Rabies in Tanzania: The need for a national control programme

Letter to the editor

Tungiasis Infestation in Tanzania.

Tungiasis is caused by the jigger flea Tunga penetrans. We describe a case of severe infestation from Kigoma region, Western Tanzania. A 19-year-old male with epilepsy and mental disability presented with ulcerated and inflamed toes. Clinical examination revealed the presence of approximately 810 embedded jigger fleas on the feet, and another 60 lesions on the hands. The patient presented with fissures on the feet, hands and soles. He had difficulty walking and erythematous, oedematous, ulcerated and inflamed skin around the feet. Living conditions were precarious. The patient was assisted to extract the embedded fleas and his feet were washed with disinfectants. Oral antibiotics were given. The case shows that the disease may reach high parasite loads in Tanzanian individuals, with consequently severe pathology. There have been single reports of returning tourists from Tanzania with tungiasis, but the epidemiological situation and the geographic occurrence of the disease in this country are not known. Systematic studies are needed to increase knowledge on the epidemiological situation of tungasis in Tanzania and to identify endemic areas

Prevalence of Schistosoma mansoni and soil transmitted helminths and factors associated with uptake of preventive chemotherapy among school children in Sengerema District in north-western Tanzania

Background: The control of intestinal schistosomiasis and soil transmitted helminths (STH) in Tanzania focuses on reducing morbidities through the treatment of infected and at risk populations, especially schoolchildren with praziquantel (PZQ) and albendazole (ALB). However, in some areas, the uptake of interventions is low. The objective of this study was to determine factors associated with the uptake of preventive chemotherapy and, secondarily, the prevalence of Schistosoma mansoni and soil-transmitted helminths' infections in Sengerema District of north western Tanzania.Methods: This cross-sectional study was conducted among 625 randomly selected school children aged 8-18 years from Sengerema district. A questionnaire was used to collect information on the reported uptake of PZQ/ALB. Single stool samples were collected, processed and examined for the presence of eggs pf S. mansoni and soil-transmitted helminths using Kato Katz technique.Results: The self-reported uptake of preventive chemotherapy was 95.6% (95%CI; 92.78-98.49). Provision of food (AOR= 25.25, 95%CI: 5.28-120.49, p<0.001) and information about the anti-helminthic drug prior to taking it (AOR =14.24, 95%CI: 3.23-62.72, p<0.001) were associated with a high reported uptake of preventive chemotherapy. The overall prevalence of S. mansoni and geometrical mean of eggs per gram (EPG) of faeces were 36.64% (95%CI: 21.55 -62.29) and 229.47 EPG (202.73-259.86). The prevalence of STH was 10.88% (95%CI; 7.52-15.75).Conclusion: The high reported uptake of preventive chemotherapy was associated with provision of food and information about the drugs prior to their administration. However, S. mansoni and soil-transmitted infections are still a public health concern in the study area. Integrating health education in mass drug administration campaigns will allow provision of other complementary public preventive measures to reduce the burden of these infections

Prevalence and factors associated with Trichomonas vaginalis infection among pregnant women attending public antenatal clinics in Mwanza city, North-western Tanzania

Background: Trichomonas vaginalis is a sexually transmitted parasitic infection known to cause vaginitis especially in women of child bearing age. The objective of this study was to determine the prevalence and factors associated with T. vaginalis among pregnant women attending public health facilities in Mwanza City, Tanzania.Methods: This cross sectional study was conducted among pregnant women aged 17-46 years attending three public antenatal clinics in Mwanza City, north-western Tanzania. Wet preparation and Giemsa stained thick smears techniques were used to diagnose T. vaginalis infection. Socio-demographic characteristics and other risk related behaviours were collected.Results: A total of 365 pregnant women participated in this study, 38 (10.41%) and 84 (23.01%) of them had trichomoniasis based on wet preparation and Giemsa stained thick smears respectively. On multivariable analysis, being HIV seropositive (AOR=11.65, 95%CI; 1.15-117.49, P<0.03) and having other sexual transmitted disease such as syphilis (AOR=4.40, 95%CI: 1.32-14.7, P<0.01) were significantly associated with T. vaginalis.Conclusion: The prevalence of T. vaginalis in pregnant women in Mwanza city is high and the infection is associated with sexually transmitted diseases such as syphilis and HIV. Routine screening of T. vaginalis during ante-natal care clinics is highly recommended to reduce pregnancy complications related to T. vaginalis infection

Entomopathogenic fungi, Metarhizium anisopliae and Beauveria bassiana reduce the survival of Xenopsylla brasiliensis larvae (Siphonaptera: Pulicidae).

Entomopathogenic fungi, particularly those belonging to the genera Metarhizium and Beauveria have shown great promise as arthropod vector control tools. These agents, however, have not been evaluated against flea vectors of plague. A 3-h exposure to the fungi coated paper at a concentration of 2 × 108 conidia m-2 infected >90% of flea larvae cadavers in the treatment groups. The infection reduced the survival of larvae that had been exposed to fungus relative to controls. The daily risk of dying was four- and over three-fold greater in larvae exposed to M. anisopliae (HR = 4, p<0.001) and B. bassiana (HR = 3.5, p<0.001) respectively. Both fungi can successfully infect and kill larvae of X. brasiliensis with a pooled median survival time (MST±SE) of 2±0.31 days post-exposure. These findings justify further research to investigate the bio-control potential of entomopathogenic fungi against fleas.\ud \u

HIV, appendectomy and postoperative complications at a reference hospital in Northwest Tanzania: cross-sectional study

Background\ud Appendicitis is a frequent surgical emergency worldwide. The present study was conducted to determine the prevalence of HIV, and the association of infection with clinical, intraoperative and histological findings and outcome, among patients with appendicitis.\ud Methods\ud We performed a cross sectional study at Weill-Bugando Medical Centre in northwest Tanzania. In total, 199 patients undergoing appendectomy were included. Demographic characteristics of patients, clinical features, laboratory, intraoperative and histopathological findings, and HIV serostatus were recorded.\ud Results\ud In total, 26/199 (13.1%) were HIV-seropositive. The HIV-positive population was significantly older (mean age: 38.4 years) than the HIV-negative population (25.3 years; p < 0.001). Leukocytosis was present in 87% of seronegative patients, as compared to 34% in seropositive patients (p = 0.0001), and peritonitis was significantly more frequent among HIV-positives (31% vs. 2%; p < 0.001). The mean (SD) length of hospital stay was significantly longer in HIV-positives (7.12 ± 2.94 days vs. 4.02 ± 1.14 days; p < 0.001); 11.5% of HIV patients developed surgical site infections, as compared to 0.6% in the HIV-negative group (p = 0.004).\ud Conclusion\ud HIV infections are common among patients with appendicitis in Tanzania, and are associated with severe morbidity, postoperative complications and longer hospital stays. Early diagnosis of appendicitis and prompt appendectomy are crucial in areas with high prevalence of HIV infection. Routine pre-test counseling and HIV screening for appendicitis patients is recommended to detect early cases who may benefit from HAART

Impact of climate change on human health and health systems in Tanzania: a review

Climate change (CC) has a number of immediate and long-term impacts on the fundamental determinants of human health. A number of potential human health effects have been associated either directly or indirectly with global climate change. Vulnerability to the risks associated with CC may exacerbate ongoing socio-economic challenges. The objective of this review was to analyse the potential risk and vulnerability in the context of climate-sensitive human diseases and health system in Tanzania. Climate sensitive vector- and water-borne diseases and other health related problems and the policies on climate adaptation in Tanzania during the past 50 years are reviewed. The review has shown that a number of climate-associated infectious disease epidemics have been reported in various areas of the country; mostly being associated with increase in precipitation and temperature. Although, there is no single policy document that specifically addresses issues of CC in the country, the National Environmental Management Act of 1997 recognizes the importance of CC and calls for the government to put up measures to address the phenomenon. A number of strategies and action plans related to CC are also in place. These include the National Biodiversity Strategy and Action Plan, the National Action Programme, and the National Bio-safety Framework. The government has put in place a National Climate Change Steering Committee and the National Climate Change Technical Committee to oversee and guide the implementation of CC activities in the country. Recognizing the adverse impacts of natural disasters and calamities, the government established a Disaster Management Division under the Prime Minister&rsquo;s Office. Epidemic Preparedness and Response Unit of the Ministry of Health and Social Welfare is responsible for emergency preparedness, mostly disease outbreaks. However, specific climate changes associated with human health issues are poorly addressed in the MoHSW strategies and the national health research priorities. In conclusion, CC threatens to slow, halt or reverses the progress the country has made or is making to achieve its national and millennium development goals. It is therefore important that Tanzania prepares itself to appropriately address CC impact on human health. It is equally important that policy makers and other stakeholders are engaged in a process to update and adapt priorities, mobilize resources and build interdisciplinary research and implementation capacity on climate change and its mitigation

Towards Malaria Elimination and its Implication for Vector Control, Disease Management and Livelihoods in Tanzania

Over the years, malaria has remained the number one cause of morbidity and mortality in Tanzania. Population based studies have indicated a decline in overall malaria prevalence among under-fives from 18.1% in 2008 to 9.7% in 2012. The decline of malaria infection has occurred in all geographical zones of the country. Malaria mortality and cumulative probability of deaths have also shown a marked decline from 2000 to 2010. During the same period, area specific studies in Muheza, Korogwe, Muleba and Mvomero have also reported a similar declining trend in malaria prevalence and incidence. The decline in malaria prevalence has been observed to coincide with a decline in transmission indices including anopheline mosquito densities. The decline in malaria prevalence has been attributed to a combination of factors including improved access to effective malaria treatment with artemisinin combination therapy and protection from mosquito bites by increased availability of insecticide treated bednets and indoor residual spraying. The objective of this paper was to review the changing landscape of malaria and its implication for disease management, vector control, and livelihoods in Tanzania. It seeks to examine the links within a broad framework that considers the different pathways given the multiplicity of interactions that can produce unexpected outcomes and trade-offs. Despite the remarkable decline in malaria burden, Tanzania is faced with a number of challenges. These include the development of resistance of malaria vectors to pyrethroids, changing mosquito behaviour and livelihood activities that increase mosquito productivity and exposure to mosquito bites. In addition, there are challenges related to health systems, community perceptions, community involvement and sustainability of funding to the national malaria control programme. This review indicates that malaria remains an important and challenging disease that illustrates the interactions among ecosystems, livelihoods, and health systems. Livelihoods and several sectoral development activities including construction, water resource development and agricultural practices contribute significantly to malaria mosquito productivity and transmission. Consequently, these situations require innovative and integrative re-thinking of the strategies to prevent and control malaria. In conclusion, to accelerate and sustain malaria control in Tanzania, the prevention strategies must go hand in hand with an intersectoral participation approach that takes into account ecosystems and livelihoods that have the potential to increase or decrease malaria transmission.\u

Intestinal schistosomiasis associated with intussusception: a case report

We report a case of intestinal schistosomiasis associated with iliocaecal intussusception resulting from obstructions of the terminal part of the ileum by schistosome egg-induced fibrosis. A 7-year-old boy presented with the history of abdominal pain and difficulties in passing stool for two months. Ultrasound examination revealed doughnut signs characterized with multiple concentric rings at the lateral abdomen, and the bowel loop appeared distended. Exploratory laparatomy confirmed intussusception of the terminal part of the ileum into the caecum, extending to the ascending colon. Hemicolectomy and end-to-end iliocolostomy was performed. Histological examination of the resected bowel revealed Schistosoma mansoni eggs within the mucosa, submucosa of the ileum, caecum and ascending colon, granulomatous inflammation with foreign body giant cells accompanied by fibrosis and eosinophilic infiltrate into the mucosa. Postoperatively, the patient recovered well. There may have been a synergistic effect of schistosomiasis with other underlying conditions, leading to intussusception. In conclusion, it is important to consider S. mansoni infection as a differential diagnosis for intestinal obstruction in endemic areas

Comparison of HIV-1 viral loads, CD4-Th2-lymphocytes and effects of praziquantel treatment among adults infected or uninfected with Schistosoma mansoni in fishing villages of north-western Tanzania

 Background: It is hypothesised that Th2 immunological environment associated with Schistosoma mansoni infection might favour replication of HIV-1 in co-infected individuals, results in increased viral loads. On the other hand, deworming using praziquantel might result in reduction of HIV-1 viral loads and increased CD4+ cell counts. This study was therefore, carried out to compare HIV -1 plasma loads, CD4-Th2-lymphocytes and the effects of praziquantel treatment on HIV-1 plasma loads and CD4+ cell counts among HIV-1 seropositive individuals infected or uninfected with S. mansoni.Methodology: A 9-month prospective longitudinal study was conducted among HIV-1 infected individuals aged 21-55 years with CD4+ cell counts ≥ 350cells/µL in fishing villages of North-Western Tanzania. Single stool samples were examined for S. mansoni eggs using Kato Katz technique at 6-month follow-up and 12 weeks after treatment. Venous blood samples were collected at baseline, at three and six-month follow-up and 12 weeks after praziquantel treatment for HIV-1 plasma viral loads and CD4+ cell quantification.Results: Of the 50 HIV-1 infected participants at baseline, 44% (22/50, 95%CI; 30.58-58.35) were found to be co-infected with S. mansoni at 6-month follow-up with a mean of 93.26GM-epg (95%CI: 60.42-143.95). The median CD4+ cell counts did not differ significantly between individuals infected with HIV-1 and those co-infected with HIV-1 and S. mansoni at baseline (P=0.62), 3-month (P=0.64) and 6-month (P=0.41) follow-up. Monthly decrease in CD4+ cells did not differ significantly between the two groups at all follow-up points (-30.39cell/µL versus -31.35cells/µL, P=0.89). Those infected with S. mansoni had a significantly higher mean log10 HIV-1 plasma viral load at baseline (5.98 ± 3.06 versus 9.21 ± 1.91copies/ml, P&lt;0.0001) and 3-month follow-up (8.19 ± 2.17 versus 9.44 ± 1.99copies/ml, P&lt;0.042) compared to those infected with HIV-1 only. This difference was not evident at the time of S. mansoni diagnosis at 6-month time point. Praziquantel treatment in co-infected individuals (n=12) did not result in any change in CD4+ cell counts and mean HIV-1 plasma viral loads (t=-0.9156, P=0.38), comparing baseline and 3-month follow-up after treatment. No correlation was observed between log S. mansoni egg counts and log10 HIV-1 RNA viral loads (r=-0.066, P=0.77) at six-month follow-up in co-infected individuals (n=22).Conclusion: HIV-1 plasma viral loads varied significantly among mono and co-infected individuals at baseline and 3-month follow-up. However, CD4+ cell counts did not vary between the two groups at all follow-up time points. Praziquantel treatment of co-infected individuals did not result in changes in CD4+ cell counts and HIV-1 plasma viral loads