Strategies for Promoting the Use of Concrete Pavements in Tanzania: Technical and Institutional Considerations

High-type roads in Tanzania have been predominantly of asphaltic concrete construction. This ever enlarging and ageing asphaltic road network represents increasing resource requirements on the road agency in the form of maintenance. Limited resources coupled with the ever sky-rocketing costs of petroleum products and the competing demands of social economic developments, presupposes the need to look for alternative road construction technology that is more cost-effective and resource optimising. Experience gained from developed and some developing countries where concrete pavements have been widely used suggests the potential of this type of pavement in many developingcountries. This paper discusses the technical aspects of design and construction- and maintenance-related aspects of concrete pavements. The discussion extends further to highlight issues pertaining to the performance of concrete pavements and strategies for promoting the use of concrete pavements in Tanzania. Conclusions and recommendationsare made with suggestions on how to start implementing the proposed strategies

Impacts of ad-hoc public transport systems provision on the physical (property) development of Dar Es Salaam city.

Paper presented at the 32nd Annual Southern African Transport Conference 8-11 July 2013 "Transport and Sustainable Infrastructure", CSIR International Convention Centre, Pretoria, South Africa.Development of an integrated public transport system is very essential for achievement of social, economic and environmental requirements of the people in the cities worldwide. For African cities, the need is more pronounced since public transport is almost a forgotten sector while the demand for the same is very high. Provision for public transport systems in African cities hardly considers the future socio-economic, physical and technical requirements of the systems despite the fact that the present and the forecasted modal splits for public to private transport put public transport on the higher magnitude. This paper discusses the impacts of developing public transport system on an ad-hoc basis to the city and property development. Findings reveal that ad-hoc implementation of the public transport systems has an insignificant effect on redressing the city public transport problems. It has, instead, negatively impacted the people through loss of their properties by demolition, loss of income through disrupted livelihood activities, and creation of bad relations between the people and the city authority. Other impacts include disruption of the Transit Oriented Development (TOD), existence of improper physical development especially along the major roads and loss of revenue to the government through property tax, business license fees and monthly returns from businesses. Planning and implementing an integrated public transport system that has been accepted by city residents, harmonising the land use and transport related legal provisions and exercising justice in compensation, are among the necessary actions to be taken for achievement of effective public transport systems provision in the city.This paper was transferred from the original CD ROM created for this conference. The material was published using Adobe Acrobat 10.1.0 Technology. The original CD ROM was produced by Document Transformation Technologies Postal Address: PO Box 560 Irene 0062 South Africa. Tel.: +27 12 667 2074 Fax: +27 12 667 2766 E-mail: nigel@doctech URL: http://www.doctech.co.zamv201

An analysis of minibus transport operational problems in Dar Es Salaam

Paper presented at the 32nd Annual Southern African Transport Conference 8-11 July 2013 "Transport and Sustainable Infrastructure", CSIR International Convention Centre, Pretoria, South Africa.The problems of public transport are varied and more evident in developing cities such as Dar es Salaam, which are experiencing rapid demographic and economic growth. The minibus sector continues to provide public bus transport services, dominating every route in Dar es Salaam city. Minibus transport service provision in Dar es Salaam city has been characterised by a very harsh operational environment which has contributed to unreliable, uncomfortable and unsafe transport services in the industry. This paper is focused on identifying the existing minibus transport operational problems, analysing the cause of these problems and suggesting possible ways of mitigating them. Basically, there is limited regulatory/institutional effectiveness and lack of a clear and comprehensive policy on public transport in Dar es Salaam. Minibus operators are subject to poor; regulation, standards of operation, and standard of maintenance of vehicles and related emissions. In addition, fares are controlled in a manner, which tends to satisfy social rather than economic factors. General traffic congestion and lack of enforcement of traffic laws/regulations creates a disorderly environment for operators to conform to acceptable standards and regulations. Policy reforms in the sector need to be directed towards; strengthening the institutional and regulatory framework in which public transport thrives, formalising the operators including the technical know-how necessary for orderly service sustenance and reforming the public bus transport system by introducing the direct competitive tendering regime where operators compete to operate. These can bring quality operation with commercial benefits at minimal social problems.This paper was transferred from the original CD ROM created for this conference. The material was published using Adobe Acrobat 10.1.0 Technology. The original CD ROM was produced by Document Transformation Technologies Postal Address: PO Box 560 Irene 0062 South Africa. Tel.: +27 12 667 2074 Fax: +27 12 667 2766 E-mail: nigel@doctech URL: http://www.doctech.co.zamv201

Perceptions of tuberculosis and treatment seeking behaviour in Ilala and Kinondoni Municipalities in Tanzania

This study was carried out in Ilala and Kinondoni Municipalities in Tanzania to explore the perceptions of Tuberculosis (TB), and treatment seeking behaviour, among patients attending healthcare facilities. The study was conducted in four randomly selected health facilities providing directly observed treatment (DOT). Exit interviews were administered to 69 randomly selected TB patients. The mean age of the respondents was 33.2 years (range= 11-72 years). Forty-six (66.7%) of the patients had primary school education. Fifty-nine (84.1%) patients had good knowledge on the transmission of TB. Majority (75%) of the respondents were of the opinion that the incidence of TB was on the increase and this was mainly associated with HIV/AIDS epidemic. All respondents knew that TB was a curable disease if one complies with the treatment. Sixty-four (60%) respondents had good knowledge on the correct duration of tuberculosis treatment. The median duration before seeking treatment from a health facility was 1.5 months. The majority of the patients 47 (68%) visited public health facilities for treatment as their fi rst action. Overall, 83.8% (57/68) respondents said females comply better with treatment than male patients. The majority of the respondents lived within a walking distance to a healthcare facility. Only 18.8% (13/69) had to spend an average of US$ 0.2-0.3 as travel costs to the healthcare facility. Most of the respondents (57.8%) said they were well attended by service providers. Half (21/42) and 59.3% (16/27) of the males and females, respectively, mentioned good patient-service provider relationship as an important reason for satisfaction of the service (χ2 =0.57, df=1, P>0.005). Twenty-nine (42%) of respondents were of the opinion that female TB patients conformed better to treatment than males and a similar number thought that both of them equally conformed to treatment. Findings from this study indicate that a large population in urban settings are aware that health facilities play a major role in TB treatment. In conclusion, there is a need to further explore how this information could potentially be used to enhance early seeking of appropriate services among TB patients in the era of rapid urbanization. Strategies in the control of TB and other diseases should focus on advocacy in seeking appropriate care. Keywords: tuberculosis, perceptions, gender, treatment, behaviour, Tanzania Tanzania Journal of Health Research Vol. 10 (2) 2008: pp. 89-9

A cross-sectional study of factors associated with dog ownership in Tanzania

Background: Mass vaccination of owned domestic dogs is crucial for the control of rabies in sub-Saharan Africa. Knowledge of the proportion of households which own dogs, and of the factors associated with dog ownership, is important for the planning and implementation of rabies awareness and dog vaccination programmes, and for the promotion of responsible dog ownership. This paper reports the results of a cross-sectional study of dog ownership by households in urban and rural communities in the United Republic of Tanzania. Results: Fourteen percent (202) of 1,471 households surveyed were identified as dog-owning, with an average of 2.4 dogs per dog-owning household. The percentage of dog-owning households was highest in inland rural areas (24%) and lowest in coastal urban communities (7%). The overall human: dog ratio was 14: 1. Multivariable logistic regression revealed that households which owned cattle, sheep or goats were much more likely to own dogs than households with no livestock. Muslim households were less likely to own dogs than Christian households, although this effect of religion was not seen among livestock-owning households. Households were more likely to own a dog if the head of the household was male; if they owned a cat; or if they owned poultry. Dog ownership was also broadly associated with larger, wealthier households. Conclusion: The human: dog ratios in Tanzania are similar to those reported elsewhere in sub-Saharan Africa, although cultural and geographic variation is evident. Estimation of the number of owned dogs, and identification of household predictors of dog ownership, will enable targeted planning of rabies control effort

Comparative analysis of public transport systems in African cities

Paper presented at the 31st Annual Southern African Transport Conference 9-12 July 2012 "Getting Southern Africa to Work", CSIR International Convention Centre, Pretoria, South Africa.This paper discusses the application of an assessment methodology on three African cities; Cape Town, Nairobi and Dar es Salaam. The purpose of the methodology is to do a comprehensive study on the performance of public transport systems in these cities. The methodology is used to describe, discuss and evaluate the public transport systems. A set of components and characteristics are needed to describe a public transport system of a city. The public transport goals and objectives of the cities are used to create a set of key performance indicators that will be used to evaluate and compare the public transport systems of the cities. The evaluation and comparison of the key performance indicators of public transport systems makes it possible to find realistic values for public transport objectives and to also build a database of the performance results. These results can be compared across different years to evaluate whether there has been any improvement in performance and if the strategies implemented are achieving the expected results. In this paper, the characteristics of the public transport systems of Cape Town, Nairobi and Dar es Salaam are described in detail as well as the evaluation of the performance of the public transport systems for all three cities. The results from the assessment on the three cities are compared across each other to give a clear overview of the public transport systems of the case cities. The aim of this paper is to present the results from the application of the assessment methodology on the three case cities. The results will represent the current status quo and qualities of the public transport systems of the case cities.This paper was transferred from the original CD ROM created for this conference. The material was published using Adobe Acrobat 10.1.0 Technology. The original CD ROM was produced by Document Transformation Technologies Postal Address: PO Box 560 Irene 0062 South Africa. Tel.: +27 12 667 2074 Fax: +27 12 667 2766 E-mail: nigel@doctech URL: http://www.doctech.co.zadm201

Improving treatment outcomes for MDR-TB - Novel host-directed therapies and personalised medicine of the future

Multidrug-resistant TB (MDR-TB) is a major threat to global health security. In 2017, only 50% of patients with MDR-TB who received WHO-recommended treatment were cured. Most MDR-TB patients who recover continue to suffer from functional disability due to long-term lung damage. Whilst new MDR-TB treatment regimens are becoming available, conventional drug therapies need to be complemented with host-directed therapies (HDTs) to reduce tissue damage and improve functional treatment outcomes. This viewpoint highlights recent data on biomarkers, immune cells, circulating effector molecules and genetics which could be utilised for developing personalised HDTs. Novel technologies currently used for cancer therapy which could facilitate in-depth understanding of host genetics and the microbiome in patients with MDR-TB are discussed. Against this background, personalised cell-based HDTs for adjunct MDR-TB treatment to improve clinical outcomes are proposed as a possibility for complementing standard therapy and other HDT agents. Insights into the molecular biology of the mechanisms of action of cellular HDTs may also aid to devise non-cell-based therapies targeting defined inflammatory pathway(s) in Mtb-driven immunopathology

Improving treatment outcomes for MDR-TB - Novel host-directed therapies and personalised medicine of the future

Multidrug-resistant TB (MDR-TB) is a major threat to global health security. In 2017, only 50% of patients with MDR-TB who received WHO-recommended treatment were cured. Most MDR-TB patients who recover continue to suffer from functional disability due to long-term lung damage. Whilst new MDR-TB treatment regimens are becoming available, conventional drug therapies need to be complemented with host-directed therapies (HDTs) to reduce tissue damage and improve functional treatment outcomes. This viewpoint highlights recent data on biomarkers, immune cells, circulating effector molecules and genetics which could be utilised for developing personalised HDTs. Novel technologies currently used for cancer therapy which could facilitate in-depth understanding of host genetics and the microbiome in patients with MDR-TB are discussed. Against this background, personalised cell-based HDTs for adjunct MDR-TB treatment to improve clinical outcomes are proposed as a possibility for complementing standard therapy and other HDT agents. Insights into the molecular biology of the mechanisms of action of cellular HDTs may also aid to devise non-cell-based therapies targeting defined inflammatory pathway(s) in Mtb-driven immunopathology

Symptoms and functional limitations related to respiratory health and carbon monoxide poisoning in Tanzania: a cross sectional study

BACKGROUND: The burden of chronic respiratory symptoms and respiratory functional limitations is underestimated in Africa. Few data are available on carbon monoxide (CO) poisoning in sub-Saharan Africa and existing data is derived from CO in ambient air, but not from biomarkers in the blood. METHODS: Data from the Tanzanian Lung Health study, a cross-sectional study on lung health among outpatients and visitors to an urban as well as a rural hospital in Tanzania, was analyzed to describe respiratory symptoms and functional limitations. Saturation of peripheral blood with carbon monoxide (SpCO) was measured transcutaneously and non-invasively in participants using a modified pulse oxymeter indicative of CO poisoning. Univariate and multivariate analysis was performed. RESULTS: Nine hundred and ninety-seven participants were included in the analysis, the median age of participants was 46 years (49% male). 38% of participants reported some degree of chronic shortness of breath and 26% felt limited in their daily activities or at work by this symptom. The median SpCO was 7% (IQR 4-13, range 2-31%) among all participants without active smoking status (N = 808). Participants cooking with gas or electricity had the lowest SpCO (median 5%), followed by participants cooking with charcoal (median 7%). Cooking with wood, particularly using a stove, resulted in highest SpCO (median 11.5%). Participants from households where cooking takes place in a separate room had the lowest SpCO as compared to cooking outside or cooking in a shared room inside (6% vs. 9% vs.10.5%, p < 0.01). Sex or the activity of cooking itself was not associated with a difference in SpCO. Multivariate analysis confirmed cooking in a separate room (as compared to cooking outside) and living in a rural vs. urban setting as protective factors against high SpCO. CONCLUSION: The findings demonstrate a high burden of chronic respiratory symptoms which also cause socioeconomic impact. High levels of SpCO indicate a relevant burden of carbon monoxide poisoning in the local population. The level of CO in the blood is more dependent on shared exposure to sources of CO with the type of housing and type of cooking fuel as most relevant factors, and less on person-individual risk factors or activities

Strengthening integration of chronic care in Africa: protocol for the qualitative process evaluation of integrated HIV, diabetes and hypertension care in a cluster randomised controlled trial in Tanzania and Uganda.

INTRODUCTION: In sub-Saharan Africa, the burden of non-communicable diseases (NCDs), particularly diabetes mellitus (DM) and hypertension, has increased rapidly in recent years, although HIV infection remains a leading cause of death among young-middle-aged adults. Health service coverage for NCDs remains very low in contrast to HIV, despite the increasing prevalence of comorbidity of NCDs with HIV. There is an urgent need to expand healthcare capacity to provide integrated services to address these chronic conditions. METHODS AND ANALYSIS: This protocol describes procedures for a qualitative process evaluation of INTE-AFRICA, a cluster randomised trial comparing integrated health service provision for HIV infection, DM and hypertension, to the current stand-alone vertical care. Interviews, focus group discussions and observations of consultations and other care processes in two clinics (in Tanzania, Uganda) will be used to explore the experiences of stakeholders. These stakeholders will include health service users, policy-makers, healthcare providers, community leaders and members, researchers, non-governmental and international organisations. The exploration will be carried out during the implementation of the project, alongside an understanding of the impact of broader structural and contextual factors. ETHICS AND DISSEMINATION: Ethical approval was granted by the Liverpool School of Tropical Medicine (UK), the National Institute of Medical Research (Tanzania) and TASO Research Ethics Committee (Uganda) in 2020. The evaluation will provide the opportunity to document the implementation of integration over several timepoints (6, 12 and 18 months) and refine integrated service provision prior to scale up. This synergistic approach to evaluate, understand and respond will support service integration and inform monitoring, policy and practice development efforts to involve and educate communities in Tanzania and Uganda. It will create a model of care and a platform of good practices and lessons learnt for other countries implementing integrated and decentralised community health services. TRIAL REGISTRATION NUMBER: ISRCTN43896688; Pre-results