Hookworm Infection and Environmental Factors in Mbeya Region, Tanzania: A Cross-sectional, Population-based study.

Hookworm disease is one of the most common infections and cause of a high disease burden in the tropics and subtropics. Remotely sensed ecological data and model-based geostatistics have been used recently to identify areas in need for hookworm control. Cross-sectional interview data and stool samples from 6,375 participants from nine different sites in Mbeya region, south-western Tanzania, were collected as part of a cohort study. Hookworm infection was assessed by microscopy of duplicate Kato-Katz thick smears from one stool sample from each participant. A geographic information system was used to obtain remotely sensed environmental data such as land surface temperature (LST), vegetation cover, rainfall, and elevation, and combine them with hookworm infection data and with socio-demographic and behavioral data. Uni- and multivariable logistic regression was performed on sites separately and on the pooled dataset. Univariable analyses yielded significant associations for all ecological variables. Five ecological variables stayed significant in the final multivariable model: population density (odds ratio (OR) = 0.68; 95% confidence interval (CI) = 0.63-0.73), mean annual vegetation density (OR = 0.11; 95% CI = 0.06-0.18), mean annual LST during the day (OR = 0.81; 95% CI = 0.75-0.88), mean annual LST during the night (OR = 1.54; 95% CI = 1.44-1.64), and latrine coverage in household surroundings (OR = 1.02; 95% CI = 1.01-1.04). Interaction terms revealed substantial differences in associations of hookworm infection with population density, mean annual enhanced vegetation index, and latrine coverage between the two sites with the highest prevalence of infection. This study supports previous findings that remotely sensed data such as vegetation indices, LST, and elevation are strongly associated with hookworm prevalence. However, the results indicate that the influence of environmental conditions can differ substantially within a relatively small geographic area. The use of large-scale associations as a predictive tool on smaller scales is therefore problematic and should be handled with care

Implementation research of a cluster randomized trial evaluating the implementation and effectiveness of intermittent preventive treatment for malaria using dihydroartemisinin-piperaquine on reducing malaria burden in school-aged children in Tanzania: methodology, challenges, and mitigation

BACKGROUND: It has been more than 20 years since the malaria epidemiologic shift to school-aged children was noted. In the meantime, school-aged children (5-15 years) have become increasingly more vulnerable with asymptomatic malaria prevalence reaching up to 70%, making them reservoirs for subsequent transmission of malaria in the endemic communities. Intermittent Preventive Treatment of malaria in schoolchildren (IPTsc) has proven to be an effective tool to shrink this reservoir. As of 3(rd) June 2022, the World Health Organization recommends IPTsc in moderate and high endemic areas. Even so, for decision-makers, the adoption of scientific research recommendations has been stifled by real-world implementation challenges. This study presents methodology, challenges faced, and mitigations used in the evaluation of the implementation of IPTsc using dihydroartemisinin-piperaquine (DP) in three councils (Handeni District Council (DC), Handeni Town Council (TC) and Kilindi DC) of Tanga Region, Tanzania so as to understand the operational feasibility and effectiveness of IPTsc on malaria parasitaemia and clinical malaria incidence. METHODS: The study deployed an effectiveness-implementation hybrid design to assess feasibility and effectiveness of IPTsc using DP, the interventional drug, against standard of care (control). Wards in the three study councils were the randomization unit (clusters). Each ward was randomized to implement IPTsc or not (control). In all wards in the IPTsc arm, DP was given to schoolchildren three times a year in four-month intervals. In each council, 24 randomly selected wards (12 per study arm, one school per ward) were chosen as representatives for intervention impact evaluation. Mixed design methods were used to assess the feasibility and acceptability of implementing IPTsc as part of a more comprehensive health package for schoolchildren. The study reimagined an existing school health programme for Neglected Tropical Diseases (NTD) control include IPTsc implementation. RESULTS: The study shows IPTsc can feasibly be implemented by integrating it into existing school health and education systems, paving the way for sustainable programme adoption in a cost-effective manner. CONCLUSIONS: Through this article other interested countries may realise a feasible plan for IPTsc implementation. Mitigation to any challenge can be customized based on local circumstances without jeopardising the gains expected from an IPTsc programme. Trial registration clinicaltrials.gov, NCT04245033. Registered 28 January 2020, https://clinicaltrials.gov/ct2/show/NCT04245033

Impact of contaminated sites legislation on closure of an acid generating mine site in British Columbia

In the past few years, numerous mine closure and reclamation projects have been subjected to the provincial Contaminated Sites Regulation (CSR) in British Columbia. A mine decommissioning and closure plan should contain among other things a Detailed Site Investigation report, a Remedial Action Plan and the necessary financial security to ensure funds are available to carry out the remediation work. The intent of the CSR has been to facilitate the complete sign off of long-term environmental liability to a company by government from a particular site through requiring a company to meet all the requirements defined in the regulation. This sign off can be in the form of a Certificate of Compliance, Conditional Certificate of Compliance or Letter of Comfort. Contaminated Sites Regulations have been developed predominantly for industrial or commercial sites usually in an urban environment with clearly defined contaminants associated with the particular industry. Problems associated with acid rock drainage and acid generating sulphide waste contamination are not clearly defined in these regulations. Complications arise when applying the CSR to the mining sector. In particular, the interpretation of a regulation which defines "contaminated site" based on concentrations of naturally occurring inorganic substances (metals) in soil and groundwater In addition, the CSR bureaucratic process has not been generally structured to blend with more traditional mine closure plans required under the Mines Act even though the regulations are somewhat linked. While the intent of government has been to link and harmonize the CSR with the mine closure regulations, in BC, the harmonization of the regulations and various ministries has yet to be tested fully and it is anticipated will require modification to the regulations. This paper will give an overview of the environmental regulatory context in British Columbia with particular reference to CSR requirements at acid generating mine sites. In addition, technical and administrative requirements will be given together with a discussion of the impacts of these regulations on the mining industry and ways to plan and manage associated liabilities.Non UBCUnreviewedOthe

The slaughter of increased numbers of pregnant cows in Tanga abattoir, Tanzania: A cause for concern?

Information on the level of foetal wastage in slaughtered cattle in Tanzania is limited. A three-month observational study (April – June 2014) of animals slaughtered at the Tanga abattoir in Tanga region, Tanzania was carried out to determine the number of pregnant cows slaughtered. The total number of cattle slaughtered during the study period was 3643, representing a monthly kill average of 1214 and a daily kill average of 40. Over 98% of the cattle presented to the abattoir for slaughter were local breed (Tanzania shorthorn zebu) and most were above 3 years of age. Improved breeds of cattle represented only 1.3% of all slaughters. Of the cattle slaughtered, 2256 (61.9%) were female and 1387 (38.1%) were male. A total of 655 slaughtered cows were pregnant, representing a foetal wastage of 29.1%. Of the 655 recovered foetuses, 333 (50.8%) were male and 322 (49.2%) were female. Of the recovered foetuses, 25.8% were recovered in the first, 42.7% in the second and 31.6% in the third trimester. This study indicates cases of significant foetal losses, negatively impacting future replacement stock as a result of the slaughter of pregnant animals. The indiscriminate slaughter of pregnant cows suggests that existing animal welfare legislation is not sufficiently enforced and routine veterinary ante-mortem inspection of trade animals is failing to prevent the high level of foetal wastage

Age specific prevalence of impairment and disability relating to hemiplegic stroke in the Hai District of northern Tanzania

OBJECTIVES—To determine the age specific prevalence of impairment and disability relating to hemiplegic stroke in one rural area of Tanzania.
METHODS—During the yearly house to house census of the study population of 148 135 (85 152 aged 15 and over) in August 1994, specific questions were asked to identify those who might be disabled from stroke. People thus identified were subsequently interviewed and examined by one investigator. In those in whom the clinical diagnosis of stroke was confirmed a more detailed interview and examination relating to risk factors and recovery was carried out.
RESULTS—One hundred and eight patients, 61 men and 47 women, were identified with a median age of 70 (range 18-100). Median age at first stroke was 65 years. The age specific rates in this study were lower than previous studies in developed countries. All were cared for at home although 23 (21%) were bedbound.
CONCLUSIONS—Although prevalence of impairment and disability related to stroke in this population as a whole was low this is mainly explained by the age structure, with less than 6% being aged 65 and over. Age standardised rates for stroke with residual disability were about half those found in previous studies in developed countries. Death from stroke in Africa may be higher but data are limited. With the demographic transition stroke is likely to become a more important cause of disability in sub-Saharan Africa.


Outcome of district Health Care Services measured using verbal autopsy technique: Experience from North-Eastern Tanzania

(Tanzania Health Research Bulletin, 2001, Supplement 2(2): 56-65