Foot-and-mouth disease in Tanzania from 2001 to 2006.

Foot-and-mouth disease (FMD) is endemic in Tanzania, with outbreaks occurring almost each year in different parts of the country. There is now a strong political desire to control animal diseases as part of national poverty alleviation strategies. However, FMD control requires improving the current knowledge on the disease dynamics and factors related to FMD occurrence so control measures can be implemented more efficiently. The objectives of this study were to describe the FMD dynamics in Tanzania from 2001 to 2006 and investigate the spatiotemporal patterns of transmission. Extraction maps, the space-time K-function and space-time permutation models based on scan statistics were calculated for each year to evaluate the spatial distribution, the spatiotemporal interaction and the spatiotemporal clustering of FMD-affected villages. From 2001 to 2006, 878 FMD outbreaks were reported in 605 different villages of 5815 populated places included in the database. The spatial distribution of FMD outbreaks was concentrated along the Tanzania-Kenya, Tanzania-Zambia borders, and the Kagera basin bordering Uganda, Rwanda and Tanzania. The spatiotemporal interaction among FMD-affected villages was statistically significant (P≤0.01) and 12 local spatiotemporal clusters were detected; however, the extent and intensity varied across the study period. Dividing the country in zones according to their epidemiological status will allow improving the control of FMD and delimiting potential FMD-free areas

Risk factors for placental malaria and associated adverse pregnancy outcomes in Rufiji, Tanzania: a hospital based cross sectional study

Background: Prevention and treatment of malaria during pregnancy is crucial for reduction of malaria in pregnancy and its adverse outcomes. The spread of parasite resistance to Sulphadoxine-Pyrimethamine (SP) used for Intermittent Preventive Treatment for malaria in pregnancy (IPTp), particularly in East Africa has raised concerns about the usefulness and the reliability of the IPTp regimen. We aimed to  assess the effectiveness of two doses of SP in treating and preventing occurrence of adverse pregnancy outcomes.Methodology: The study was an analytical cross sectional study which enrolled 350 pregnant women from Kibiti Health Centre, South Eastern Tanzania. Structured questionnaires were used to obtain  previous obstetrics and medical history of participants and verified by reviewing antenatal clinic cards. Maternal placental blood samples for microscopic examination of malaria parasites were collected after delivery. Data was analyzed for associations between SP dosage, risk for PM and pregnancy outcome. Sample size was estimated based on precisionResults: Prevalence of placental maternal (PM) was 8% among pregnant women (95%CI, 4.4-13.1%). Factors associated with increased risk of PM were primigravidity (P<0.001) and history of fever during pregnancy (P= 0.02). Use of at least 2 doses of SP for IPTp during pregnancy was insignificantly associated with reducing the risk PM (P=0.08), low birth weight (P=0.73) and maternal anemia (P=0.71) but associated significantly with reducing the risk of preterm birth (P<0.001).Conclusion: Two doses of SP for IPTp regime are ineffective in preventing and treating PM and adverse pregnancy outcome. Hence a review to the current IPTp regimen should be considered with possibility of integrating it with other malaria control strategies.Keywords: Placental malaria, intermittent preventive treatment, Sulphadoxine-Pyrimethamine, Malaria in pregnanc

The costs of accessible quality assured syphilis diagnostics: informing quality systems for rapid syphilis tests in a Tanzanian setting.

OBJECTIVES: To determine the costs of Rapid Syphilis Test (RSTs) as compared with rapid plasma reagin (RPR) when implemented in a Tanzanian setting, and to determine the relative impact of a quality assurance (QA) system on the cost of RST implementation. METHODS: The incremental costs for RPR and RST screening programmes in existing antenatal care settings in Geita District, Tanzania were collected for 9 months in subsequent years from nine health facilities that varied in size, remoteness and scope of antenatal services. The costs per woman tested and treated were estimated for each facility. A sensitivity analysis was constructed to determine the impact of parameter and model uncertainty. FINDINGS: In surveyed facilities, a total of 6362 women were tested with RSTs compared with 224 tested with RPR. The range of unit costs was $1.76-$3.13 per woman screened and $12.88-$32.67 per woman treated. Unit costs for the QA system came to $0.51 per woman tested, of which 50% were attributed to salaries and transport for project personnel. CONCLUSIONS: Our results suggest that rapid syphilis diagnostics are very inexpensive in this setting and can overcome some critical barriers to ensuring universal access to syphilis testing and treatment. The additional costs for implementation of a quality system were found to be relatively small, and could be reduced through alterations to the programme design. Given the potential for a quality system to improve quality of diagnosis and care, we recommend that QA activities be incorporated into RST roll-out

Ferroelectric Polarization Dependent Interactions at Pd-LiNbO\u3csub\u3e3\u3c/sub\u3e(0001) Interfaces

A combination of Auger electron spectroscopy and temperature-programed desorption was used to characterize the growth and interaction of Pd films with positively and negatively terminated ferroelectric LiNbO3(0001) surfaces. The growth mode of vapor-deposited Pd layers at 300 K was found to be dependent on the direction of the ferroelectric polarization with layer-by-layer growth occurring on the negative (c−) surface and particle formation occurring on the positive (c+) surface. The Pd metal layers were also found to be more thermally stable on the c− surface relative to the c+ surface. These results provide another example of how the polarization orientation in ferroelectric materials affects adsorption and reaction on their exposed surfaces

Development partner support to the health sector at the local level in Morogoro region, Tanzania

Background: The Tanzanian health sector receives large amounts of funding from multiple international development partners to support a broad range of population-health interventions. However, little is known about the partners’ level of commitment to sustain funding, and the implications of uncertainties created by these funding mechanisms.  This study had the following objectives: 1) To present a theoretical model for assessing funding commitments by health development partners in a specified region; 2) to describe development partner funding commitments against this framework, using a case study example of Morogoro Region, Tanzania; and 3) to discuss policy considerations using this framework for district, regional and national level.Methods: Qualitative case study methodology was used to assess funding commitments of health-related development partners in Morogoro Region, Tanzania. Using qualitative data, collected as part of an evaluation of maternal and child health programs in Morogoro Region, key informants from all development partners were interviewed and thematic analysis was conducted for the assessment. Results: Our findings show that decisions made on where to commit and direct funds were based on recipient government and development partner priorities. These decisions were based on government directives, such as the need to provide health services to vulnerable populations; the need to contribute towards alleviation of disease burden and development partner interests, including humanitarian concerns. Poor coordination of partner organizations and their funding priorities may undermine benefits to target populations. This weakness poses a major challenge on development partner investments in health, leading to duplication of efforts and resulting in stagnant disease burden levels.Conclusion: Effective coordination mechanisms between all stakeholders at each level should be advocated to provide a forum to discuss interests and priorities, so as to harmonize them and facilitate the implementation of development partner funded activities in the recipient countries

Optimal timing of primaquine to reduce Plasmodium falciparum gametocyte carriage when co-administered with artemether-lumefantrine.

BACKGROUND: Primaquine is an important gametocytocidal drug that is combined with conventional malaria treatment for prevention of Plasmodium falciparum malaria transmission. Primaquine has been administered together on the first or the last day of conventional treatment but the impact of primaquine timing has never been examined. This study aimed to assess safety, efficacy and optimal timing of single full-dose (0.75 mg/kg) primaquine when added to a standard 6-dose regimen of artemether-lumefantrine (AL). METHODS: In an individual-level randomized controlled trial, enrolled participants who were G6PD normal and had uncomplicated P. falciparum malaria were randomly assigned to receive: AL only; AL and a single 0.75 mg/kg primaquine dose on the first day of AL (day 1); or AL and single 0.75 mg//kg primaquine on the last day of AL (day 3). On days 2, 3, 4, 8, 11 and 15, gametocytes were assessed and quantified by microscope and quantitative nuclear acid sequence based quantification (QT-NASBA). RESULTS: Overall, 111 participants aged between 3 and 17 years were randomly allocated to receive AL only (36) or combined with primaquine on day 1 (38), or primaquine on day 3 (37). Day 4 gametocyte prevalence in AL?+?day 1 primaquine was half the level seen in either AL?+?day 3 primaquine or AL only arm (11% [4/35] vs 26% [8/31] and 27% [8/30], respectively) albeit not statistically significant. A similar trend of lower gametocyte in the AL?+?day 1 primaquine verses AL?+?day 3 primaquine or AL only arm was observed in mean gametocyte density. Mean (sd) haemoglobin level in AL?+?day 3 primaquine arm recovered from -0.42(1.2) g/dl on day 2 to 0.35 (1.5) g/dl on day 15 of follow up. This was not the case in AL only and AL?+?day 1 primaquine arms during the same follow-up period, although the difference was not statistically significant (p?=?318). No serious adverse events reported in the study. Across arms, 23% (26/111) of participants reported a total of 31 mild adverse events and the difference was not statistically significant (p?=?0.477). CONCLUSION: Primaquine administration on the first day of AL is well tolerated and as safe as later administration. Whilst the World Health Organization currently recommends a lower dose of primaquine (0.25 mg/kg), the findings are supportive of early primaquine administration when combined with artemisinin-combination therapy. ClinicalTrials.gov Registration NCT01906788

Factors influencing adherence to antiretroviral therapy among people living with HIV in an urban and rural setting, Tanzania

Adherence is one of the most crucial determinants of treatment response to antiretroviral therapy (ART). An analytical cross-sectional study was conducted in 24 Care and Treatment Centres (CTC) in Dar es Salaam and Iringa regions in Tanzania. Data was collected using questionnaire and appointments records. A total of 943 patients attending at the care and treatment sites in Dar es Salaam and Iringa were recruited. Adherence based on keeping appointments and on four days recall was 65% and 70%, respectively. Adherence based on taking ART more than 95% of the time in one month was 83%. Satisfaction with health services, having treatment support, having knowledge on the use of ART, early presentation to CTC, and being on ART for more than one year, were associated with good adherence. Being in the urban region, using traditional medicine, medicine side effects and alcohol consumption problems negatively associated with adherence to ART.Keywords: Adherence barriers, antiretroviral therapy, HIV, Tanzania, rural, urba

Combination of Insecticide Treated Nets and Indoor Residual Spraying in Northern Tanzania Provides Additional Reduction in Vector Population Density and Malaria Transmission Rates Compared to Insecticide Treated Nets Alone: A Randomised Control Trial.

Indoor residual spraying (IRS) combined with insecticide treated nets (ITN) has been implemented together in several sub-Saharan countries with inconclusive evidence that the combined intervention provides added benefit. The impact on malaria transmission was evaluated in a cluster randomised trial comparing two rounds of IRS with bendiocarb plus universal coverage ITNs, with ITNs alone in northern Tanzania. From April 2011 to December 2012, eight houses in 20 clusters per study arm were sampled monthly for one night with CDC light trap collections. Anopheles gambiae s.l. were identified to species using real time PCR Taq Man and tested for the presence of Plasmodium falciparum circumsporozoite protein. ITN and IRS coverage was estimated from household surveys. IRS coverage was more than 85% in two rounds of spraying in January and April 2012. Household coverage with at least one ITN per house was 94.7% after the universal coverage net campaign in the baseline year and the proportion of household with all sleeping places covered by LLIN was 50.1% decreasing to 39.1% by the end of the intervention year. An.gambiae s.s. comprised 80% and An.arabiensis 18.3% of the anopheline collection in the baseline year. Mean An.gambiae s.l. density in the ITN+IRS arm was reduced by 84% (95%CI: 56%-94%, p = 0.001) relative to the ITN arm. In the stratum of clusters categorised as high anopheline density at baseline EIR was lower in the ITN+IRS arm compared to the ITN arm (0.5 versus 5.4 per house per month, Incidence Rate Ratio: 0.10, 95%CI: 0.01-0.66, p-value for interaction <0.001). This trial provides conclusive evidence that combining carbamate IRS and ITNs produces major reduction in Anopheles density and entomological inoculation rate compared to ITN alone in an area of moderate coverage of LLIN and high pyrethroid resistance in An.gambiae s.s

Spatial and temporal variation in malaria transmission in a low endemicity area in northern Tanzania

BACKGROUND: Spatial and longitudinal monitoring of transmission intensity will allow better targeting of malaria interventions. In this study, data on meteorological, demographic, entomological and parasitological data over the course of a year was collected to describe malaria epidemiology in a single village of low transmission intensity. METHODS: Entomological monitoring of malaria vectors was performed by weekly light trap catches in 10 houses. Each house in the village of Msitu wa Tembo, Lower Moshi, was mapped and censused. Malaria cases identified through passive case detection at the local health centre were mapped by residence using GIS software and the incidence of cases by season and distance to the main breeding site was calculated. RESULTS: The principle vector was Anopheles arabiensis and peak mosquito numbers followed peaks in recent rainfall. The entomological inoculation rate estimated was 3.4 (95% CI 0.7–9.9) infectious bites per person per year. The majority of malaria cases (85/130) occurred during the rainy season (χ(2 )= 62,3, p < 0.001). Living further away from the river (OR 0.96, CI 0.92–0.998, p = 0.04 every 50 m) and use of anti-insect window screens (OR 0.65, CI 0.44–0.94, p = 0.023) were independent protective factors for the risk of malaria infection. Children aged 1–5 years and 5–15 years were at greater risk of clinical episodes (OR 2.36, CI 1.41–3.97, p = 0.001 and OR 3.68, CI 2.42–5.61, p < 0.001 respectively). CONCLUSION: These data show that local malaria transmission is restricted to the rainy season and strongly associated with proximity to the river. Transmission reducing interventions should, therefore, be timed before the rain-associated increase in mosquito numbers and target households located near the river