Injury experience in Tanzania - Need for intervention

Objective: To determine distribution of injuries and factors associated with mortality in six hospitals of Tanzania mainland.Design: A Cross - Sectional hospital based study.Setting: Data were collected from casualty departments of Muhimbili Orthopaedic Institute, Morogoro, Mtwara, Kigoma, Musoma regional hospitals and Korogwe district hospital.Subjects: Patients who sustained injuries and attended in six involved hospitals between November 2011 and December 2012.Results: Of the 9316 injury patients seen, 71.7% were males. Majority (55%) were between 18 – 45 years age group. Traffic crashes were the leading cause of injuries and accounted for 47.5% of all injuries. Fractures accounted for 49.2%, and injuries were severe in 1.2% as determined by the Kampala trauma score II (KTS II). Majorities 66.7% were admitted and 2.4% died at the casualty. Factors associated with mortality were; being unemployed (P = 0.000), using ambulances to the hospital (P = 0.000), receiving medical attention within 2 to 10 hours after injury (P = 0.001), road traffic crashes (P = 0.000), 18 - 45 years age group (P = 0.003), low KTS II score (P = 0.000) and sustaining head injury (P = 0.000).Conclusion: Injuries in Tanzania are an important public health problem, predominantly in adult males, mostly due to traffic crashes. It is therefore important to reinforce preventive measures and pre-hospital emergency service is urgently needed

Phenotypic Variation in Fruit Morphology among Provenances of Sclerocarya birrea

Sclerocarya birrea (A. Rich.) Hochst. is a multipurpose fruit tree which is very useful in providing food security and meeting nutritional and economic needs. This study was conducted to assess eighteen provenances of Sclerocarya birrea planted in Mangochi, Malawi. The trial was assessed for fruit traits at fifteen years of age. There were significant (P<0.001) variations among the provenances in number of fruits, fruit weight, pulp weight, seed weight, fruit length, and diameter. Magunde provenance from Mozambique had the highest mean number of fruits, 2196 ± 200. Mangochi and Moamba provenances from Malawi and Mozambique were the most outstanding in the other parameters measured attaining the mean fruit weight of 20.89 ± 0.25 g and 25.67 ± 0.67 g, pulp weight of 25.70 ± 0.08 g and 21.55 ± 0.83 g, seed weight of 4.81 ± 0.35 g and 4.12 ± 0.18 g, fruit length of 2.61 ± 0.14 cm and 2.33 ± 0.07 cm, and fruit diameter of 2.33 ± 0.15 cm and 1.97 ± 0.08 cm, respectively. There was no significant (P>0.05) correlation between number of fruits and the other fruit traits. However, there were significant (P<0.05) and strong positive relationships between fruit weight and pulp weight (r=0.987) and fruit length and diameter (r=0.775). This suggests that fruit weight can be used indirectly for selection of pulp. Further studies should investigate fruit taste quality of products from the fruits

The impact of HIV on morbidity and mortality from tuberculosis in sub-Saharan Africa: a study of rural Malawi and review of the literature

Since the mid-1980s tuberculosis (TB) case numbers and HIV seroprevalence have both risen sharply in sub-Saharan Africa. Estimates for the relative risk of TB in those infected with HIV have ranged from less than five to more than 20. The proportion of TB cases attributable to HIV (the population attributable fraction) has been calculated for several populations but is difficult to interpret if no account is taken of the age and sex distribution of the cases. In a rural area of Malawi we have studied the proportion of TB attributable to HIV over time. Nearly 40 per cent of smear-positive TB cases in this rural area of Malawi can now be attributed directly to HIV. The actual effect of HIV on TB is even greater than this because increased case numbers increase transmission of tuberculosis infection to both HIV-infected and non-infected sections of the population. We compare our findings with others from sub-Saharan Africa and discuss reasons for the differences, and methodological issues in interpretatio

Genetic risk score for adult body mass index associations with childhood and adolescent weight gain in an African population

Abstract Background Ninety-seven independent single nucleotide polymorphisms (SNPs) are robustly associated with adult body mass index (BMI kg/m2) in Caucasian populations. The relevance of such variants in African populations at different stages of the life course (such as childhood) is unclear. We tested whether a genetic risk score composed of the aforementioned SNPs was associated with BMI from infancy to early adulthood. We further tested whether this genetic effect was mediated by conditional weight gain at different growth periods. We used data from the Birth to Twenty Plus Cohort (Bt20+), for 971 urban South African black children from birth to 18 years. DNA was collected at 13 years old and was genotyped using the Metabochip (Illumina) array. The weighted genetic risk score (wGRS) for BMI was constructed based on 71 of the 97 previously reported SNPs. Results The cross-sectional association between the wGRS and BMI strengthened with age from 5 to 18 years. The significant associations were observed from 11 to 18 years, and peak effect sizes were observed at 13 and 14 years of age. Results from the linear mixed effects models showed significant interactions between the wGRS and age on longitudinal BMI but no such interactions were observed in sex and the wGRS. A higher wGRS was associated with an increased relative risk of belonging to the early onset obese longitudinal BMI trajectory (relative risk = 1.88; 95%CI 1.28 to 2.76) compared to belonging to a normal longitudinal BMI trajectory. Adolescent conditional relative weight gain had a suggestive mediation effect of 56% on the association between wGRS and obesity risk at 18 years. Conclusions The results suggest that genetic susceptibility to higher adult BMI can be tracked from childhood in this African population. This supports the notion that prevention of adult obesity should begin early in life. The genetic risk score combined with other non-genetic risk factors, such as BMI trajectory membership in our case, has the potential to be used to screen for early identification of individuals at increased risk of obesity and other related NCD risk factors in order to reduce the adverse health risk outcomes later

The effect of HIV and antiretroviral therapy on characteristics of pulmonary tuberculosis in northern Malawi: a cross-sectional study.

BACKGROUND: HIV infection reduces the likelihood that individuals with pulmonary tuberculosis are smear positive and that they have cavitatory disease. Antiretroviral therapy (ART) may shift the pattern of disease to be more similar to that of HIV negative patients. This would aid diagnosis--which often depends on sputum smears--but would also increase infectiousness. We assessed the effect of HIV and ART on smear positivity and cavitatory disease in laboratory-confirmed pulmonary TB patients. METHODS: Three sputum samples were collected per pulmonary TB suspect and were examined using microscopy and culture. Chest radiographs were available for a subset of patients as part of another study. The effect of HIV and ART status on sputum smear positivity and lung cavitation were evaluated using multivariable logistic regression. RESULTS: Of 1024 laboratory-confirmed pulmonary TB patients who were identified between January 2005 and December 2011, 766 had HIV and ART status available. Positive sputum smears were significantly more common among HIV negative individuals than HIV positive individuals (adjusted OR = 2.91, 95% CI 1.53-5.55). Compared to those HIV positive but not on ART, patients on ART were more likely to be smear positive (adjusted OR = 2.33, 95% CI 1.01-5.39) if they had been on ART ≤ 6 months, but only slightly more likely to be smear positive (adjusted OR = 1.43, 95% CI 0.68-2.99) if they were on ART > 6 months. HIV negative patients were more likely than HIV positive patients to have cavitatory disease (adjusted OR = 1.97, 95% CI 1.20-3.23). Patients on ART > 6 months had a slight increase in cavitatory disease compared to HIV positive patients not on ART (adjusted OR = 1.68, CI 0.78-3.63). CONCLUSIONS: HIV infection is associated with less smear positivity and cavitation in pulmonary TB patients. Among HIV positive patients, the use of ART shifts the presentation of disease towards that seen in HIV-negative individuals, which facilitates diagnosis but which also could increase infectiousness

Phenology of Sclerocarya birrea (A. Rich.) Hochst. Provenances

Phenology study was conducted to assess 22 genotypes of Sclerocarya birrea (A. Rich.) Hochst, collected from West, Eastern and Southern Africa. Assessments were done on time for bud onset, flower opening, leaf flush, fruit set, fruit maturity period and fruit production.  Highly significant (P< 0.001) variations between provenances were obtained in all the phenological traits assessed including variations between sexes in time from flower bud set to anthesis. There was flowering overlaps and synchrony between provenances and sexes with males flowering earlier than females. So far two subpopulations have emerged within the trial referred to as early and late flowering genotypes. The early flowering included provenances from Mozambique, and Swaziland while the late flowering encompassed provenances from Malawi, Zimbabwe, Namibia, Tanzania and Zambia. Fruit maturity period ranged from 76±2 to 192±15days. The early flowering genotypes flowered, fruited and matured between August and January while the late genotypes flowered and fruited from September to May. There were highly significant (P≤0.001) variations in fruit yield of S. birrea provenances between 2016/2017 and 2017/2018 seasons with the former being more productive than the later confirming that S. birrea fruit yield is not constant across seasons due to seed mating effects. There were very strong positive relationship ranging r=0.81 to r=0.78 between leaf flush, bud set, flower opening and fruit set significant at (P<0.001). Some trees classified as females in the first year as based on flowers were found have male flowers which calls for more detailed investigations into this sex change behaviour

Aflatoxin contamination: Knowledge disparities among agriculture extension officers, frontline health workers and small holder farming households in Malawi

The aims of this study were to assess the state of knowledge and perceptions regarding aflatoxin contamination among frontline workers in direct contact with small holder farming households in Malawi as well as among the households themselves. The study first investigated and documented demographic profiles of agriculture extension workers (n = 22) and frontline health workers (n = 161) both from Ntchisi district and small holder farming households (n = 915) from Dedza, Balaka and Mzimba districts. Structured questionnaires were administered to document knowledge and perceptions. Majority of the respondents in Ntchisi were frontline nutrition and health workers as follows: care group promoters (31.7%), cluster leaders (51.9%) and health surveillance assistants (4.4%). Only 12% of the respondents were agriculture extension officers. Among frontline workers, using factor analyses, factors highly associated with the knowledge on domestic management of aflatoxin contamination and the impact of aflatoxin contamination on child linear growth and health in general were most prominent. Whereas, their knowledge of pre & post-harvest practices that pre-dispose crops to aflatoxin contamination and impact of aflatoxin contamination on trade and income losses was relatively low. On the other hand, among small holder farming households, lowest knowledge was related to occurrence of aflatoxin contamination pre and post-harvest. Highest knowledge was observed on issues around loss of income due to aflatoxin contamination. Across all districts over 50% of surveyed respondents reported that they perceived aflatoxin contamination severity as low. Majority of the households (>50%) did not perceive aflatoxin contamination as a problem that could be controlled. This is the first study to investigate knowledge, attitudes, practices and perceptions on aflatoxin contamination among a combination of agriculture extension officers and frontline health workers in parallel with the households they usually are in contact with. The current investigation is crucial because it elucidates knowledge gaps in aflatoxin critical control across agriculture extension, health workers and the small holder farming households. This is especially crucial among agriculture extension workers and frontline health workers as they have direct contact with households and therefore serve as an important source of information that could influence behavior change

Agronomic biofortification increases grain zinc concentration of maize grown under contrasting soil types in Malawi

Zinc (Zn) deficiency remains a public health problem in Malawi, especially among poor and marginalized rural populations, linked with low dietary intake of Zn due to consumption of staple foods that are low in Zn content. The concentration of Zn in staple cereal grain can be increased through application of Zn-enriched fertilizers, a process called agronomic biofortification or agro-fortification. Field experiments were conducted at three Agricultural Research Station sites to assess the potential of agronomic biofortification to improve Zn concentration in maize grain in Malawi as described in registered report published previously. The hypotheses of the study were (i) that application of Zn-enriched fertilizers would increase in the concentration of Zn in maize grain to benefit dietary requirements of Zn and (ii) that Zn concentration in maize grain and the effectiveness of agronomic biofortification would be different between soil types. At each site two different subsites were used, each corresponding to one of two agriculturally important soil types of Malawi, Lixisols and Vertisols. Within each subsite, three Zn fertilizer rates (1, 30, and 90 kg ha−1) were applied to experimental plots, using standard soil application methods, in a randomized complete block design. The experiment had 10 replicates at each of the three sites as informed by a power analysis from a pilot study, published in the registered report for this experiment, designed to detect a 10% increase in grain Zn concentration at 90 kg ha−1, relative to the concentration at 1 kg ha−1. At harvest, maize grain yield and Zn concentration in grain were measured, and Zn uptake by maize grain and Zn harvest index were calculated. At 30 kg ha−1, Zn fertilizer increased maize grain yields by 11% compared with nationally recommended application rate of 1 kg ha−1. Grain Zn concentration increased by 15% and uptake by 23% at the application rate of 30 kg ha−1 relative to the national recommendation rate. The effects of Zn fertilizer application rate on the response variables were not dependent on soil type. The current study demonstrates the importance of increasing the national recommendation rate of Zn fertilizer to improve maize yield and increase the Zn nutritional value of the staple crop

Supporting Children with Disabilities in Low- and Middle- Income Countries: Promoting Inclusive Practice within Community-Based Childcare Centres in Malawi through a Bioecological Systems Perspective

RLOsGiven the narrow scope and conceptualisation of inclusion for young children with disabilities in research within low- and middle income countries (LMICs) contexts, we draw on a bioecological systems perspective to propose the parameters for a broader unit of analysis. This perspective situates human development within a specific cultural context in which family, peers and schooling are regarded as key in responding to young children with disabilities in a given setting. We outline a new bioecological model to illustrate the proximal and distal factors that can influence inclusive early development for children with disabilities within LMICs. To illustrate the relevance of this model to early child development research, we consider its application, as a conceptual framework, with reference to a research study in Malawi. The study was designed to promote greater inclusive practice for young children with disabilities in Community-Based Childcare Centres (CBCCs) with a particular focus on the role of the CBCC volunteer ‘caregiver’ in rural Malawi. It has significance for educators, service providers and researchers concerned with facilitating inclusive early development across national boundaries and contexts.ESRC-DFI