Policy and stakeholder analysis to inform advocacy on drowning reduction among fishers in southern Lake Victoria, Tanzania: Report

Drowning is a significant risk in fishing communities in Lake Victoria, East Africa. In the southern part of the lake, within the United Republic of Tanzania (URT), the incidence of fatal drowning is estimated at 217 people per 100,000 person-years, far exceeding the estimated national average incidence (Sarassett et al. 2019; Whitworth et al. 2019). This study aimed to identify major stakeholders and potential approaches to drowning reduction advocacy for small-scale and artisanal fishers in southern Lake Victoria. Four key research questions were the focus of the study: a. Who are the main individual and institutional actors affecting or affected by changes in drowning policies or practices related to fishers in southern Lake Victoria? b. What is the existing policy and regulatory framework governing safety on the lake for fishers in southern Lake Victoria? c. Why have efforts to increase lake safety among fishers in southern Lake Victoria been successful or unsuccessful? d. How could current and potential stakeholders become more engaged in advocacy and agenda-setting to reduce fisher drowning in southern Lake Victoria? Research methods consisted of: • Review of 18 national acts, rules, regulations, policies and plans and 20 international agreements and voluntary guidance documents that are relevant to fisher water safety and drowning reduction in southern Lake Victoria, Tanzania; • 31 semi-structured in-depth interviews primarily conducted with government officers who work directly with the fisheries industry (i.e. shipping/transport, fisheries, or police) from the local to national levels; and • 8 focus group discussions primarily conducted with fishers and fishing community leaders in four villages in southern Lake Victoria. Results: Currently the main water safety stakeholders affecting or affected by drowning-related policies and practices in southern Lake Victoria are: small-scale fishers and their families; boat owners and builders; Beach Management Units (BMUs) and other local leaders; and Tanzania Shipping Agencies Corporation (TASAC), fisheries, and marine police officers; and the East African Community (EAC), e.g. the Lake Victoria Basin Commission (LVBC). Strengths of the national policy and regulatory framework are: active collaboration between the fisheries, transport, and police sectors; the meteorology sector is becoming stronger; the fisheries and shipping sectors generally have clear policies, rules, and regulations; the health and labour sectors have broadly relevant policies; and the youth sector has a specifically relevant policy. Weaknesses and gaps are that there is no national water safety plan or strategy, as recommended by the World Health Organization (WHO 2017; WHO 2018); few national documents directly address water safety among fishers on inland waters; and there is little attention to fisher water safety education and training needs. • Strengths of the international policy and regulatory framework include the planned LVMCT Project, the ratified SADC protocols, and the detailed, voluntary guidance on fisher water safety from international bodies within which the URT is a member. • Weaknesses and gaps are that many of the international fisheries documents do not address small-scale fishers in inland waters, and very few relevant international Conventions have been ratified by the URT

An observational study to inform potential drowning intervention strategies among fishing communities in the lake zone of Tanzania (DRIFT)

Lake Victoria, Africa's largest lake, is surrounded by an abundance of lakeside communities and supports a huge fishing industry. A recent study in Uganda suggested that drowning is a common threat within these communities. Perceived risk of drowning among fisher-folk on Lake Victoria is high, and possibly of greater concern than Human Immunodeficiency Virus (HIV) infection. Yet anecdotal evidence from Tanzanian communities suggests that risky behaviours associated with drowning are common practice. DRIFT was a mixed-methods study. We first obtained estimates of the drowning incidence among the lake-side communities by collecting data on all deaths occurring in each community over the past two years. Second, data on risk factors associated with drowning, risky behaviours in the fishing communities, perceived health risks and threats, and perceptions of potential interventions were collected from fishermen and the wider communities at eight lakeside fishing villages through structured surveys/questionnaires, in-depth interviews, focus group discussions, in-depth death reviews and observational analyses of behaviour. Preliminary data on social and economic impacts of drowning deaths were collected by interviewing family members and colleagues of victims

Drowning among fishing communities on the Tanzanian shore of lake Victoria: a mixed-methods study to examine incidence, risk factors and socioeconomic impact.

OBJECTIVES: To estimate the incidence of unintentional fatal drowning and describe associated risk factors among Lake Victoria fishing communities, and to assess perceived social, financial and other impacts among families and colleagues of persons who drowned. DESIGN: A retrospective, observational mixed-methods study, conducted between September 2017 and February 2018. SETTING: Eight Tanzanian fishing communities on Lake Victoria. PARTICIPANTS: Persons who drowned in the preceding 24 months were identified using an extensive community networking approach. Adult family members, colleagues or community members familiar with the habits and behaviours of people who drowned and/or circumstances of drowning incidents participated in surveys (n=44) and in-depth interviews (n=22). MAIN OUTCOME MEASURES: Pooled drowning incidence, with sensitivity analyses allowing for uncertainties in population estimates. Risk factors were identified through the evaluation of behavioural characteristics of persons who drowned and circumstances of drowning incidents. Perceived socioeconomic impacts were assessed through semi-structured interviews with their family members and colleagues. RESULTS: The estimated drowning incidence was 217/100 000 person-years (95% CI 118 to 425/100 000). Of 86 victims identified, 70 (81%) were fishermen (79% aged 18-40 years; all men) and 9 were children (all ≤10 years). All deaths occurred in the lake. Most adults (65/77; 84%) were fishing from a boat when they drowned; 57/77 (74%) died in the evening (from ~5 pm) or at night. Six children (67%) drowned while swimming/playing at the lakeshore unsupervised. Few victims (2/86; 2%) were wearing a life jacket at the time of death. Reported socioeconomic impacts of these deaths ranged from income loss to family break-up. CONCLUSIONS: Drowning is a significant risk in Tanzanian lakeside fishing communities, with estimated mortality exceeding national incidence rates of fatal malaria, tuberculosis or HIV, but preventative strategies appear uncommon. Socioeconomic impact at the family level may be substantial. Intervention strategies are required to reduce the drowning burden among this neglected at-risk population

Diagnosis of Burkitt lymphoma using an algorithmic approach - applicable in both resource-poor and resource-rich countries

Distinguishing Burkitt lymphoma (BL) from B cell lymphoma, unclassifiable with features intermediate between diffuse large B-cell lymphoma (DLBCL) and BL (DLBCL/BL), and DLBCL is challenging. We propose an immunohistochemistry and fluorescent in situ hybridization (FISH) based scoring system that is employed in three phases – Phase 1 (morphology with CD10 and BCL2 immunostains), Phase 2 (CD38, CD44 and Ki-67 immunostains) and Phase 3 (FISH on paraffin sections for MYC, BCL2, BCL6 and immunoglobulin family genes). The system was evaluated on 252 aggressive B-cell lymphomas from Europe and from sub-Saharan Africa. Using the algorithm, we determined a specific diagnosis of BL or not-BL in 82%, 92% and 95% cases at Phases 1, 2 and 3, respectively. In 3Æ4% cases, the algorithm was not completely applicable due to technical reasons. Overall, this approach led to a specific diagnosis of BL in 122 cases and to a specific diagnosis of either DLBCL or DLBCL/BL in 94% of cases that were not diagnosed as BL. We also evaluated the scoring system on 27 cases of BL confirmed on gene expression/microRNA expression profiling. Phase 1 of our scoring system led to a diagnosis of BL in 100% of these cases