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

Lymphomas in sub-Saharan Africa - what can we learn and how can we help in improving diagnosis, managing patients and fostering translational research?

Approximately 30 000 cases of non-Hodgkin lymphoma (NHL) occur in the equatorial belt of Africa each year. Apart from the fact that Burkitt lymphoma (BL) is very common among children and adolescents in Africa and that an epidemic of human immunodeficiency virus (HIV) infection is currently ongoing in this part of the world, very little is known about lymphomas in Africa. This review provides information regarding the current infrastructure for diagnostics in sub-Saharan Africa. The results on the diagnostic accuracy and on the distribution of different lymphoma subsets in sub-Saharan Africa were based on a review undertaken by a team of lymphoma experts on 159 fine needle aspirate samples and 467 histological samples during their visit to selected sub- Saharan African centres is presented. Among children (age), BL accounted for 82% of all NHL, and among adults, diffuse large B-cell lymphoma accounted for 55% of all NHLs. Among adults, various lymphomas other than BL, including T-cell lymphomas, were encountered. The review also discusses the current strategies of the International Network of Cancer Treatment and Research on improving the diagnostic standards and management of lymphoma patients and in acquiring reliable clinical and pathology data in sub- Saharan Africa for fostering high-quality translational research

Trends of frequency, mortality and risk factors among patients admitted with stroke from 2017 to 2019 to the medical ward at Kilimanjaro Christian Medical Centre hospital: a retrospective observational study

Objective The burden of stroke has increased in recent years worldwide, particularly in low-income and middle-income countries. In this study we aim to determine the number of stroke admissions, and associated comorbidities, at a referral hospital in Northern Tanzania.Design This was a retrospective observational study.Setting The study was conducted at a tertiary referral hospital, Kilimanjaro Christian Medical Centre (KCMC), in the orthern zone of Tanzania.Participants The study included adults aged 18 years and above, who were admitted to the medical wards from 2017 to 2019.Outcome The primary outcome was the proportion of patients who had a stroke admitted in the medical ward at KCMC and the secondary outcome was clinical outcome such as mortality.Methods We conducted a retrospective audit of medical records from 2017 to 2019 for adult patients admitted to the medical ward at KCMC. Data extracted included demographic characteristics, previous history of stroke and outcome of the admission. Factors associated with stroke were investigated using logistic regression.Results Among 7976 patients admitted between 2017 and 2019, 972 (12.2%) were patients who had a stroke. Trends show an increase in patients admitted with stroke over the 3 years with 222, 292 and 458 in 2017, 2018 and 2019, respectively. Of the patients who had a stroke, 568 (58.4%) had hypertension while 167 (17.2%) had diabetes mellitus. The proportion of admitted stroke patients aged 18–45 years, increased from 2017 (n=28, 3.4%) to 2019 (n=40, 4.3%). The in-hospital mortality related to stroke was 229 (23.6%) among 972 patients who had a stroke and female patients had 50% higher odds of death as compared with male patients (OR:1.5; CI 1.30 to 1.80).Conclusion The burden of stroke on individuals and health services is increasing over time, which reflects a lack of awareness on the cause of stroke and effective preventive measures. Prioritising interventions directed towards the reduction of non-communicable diseases and associated complications, such as stroke, is urgently needed

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

Abstracts of Tanzania Health Summit 2020

This book contains the abstracts of the papers/posters presented at the Tanzania Health Summit 2020 (THS-2020) Organized by the Ministry of Health Community Development, Gender, Elderly and Children (MoHCDGEC); President Office Regional Administration and Local Government (PORALG); Ministry of Health, Social Welfare, Elderly, Gender, and Children Zanzibar; Association of Private Health Facilities in Tanzania (APHFTA); National Muslim Council of Tanzania (BAKWATA); Christian Social Services Commission (CSSC); & Tindwa Medical and Health Services (TMHS) held on 25–26 November 2020. The Tanzania Health Summit is the annual largest healthcare platform in Tanzania that attracts more than 1000 participants, national and international experts, from policymakers, health researchers, public health professionals, health insurers, medical doctors, nurses, pharmacists, private health investors, supply chain experts, and the civil society. During the three-day summit, stakeholders and decision-makers from every field in healthcare work together to find solutions to the country’s and regional health challenges and set the agenda for a healthier future. Summit Title: Tanzania Health SummitSummit Acronym: THS-2020Summit Date: 25–26 November 2020Summit Location: St. Gasper Hotel and Conference Centre in Dodoma, TanzaniaSummit Organizers: Ministry of Health Community Development, Gender, Elderly and Children (MoHCDGEC); President Office Regional Administration and Local Government (PORALG); Ministry of Health, Social Welfare, Elderly, Gender and Children Zanzibar; Association of Private Health Facilities in Tanzania (APHFTA); National Muslim Council of Tanzania (BAKWATA); Christian Social Services Commission (CSSC); & Tindwa Medical and Health Services (TMHS)