A Profile of Acquired Causes of Childhood Anaemia in General Paediatric Wards at Muhimbili National Hospital Dar es Salaam, Tanzania

Anaemia is a growing public health and greatly determines the prognosis of children in the paediatric wards. There is paucity of data describing its magnitude, haematological values and acquired causes among patients admitted in paediatric wards. Anaemia is the major cause of morbidity and mortality in paediatric age yet the magnitude of acquired causes of anaemia have been inadequately studies in Tanzania. The study was aimed at determining the profile of acquired cause of childhood anaemia in general paediatric wards at Mihimbili National Hospital (MNH) in Dar es Salaam. This was a descriptive cross-sectional study. This was conducted at MNH in general paediatric wards from 20th August, 2009 to 15th December, 2009; and A total of 315 patients, aged 1-84 months, consecutively admitted were recruited in the study. After informed verbal content consent from the guardian or parent was obtained, information on demographic and clinical characteristics was collected from the parent or guardian. Physical examination and laboratory tests on blood; stool samples for hookworm screening; blood slides for malaria parasites; Human Immunodeficiency Virus (HIV); blood peripheral smears; active serum vitamin B12;serum folate; serum transferrrin; and serum iron were done on all subjects Additional information was taken from medical files. The prevalence of anemia was determined as a percentage of all paediatric patients recruited during the time of data collection. All information was recorded using questionnaires and analysis was done using SPSS version 13.0. A p value of <0.05 was considered statistically significant. Fatigue, headache, pallor, jaundice, hepatomegaly and splenomegaly were shown to be the most common presenting clinical feature in patients with anaemia (p<0.05). The status of anaemia (Hb<11g/dl) was 80.3%. The proportion of malaria was 7.9%, HIV seropositive was 10.2% and hookworm was 1.0% of all admissions. There was an increased risk of anaemia in patients with HIV seropositive and or malaria although this was not statistically significant (OR>1.0,p>0.05). Iron deficiency was the most common micronutrient deficiency occurring in 42% of all admission and 41-46% among the anaemic children; around one third of non anaemic patients had iron deficiency (p=0.05). The proportion of folate deficiency was 8.6% and vitamin B12 deficiency 3.4% of all recruited patients (p>0.05). Stutus of anaemia was 80.3%. Iron deficiency was common but HIV seropositive, malaria, hookworm, folate and vitamin B12 deficiencies were not prominent. It was noted that one third of the non anaemic paediatric patients have iron deficiency as stages of developing anaemia. Iron studies should be performed in microcytic anaemia and causes of iron deficiency investigated. Iron food fortification programs should be developed and implemented. Further studies should be done to determine serum B12 and serum and red cell folate levels in children on a large scale in order to resolve the controversy of these micronutrient deficiencies in children. Since this was a cross sectional hospital based study, bias could not be avoided in determining the profile of acquired causes of childhood anaemia

Creating an "enabling environment" for taking insecticide treated nets to national scale: the Tanzanian experience

INTRODUCTION: Malaria is the largest cause of health services attendance, hospital admissions and child deaths in Tanzania. At the Abuja Summit in April 2000 Tanzania committed itself to protect 60% of its population at high risk of malaria by 2005. The country is, therefore, determined to ensure that sustainable malaria control using insecticide-treated nets is carried out on a national scale. CASE DESCRIPTION: Tanzania has been involved for two decades in the research process for developing insecticide-treated nets as a malaria control tool, from testing insecticides and net types, to assessing their efficacy and effectiveness, and exploring new ways of distribution. Since 2000, the emphasis has changed from a project approach to that of a concerted multi-stakeholder action for taking insecticide-treated nets to national scale (NATNETS). This means creating conditions that make insecticide-treated nets accessible and affordable to all those at risk of malaria in the country. This paper describes Tanzania's experience in (1) creating an enabling environment for insecticide-treated nets scale-up, (2) promoting the development of a commercial sector for insecticide-treated nets, and (3) targeting pregnant women with highly subsidized insecticide-treated nets through a national voucher scheme. As a result, nearly 2 million insecticide-treated nets and 2.2 million re-treatment kits were distributed in 2004. CONCLUSION: National upscaling of insecticide-treated nets is possible when the programme is well designed, coordinated and supported by committed stakeholders; the Abuja target of protecting 60% of those at high risk is feasible, even for large endemic countries

Comparison of the CDC Backpack aspirator and the Prokopack aspirator for sampling indoor- and outdoor-resting mosquitoes in southern Tanzania.

BACKGROUND\ud \ud Resting mosquitoes can easily be collected using an aspirating device. The most commonly used mechanical aspirator is the CDC Backpack aspirator. Recently, a simple, and low-cost aspirator called the Prokopack has been devised and proved to have comparable performance. The following study evaluates the Prokopack aspirator compared to the CDC backpack aspirator when sampling resting mosquitoes in rural Tanzania.\ud \ud METHODS\ud \ud Mosquitoes were sampled in- and outdoors of 48 typical rural African households using both aspirators. The aspirators were rotated between collectors and households in a randomized, Latin Square design. Outdoor collections were performed using artificial resting places (large barrel and car tyre), underneath the outdoor kitchen (kibanda) roof and from a drop-net. Data were analysed with generalized linear models.\ud \ud RESULTS\ud \ud The number of mosquitoes collected using the CDC Backpack and the Prokopack aspirator were not significantly different both in- and outdoors (indoors p = 0.735; large barrel p = 0.867; car tyre p = 0.418; kibanda p = 0.519). The Prokopack was superior for sampling of drop-nets due to its smaller size. The number mosquitoes collected per technician was more consistent when using the Prokopack aspirator. The Prokopack was more user-friendly: technicians preferred using the it over the CDC backpack aspirator as it weighs considerably less, retains its charge for longer and is easier to manoeuvre.\ud \ud CONCLUSIONS\ud \ud The Prokopack proved in the field to be more advantageous than the CDC Backpack aspirator. It can be self assembled using simple, low-cost and easily attainable materials. This device is a useful tool for researchers or vector-control surveillance programs operating in rural Africa, as it is far simpler and quicker than traditional means of sampling resting mosquitoes. Further longitudinal evaluations of the Prokopack aspirator versus the gold standard pyrethrum spray catch for indoor resting catches are recommended

Loss of Household Protection from Use of Insecticide-Treated Nets against Pyrethroid-Resistant Mosquitoes, Benin

Restoring protection requires innovation combining pyrethroids and novel insecticides

Analysing and Recommending Options for Maintaining Universal Coverage with Long-Lasting Insecticidal Nets: The Case of Tanzania in 2011.

Tanzania achieved universal coverage with long-lasting insecticidal nets (LLINs) in October 2011, after three years of free mass net distribution campaigns and is now faced with the challenge of maintaining high coverage as nets wear out and the population grows. A process of exploring options for a continuous or "Keep-Up" distribution system was initiated in early 2011. This paper presents for the first time a comprehensive national process to review the major considerations, findings and recommendations for the implementation of a new strategy. Stakeholder meetings and site visits were conducted in five locations in Tanzania to garner stakeholder input on the proposed distribution systems. Coverage levels for LLINs and their decline over time were modelled using NetCALC software, taking realistic net decay rates, current demographic profiles and other relevant parameters into consideration. Costs of the different distribution systems were estimated using local data. LLIN delivery was considered via mass campaigns, Antenatal Care-Expanded Programme on Immunization (ANC/EPI), community-based distribution, schools, the commercial sector and different combinations of the above. Most approaches appeared unlikely to maintain universal coverage when used alone. Mass campaigns, even when combined with a continuation of the Tanzania National Voucher Scheme (TNVS), would produce large temporal fluctuations in coverage levels; over 10 years this strategy would require 63.3 million LLINs and a total cost of $444 million USD. Community mechanisms, while able to deliver the required numbers of LLINs, would require a massive scale-up in monitoring, evaluation and supervision systems to ensure accurate application of identification criteria at the community level. School-based approaches combined with the existing TNVS would reach most Tanzanian households and deliver 65.4 million LLINs over 10 years at a total cost of$449 million USD and ensure continuous coverage. The cost of each strategy was largely driven by the number of LLINs delivered. The most cost-efficient strategy to maintain universal coverage is one that best optimizes the numbers of LLINs needed over time. A school-based approach using vouchers targeting all students in Standards 1, 3, 5, 7 and Forms 1 and 2 in combination with the TNVS appears to meet best the criteria of effectiveness, equity and efficiency

Insecticide resistance status in Anopheles gambiae in southern Benin

BACKGROUND: The emergence of pyrethroid resistance in Anopheles gambiae has become a serious concern to the future success of malaria control. In Benin, the National Malaria Control Programme has recently planned to scaling up long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) for malaria prevention. It is, therefore, crucial to monitor the level and type of insecticide resistance in An. gambiae, particularly in southern Benin where reduced efficacy of insecticide-treated nets (ITNs) and IRS has previously been reported. METHODS: The protocol was based on mosquito collection during both dry and rainy seasons across forty districts selected in southern Benin. Bioassay were performed on adults collected from the field to assess the susceptibility of malaria vectors to insecticide-impregnated papers (permethrin 0.75%, delthamethrin 0.05%, DDT 4%, and bendiocarb 0.1%) following WHOPES guidelines. The species within An. gambiae complex, molecular form and presence of kdr and ace-1 mutations were determined by PCR. RESULTS: Strong resistance to permethrin and DDT was found in An. gambiae populations from southern Benin, except in Aglangandan where mosquitoes were fully susceptible (mortality 100%) to all insecticides tested. PCR showed the presence of two sub-species of An. gambiae, namely An. gambiae s.s, and Anopheles melas, with a predominance for An. gambiae s.s (98%). The molecular M form of An. gambiae was predominant in southern Benin (97%). The kdr mutation was detected in all districts at various frequency (1% to 95%) whereas the Ace-1 mutation was found at a very low frequency (<or= 5%). CONCLUSION: This study showed a widespread resistance to permethrin in An. gambiae populations from southern Benin, with a significant increase of kdr frequency compared to what was observed previously in Benin. The low frequency of Ace-1 recorded in all populations is encouraging for the use of bendiocarb as an alternative insecticide to pyrethroids for IRS in Benin

Development of vegetable farming: a cause of the emergence of insecticide resistance in populations of Anopheles gambiae in urban areas of Benin

<p>Abstract</p> <p>Background</p> <p>A fast development of urban agriculture has recently taken place in many areas in the Republic of Benin. This study aims to assess the rapid expansion of urban agriculture especially, its contribution to the emergence of insecticide resistance in populations of <it>Anopheles gambiae</it>.</p> <p>Methods</p> <p>The protocol was based on the collection of sociological data by interviewing vegetable farmers regarding various agricultural practices and the types of pesticides used. Bioassay tests were performed to assess the susceptibility of malaria vectors to various agricultural insecticides and biochemical analysis were done to characterize molecular status of population of <it>An. gambiae</it>.</p> <p>Results</p> <p>This research showed that:</p> <p>(1) The rapid development of urban agriculture is related to unemployment observed in cities, rural exodus and the search for a balanced diet by urban populations;</p> <p>(2) Urban agriculture increases the farmers' household income and their living standard;</p> <p>(3) At a molecular level, PCR revealed the presence of three sub-species of <it>An. gambiae </it>(<it>An. gambiae s.s., Anopheles melas and Anopheles arabiensis</it>) and two molecular forms (M and S). The <it>kdr </it>west mutation recorded in samples from the three sites and more specifically on the M forms seems to be one of the major resistance mechanisms found in <it>An. gambiae </it>from agricultural areas. Insecticide susceptibility tests conducted during this research revealed a clear pattern of resistance to permethrin (76% mortality rate at Parakou; 23.5% at Porto-Novo and 17% at Cotonou).</p> <p>Conclusion</p> <p>This study confirmed an increase activity of the vegetable farming in urban areas of Benin. This has led to the use of insecticide in an improper manner to control vegetable pests, thus exerting a huge selection pressure on mosquito larval population, which resulted to the emergence of insecticide resistance in malaria vectors.</p

Audit of clinical-laboratory practices in haematology and blood transfusion at Muhimbili National Hospital in Tanzania

In Tanzania, there is paucity of data for monitoring laboratory medicine including haematology. This therefore calls for audits of practices in haematology and blood transfusion in order to provide appraise practice and devise strategies that would result in improved quality of health care services. This descriptive cross-sectional study which audited laboratory practice in haematology and blood transfusion at Muhimbili National Hospital (MNH) aimed at assessing the pre-analytical stage of laboratory investigations including laboratory request forms and handling specimen processing in the haematology laboratory and assessing the chain from donor selection, blood component processing to administration of blood during transfusion. A national standard checklist was used to audit the laboratory request forms (LRF), phlebotomists’ practices on handling and assessing the from donor selection to administration of blood during transfusion. Both interview and observations were used. A total of 195 LRF were audited and 100% of had incomplete information such as patients’ identification numbers, time sample ordered, reason for request, summary of clinical assessment and differential diagnoses. The labelling of specimens was poorly done by phlebotomists/clinicians in 82% of the specimens. Also 65% (132/202) of the blood samples delivered in the haematology laboratory did not contain the recommended volume of blood. There was no laboratory request form specific for ordering blood and there were no guidelines for indication of blood transfusion in the wards/clinics. The blood transfusion laboratory section was not participating in external quality assessment and the hospital transfusion committee was not in operation. It is recommended that a referral hospital like MNH should have a transfusion committee to provide an active forum to facilitate communication between those involved with transfusion, monitor, coordinate and audit blood transfusion practices as per national guidelines

Public health review : creating an enabling environment for taking insecticide treated nets to national scale; the Tanzanian experience

Malaria is the major single cause of health service attendances, hospital admissions and child deaths in Tanzania and a major impediment to social and economic development in the country. Despite the heavy health, social and economic burden efforts to support malaria control have been inadequate. With the advent of Insecticide Treated Nets (ITNs) as a tool for malaria control, the Roll Back Malaria Initiative launched in 1998 advocated renewed emphasis on sustainable preventive measures. Tanzania committed itself at the Summit of African Heads of State in Abuja in April 2000 to protect 60% of its population at high risk by 2005. The country is therefore determined to ensure that sustainable malaria control using ITNs is carried out at national scale. // Tanzania has been involved for two decades in the research process for developing ITNs as a malaria control tool, from testing insecticides and net types, to assessing their efficacy and effectiveness, and exploring new ways of distribution. To this effect, a number of small and large-scale implementation projects have taken place. Since 2000 the emphasis has changed from a project approach to that of a concerted multistakeholder action for taking high coverage of ITNs to national scale. This means creating conditions that make ITNs accessible and affordable to all those at risk of malaria in the country. This paper describes Tanzania’s experience in creating an enabling environment for ITN scale-up, and reviews the numerous important issues that need to be considered in making this vision a reality