Microbicides development programme: engaging the community in the standard of care debate in a vaginal microbicide trial in Mwanza, Tanzania.

BACKGROUND: HIV prevention research in resource-limited countries is associated with a variety of ethical dilemmas. Key amongst these is the question of what constitutes an appropriate standard of health care (SoC) for participants in HIV prevention trials. This paper describes a community-focused approach to develop a locally-appropriate SoC in the context of a phase III vaginal microbicide trial in Mwanza City, northwest Tanzania. METHODS: A mobile community-based sexual and reproductive health service for women working as informal food vendors or in traditional and modern bars, restaurants, hotels and guesthouses has been established in 10 city wards. Wards were divided into geographical clusters and community representatives elected at cluster and ward level. A city-level Community Advisory Committee (CAC) with representatives from each ward has been established. Workshops and community meetings at ward and city-level have explored project-related concerns using tools adapted from participatory learning and action techniques e.g. chapati diagrams, pair-wise ranking. Secondary stakeholders representing local public-sector and non-governmental health and social care providers have formed a trial Stakeholders' Advisory Group (SAG), which includes two CAC representatives. RESULTS: Key recommendations from participatory community workshops, CAC and SAG meetings conducted in the first year of the trial relate to the quality and range of clinic services provided at study clinics as well as broader standard of care issues. Recommendations have included streamlining clinic services to reduce waiting times, expanding services to include the children and spouses of participants and providing care for common local conditions such as malaria. Participants, community representatives and stakeholders felt there was an ethical obligation to ensure effective access to antiretroviral drugs and to provide supportive community-based care for women identified as HIV positive during the trial. This obligation includes ensuring sustainable, post-trial access to these services. Post-trial access to an effective vaginal microbicide was also felt to be a moral imperative. CONCLUSION: Participatory methodologies enabled effective partnerships between researchers, participant representatives and community stakeholders to be developed and facilitated local dialogue and consensus on what constitutes a locally-appropriate standard of care in the context of a vaginal microbicide trial in this setting. TRIAL REGISTRATION: Current Controlled Trials ISRCTN64716212

Multi-Criteria Decision Making and Numerical Optimization Approaches for Optimizing Water Loss Management Strategies in Water Distribution System A case of Urban Water Supply and Sanitation Authorities in Tanzania

This research article published by Modern Education and Computer Science Press, 2019Water loss in water distribution systems (WDS) is a serious problem in Tanzania and the third world countries at large. A lot of water is lost on its way before reaching the consumers. This causes a shortage of water supply which leads to loss of revenues of the concerned water authorities. The control or reduction of water loss in the WDS is closely dependent on the commitment of the decision-makers and on the strategies and budget, they set for that purpose. This paper presents a combined model of Multi-Criteria Decision Making (MCDM) and Numerical optimization techniques which may help decision-makers to prioritize and select the best strategies to be used in the management of water loss in the WDS at Moshi Urban Water Supply and Sanitation Authority (MUWSA), Tanzania. The Multi-Criteria Decision Making family methods namely the Multi-Attribute Value Theory (MAVT), Simple Multi-Attribute Rating Technique Exploiting Ranks (SMARTER), and Complex Proportional Assessment (COPRAS) were used to evaluate and prioritize the strategies, whereas the Integer Linear Programming (ILP) technique a numerical optimization technique was used to select the best strategies or alternatives to be employed in water loss management. The results show that the most preferable alternative is replacement of dilapidated pipes while the least preferable alternative is network zoning. The model selects thirteen out of sixteen alternatives, which cost 97% (TZS 235.71 million) of the total budgets set by the water authority to form a portfolio of the best alternatives for water loss management. Furthermore, the model showed robustness as the selected portfolio of alternatives remained the same even when the weights of the evaluation criteria changed

Optimisation of Water Loss Management Strategies: Multi-Criteria Decision Analysis Approaches

This research article published by the Journal of Mathematics and Informatics, 2020Water loss in the water distribution systems (WDS) is a challenge to many water authorities in the world but the problem is crucial in the less developed countries. The effect of water losses in the WDS includes the reduction in the revenue and availability of water, interruption in the quality of water, and inflation of the operation and maintenance cost of the water authorities. Using data from the Moshi Urban Water Supply and Sanitation Authority (MUWSA) Tanzania, an assessment of strategies used for water loss management (WLM) was carried out through an integrated model of Multi- Criteria Decision Making (MCDM) and Integer Linear Programming (ILP) which is an optimisation technique. The family of MCDM methods, Multi-Attribute Value Theory (MAVT), Simple Multi-Attribute Rating Technique Exploiting Ranks (SMARTER), and Simple Additive Weighting (SAW) were employed to assess and prioritise the strategies while the ILP was used to formulate a decision model. The model was used to select a portfolio of the best strategies. Sixteen strategies were identified. The results show that the comparison between the bulk meter and customers’ meter on detecting the physical or apparent losses was ranked as the best strategy in managing the loss while the network zoning was ranked as the worst strategy. The model selected thirteen out of sixteen strategies to form the portfolio of the best strategies to be employed by the MUWSA for water loss management. Furthermore, the model was found to be robust as the selected portfolio of strategies remained the same even when the weights of the criteria were changed. The developed model in this study will assist the decision-makers to assess, prioritise and choose the best strategies for reducing or controlling water loss in the distribution system

An Application of Computational Fluid Dynamics to Optimize Municipal Sewage Networks; A Case of Tororo Municipality, Eastern Uganda.

This research article published by the Journal of Advances in Mathematics Vol 18, 2020Two-phase pipe flow is a common occurrence in many industrial applications such as sewage, water, oil, and gas transportation. Accurate prediction of liquid velocity, holdup and pressure drop is of vast importance to ensure effective design and operation of fluid transport systems. This paper aimed at the simulation of a twophase flow of air and sewage (water) using an open source software OpenFOAM. Numerical Simulations have been performed using varying dimensions of pipes as well as their inclinations. Specifically, a Standard k- turbulence model and the Volume of Fluid (VOF) free water surface model is used to solve the turbulent mixture flow of air and sewage (water). A two dimensional, 0.5m diameter pipe of 20m length is used for the CFD approach based on the Navier-Stokes equations. Results showed that the flow pattern behaviour is influenced by the pipe diameters as well as their inclination. It is concluded that the most effective way to optimize a sewer network system for Tororo Municipality conditions and other similar situations, is by adjusting sewer diameters and slope gradients and expanding the number of sewer network connections of household and industries from 535 (i.e., 31.2% of total) to at least 1,200 (70% of total)

Vitamin A supplementation in Tanzania: the impact of a change in programmatic delivery strategy on coverage.

BACKGROUND\ud \ud Efficient delivery strategies for health interventions are essential for high and sustainable coverage. We report impact of a change in programmatic delivery strategy from routine delivery through the Expanded Programme on Immunization (EPI+) approach to twice-yearly mass distribution campaigns on coverage of vitamin A supplementation in Tanzania\ud \ud METHODS\ud \ud We investigated disparities in age, sex, socio-economic status, nutritional status and maternal education within vitamin A coverage in children between 1 and 2 years of age from two independent household level child health surveys conducted (1) during a continuous universal targeting scheme based on routine EPI contacts for children aged 9, 15 and 21 months (1999); and (2) three years later after the introduction of twice-yearly vitamin A supplementation campaigns for children aged 6 months to 5 years, a 6-monthly universal targeting scheme (2002). A representative cluster sample of approximately 2,400 rural households was obtained from Rufiji, Morogoro Rural, Kilombero and Ulanga districts. A modular questionnaire about the health of all children under the age of five was administered to consenting heads of households and caretakers of children. Information on the use of child health interventions including vitamin A was asked.\ud \ud RESULTS\ud \ud Coverage of vitamin A supplementation among 1-2 year old children increased from 13% [95% CI 10-18%] in 1999 to 76% [95%CI 72-81%] in 2002. In 2002 knowledge of two or more child health danger signs was negatively associated with vitamin A supplementation coverage (80% versus 70%) (p = 0.04). Nevertheless, we did not find any disparities in coverage of vitamin A by district, gender, socio-economic status and DPT vaccinations.\ud \ud CONCLUSION\ud \ud Change in programmatic delivery of vitamin A supplementation was associated with a major improvement in coverage in Tanzania that was been sustained by repeated campaigns for at least three years. There is a need to monitor the effect of such campaigns on the routine health system and on equity of coverage. Documentation of vitamin A supplementation campaign contacts on routine maternal and child health cards would be a simple step to facilitate this monitoring

Early life risk factors of motor, cognitive and language development: a pooled analysis of studies from low/middle-income countries.

OBJECTIVE:To determine the magnitude of relationships of early life factors with child development in low/middle-income countries (LMICs). DESIGN:Meta-analyses of standardised mean differences (SMDs) estimated from published and unpublished data. DATA SOURCES:We searched Medline, bibliographies of key articles and reviews, and grey literature to identify studies from LMICs that collected data on early life exposures and child development. The most recent search was done on 4 November 2014. We then invited the first authors of the publications and investigators of unpublished studies to participate in the study. ELIGIBILITY CRITERIA FOR SELECTING STUDIES:Studies that assessed at least one domain of child development in at least 100 children under 7 years of age and collected at least one early life factor of interest were included in the study. ANALYSES:Linear regression models were used to assess SMDs in child development by parental and child factors within each study. We then produced pooled estimates across studies using random effects meta-analyses. RESULTS:We retrieved data from 21 studies including 20 882 children across 13 LMICs, to assess the associations of exposure to 14 major risk factors with child development. Children of mothers with secondary schooling had 0.14 SD (95% CI 0.05 to 0.25) higher cognitive scores compared with children whose mothers had primary education. Preterm birth was associated with 0.14 SD (-0.24 to -0.05) and 0.23 SD (-0.42 to -0.03) reductions in cognitive and motor scores, respectively. Maternal short stature, anaemia in infancy and lack of access to clean water and sanitation had significant negative associations with cognitive and motor development with effects ranging from -0.18 to -0.10 SDs. CONCLUSIONS:Differential parental, environmental and nutritional factors contribute to disparities in child development across LMICs. Targeting these factors from prepregnancy through childhood may improve health and development of children

A Comparative Analysis of Multi-Criteria Decision Making Methods in Optimizing Water Loss Management Strategies used in Water Distribution System

This paper presents a comparative analysis of Multi-Criteria Decision Making (MCDM) methods integrated with numerical optimization technique to optimize water loss management strategies used in the water distribution system. The study was conducted at Moshi Urban Water Supply and Sanitation Authority (MUWSA), Tanzania. Two ranking methods, Complex Proportional Assessment (COPRAS) and Simple Additive Weighting (SAW) integrated with Integer Linear Programming (ILP) technique were compared. The aim is to help decision-makers to choose the best decision-making method that may help to optimize the water loss management strategies used in water distribution systems. The Multi-Criteria Decision Making methods were used in evaluating and prioritizing the strategies while the Integer Linear Programming technique was used to formulate a decision model and selecting the best strategies (alternatives) employed in water loss management. Results show that the methods rank the given alternatives differently while when integrated with integer linear programming technique, the formulated models select the same portfolios of alternatives. Both models select thirteen alternatives, which cost 97% (TZS 235.71 million) of the total budgets set by the water authority for WLM. Furthermore, the models showed robustness to their results; when the ranking of evaluation criteria changes, the portfolios of alternatives remained the same. In general, this paper elaborates how decision-making methods can be coupled with mathematics in operation research to solve issues in water management and planning

Evaluating the impact of community health worker integration into prevention of mother-to-child transmission of HIV services in Tanzania

De-identified Stata dataset and do-files used to publish the report to 3ie on the project, "Evaluating the impact of community health worker integration into prevention of mother-to-child transmission of HIV services in Tanzania" (project code TW7.18). This project was funded under Thematic Window 7 on integrated HIV services

Short-term effectiveness of a community health worker intervention for HIV-infected pregnant women in Tanzania to improve treatment adherence and retention in care: A cluster-randomized trial.

IntroductionCommunity health workers (CHWs) are lay workers who have the potential to enhance services to prevent mother-to-child HIV transmission (PMTCT) and improve the health of women living with HIV infection. We conducted a cluster-randomized trial of an intervention to integrate CHWs with 'Option B+' PMTCT services in Shinyanga Region, Tanzania.MethodsThe intervention was implemented for 11 months and included four integrated components: 1) formal linkage of CHWs to health facilities; 2) CHW-led antiretroviral therapy (ART) adherence counseling; 3) loss to follow-up tracing by CHWs; and 4) distribution of Action Birth Cards (ABCs), a birth planning tool. We cluster-randomized 32 facilities offering PMTCT services, within strata of size, to the intervention (n = 15) or comparison (standard of care, n = 17) groups. Intervention effectiveness was determined with a difference-in-differences strategy based on clinical and pharmacy data from HIV-infected postpartum women at baseline (births in 2014) and endline (births April-Oct 2015). The primary outcome was retention in care between 60 and 120 days postpartum. Secondary outcomes included ART initiation, timing of ART initiation (as measured by week of gestation), and ART adherence 90 days postpartum, measured using the medication possession ratio (MPR≥95%).ResultsIntervention and comparison facilities were similar at baseline. Data were collected from 1,152 and 678 mother-infant pairs at baseline and endline, respectively. There were no significant differences in retention in care, ART initiation, or timing of ART initiation between the intervention and control groups. Adherence (MPR≥95%) at 90 days postpartum was 11.3 percentage points higher in the intervention group in ITT analyses (95% CI: -0.7, 23.3, p = 0.06), though this effect was attenuated after adjusting for baseline imbalance (9.5 percentage points, 95% CI: -2.9, 22.0, p = 0.13). Among only sites that had the greatest fidelity to the intervention, however, we found a stronger effect on adherence (13.6 percentage points, 95% CI: 2.5, 24.6).ConclusionsDespite being feasible and acceptable, the CHW-based intervention did not have strong effects on most PMTCT indicators. CHW involvement in PMTCT programs may improve ART adherence among HIV-infected postpartum women, however, and success appears heavily dependent on program implementation.Trial registrationRegistry for International Development Impact Evaluations (RIDIE, ID 552553838b402) and ClinicalTrials.gov (NCT03058484)

Short-term effectiveness of a community health worker intervention for HIV-infected pregnant women in Tanzania to improve treatment adherence and retention in care: A cluster-randomized trial

<div><p>Introduction</p><p>Community health workers (CHWs) are lay workers who have the potential to enhance services to prevent mother-to-child HIV transmission (PMTCT) and improve the health of women living with HIV infection. We conducted a cluster-randomized trial of an intervention to integrate CHWs with ‘Option B+’ PMTCT services in Shinyanga Region, Tanzania.</p><p>Methods</p><p>The intervention was implemented for 11 months and included four integrated components: 1) formal linkage of CHWs to health facilities; 2) CHW-led antiretroviral therapy (ART) adherence counseling; 3) loss to follow-up tracing by CHWs; and 4) distribution of Action Birth Cards (ABCs), a birth planning tool. We cluster-randomized 32 facilities offering PMTCT services, within strata of size, to the intervention (n = 15) or comparison (standard of care, n = 17) groups. Intervention effectiveness was determined with a difference-in-differences strategy based on clinical and pharmacy data from HIV-infected postpartum women at baseline (births in 2014) and endline (births April-Oct 2015). The primary outcome was retention in care between 60 and 120 days postpartum. Secondary outcomes included ART initiation, timing of ART initiation (as measured by week of gestation), and ART adherence 90 days postpartum, measured using the medication possession ratio (MPR≥95%).</p><p>Results</p><p>Intervention and comparison facilities were similar at baseline. Data were collected from 1,152 and 678 mother-infant pairs at baseline and endline, respectively. There were no significant differences in retention in care, ART initiation, or timing of ART initiation between the intervention and control groups. Adherence (MPR≥95%) at 90 days postpartum was 11.3 percentage points higher in the intervention group in ITT analyses (95% CI: -0.7, 23.3, p = 0.06), though this effect was attenuated after adjusting for baseline imbalance (9.5 percentage points, 95% CI: -2.9, 22.0, p = 0.13). Among only sites that had the greatest fidelity to the intervention, however, we found a stronger effect on adherence (13.6 percentage points, 95% CI: 2.5, 24.6).</p><p>Conclusions</p><p>Despite being feasible and acceptable, the CHW-based intervention did not have strong effects on most PMTCT indicators. CHW involvement in PMTCT programs may improve ART adherence among HIV-infected postpartum women, however, and success appears heavily dependent on program implementation.</p><p>Trial registration</p><p>Registry for International Development Impact Evaluations (RIDIE, ID <a href="https://clinicaltrials.gov/ct2/show/552553838b402" target="_blank">552553838b402</a>) and ClinicalTrials.gov (<a href="https://clinicaltrials.gov/ct2/show/NCT03058484" target="_blank">NCT03058484</a>)</p></div