Ecological and epidemiological findings associated with zoonotic rabies outbreaks and control in Moshi, Tanzania, 2017–2018

Approximately 1500 people die annually due to rabies in the United Republic of Tanzania. Moshi, in the Kilimanjaro Region, reported sporadic cases of human rabies between 2017 and 2018. In response and following a One Health approach, we implemented surveillance, monitoring, as well as a mass vaccinations of domestic pets concurrently in >150 villages, achieving a 74.5% vaccination coverage (n = 29, 885 dogs and cats) by September 2018. As of April 2019, no single human or animal case has been recorded. We have observed a disparity between awareness and knowledge levels of community members on rabies epidemiology. Self-adherence to protective rabies vaccination in animals was poor due to the challenges of costs and distances to vaccination centers, among others. Incidence of dog bites was high and only a fraction (65%) of dog bite victims (humans) received post-exposure prophylaxis. A high proportion of unvaccinated dogs and cats and the relative intense interactions with wild dog species at interfaces were the risk factors for seropositivity to rabies virus infection in dogs. A percentage of the previously vaccinated dogs remained unimmunized and some unvaccinated dogs were seropositive. Evidence of community engagement and multi-coordinated implementation of One Health in Moshi serves as an example of best practice in tackling zoonotic diseases using multi-level government e orts. The district-level establishment of the One Health rapid response team (OHRRT), implementation of a carefully structured routine vaccination campaign, improved health education, and the implementation of barriers between domestic animals and wildlife at the interfaces are necessary to reduce the burden of rabies in Moshi and communities with similar profiles.The USAID funded project—OSRO/GLO/507/USA on Global Health Security Agenda for the control of zoonosis in Africa.http://www.mdpi.com/journal/ijerpham2020Veterinary Tropical Disease

Isolation and characterization of Escherichia coli from animals, humans, and environment

Working on a diverse species of bacteria that have hundreds of pathotypes representing hundreds of strains and many closely related family members is a challenge. Appropriate research design is required not only to achieve valid desired outcome but also to minimize the use of resources, including time to outcome and intervention. This chapter outlines basics of Escherichia coli isolation and characterization strategies that can assist in research designing that matches the set objectives. Types of samples to be collected, collection and storage strategies, and processing of samples are described. Different approaches to isolation, confirmation and concentration of various E. coli strains are summarized in this chapter. Characterization and typing of E. coli isolates by biochemical, serological, and molecular methods have been explained so that an appropriate choice is made to suite a specific E. coli strain/pathotype. Some clues on sample and isolate preservation for future use are outlined, and general precautions regarding E. coli handling are also presented to the researcher to avoid improper planning and execution of E. coli-related research. Given different options, the best E. coli research design, however, should try as much as possible to shorten the length of time to outcomes

Epidemiology of Shiga toxin-producing Escherichia coli O157:H7 in Africa in review

Southern African Journal of Infectious Diseases, 2018; 33(1): 24–30Shiga toxin-producing Escherichia coli (STEC) O157:H7 is responsible for intestinal and extra-intestinal disease syndromes in human. Isolation of the pathogen from animals, food, clinical samples and environment has been reported from all continents. A review of STEC O157:H7 in Africa from a structured literature search of the PubMed electronic database is presented. It describes the epidemiological status of the pathogen on the aspects of source, transmission, pathogenesis, disease syndromes, diagnosis, disease burden and the challenges in treatment and control strategies. About a quarter of African countries have reported isolation of STEC O157:H7 either from humans, animals, food or the environment. Different methods have been used in detection of the pathogen. Most reported human infections do not show temporal relationships with reports of isolation of the pathogen from other sources such as animals, water or food. Lack of a direct link between isolates from humans and other sources makes it difficult to point out incident specific determinants and direction of transmission. The aim of this review is to give an insight into the features of STEC O157:H7 infection in Africa and draw the attention of various stakeholders to the public health threat of the pathogen for possible interdisciplinary and multi-sectoral joint efforts in the control strategies

Epidemiology of Shiga toxin-producing Escherichia coli O157:H7 in Africa in review

Southern African Journal of Infectious Diseases, 2018; 33(1): 24–30Shiga toxin-producing Escherichia coli (STEC) O157:H7 is responsible for intestinal and extra-intestinal disease syndromes in human. Isolation of the pathogen from animals, food, clinical samples and environment has been reported from all continents. A review of STEC O157:H7 in Africa from a structured literature search of the PubMed electronic database is presented. It describes the epidemiological status of the pathogen on the aspects of source, transmission, pathogenesis, disease syndromes, diagnosis, disease burden and the challenges in treatment and control strategies. About a quarter of African countries have reported isolation of STEC O157:H7 either from humans, animals, food or the environment. Different methods have been used in detection of the pathogen. Most reported human infections do not show temporal relationships with reports of isolation of the pathogen from other sources such as animals, water or food. Lack of a direct link between isolates from humans and other sources makes it difficult to point out incident specific determinants and direction of transmission. The aim of this review is to give an insight into the features of STEC O157:H7 infection in Africa and draw the attention of various stakeholders to the public health threat of the pathogen for possible interdisciplinary and multi-sectoral joint efforts in the control strategies

Knowledge and attitude of pregnant women in rural Tanzania on prevention of Anaemia

Anaemia during pregnancy is the leading cause of morbidity and mortality and poor birth outcomes worldwide. Despite control programmes, anaemia is far beyond the target of the fifth Millennium Development Goal. This study aimed at assessing the trend in anaemia and knowledge and attitude of pregnant women towards control measures in low income rural settings. A crosssectional study involving 354 pregnant women was conducted in Mbulu District, Tanzania. Socio-demographic and anaemia related information was gathered, and anaemia status determined. Descriptive statistics for socio-demographic and anaemia related data were computed. Knowledge and attitudes of pregnant women to anaemia were assessed using summated index and Likert scales respectively. Fisher‘s exact test was used to determine associations between variables. Multivariable logistic regression was run to quantify the risk factors for occurrence of anaemia. Prevalence of anaemia unadjusted and adjusted for altitude were 38.7% (95% CI: 0.34-0.44) and 46.3% (95% CI: 0.41-0.51) respectively. The overall score on the 11-point summated scale was 5.2, indicating low knowledge, while the overall score on Likert scale was 21.7 out of 40 points, indicating unfavorable attitude. High gravidity was a risk factor for anaemia during pregnancy (OR=13.09, 95% CI: 5.68 – 47.04 for 3-4 gravidity and OR=25.16, 95% CI: 12.46 – 37.23 for gravidity ≥ 5). There was upsurge of anaemia prevalence and low knowledge and unfavourable attitude were associated with anaemia (p-value<0.001). There is a need to set appropriate anaemia knowledge transfer and attitude change strategies in the community to have successful anaemia control program

Salmonella enterica in raw and boiled eggs: call for comprehensive preventive measures throughout the production and processing chain

Tanzania Veterinary Journal, 2019; 34 (2): 13-22Eggs are good source of proteins to human. However, consumption of contaminated eggs may lead to ill-health. Salmonella enterica typifies one of such pathogens causing food poisoning in humans. The present study aimed at assessing the bacteriological quality of eggs from chicken in respect to Salmonella enterica. A total of 570 chicken eggs were collected and examined from November 2015 to May 2016 in Morogoro municipality. Salmonella was isolated from egg content and eggshell samples by conventional culture and biochemical methods. Salmonella enterica were confirmed to genus level by PCR targeting invA gene. Salmonella enterica were tested for resistance against common antimicrobial agents. Salmonella enterica was recovered from 11 out 30 sample pools, of which 6 (20.0%) from egg contents and 5 (16.7%) from eggshell surfaces. Eggs from local chicken breeds were highly contaminated (20.0%) than eggs from exotic chicken breeds (16.7%) whereas raw eggs were highly contaminated (26.7%) than boiled eggs (10%). Clean eggs were highly contaminated (20.0%) than faecal socked (13.3%) and cracked eggs (3.4%). Salmonella enterica were susceptible to Ciprofloxacin, Chloramphenicol, Gentamicin, Tetracycline, Sulfamethaxole-Trimethoprim, Imepenem, Cefotaxime, Ceftriaxone and Caftazidime, and resistant to Kanamycin. Presence of pathogenic Salmonellae in different forms of chicken eggs indicates that eggs are unwholesome for human consumption and control measures should be implemented throughout egg production chain to prevent human and animal salmonellosis

Knowledge and attitude of pregnant women in rural Tanzania on prevention of Anaemia

Anaemia during pregnancy is the leading cause of morbidity and mortality and poor birth outcomes worldwide. Despite control programmes, anaemia is far beyond the target of the fifth Millennium Development Goal. This study aimed at assessing the trend in anaemia and knowledge and attitude of pregnant women towards control measures in low income rural settings. A crosssectional study involving 354 pregnant women was conducted in Mbulu District, Tanzania. Socio-demographic and anaemia related information was gathered, and anaemia status determined. Descriptive statistics for socio-demographic and anaemia related data were computed. Knowledge and attitudes of pregnant women to anaemia were assessed using summated index and Likert scales respectively. Fisher‘s exact test was used to determine associations between variables. Multivariable logistic regression was run to quantify the risk factors for occurrence of anaemia. Prevalence of anaemia unadjusted and adjusted for altitude were 38.7% (95% CI: 0.34-0.44) and 46.3% (95% CI: 0.41-0.51) respectively. The overall score on the 11-point summated scale was 5.2, indicating low knowledge, while the overall score on Likert scale was 21.7 out of 40 points, indicating unfavorable attitude. High gravidity was a risk factor for anaemia during pregnancy (OR=13.09, 95% CI: 5.68 – 47.04 for 3-4 gravidity and OR=25.16, 95% CI: 12.46 – 37.23 for gravidity ≥ 5). There was upsurge of anaemia prevalence and low knowledge and unfavourable attitude were associated with anaemia (p-value<0.001). There is a need to set appropriate anaemia knowledge transfer and attitude change strategies in the community to have successful anaemia control program

The role of nontuberculous mycobacteria in the diagnosis, management and quantifying risks of tuberculosis in Tanga, Tanzania

Tanzania Journal of Health Research 2016; Vol.18(2)Background: The role of nontuberculous mycobacteria (NTM) in tuberculosis (TB) diagnosis is well documented in many developing settings. However, this has not been the case in many resource poor settings like Tanzania. This study aimed at understanding the role of NTM in the diagnosis and management of TB in resource poor settings of Tanzania. Methods: A cross-sectional study was conducted in Tanga, Tanzania. Patients with symptoms suggestive of TB self-referred to health care facilities were recruited. Two sputum samples were collected for standard direct smear microscopy. Culture was performed using BacT/Alert 3D system, Löwenstein-Jensen and Gottsacker slopes. Identification of Mycobacterium tuberculosis and NTM was done by using GenoType®MTBC and GenoType®CM/AS, respectively. Results: A total of 372 patients were involved in the study. Eighty-one (21.8%) patients were diagnosed as having M. tuberculosis by the isolation of the organism from cultures of sputum. Further analysis of culture showed that 8.1% (30/372) were NTM with 7/372 (1.9%) cases of NTM classified as pulmonary tuberculosis (PTB) patients. Ziehl Neelsen stain had a sensitivity of 68.8% and produced 10 false negative results. On the other hand, Fluorescence stain had a sensitivity of 85.7% and gave seven false negative samples when compared with culture results. Weight loss (p = 0.0001), fatigue (p = 0.003), fever (p = 0.038) and night sweats (p = 0.004), young population (18-40 years) (p = 0.0352), males (p = 0.0025) were important risk factors for TB. Four out of 30 NTM diagnosed by culture received first line anti-TB treatment suggesting that a good proportion of patients (4/65, 6.2%) were mistreated as TB patients. Conclusion: Inefficient screening of TB patients in resource poor settings and prevalent increase of NTM may contribute to over diagnosis of TB cases. The need to integrate NTM diagnosis in the routine management of TB is urgently needed for designing effective tuberculosis prevention and control strategies in the country

The role of nontuberculous mycobacteria in the diagnosis, management and quantifying risks of tuberculosis in Tanga, Tanzania

Tanzania Journal of Health Research 2016; Vol.18(2)Background: The role of nontuberculous mycobacteria (NTM) in tuberculosis (TB) diagnosis is well documented in many developing settings. However, this has not been the case in many resource poor settings like Tanzania. This study aimed at understanding the role of NTM in the diagnosis and management of TB in resource poor settings of Tanzania. Methods: A cross-sectional study was conducted in Tanga, Tanzania. Patients with symptoms suggestive of TB self-referred to health care facilities were recruited. Two sputum samples were collected for standard direct smear microscopy. Culture was performed using BacT/Alert 3D system, Löwenstein-Jensen and Gottsacker slopes. Identification of Mycobacterium tuberculosis and NTM was done by using GenoType®MTBC and GenoType®CM/AS, respectively. Results: A total of 372 patients were involved in the study. Eighty-one (21.8%) patients were diagnosed as having M. tuberculosis by the isolation of the organism from cultures of sputum. Further analysis of culture showed that 8.1% (30/372) were NTM with 7/372 (1.9%) cases of NTM classified as pulmonary tuberculosis (PTB) patients. Ziehl Neelsen stain had a sensitivity of 68.8% and produced 10 false negative results. On the other hand, Fluorescence stain had a sensitivity of 85.7% and gave seven false negative samples when compared with culture results. Weight loss (p = 0.0001), fatigue (p = 0.003), fever (p = 0.038) and night sweats (p = 0.004), young population (18-40 years) (p = 0.0352), males (p = 0.0025) were important risk factors for TB. Four out of 30 NTM diagnosed by culture received first line anti-TB treatment suggesting that a good proportion of patients (4/65, 6.2%) were mistreated as TB patients. Conclusion: Inefficient screening of TB patients in resource poor settings and prevalent increase of NTM may contribute to over diagnosis of TB cases. The need to integrate NTM diagnosis in the routine management of TB is urgently needed for designing effective tuberculosis prevention and control strategies in the country

Paralleling of diagnostic endeavor for control of mycobacterial infections and tuberculosis

Mycobacterial infections and tuberculosis pose global public health threats. High tuberculosis morbidities and mortalities are due to the diagnosis problems among other causes. This chapter describes and compares diverse mycobacterial infections and tuberculosis diagnostic efforts and point-out the direction so as to inform areas of and motivate research toward early, rapid, and accurate diagnosis for effective TB control. We have grouped diagnostic approaches according to the type of sample taken for or organ targeted during diagnosis. The sputum-based methods include smear microscopy, culture, and rat sniffing. Interferon-γ (INF-γ) release assays, transcriptional blood signatures, and proteomic profiling use blood samples while colorimetric sensor array (CSA) and mass spectrometry use urine samples. Patho-physiological methods include tuberculin skin tests (TSTs) and radiography. Chromatography and acoustic wave detection can also be used to diagnose TB from breath. Comparative description of these methods is based on a time frame to diagnosis, accuracy, cost, and convenience. The trend shows that there is a move from time-consuming, slow and narrow-spectrum to quick and broad-spectrum TB diagnostic procedures. The sputum-based and patho-physiological approaches remain conformist while blood-based procedures lead research developments. Absence of single best approach calls for synergistic research combinations that form accurate, rapid, cheap, and convenient package at point-of-care centers