Public Health Concern and Initiatives on the Priority Action Towards Non-Communicable Diseases in Tanzania

Tanzania is already facing challenges caused by existing burden of communicable diseases, and the growing trend of non-communicable diseases (NCDs), which raises a lot of concerns and challenges. The objective of this review is to provide broad insight of the “silent epidemic” of NCDs, existing policies, strategies and interventions, and recommendations on prioritized actions. A review of existing literature including published articles, technical reports, and proceedings from national and international NCDs meetings was carried out. The burden, existing interventions, socio-economic impact, lessons learnt, and potential for expanding cost effective interventions in Tanzania were explored. Challenges to catch up with global\ud momentum on NCD agenda were identified and discussed. The review has indicated that the burden of NCDs and its underlying risk factors in Tanzania is alarming, and affects people of all socio-economic status. The\ud costs of health care for managing NCDs are high, and thus impoverishing the already poor people. The country\ud leadership has a high political commitment; there are policies and strategies, which need to be implemented to\ud address the growing NCD burden. In conclusion, NCDs in Tanzania are a silent rising health burden and has\ud enormous impact on an individual and country’s social-economical status. From the experience of other countries, interventions for NCDs are affordable, feasible and some are income generating. Multi-sectoral approach, involving national and international partners has a unique role in intensifying action on NCDs.\ud Tanzania should strategize on implementation research on how to adapt the interventions and apply multisectoral\ud approach to control and prevent NCDs in the country.\u

Predictive equations for spirometric reference values in a healthy adult suburban population in Tanzania

This study was conducted in Kinondoni district, Dar Es Salaam, Tanzania, with the objectives to generate prediction equations for forced expiratory volume in 1 second (FEV1), forced expiratory volume in 6 seconds (FEV6), FEV1/FEV6 ratio and peak expiratory flow (PEF) from a non-symptomatic sample of the population, and to compare these equations to published reference values. The study included adults aged ≥ 15 years who were recruited by use of community based, multistage cluster random sampling. Participants performed spirometry and answered questionnaires regarding respiratory symptoms and socioeconomic conditions. Anthropometric data were collected. Selection of subjects for generation of reference values followed American Thoracic Society (ATS) recommendations. Data were analyzed using multiple regression techniques. Fifty two men and 98 women were selected to the reference value group. FEV1, FEV6, FEV1/FEV6 and PEF were regressed against age, height and weight.. For men a curvilinear model was chosen when predicting FEV1, FEV6 and PEF, and a linear model predicted FEV1/FEV6. For women a linear model was used in the regression equations. The reference values generated from our study were lower than in several previously published studies. Our study suggests that assessment of respiratory function should be based on reference values generated from the same population as those being assessed

Household socio-economic status and the risk of HIV infection among under five-year children in Muheza district, north-eastern Tanzania

Background: There are pieces of evidence of the association between socioeconomic factors and HIV prevalence in sub-Saharan Africa. However, there is a dearth of information on such a relationship in Tanzania. Objective: To determine the relationship between household socioeconomic factors and HIV prevalence among under five-year children in Muheza district, Tanzania. Methods: A facility-based study among HIV-exposed children with their respective mothers/guardians was conducted from June 2015 to June 2016. Information on the HIV status of the child and household socio-demographic characteristics were analyzed in the STATA version 13.0. Results: A total of 576 child-mother/guardian pairs were interviewed. Sixty-one (10.6%) children were confirmed to be HIV positive. The odds of HIV infection were found to be lower among children belonging to the heads of households with secondary and high levels of education (AOR = 0.5, 95% CI 0.2-0.9); P=0.04, those living in wealthier households (AOR = 0.5, 95% CI  0.3-0.9; P=0.03) and those whose mothers/guardians had good knowledge of HIV  (AOR = 0.2, 95% CI 0.1-0.3; P<0.001) compared to their counterparts. Conclusion: Children with heads of households having high educational levels and those from wealthier households were associated with reduced odds of acquiring HIV infection in Muheza district

A first insight into the genetic diversity of Mycobacterium tuberculosis in Dar es Salaam, Tanzania, assessed by spoligotyping

BACKGROUND: Tanzania has a high tuberculosis incidence, and genotyping studies of Mycobacterium tuberculosis in the country are necessary in order to improve our understanding of the epidemic. Spoligotyping is a potentially powerful genotyping method due to fast generation of genotyping results, high reproducibility and low operation costs. The recently constructed SpolDB4 database and the model-based program 'Spotclust' can be used to assign isolates to families, subfamilies and variants. The results of a study can thus be analyzed in a global context. RESULTS: One hundred forty-seven pulmonary isolates from consecutive tuberculosis patients in Dar es Salaam were spoligotyped. SpolDB4 and 'Spotclust' were used to assign isolates to families, subfamilies and variants. The CAS (37%), LAM (22%) and EAI (17%) families were the most abundant. Despite the dominance of these three families, diversity was high due to variation within M. tuberculosis families. Of the obtained spoligopatterns, 64% were previously unrecorded. CONCLUSION: Spoligotyping is useful to gain an overall understanding of the local TB epidemic. This study demonstrates that the extensive TB epidemic in Dar es Salaam, Tanzania is caused by a few successful M. tuberculosis families, dominated by the CAS family. Import of strains was a minor problem

Parental Concerns and Uptake of Childhood Vaccines in Rural Tanzania – A Mixed Methods Study

Background Vaccine hesitancy has been recognized as an important barrier to timely vaccinations around the world, including in sub-Saharan Africa. In Tanzania, 1 in 4 children is not fully vaccinated. The objective of this mixed methods study was to describe and contextualize parental concerns towards vaccines in Tanzania. Methods Between 2016 and 2017, we conducted a cross-sectional survey (n = 134) and four focus group discussions (FGDs, n = 38) with mothers of children under 2 years of age residing in Mtwara region in Southern Tanzania. The survey and FGDs assessed vaccination knowledge and concerns and barriers to timely vaccinations. Vaccination information was obtained from government-issued vaccination cards. Results In the cross-sectional survey, 72% of mothers reported missed or delayed receipt of vaccines for their child. Although vaccine coverage was high, timeliness of vaccinations was lower and varied by vaccine. Rural mothers reported more vaccine-related concerns compared to urban mothers; literacy and access to information were identified as key drivers of the difference. Mothers participating in FGDs indicated high perceived risk of vaccine-preventable illnesses, but expressed concerns related to poor geographic accessibility, unreliability of services, and missed opportunities for vaccinations resulting from provider efforts to minimize vaccine wastage. Conclusions Findings from our cross-sectional survey indicate the presence of vaccination delays and maternal concerns related to childhood vaccines in Tanzania. In FGDs, mothers raised issues related to convenience more often than issues related to vaccine confidence or complacency. Further research is necessary to understand how these issues may contribute to the emergence and persistence of vaccine hesitancy and to identify effective mitigation strategies

Shauri et al. BMC Infect Dis (2021) 21:911 https://doi.org/10.1186/s12879-021-06549-y RESEARCH Seroprevalence of Dengue and Chikungunya antibodies among blood donors in Dar es Salaam and Zanzibar, Tanzania: a cross-sectional study

This research article was published by BMC Infectious Medical in 2021Background: The potential shift of major causes of febrile illnesses from malaria to non-malarial febrile illnesses, including arboviral diseases such as chikungunya and dengue, is of concern. The last outbreaks of these infections were reported in 2018 and 2019 for chikungunya in Zanzibar and dengue in Dar es Salaam. We conducted a cross- sectional study that involved serological testing of stored blood samples from the blood banks in Temeke Referral Hospital in Dar es Salaam and the National Blood Bank Unit in Zanzibar. The samples were collected from Zanzibar and Dar es Salaam donors in May and June 2020, respectively. A total of 281 samples were included in the study, and their demographic information extracted from the registers. The samples were then transported to Muhimbili Univer- sity of Health and Allied Sciences at the Microbiology Laboratory. They were subjected to an indirect ELISA to detect IgG and IgM against dengue and chikungunya viruses. Results: Seropositive IgM samples from Dar es Salaam were 3/101 (2.97%) for chikungunya and 1/101 (0.9%) for dengue, while samples from Zanzibar were all IgM negative for both viruses. Chikungunya IgG seropositivity was significantly higher (p ≤ 0.05) in Dar es Salaam 21/101 (21.2%) than Zanzibar 22/180 (12.2%). There was no difference in dengue IgG seropositivity between Dar es Salaam 44/101 (43.5%) and Zanzibar 68/180 (37.8%). Similarly, dual IgG seropositivity for both dengue and chikungunya viruses were not different between Dar es Salaam 13/101 (12.9%) and Zanzibar 11/180 (6.1%). Conclusion: Detection of IgM for dengue and chikungunya in Dar es Salaam indicates recent or ongoing transmis- sion of the two viruses in the absence of a reported outbreak. These findings suggest the possibility of transmission of the two infections through blood transfusion. Detection of IgG antibodies for dengue and chikungunya viruses might be contributed by both; the ongoing infections and residual responses caused by preceding infections in the country. Results from blood banks may represent the tip of the iceberg. Further studies are needed to gain insight into the actual burden of the two diseases in Tanzania

Prevalence and Predictors of HIV Infection among Under FiveYear Children Born to HIV Positive Mothers in Muheza District, North-Eastern Tanzania

Background: Human Immunodeficiency Virus (HIV) pandemic has become a serious public health concern worldwide. The prevalence of paediatric HIV infection is largely unknown in many countries in Sub-Saharan Africa (SSA). We aimed to determine the prevalence and predictors of HIV infection among under-5 years children in Muheza District, Tanzania.Methods: A facility-based study among mothers/guardians with their under-5 years children exposed to HIV infection was conducted from June 2015 to June 2016. Information on HIV status, socio-demographic and other family characteristics was collected using a structured questionnaire. Data analysis was performed using STATA version 13.0.Results: A total of 576 HIV-exposed under-5 years children were recruited together with their respective mothers/guardians. The HIV prevalence among under-5 years children was 10.6% (95% CI: 8.1-13.1%). The burden of HIV infection was observed among older children aged 25 to 59 months (AOR= 8.0, 95% CI 2.5-26.0) than in the younger children. There was a four-fold (AOR=3.9, 95% CI 1.7-9.1) risk of HIV infection among children born to mothers of unknown HIV status at conception than among children born to mothers with known HIV status. The odds of HIV infection were higher among children who were delivered from home (AOR=2.6, 95% CI 1.0-6.5), received mixed feeding (AOR=2.4, 95% CI 1.2-4.9), and those living far from a health facility (AOR=3.0, 95% CI 1.4-6.5).Conclusion: The prevalence of HIV among under-5 years children in Muheza is higher among older children. The high prevalence is associated with being born to mothers with unknown HIV status at conception, received mixed feeding, home delivery, and living far from the health facility. Campaigns that provide health educational massages addressing risk factors of HIV need to be emphasised in order to promote the control and prevention of HIV among children

Evaluation of the KEMRI Hep-cell II test kit for detection of hepatitis B surface antigens in Tanzania

Hepatitis B surface antigen (HBsAg) is one of the most important serological markers used to diagnose acute and chronic hepatitis B infection. The objective of the current evaluation was to assess the operational characteristics of the Kenya Medical Research Institute (KEMRI) Hep-cell II against an ELISA Exsym HBsAg in the detection of hepatitis B surface antigens. To evaluate the Hep-cell II test, blood samples were collected from blood donors and processed for detection of HBsAg using Hep-cell II based on the test principle and procedure outlined by the manufacturer. ELISA Axsym HBsAg test was used as golden standard. Of the 400 samples tested, 287 (71.8%) were positive by Hep-cell test and 295 (73.8%) were positive by the ELISA Axsym. Hep-cell test had a sensitivity of 98.6% and specificity of 95.96%. Similar values of sensitivity and specificity of the Hep-cell test were obtained even when Bayesian Analysis Model was applied. The positive and negative predictive values of Hep-cell test were 98.61% and 95.96%, respectively. The positive and negative diagnostic likelihood ratios of Hep-cell test were 24.4% and 0.0145, respectively. In conclusion, the Hep-cell test is useful for detecting hepatitis B virus and the high likelihood ratio observed suggests that it may be useful in blood screening. However, it may be necessary to evaluate for cost-effectiveness and robustness in field conditions before the test is recommended for use

Magnitude and factors associated with pre-diagnosis loss to follow-up among tuberculosis presumptive patients in the Cycle of Health Care, Musoma, Tanzania: Cross-sectional study

Background: Despite National Tuberculosis (TB) Program efforts on tuberculosis control in the country, pre-diagnosis loss to follow-up is still a major problem. The study aims at exploring the magnitude and risk factors of presumptive TB cases who either do not submit a second sputum sample or do not show up for their laboratory results. Methods: The study included presumptive TB registered at the Musoma Regional Referral Hospital between May and November 2014.  Lost to follow up presumptive TB were then traced and interviewed from December 2014 to April 2015. One hundred and thirty-two among those who submitted both samples and showed up for their results were randomly selected as a comparison group.  Results: A total of 620 presumptive TB was registered at the Musoma Regional Referral Hospital (MRRH), of which 521 (84.0%) completed TB testing in accordance with the national TB diagnostic algorithm while 99 (16.0%) did not complete. Out of those who did not complete, 65 (65.7%) submitted only one spot sample and 34 (34.3%) submitted both but all of these did not pick-up their results. The Mean age of participants was 45.3 years (Standard deviation 17.7). The main reasons for loss to follow-up were: 23 (23.2%) opted to go to other health care facilities; 23 (23.2%) lack of transport fare; and 20 (20.2%) long distance to the hospital. Males were 1.6 (95%CI1.02-2.90) more likely to complete TB diagnostic algorithm

Primary health care staff's perceptions of childhood tuberculosis: a qualitative study from Tanzania

<p>Abstract</p> <p>Background</p> <p>Diagnosing tuberculosis in children remains a great challenge in developing countries. Health staff working in the front line of the health service delivery system has a major responsibility for timely identification and referral of suspected cases of childhood tuberculosis. This study explored primary health care staff's perception, challenges and needs pertaining to the identification of children with tuberculosis in Muheza district in Tanzania.</p> <p>Methods</p> <p>We conducted a qualitative study that included 13 semi-structured interviews and 3 focus group discussions with a total of 29 health staff purposively sampled from primary health care facilities. Analysis was performed in accordance with the principles of a phenomenological analysis.</p> <p>Results</p> <p>Primary health care staff perceived childhood tuberculosis to be uncommon in the society and tuberculosis was rarely considered as a likely differential diagnosis. Long duration and severe signs of disease together with known exposure to tuberculosis were decisive for the staff to suspect tuberculosis in children and refer them to hospital. None of the staff felt equipped to identify cases of childhood tuberculosis and they experienced lack of knowledge, applicable tools and guidelines as the main challenges. They expressed the need for more training, supervision and referral feedback to improving case identification.</p> <p>Conclusions</p> <p>Inadequate awareness of the burden of childhood tuberculosis, limited knowledge of the wide spectrum of clinical presentation and lack of clinical decision support strategies is detrimental to the health staff's central responsibility of suspecting and referring children with tuberculosis especially in the early disease stages. Activities to improve case identification should focus on skills required by primary health care staff to fulfil their responsibility and reflect primary health care level capacities and challenges.</p