Community knowledge, perceptions and practices on malaria in Mpwapwa District, central Tanzania

A study on community knowledge, attitudes and perception on malaria and its management was conducted in Mpwapwa district of central Tanzania in January-February 2001. Six villages, three with health facilities (Kibakwe, Makose and Mwanawota) and three without health facilities (Chogola, Kidenge and Wangi) lying between 975 and 1859 m above sea level were selected for the study. According to most respondents, the general health problems for adults in the district included malaria, diarrhoea, typhoid fever and pneumonia. Malaria, pneumonia and diarrhoea were the major health problems among children. Among pregnant women, malaria, abortions and diarrhoea were identified as the major public health problems in the district. In the view of most of villagers, malaria was the cause of most fevers and convulsions at low and intermediate altitudes. Cold weather was considered as the main predisposing factor to most of the fevers experienced in the highland villages. The common antimalarial drugs used in Mpwapwa district were chloroquine and quinine. The cost of antimalarial drugs ranged between TShs. 10/- and 20/- for one tablet of chloroquine, 600/- for chloroquine syrup, and 320/- for a single dose of chloroquine injection. However, shortage of drugs was frequently encountered in most of the health facilities. Traditional medicine practitioners were most frequently consulted for cases of convulsions in the district. Our findings showed that only 2.1% of the children in the district were sleeping under mosquito nets. The use of mosquito net was common among individuals living in the villages with health facilities than in those without health facilities. Generally, most respondents considered long distances to health facilities and inability to pay for health services as the main constraints in obtaining proper health care. Tanzania Health Research Bulletin Vol.6(2) 2004: 37-4

The relationship between malaria parasitaemia and availability of healthcare facility in Mpwapwa District, central Tanzania

A study was carried out in six villages located at different altitudes in Mpwapwa district of central Tanzania to determine malaria parasitaemia and transmission levels in villages with or without health care facilities. A total of 1119 schoolchildren (age= 5.9-12.3 years) were examined for malaria parasitaemia. Plasmodium falciparum was the predominant malaria species accounting for 92.8% of all species. The average malaria prevalence rate among schoolchildren was 25.8% (range 1.5-53.8%). The geometric mean parasite densities for P. falciparum was 361 (N= 286). Higher malaria prevalence was observed in villages at lower (1500m) altitudes. Schoolchildren in areas with health care facilities were less at risk of acquiring malaria by 33.4% as compared with those living in areas without health facilities. Mean packed cell volume in schoolchildren was 38.5% (range= 35.2-41.0%). Splenomegaly was observed in 18.1% (0-40.2%) of the schoolchildren examined and it was higher among those in villages without health care facilities. Anopheles gambiae sensu lato was the only malaria vector found in the district and was found in all villages and at all altitudes. Sporozoite rate in An. gambiae s.l. ranged from 0-10.5%, with the lowland villages recording the highest rates. This study indicates that altitude and geographical accessibility to healthcare service are important determinants of malaria infection among rural communities in Tanzania. Keywords: malaria, schoolchildren, altitudes, health care facility, Tanzania Tanzania Health Research Bulletin Vol. 8(1) 2006: 22-2

Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.

BACKGROUND: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. METHODS: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. FINDINGS: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0). INTERPRETATION: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. FUNDING: Medical Research Council of South Africa.Medical Research Council of South Africa