistosome and geohelminth infections in the region, both in parasitological terms and in the context of their combined effects on health. Implications for the feasibility and benefits of combined control of geohelminths and schistosomes are discusse

Prevalence of trachoma in six districts of Kenya

Objectives: To estimate the prevalence of active trachoma (TF) in children aged one to nine years and potentially blinding trachoma (TT) in adults aged 15 years and older in six known trachomaendemic districts in Kenya. Design: Community based survey. Setting: Six known trachoma endemic districts in Kenya (Samburu, Narok, West Pokot, Kajiado Baringo and Meru North).Subjects: A total of 6,982 children aged one to nine years and 8,045 adults aged 15 years and older were randomly selected in a two stage random cluster sampling method: Twenty sub-locations (clusters) per district and three villages per sub-location were randomly selected. Eligible children and adults were enumerated and examined for signs of trachoma. Results: Blinding trachoma was found to be a public health problem in all the surveyed districts. Active trachoma was a district wide public health problem in four districts (Samburu, Narok, West Pokot and Kajiado) and only in some of the sub-locations of the other two (Baringo and Meru North).Conclusions: There is need for district trachoma control programmes preferably using the WHO recommended SAFE strategy in all the surveyed districts. Extrapolation of these survey results to the entire country could not be justified. There is need to survey the remaining 12 suspected endemic districts in Kenya.East African Medical Journal Vol. 83(4) 2006: 63-6

The use of morbidity questionnaires to identify communities with high prevalences of schistosome or geohelminth infections in Tanzania

Parasitic infections were investigated in Morogoro Rural District, Tanzania, between October 1992 and June 1993. A total of 4589 schoolchildren (aged 7-17 years) from 30 primary schools was screened for infection with Ascaris lumbricoides, Trichuris trichiura, hookworms (3456 children only), Schistosoma mansoni and S. haematobium. The children were also asked about their recent experiences of the following: diarrhoea, abdominal pain, blood in stool, perception of suffering from schistosomiasis, and worm infection and examined for spleen and liver enlargement. Among schools, there were correlations between the prevalence of S. mansoni infection and bloody stools, spleen enlargement and liver enlargement, and between S. haematobium infection and the presence of blood in urine. To exclude ecological explanations for the correlations, logistic regression was used to estimate the adjusted odds ratio (OR) for each infection and each sign or symptom. No sign or symptom was significantly associated with any geohelminth infection. Reported blood in stool was significantly associated with S. mansoni infection (OR = 1·62, P = 0·045). Reported blood in urine was significantly associated with S. haematobium infection (OR = 7·71, P < 0·001), as was reported blood in stool (OR = 11·52, P < 0·001), indicating that presence of blood in either form of excreta was related to the local term for schistosomiasis. These results support the possibility of using reported blood in stool as a means of rapid assessment for identifying communities with a high prevalence of S. mansoni infectio

Validation of the Kiswahili version of the SF-36 Health Survey in a representative sample of an urban population in Tanzania

The objective of this study was to assess the validity of a Kiswahili translation of the SF-36 Health Survey (SF-36) among an urban population in Tanzania, using the method of known-groups validation. People were randomly selected from a demographic surveillance system in Dar es Salaam. The representative sample consisted of 3,802 adults (15 years and older). Health status differences were hypothesized among groups, who differed in sex, age, socio-economic status and self-reported morbidity. Mean SF-36 scale scores were calculated and compared using t-test and ANOVA. Women had significantly lower mean SF-36 scale scores (indicating worse health status) than men on all scales and scores were lower for older people than younger on all domains, as hypothesized. On five of the eight SF-36 scales, means were higher for people of higher socio-economic status compared to those of lower socio-economic status. People who reported an illness within the previous 2 weeks scored significantly lower on all scales compared to those who were healthy, as did people who said they had a disability or a chronic conditio

Availability of HIV/AIDS community intervention programmes and quality of services in and around selected mining sites in Tanzania

Background: Mining is one of the major sectors of the country’s economy as it employs and attracts a large number of people from different areas. As a result, mining sites are at great risk of HIV transmission. While a few unsynchronized mine-specific population-based studies provide evidence of a growing HIV problem in this sector, virtually few evidence exists on availability and quality of interventions targeting HIV and AIDS in this population. The study was conducted to assess the availability and quality of HIV/AIDS intervention programmes in and around mining sites in Tanzania.Methods: This cross sectional study was conducted from November 2012 to April 2013. Both quantitative and qualitative methods were used to collect data. Study areas involved both mining sites and its surrounding communities in Kahama, Nzega and Geita Districts. It involved household members from villages in and around the mining sites, mining community relations officers, community health facility workers, district HIV/AIDS focal persons and village leaders.Results: A total of 463 individuals were recruited into the study for household interviews. In-depth interviews with Key Informants involved 15 respondents. HIV/AIDS intervention programmes in the study area were available despite that knowledge of their existence was limited to a segment of the community.  Their availability was only known to about 25% of the study respondents in Geita and Kahama study sites.  The programmes carried out intervention activities which included HIV/AIDS education campaigns, promoting uptake of voluntary counselling and testing services, promoting and supporting condom use, safer sex, and male circumcision. HIV/AIDS services such as screening, distribution of condoms and ARVs for infected people were available and were offered free of charge. Conclusion: Our findings show that HIV/AIDS intervention programmes were available despite that they were unequally distributed. Although their availability has contributed to the decrease of HIV prevalence in the community, knowledge of their availability was limited to some people in the community

Integrating reproductive and child health and HIV services in Tanzania: Implication to policy, systems and services

In Tanzania, reproductive health and HIV services are coordinated by the Ministry of Health and Social Welfare in two separate units namely Reproductive and Child Health Section and the National AIDS Control Programme. The importance of integrating the two services that are vertically run is expected to improve access to and uptake of key essential services and extend coverage to underserved and vulnerable populations and thus minimizing missed opportunities. Experts around the world recognize the central role of Sexual and Reproductive Health (SRH) services in preventing HIV infection. Evidence suggests that improving access to contraception for women to prevent pregnancy is an important and cost-effective way to prevent HIV-positive births. Integrating SRH and HIV services therefore verifies its importance for improving maternal and child health as well as leading to prevention of HIV infection.  The primary objective of this review was to gain an understanding of the current linkages between SRH and HIV within Tanzania’s policies, programmes, systems and services. Policy documents, guidelines, national laws, and published reports on SRH and HIV were reviewed.  The majority of the reviewed documents mentioned fundamentals of integration between SRH and HIV. Majority of policies and guidelines both in family planning (FP) and HIV documents mandate bi-directional linkages. This review suggests that there are linkages between the two services and can be operationalised together. However, policies and guidelines only specify services to be integrated without due consideration of resources and structural orientation for linked services

Experiences, Opportunities and Challenges of Implementing Task Shifting in Underserved Remote Settings: The Case of Kongwa District, Central Tanzania.

Tanzania is experiencing acute shortages of Health Workers (HWs), a situation which has forced health managers, especially in the underserved districts, to hastily cope with health workers' shortages by adopting task shifting. This has however been due to limited options for dealing with the crisis of health personnel. There are on-going discussions in the country on whether to scale up task shifting as one of the strategies for addressing health personnel crisis. However, these discussions are not backed up by rigorous scientific evidence. The aim of this paper is two-fold. Firstly, to describe the current situation of implementing task shifting in the context of acute shortages of health workers and, secondly, to provide a descriptive account of the potential opportunities or benefits and the likely challenges which might ensue as a result of implementing task shifting. We employed in-depth interviews with informants at the district level and supplemented the information with additional interviews with informants at the national level. Interviews focussed on the informants' practical experiences of implementing task shifting in their respective health facilities (district level) and their opinions regarding opportunities and challenges which might be associated with implementation of task shifting practices. At the national level, the main focus was on policy issues related to management of health personnel in the context of implementation of task shifting, in addition to seeking their opinions and perceptions regarding opportunities and challenges of implementing task shifting if formally adopted. Task shifting has been in practice for many years in Tanzania and has been perceived as an inevitable coping mechanism due to limited options for addressing health personnel shortages in the country. Majority of informants had the concern that quality of services is likely to be affected if appropriate policy infrastructures are not in place before formalising tasks shifting. There was also a perception that implementation of task shifting has ensured access to services especially in underserved remote areas. Professional discontent and challenges related to the management of health personnel policies were also perceived as important issues to consider when implementing task shifting practices. Additional resources for additional training and supervisory tasks were also considered important in the implementation of task shifting in order to make it deliver much the same way as it is for conventional modalities of delivering care. Task shifting implementation occurs as an ad hoc coping mechanism to the existing shortages of health workers in many undeserved areas of the country, not just in the study site whose findings are reported in this paper. It is recommended that the most important thing to do now is not to determine whether task shifting is possible or effective but to define the limits of task shifting so as to reach a consensus on where it can have the strongest and most sustainable impact in the delivery of quality health services. Any action towards this end needs to be evidence-based

Optimal fertilizer warehousing and distribution systems for farm supply cooperatives

Paper Presented at NCR-194 Research on Cooperatives Annual Meeting November 2-3, 2004 Kansas City, MissouriFertilizer sales and appli cation services are important business areas for farm supply cooperatives. These firms account for roughly one-third of the $800M, which U.S. producers paid for fertilizer, lime and soil amendments in 2003 (USDA, 2004). Many cooperatives are re-examining the struct ure and organization of their fertilizer operations. A number of for ces are impacting the retail fert ilizer industry. Differential production costs have shifted the production of nitrogen-based fertilizer away from domestic manufacturers to off shore suppliers. The portion of nitrog en fertilizer imported into the U.S. grew from 21% in 1999 to 42% in 2002 (U.S. Geological Survey). The production shift has impacted the form of nitrogen fertilizers. Historically, anhydrous ammonia has been the least cost form of nitrogen fertilizer. Because the infrastructure to off-load anhydrous amm onia and transport it to demand regions is limited, the shift toward off-shore supply source s has led to a shift to urea and other dry forms of nitrogen fertilizer (Agriliance). Changing farm demographics have also contributed to the shift to dr y fertilizer forms. Large-sc ale producers typically find it more economical for the input supplier to ap ply fertilizer using la rge-scale machinery. Most agribusinesses offering custom fertilizer application concentrat e on dry and liquid (UAN) forms of nitrogen fertilizers. Secu rity concerns associ ated with theft of anhydrous ammonia for use in the illegal drug manufacturing has also contributed to the shift to dry formulations. 3 Another factor impacting the structure of cooperative fertil izer operations has been the consolidation among local coopera tives. A USDA study identified 367 mergers and consolidations among grain coop eratives during the 1993 to1997 time period (USDA, 1998). As local cooperatives cons olidate and expand their geographic trade territories they often attempt to consolidate their existing systems of multiple warehouses. Determining the feasibility of a centralized warehouse system is complex. Centralization generally reduces warehousing costs since cons truction and operating costs decrease with size. However centralization increases the warehouse-to-field transportation costs. Shifts in fertilizer product forms further increases the complexity of analyzing warehousing centralization as per-unit warehousing and tran sportation costs differ dramatically across anhydrous, dry and liquid formulations. This study pursues two objectives re lated to fertilizer warehousing and application: (1) Identify th e major cost components of a typical fertilizer warehousing and distribution system and product margins and fees needed to cover costs; (2) Determine the optimal level of warehouse centralization and equipment complement

Optimal fertilizer warehousing and distribution systems for farm supply cooperatives

Paper Presented at NCR-194 Research on Cooperatives Annual Meeting November 2-3, 2004 Kansas City, MissouriFertilizer sales and appli cation services are important business areas for farm supply cooperatives. These firms account for roughly one-third of the $800M, which U.S. producers paid for fertilizer, lime and soil amendments in 2003 (USDA, 2004). Many cooperatives are re-examining the struct ure and organization of their fertilizer operations. A number of for ces are impacting the retail fert ilizer industry. Differential production costs have shifted the production of nitrogen-based fertilizer away from domestic manufacturers to off shore suppliers. The portion of nitrog en fertilizer imported into the U.S. grew from 21% in 1999 to 42% in 2002 (U.S. Geological Survey). The production shift has impacted the form of nitrogen fertilizers. Historically, anhydrous ammonia has been the least cost form of nitrogen fertilizer. Because the infrastructure to off-load anhydrous amm onia and transport it to demand regions is limited, the shift toward off-shore supply source s has led to a shift to urea and other dry forms of nitrogen fertilizer (Agriliance). Changing farm demographics have also contributed to the shift to dr y fertilizer forms. Large-sc ale producers typically find it more economical for the input supplier to ap ply fertilizer using la rge-scale machinery. Most agribusinesses offering custom fertilizer application concentrat e on dry and liquid (UAN) forms of nitrogen fertilizers. Secu rity concerns associ ated with theft of anhydrous ammonia for use in the illegal drug manufacturing has also contributed to the shift to dry formulations. 3 Another factor impacting the structure of cooperative fertil izer operations has been the consolidation among local coopera tives. A USDA study identified 367 mergers and consolidations among grain coop eratives during the 1993 to1997 time period (USDA, 1998). As local cooperatives cons olidate and expand their geographic trade territories they often attempt to consolidate their existing systems of multiple warehouses. Determining the feasibility of a centralized warehouse system is complex. Centralization generally reduces warehousing costs since cons truction and operating costs decrease with size. However centralization increases the warehouse-to-field transportation costs. Shifts in fertilizer product forms further increases the complexity of analyzing warehousing centralization as per-unit warehousing and tran sportation costs differ dramatically across anhydrous, dry and liquid formulations. This study pursues two objectives re lated to fertilizer warehousing and application: (1) Identify th e major cost components of a typical fertilizer warehousing and distribution system and product margins and fees needed to cover costs; (2) Determine the optimal level of warehouse centralization and equipment complement