Injury experience in Tanzania - Need for intervention

Objective: To determine distribution of injuries and factors associated with mortality in six hospitals of Tanzania mainland.Design: A Cross - Sectional hospital based study.Setting: Data were collected from casualty departments of Muhimbili Orthopaedic Institute, Morogoro, Mtwara, Kigoma, Musoma regional hospitals and Korogwe district hospital.Subjects: Patients who sustained injuries and attended in six involved hospitals between November 2011 and December 2012.Results: Of the 9316 injury patients seen, 71.7% were males. Majority (55%) were between 18 – 45 years age group. Traffic crashes were the leading cause of injuries and accounted for 47.5% of all injuries. Fractures accounted for 49.2%, and injuries were severe in 1.2% as determined by the Kampala trauma score II (KTS II). Majorities 66.7% were admitted and 2.4% died at the casualty. Factors associated with mortality were; being unemployed (P = 0.000), using ambulances to the hospital (P = 0.000), receiving medical attention within 2 to 10 hours after injury (P = 0.001), road traffic crashes (P = 0.000), 18 - 45 years age group (P = 0.003), low KTS II score (P = 0.000) and sustaining head injury (P = 0.000).Conclusion: Injuries in Tanzania are an important public health problem, predominantly in adult males, mostly due to traffic crashes. It is therefore important to reinforce preventive measures and pre-hospital emergency service is urgently needed

Impact of changing diagnostic criteria for smear-positive tuberculosis: a cohort study in Malawi.

We assessed the impact on measured burden and outcomes of the revised World Health Organization and Malawi guidelines reclassifying people with single (including 'scanty') positive smears as smear-positive pulmonary tuberculosis cases. In a retrospective cohort in rural Malawi, 567 (34%) of 1670 smear-positive episodes were based on single positive smears (including 176 with scanty smears). Mortality rates and the proportion starting treatment were similar in those with two positive smears or single, non-scanty smears. Those with single scanty smears had higher mortality and a lower proportion starting treatment. The reclassification will increase the reported burden substantially, but should improve treatment access

Endoscopic third ventriculostomy and choroid plexus cauterization in childhood hydrocephalus in Zambia

Background: Endoscopic third ventriculostomy (ETV) and Choroid Plexus Cauterization (CPC) have been recommended as reliable surgical options in developing countries for childhood hydrocephalus owing to reported shunt failures in shunt dependency.Objective: To evaluate outcomes of the ETV and ETV-CPC procedures as surgical options for selected forms of hydrocephalus in Zambia.Methods: Between 2007 and 2010, 131 children with hydrocephalus underwent the ETV or ETVCPC procedures at Beit Cure Hospital (BCH) and were eligible for the analysis. Failed ETV was defined as cases that needed subsequent surgical procedures within 6 months of operation.Results: A total number of 110 (84%) children underwent ETV-CPC and 21 (16%) had ETV alone. The overall success rate was 74%, whereas ETV-CPC was 76% and ETV alone was 62% (p < 0.0001). ETV success rate was more likely with children aged one year and above (p < 0.06) and with non-post infectious hydrocephalus (p < 0.29). Age and etiology were not significantly associated with the outcomes.Conclusions: Endoscopic third ventriculostomy is a safe, reliable and effective option for selected forms of hydrocephalus in Zambia. The combination of ETV and CPC was more effective than ETV alone. It is highly recommended that such services be extended to other referral hospitals as options to shunt placement, especially in cases where access for treatment failure is likely to be delayed.Keywords: Hydrocephalus, endoscopic third ventriculostomy, choroid plexus cauterization, Outcomes, Physiotherapy, Zambi

What happens to ART-eligible patients who do not start ART? Drop out between screening and ART initiation: a cohort study in Karonga, Malawi

BACKGROUND: Routine ART programme statistics generally only provide information about individuals who start treatment. We aimed to investigate the outcome of those who are eligible but do not start ART in the Malawi programme, factors associated with this dropout, and reasons for not starting treatment, in a prospective cohort study.METHODS: Individuals having a first screening visit at the ART clinic at Karonga District Hospital, northern Malawi, between September 2005 and July 2006 were interviewed. Study follow-up to identify treatment outcomes was conducted at the clinic and in the community. Logistic regression models were used to identify factors associated with dropout before ART initiation among participants identified as clinically eligible for ART.RESULTS: 88 participants eligible for ART at their first screening visit (out of 633, 13.9%) defaulted before starting ART. Participants with less education, difficulties in dressing, a more delayed ART initiation appointment, and mid-upper arm circumference (MUAC) < 22 cm were significantly less likely to have visited the clinic subsequently. Thirty-five (58%) of the 60 participants who defaulted and were tracked at home had died, 21 before their ART initiation appointment.CONCLUSIONS: MUAC and reported difficulties in dressing may provide useful screening indicators to identify sicker ART-eligible individuals at high risk of dropping out of the programme who might benefit from being brought back quickly or admitted to hospital for observation. Individuals with less education may need adapted health information at screening. Deaths of ART-eligible individuals occurring prior to ART initiation are not included in routine programme statistics. Considering all those who are eligible for ART as a denominator for programme indicators would help to highlight this vulnerable group, in order to identify new opportunities for further improving ART programmes

Characterization of pit latrines to support the design and selection of emptying tools in peri-urban Mzuzu, Malawi

The urban areas of many low-income countries must balance a rising demand for pit latrines for household sanitation provision against limitations in space, resulting in a need for pit latrine emptying services. This study was undertaken in the peri-urban neighborhood of Area 1B in the city of Mzuzu, Malawi, to examine the characteristics of household pit latrines for designing and selecting pit latrine emptying tools. We used 150 structured household surveys and field observations. From this, a subset was selected and 30 manual cone penetrometer tests were conducted at full latrines. Chemical oxygen demand analysis was also performed for 14 pit latrines. The results indicated that in addition to serving as a disposal for fecal matter, 90% of households also used pit latrines for domestic waste. Only 10% of the studied pit latrines were lined. The filling rate in the study area is calculated to be about three years, and no respondents reported previous emptying. It is suggested pit latrine emptying technology development focuses on a maximum tool diameter of 10 cm to fit through the keyhole (squat hole) and height of 146 cm to fit inside the superstructure, as well as supporting unlined pits and the ability to pump trash

How to Reduce Aflatoxin Contamination in Groundnuts and Maize A Guide for Extension Workers

Many agricultural commodities are susceptible to several diseases caused by fungi, viruses and insect pests. These diseases may also contaminate the crops with deadly toxins. Fungi are of particular concern. Many fungi are free-living organisms capable of surviving in the environment (soil, air and water) and can easily find their way into crop products especially when the weather conditions are suitable. Many of these fungi are free-living organisms and can survive in the environment even without the crops we grow. The toxins produced by fungi are called mycotoxins (Myco=fungus; toxin=poison)..

Genotype-by-environment interactions for grain yield of Valencia groundnut genotypes in East and Southern Africa

Grain yield is a quantitatively inherited trait in groundnut (Arachis hypogea L.) and subject to genotype by environment interactions. Groundnut varieties show wide variation in grain yield across different agro-ecologies. The objectives of this study were to evaluate Valencia groundnut genotypes for yield stability and classify environments to devise appropriate breeding strategies. Seventeen multi-location trials were conducted in six countries, viz., Malawi, Tanzania, Uganda, Zimbabwe, Mozambique and Zambia, from 2013 to 2016. The experiments were laid out following a resolvable incomplete block design, with two replications at each location (hereafter referred to as ‘environments’) using 14 test lines and two standard checks. The additive main effects and multiplicative interaction (AMMI) analysis was conducted. Variation attributable to environments, genotypes and genotype × environment interaction for grain yield was highly significant (P<0.001). Genotype, environment and genotype × environment interactions accounted for 7%, 53 % and 40% of the total sum of squares respectively. Superior-performing genotypes possessing high to moderate adaptability and stability levels included ICGV-SM 0154, ICGV-SM 07539, ICGV-SM 07536, ICGV-SM 7501, ICGV-SM 99568 and ICGV SM 07520. Nachingwea 2013 in Tanzania, Nakabango 2014 in Uganda and Chitedze 2015 in Malawi were the most representative and discriminative environments. Considering the implications of interactions for Valencia groundnut breeding in East and Southern Africa we propose that different varieties should be targeted for production in different environments and at the same time used for breeding in specific environments

Agronomic biofortification increases grain zinc concentration of maize grown under contrasting soil types in Malawi

Zinc (Zn) deficiency remains a public health problem in Malawi, especially among poor and marginalized rural populations, linked with low dietary intake of Zn due to consumption of staple foods that are low in Zn content. The concentration of Zn in staple cereal grain can be increased through application of Zn-enriched fertilizers, a process called agronomic biofortification or agro-fortification. Field experiments were conducted at three Agricultural Research Station sites to assess the potential of agronomic biofortification to improve Zn concentration in maize grain in Malawi as described in registered report published previously. The hypotheses of the study were (i) that application of Zn-enriched fertilizers would increase in the concentration of Zn in maize grain to benefit dietary requirements of Zn and (ii) that Zn concentration in maize grain and the effectiveness of agronomic biofortification would be different between soil types. At each site two different subsites were used, each corresponding to one of two agriculturally important soil types of Malawi, Lixisols and Vertisols. Within each subsite, three Zn fertilizer rates (1, 30, and 90 kg ha−1) were applied to experimental plots, using standard soil application methods, in a randomized complete block design. The experiment had 10 replicates at each of the three sites as informed by a power analysis from a pilot study, published in the registered report for this experiment, designed to detect a 10% increase in grain Zn concentration at 90 kg ha−1, relative to the concentration at 1 kg ha−1. At harvest, maize grain yield and Zn concentration in grain were measured, and Zn uptake by maize grain and Zn harvest index were calculated. At 30 kg ha−1, Zn fertilizer increased maize grain yields by 11% compared with nationally recommended application rate of 1 kg ha−1. Grain Zn concentration increased by 15% and uptake by 23% at the application rate of 30 kg ha−1 relative to the national recommendation rate. The effects of Zn fertilizer application rate on the response variables were not dependent on soil type. The current study demonstrates the importance of increasing the national recommendation rate of Zn fertilizer to improve maize yield and increase the Zn nutritional value of the staple crop

Assessment of genetic variability among groundnut accessions under natural rosette disease infestation in Malawi

Groundnut production in East and South African region is low due to several constraints. Success in development of resilient varieties rides on genetic diversity in available germplasm for key traits in question. This study was undertaken to dissect the magnitude of variability among groundnut accessions. The experimental design was an alpha lattice design replicated thrice. Significant differences in yield traits were observed among the accessions. There was high phenotypic (PCV) and genotypic (GCV) coefficient of variation in most of the traits except for the number of primary branches and shelling percentage. A combination of high heritability and genetic advance was recorded for the number of secondary branches, height, seed yield and rosette incidence. This indicates that it is possible to carry out phenotypic selection based on the mean for successful improvement of yield and resistance to rosette disease