Clinician’s awareness and knowledge on the management of differentiated thyroid cancer and the use of radioactive iodine in Tanzania

Introduction: Thyroid cancer is the most common endocrine malignancy worldwide with better outcome if timely and properly managed. Surgery followed by radioactive iodine (RAI) ablation remains the mainstay in the management of differentiated thyroid cancer (DTC). In Tanzania however, few patients with DTC receive RAI ablation post-surgery, and most of these present late, with advanced disease resulting in poor treatment outcome. The objective of this study was to determine the course for late referral by assessing clinician’s awareness and knowledge on the management of DTC and the use of RAI in Tanzania.Methods: This descriptive cross sectional study was carried out in referral hospitals in Tanzania. Data collection used a standardized self-administered questionnaire. Information sought included awareness, knowledge and practices of clinicians on the management and the use of RAI on patients with DTC was explored.Results: Majority of clinicians managing DTC patients were males (86%), in-training surgeons (54%), and attended less than ten DTC patients per year (62%). About 44% of in-training surgeons never heard of nuclear medicine (p=0.04), and 20% were not aware of the role of RAI in the management of DTC (p=0.031). Only 7.3% of surgeons were aware of the role of thyroxine therapy, or RAI ablation post-surgery. Of all DTC patients managed surgically, only 16% had total thyroidectomy with lymphadenectomy (p=0.05).Conclusion: The findings of this study indicate there is insufficient knowledge on proper management and use of RAI on patients with DTC among clinicians in Tanzania

Assessing the Effects of Mosquito Nets on Malaria Mortality Using a Space Time Model: A Case Study of Rufiji and Ifakara Health and Demographic Surveillance System Sites in Rural Tanzania.

Although malaria decline has been observed in most sub-Saharan African countries, the disease still represents a significant public health burden in Tanzania. There are contradictions on the effect of ownership of at least one mosquito net at household on malaria mortality. This study presents a Bayesian modelling framework for the analysis of the effect of ownership of at least one mosquito net at household on malaria mortality with environmental factors as confounder variables. The analysis used longitudinal data collected in Rufiji and Ifakara Health Demographic Surveillance System (HDSS) sites for the period of 1999-2011 and 2002-2012, respectively. Bayesian framework modelling approach using integrated nested laplace approximation (INLA) package in R software was used. The space time models were established to assess the effect of ownership of mosquito net on malaria mortality in 58 villages in the study area. The results show that an increase of 10 % in ownership of mosquito nets at village level had an average of 5.2 % decrease inall age malaria deaths (IRR = 0.948, 95 % CI = 0.917, 0.977) in Rufiji HDSS and 12.1 % decrease in all age malaria deaths (IRR = 0.879, 95 % CI = 0.806, 0.959) in Ifakara HDSS. In children under 5 years, results show an average of 5.4 % decrease of malaria deaths (IRR = 0.946, 95 % CI = 0.909, 0.982) in Rufiji HDSS and 10 % decrease of malaria deaths (IRR = 0.899, 95 % CI = 0.816, 0.995) in Ifakara HDSS. Model comparison show that model with spatial and temporal random effects was the best fitting model compared to other models without spatial and temporal, and with spatial-temporal interaction effects. This modelling framework is appropriate and provides useful approaches to understanding the effect of mosquito nets for targeting malaria control intervention. Furthermore, ownership of mosquito nets at household showed a significant impact on malaria mortality

Count time series models for road traffic accidents in Tanzania Mainland

A pairwise analysis was conducted to assess the trends and factors associated with road traffic accidents in Tanzania. The Poisson and Negative Binomial Autoregressive Models were used to extend log linear functions by accounting time-varying components. A total of 85,514 road traffic accidents in Tanzania mainland that occurred from 2012 to 2017 were extracted from Tanzania Police Office records. Eleven factors were grouped into a human, vehicle, physical/environmental and pedestrian-related factors. The Likelihood ratio test, Akaike Information Criterion, Bayesian Information Criterion and residual ACF plots were used to evaluate the performance of the models in Dar es Salaam and other combined regions. The trend analysis indicated a declining pattern in all factors and human-related factors appeared higher than the other three factors. The highest number of road traffic accidents was observed in Dar es Salaam Region compared to other combined regions. The models, including its past values and time-varying factors, were in favour-of other models. In both, Dar es Salaam and other combined regions, non-linear pattern and Negative Binomial Autoregressive Models fitted the data well. The implementation of collective actions in recent years seems positive on road traffic accidents. Nevertheless, more emphasis is needed to monitor trends on the number of accidents and related fatalities. Keywords: Road Traffic Accidents, Poisson, Negative binomial, Autoregressive Models, Tanzania

Community Perceptions and Experiences on the Use of Oil and Gas in Tanzania Mainland: A Triangulation Method Study

This paper employed a cross-sectional mixed design to explore community perceptions and experiences on the use of oil and gas through triangulation methods. Quantitative and qualitative research designs were adopted for data collection and analysis. The quantitative data collection strand comprised 403 individual respondents, while the qualitative part involved 8 focus group discussions. Village mapping was also undertaken to describe the community-level energy network and identify potential stakeholders. The paper applied the logistic regression model to convert response averages of selected impacts and contributions that reflect perceptions of oil and gas in the community. On the other hand, the study used a qualitative technique for theme identification. The results suggest  positive perceptions of respondents about the use of oil and gas. Specifically, sex, highest level of education, average expenditure per day, and region and government initiatives predicted peoples’ perceptions of continuous supply of electricity, conservation of the environment, and suitability on domestic use. Factors identified to be associated with contribution to employment and social  infrastructure include sex, age, highest level of education, region, government enforcement of openness, and people’s attendance ofvillage meetings. It is recommended that efforts be devoted to providing people with adequate and relevant information that will equip them with knowledge about oil and gas. and thus empower them to manage uses of modern energy. Keywords: perceptions, oil, gas, mixed approach, Mtwara and Pwan