Public Health Concern and Initiatives on the Priority Action Towards Non-Communicable Diseases in Tanzania

Tanzania is already facing challenges caused by existing burden of communicable diseases, and the growing trend of non-communicable diseases (NCDs), which raises a lot of concerns and challenges. The objective of this review is to provide broad insight of the “silent epidemic” of NCDs, existing policies, strategies and interventions, and recommendations on prioritized actions. A review of existing literature including published articles, technical reports, and proceedings from national and international NCDs meetings was carried out. The burden, existing interventions, socio-economic impact, lessons learnt, and potential for expanding cost effective interventions in Tanzania were explored. Challenges to catch up with global\ud momentum on NCD agenda were identified and discussed. The review has indicated that the burden of NCDs and its underlying risk factors in Tanzania is alarming, and affects people of all socio-economic status. The\ud costs of health care for managing NCDs are high, and thus impoverishing the already poor people. The country\ud leadership has a high political commitment; there are policies and strategies, which need to be implemented to\ud address the growing NCD burden. In conclusion, NCDs in Tanzania are a silent rising health burden and has\ud enormous impact on an individual and country’s social-economical status. From the experience of other countries, interventions for NCDs are affordable, feasible and some are income generating. Multi-sectoral approach, involving national and international partners has a unique role in intensifying action on NCDs.\ud Tanzania should strategize on implementation research on how to adapt the interventions and apply multisectoral\ud approach to control and prevent NCDs in the country.\u

Delay in Tuberculosis case detection in Pwani region, Tanzania. a cross sectional study

<p>Abstract</p> <p>Background</p> <p>Delay in Tuberculosis (TB) case detection may worsen the disease and increase TB transmission. It is also a challenge to the National TB and Leprosy control Program (NTLP).</p> <p>Methods</p> <p>We conducted a cross sectional study in four out of six districts in Pwani region to estimate the extent and factors responsible for delay in TB case detection in Pwani region. Delays were divided into patient, health facility and total delay.</p> <p>Results</p> <p>We enrolled a total of 226 smear positive TB patients. Out of 226 patient's results were available for 206. The majority (66.5%) of the patients were males. Mean age for males and females were 37.3 and 33.7 years respectively. Mean (SD) total delay was 125.5 (98.5) days (median 90). Out of 206 patients, 79 (38.35%) delayed to seek TB health care. Health facility delay was observed among 121 (58.7%) patients.</p> <p>Risk factors for delay was poor knowledge that chest pain may be a TB symptom (OR = 2.9; 95%CI 1.20- 7.03) and the belief that TB is always associated with HIV/AIDS (OR = 2.7; 95%CI 1.39-5.23). Risk for delay was low among patients who first presented to a government health facility (OR = 0.3; 95%CI 0.12- 0.71) and those presenting with chest pain (OR = 0.2; 95%CI 0.10-0.61).</p> <p>Conclusion</p> <p>There is a considerable delay in TB case detection in Pwani mainly contributed by patients. Risk factors for delay include misconception about TB/HIV and poor knowledge of TB symptoms.</p

Parental Concerns and Uptake of Childhood Vaccines in Rural Tanzania – A Mixed Methods Study

Background Vaccine hesitancy has been recognized as an important barrier to timely vaccinations around the world, including in sub-Saharan Africa. In Tanzania, 1 in 4 children is not fully vaccinated. The objective of this mixed methods study was to describe and contextualize parental concerns towards vaccines in Tanzania. Methods Between 2016 and 2017, we conducted a cross-sectional survey (n = 134) and four focus group discussions (FGDs, n = 38) with mothers of children under 2 years of age residing in Mtwara region in Southern Tanzania. The survey and FGDs assessed vaccination knowledge and concerns and barriers to timely vaccinations. Vaccination information was obtained from government-issued vaccination cards. Results In the cross-sectional survey, 72% of mothers reported missed or delayed receipt of vaccines for their child. Although vaccine coverage was high, timeliness of vaccinations was lower and varied by vaccine. Rural mothers reported more vaccine-related concerns compared to urban mothers; literacy and access to information were identified as key drivers of the difference. Mothers participating in FGDs indicated high perceived risk of vaccine-preventable illnesses, but expressed concerns related to poor geographic accessibility, unreliability of services, and missed opportunities for vaccinations resulting from provider efforts to minimize vaccine wastage. Conclusions Findings from our cross-sectional survey indicate the presence of vaccination delays and maternal concerns related to childhood vaccines in Tanzania. In FGDs, mothers raised issues related to convenience more often than issues related to vaccine confidence or complacency. Further research is necessary to understand how these issues may contribute to the emergence and persistence of vaccine hesitancy and to identify effective mitigation strategies

Magnitude and factors associated with pre-diagnosis loss to follow-up among tuberculosis presumptive patients in the Cycle of Health Care, Musoma, Tanzania: Cross-sectional study

Background: Despite National Tuberculosis (TB) Program efforts on tuberculosis control in the country, pre-diagnosis loss to follow-up is still a major problem. The study aims at exploring the magnitude and risk factors of presumptive TB cases who either do not submit a second sputum sample or do not show up for their laboratory results. Methods: The study included presumptive TB registered at the Musoma Regional Referral Hospital between May and November 2014.&nbsp; Lost to follow up presumptive TB were then traced and interviewed from December 2014 to April 2015. One hundred and thirty-two among those who submitted both samples and showed up for their results were randomly selected as a comparison group.&nbsp; Results: A total of 620 presumptive TB was registered at the Musoma Regional Referral Hospital (MRRH), of which 521 (84.0%) completed TB testing in accordance with the national TB diagnostic algorithm while 99 (16.0%) did not complete. Out of those who did not complete, 65 (65.7%) submitted only one spot sample and 34 (34.3%) submitted both but all of these did not pick-up their results. The Mean age of participants was 45.3 years (Standard deviation 17.7). The main reasons for loss to follow-up were: 23 (23.2%) opted to go to other health care facilities; 23 (23.2%) lack of transport fare; and 20 (20.2%) long distance to the hospital. Males were 1.6 (95%CI1.02-2.90) more likely to complete TB diagnostic algorithm

Shauri et al. BMC Infect Dis (2021) 21:911 https://doi.org/10.1186/s12879-021-06549-y RESEARCH Seroprevalence of Dengue and Chikungunya antibodies among blood donors in Dar es Salaam and Zanzibar, Tanzania: a cross-sectional study

This research article was published by BMC Infectious Medical in 2021Background: The potential shift of major causes of febrile illnesses from malaria to non-malarial febrile illnesses, including arboviral diseases such as chikungunya and dengue, is of concern. The last outbreaks of these infections were reported in 2018 and 2019 for chikungunya in Zanzibar and dengue in Dar es Salaam. We conducted a cross- sectional study that involved serological testing of stored blood samples from the blood banks in Temeke Referral Hospital in Dar es Salaam and the National Blood Bank Unit in Zanzibar. The samples were collected from Zanzibar and Dar es Salaam donors in May and June 2020, respectively. A total of 281 samples were included in the study, and their demographic information extracted from the registers. The samples were then transported to Muhimbili Univer- sity of Health and Allied Sciences at the Microbiology Laboratory. They were subjected to an indirect ELISA to detect IgG and IgM against dengue and chikungunya viruses. Results: Seropositive IgM samples from Dar es Salaam were 3/101 (2.97%) for chikungunya and 1/101 (0.9%) for dengue, while samples from Zanzibar were all IgM negative for both viruses. Chikungunya IgG seropositivity was significantly higher (p ≤ 0.05) in Dar es Salaam 21/101 (21.2%) than Zanzibar 22/180 (12.2%). There was no difference in dengue IgG seropositivity between Dar es Salaam 44/101 (43.5%) and Zanzibar 68/180 (37.8%). Similarly, dual IgG seropositivity for both dengue and chikungunya viruses were not different between Dar es Salaam 13/101 (12.9%) and Zanzibar 11/180 (6.1%). Conclusion: Detection of IgM for dengue and chikungunya in Dar es Salaam indicates recent or ongoing transmis- sion of the two viruses in the absence of a reported outbreak. These findings suggest the possibility of transmission of the two infections through blood transfusion. Detection of IgG antibodies for dengue and chikungunya viruses might be contributed by both; the ongoing infections and residual responses caused by preceding infections in the country. Results from blood banks may represent the tip of the iceberg. Further studies are needed to gain insight into the actual burden of the two diseases in Tanzania

Knowledge and Perceptions about Tuberculosis in Agropastoral Communities in Northern Tanzania: A Cross-Sectional Study

Aim: To determine knowledge and perceptions about tuberculosis in agropastoral communities in Northern Tanzania. Study Design: This was a cross sectional study on habits and attitudes to tuberculosis. Methods: The study was conducted between June 2011 and May 2012.We enrolled tuberculosis patients registered at Mount Meru Hospital in Arusha municipal, Enduleni Hospital in Ngorongoro district, and Haydom Lutheran Hospital in Mbulu district. In addition we selected for comparison some of their household relatives and individuals from the neighborhood. Data was collected using a structured questionnaire. Knowledge about tuberculosis was assessed by questions concerning causes, symptoms, modes of transmission and prevention and treatment. Key variables for assessment of perception on tuberculosis included: individuals considered most at risk, and misconceptions. Results: We recruited 164 respondents of whom 25% were confirmed tuberculosis patients, 41.5% relatives of the patients and 33.5% neighbors. Females constituted 48.8% of all respondents. Of all the participants, only two of the neighbors had never heard about tuberculosis in their life time. Even though 99% had heard about tuberculosis, specific knowledge on causes, prevention and treatment was poor. A total of 67.7% thought that transmission of tuberculosis occurs during sexual intercourse. Respondents thought that risk from tuberculosis was higher among adults (68.9%), alcohol users (39.6%), smoking (26.8%), consumption of raw animal products (6.1%) and childhood (23.2%). Conclusion: Our study shows that study participants had heard about tuberculosis but specific knowledge was low. Misconceptions surrounding causes, transmission, prevention and treatment of the disease were common. Selection of appropriate channels for public health education and awareness programmes targeting knowledge about prevention and control of tuberculosis in agropastoral communities may improve this situation.publishedVersio

Reducing delays to multidrug-resistant tuberculosis case detection through a revised routine surveillance system

Background: Implementation of an effective Tuberculosis Routine Surveillance System in low-income countries like Tanzania is problematic, despite being an essential tool for the detection and effective monitoring of drug resistant tuberculosis. Long delays in specimen transportation from the facilities to reference laboratory and results dissemination back to the health facilities, result in poor patient management, particularly where multidrug-resistant tuberculosis disease is present. Methods: Following a detailed qualitative study, a pilot intervention of a revised Tuberculosis Routine Surveillance System was implemented in Mwanza region, Tanzania. This included the use of rapid molecular methods for the detection of both tuberculosis and drug resistance using Xpert MTB/RIF in some Mwanza sites, the use of Xpert MTB/RIF and Line Probe Assay at the Central Tuberculosis Reference Laboratory, a revised communication strategy and interventions to address the issue of poor form completion. A before and after comparison of the intervention on the number of drug resistant tuberculosis cases identified and the time taken for results feedback to the requesting site was reported. Results: The revised system for previously treated cases tested at the Central Reference Laboratory was able to obtain the following findings; the number of cases tested increased from 75 in 2016 to 185 in 2017. The times for specimen transportation from health facilities to the reference laboratory were reduced by 22% (from 9 to 7 days). The median time for the district to receive results was reduced by 36% (from 11 to 7 days). Overall the number of drug resistant tuberculosis cases starting treatment increased by 67% (from 12 to 20). Conclusion: Detection of drug resistance could significantly be enhanced, and delays reduced by introduction of new technologies and improved routine surveillance system, including better communication using mobile applications such as ‘WhatsApp’ and close follow-ups. A larger scale study is now merited to ascertain if these benefits are robust across different context

Genome sequence of Mycobacterium yongonense RT 955-2015 isolate from a patient misdiagnosed with multidrug-resistant tuberculosis: First clinical detection in Tanzania

Background: Mycobacterium yongonense is a recently described novel species belonging to Mycobacterium avium complex, which is the most prevalent aetiology of non-tuberculous mycobacteria associated with pulmonary infections, and poses tuberculosis diagnostic challenges in high-burden, resource-constrained settings. Methods: Whole genome shotgun sequencing and comparative microbial genomic analyses were used to characterize the isolate from a patient diagnosed with multidrug-resistant tuberculosis (MDR-TB) after relapse. Results: The genome sequence of the first case of M. yongonense (M. yongonense RT 955-2015) in Tanzania is presented. Sequence analysis revealed that the RT 955-2015 strain had a high similarity to M. yongonense 05-1390(T) (98.74%) and Mycobacterium chimaera DSM 44623(T) (98%). Its 16S rRNA showed similarity to Mycobacterium paraintracellulare KCTC 290849(T) (100%), Mycobacterium intracellulare ATCC 13950(T) (100%), M. chimaera DSM 44623(T) (99.9%), and M. yongonense 05-1390(T) (98%). The strain exhibited a substantially different rpoB sequence to that of M. yongonense 05-1390 (95.16%), but closely related to that of M. chimaera DSM 44623(T) (99.86%), M. intracellulare ATCC 13950(T), (99.53%), and M. paraintracellulare KCTC 290849(T) (99.53%). Conclusions: In light of the OrthoANI algorithm and phylogenetic analysis, it was concluded that the isolate was M. yongonense Type II genotype, which is an indication that the patient was misdiagnosed with TB/MDR-TB and received inappropriate treatment. (C) 2018 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.

Routine surveillance for the identification of drug resistant Tuberculosis in Tanzania: A cross-sectional study of stakeholders' perceptions

<p>Background: Routine surveillance is required to monitor the performance of tuberculosis diagnostic programme and is essential for the rapid detection of drug resistance. The main objective of this study was to explore the effectiveness and stakeholder perception of the current routine surveillance system for previously treated tuberculosis cases in Tanzania with a view to identify interventions to improve and accelerate positive patient outcomes.<b></b></p> <p>Methods:<b> </b>A study using quantitative and qualitative methods of data collection including in-depth interviews and focus group discussions with health care service providers was conducted in four regions. Quantitative data were extracted from the routine databases to assess performance.</p> <p>Results: Quantitative findings from 2011 to 2013 showed 2,750 specimens from previously treated TB cases were received at the reference laboratory. The number increased year on year, but even in the most recent year was only 61% of that expected. The median and interquartile range of turnaround time in days from specimen reception to results reported for smear microscopy, culture and drug susceptibility testing were 1(1, 1), 61(43, 71) and 129(72, 170) respectively. Contaminated specimens were reported in 3.6% of cases. The qualitative analysis showed the system of sending specimens using postal services was seen to be efficient by participants. However, there were many challenges and significant delays in specimens reaching the reference laboratory associated with lack of funds to transfer specimens, weak form completion, inadequate training and poor supervision. These all adversely affected the implementation of the routine surveillance system.</p> Conclusions: Many issues limit the effectiveness of the routine surveillance system in Tanzania. Priority areas for strengthening are; specimen transportation, supervision and availability of commodities. A pilot study of a revised routine surveillance system that takes into account the observations from this study alongside improved access to drug susceptibility testing using Xpert MTB/RIF should be considere

Prevalence and Correlates of Cardio-Metabolic Risk Factors Among Regular Street Food Consumers in Dar es Salaam, Tanzania

Background: Regular street food consumers (RSFCs) in Africa are at an increased risk of unhealthy eating practices, which have been associated with intermediate risk factors of cardio-metabolic diseases. However, knowledge of the magnitude and correlates of these risk factors is limited in Tanzania. This study aimed to fill this gap using data collected from RSFCs in Dar es Salaam, the largest city in Tanzania. Methodology: A cross-sectional study was carried out among 560 RSFCs in three districts of Dar es Salaam between July and September 2018. Information on socio-economic factors and demographics, behavioral risks, anthropometric and biochemical indicators was collected. Adjusted odds ratios (OR) and prevalence ratio (PR) with corresponding 95% confidence intervals (CI) were estimated using multivariable binary logistic and modified Poisson regression models, respectively. Results: On average, participants consumed 11 street food meals/week. The prevalence (95% CI) of cardio-metabolic risk factors was 63.9% (60.6– 69.9%) for overweight/obesity, 42.5% (38.3– 46.9%) for raised blood pressure, 13.5% (10.9– 16.8%) for raised triglycerides and 6.6% (4.9– 9.3%) for raised glucose levels. The correlates of overweight/obesity were female vs male sex (APR=1.3; 95% CI 1.2– 1.5), age of 41– 64 vs 25– 40 years (APR=1.4; 95% CI 1.2– 1.6), high vs low income (APR=1.2; 95% CI 1.04– 1.3), being married/cohabiting vs other (APR=1.2; 95% CI 1.01– 1.4) and family history of diabetes vs no family history (APR=1.2; 95% CI 1.01– 1.3). Age 41– 64 vs 25– 40 years, was the only significant factor associated with raised blood pressure APR (95% CI) 2.2 (1.7– 2.9) and raised glucose AOR (95% CI) 3.9 (1.5– 10.5). Conclusion: Our study revealed that RSFCs are at risk of cardio-metabolic health problems, especially women, middle-aged people and those with higher incomes. Transdisciplinary studies to understand the drivers of street food consumption are needed in order to inform interventions to mitigate the risk of developing cardio-metabolic diseases. These interventions should target both street food vendors and their consumers. Keywords: street food consumers, cardio-metabolic risks, cardio-metabolic correlates, Tanzani