Editorial

Non

Is sickle cell disease sufficiently prioritized in policy and socio-economic research on diseases in Tanzania? Lessons for the past 50 years

Catastrophic health consequences associated with chronic and genetic disorders, including those related to sickle cell disease (SCD) remain lowly measured and understood. Illnesses associated with SCD, especially the, sickle cell anaemia (SCA) pose significant tolls to individual patients and their families and contribute to poverty due to loss in production and retardation of economic development. This paper synthesises evidence from systematic literature reviews on policy priorities both in theory and practice and studies carried out on SCD. The review was systematically done by drawing evidence from published and unpublished literature searched through online search engines and other sources. The magnitude of SCA problem is yet to be adequately measured and documented in terms of thescale of its prevalence in many countries including Tanzania. However, a few reports available pinpoint Tanzania as one of the African countries with a large number of patients with SCD. Social stigma and discrimination against patients with SCD pose psychological affect to either the individual patients or their family members and this is partly due to low community knowledge on this disease on one hand and the perceived socio-economic disturbances associated with the disease that at times reduce the morale of caregivers/takers in families to attend  patients. A few studies so far seem to have much focused on the medical dimensions of the disease usually reported at health facilities therefore, failing to establish the actual magnitude and socio-economic consequences of the disease, thus limiting the room for more informed policy decisions. Unfortunately, the inadequate public policy and research attention to this disease indicates that there is need for revisiting research and policy agenda towards making a difference in its interventions, and this include creation of public awareness and prioritizing research. &nbsp

Prevalence and risk factors of asymptomatic malaria among underfive children in Huye District, Southern Rwanda

Background: Enhanced malaria control has resulted in its reduction in some areas of Sub Saharan Africa including Rwanda. However, asymptomatic hosts serve as a reservoir for the malaria parasite for communities. The objective of this study was to determine the prevalence of malaria parasites and risk factors associated with malaria infection among children underfive years in Huye district, Rwanda.Methods: This community-based cross sectional study was conducted from May to June 2016 among underfive years children.  Asymptomatic children underfive years of age were randomly selected from 13 villages. Thick and thin blood smears were prepared from each child for malaria parasite diagnosis.  Interviews with parents or guardians were conducted to collect data on malaria associated risk factors. Observations were made of the presence of mosquito breeding sites near and around the homestead.Results: A total of 222 children were included in the study. Nearly a third (28.8%) of the children were within the age of 25-36 months. The majority (54%) of the children were females. Most of the parents/guardians were married (95.9%), nearly all (99.5%) had attended primary school and most (97.3%) were peasants. The overall Plasmodium falciparum prevalence in children was 12.2%. Children aged 1 to 12 months were 3.5 times more likely to have malaria parasites than children aged 13 to 59 months [AOR=3.56; 95%CI=1.18-10.71; p=0.024]. Children who were not sleeping under insecticide treated nets were 15 times more likely to be infected with malaria parasites compared to those who were sleeping under nets [AOR=15.27; 95%CI=4.42-52.82; p<0.001].Conclusion: Malaria parasite prevalence in under-five year children in Huye District, Rwanda is moderate.  The asymptomatic infections in the community forms a reservoir for transmission in the area. Young age of the child and not sleeping under mosquito net were associated with malaria parasite infection. The continuing use of mosquito nets needs to be emphasized

Public Knowledge, Perceptions and Practices in Relation to Infectious and other Communicable Diseases in Tanzania: Lessons Learnt from Babati District

We report public knowledge, perceptions and practices on selected infectious diseases in Tanzania using a study done in Babati district, and identify policy related messages in light of health promotion strategies instituted for communicable disease control. Data were gathered through semi-structured interviews with individual household members and focus group discussions with other residents in several villages; in-depth interviews with health workers, local government leaders, and district health managers. Many villagers associated malaria transmission with people’s exposure to intense sunrays; TB and brucellosis with people drinking raw-milk, animal blood and meat; sharing a bed or utensils with TB/brucellosis patients; TB with smoking or inhaling cigarette smoke; leprosy with witchcraft; and lymphatic filariasis and schistosomiasis with people contacting dirty-water or through sexual intercourse. Occasional shortage of drugs and laboratory services, lack of reliable transport facilities, low public use of latrines, unaffordable bednet prices, and common sale of counterfeit drugs by unregulated retailers were perceived to perpetuate the existence and widespread communicable diseases. Use of traditional medicines to treat these diseases was reported to be a common practice. Culturally rooted knowledge and beliefs about diseases influence people’s health care seeking practices and may perpetuate prevalence and transmission of diseases. There should be educational policy program considerations among the strategies aimed at effective disease control.\u

Seroprevalence and risk factors of Toxoplasma gondii infection among pregnant women attending antenatal care in Kigali, Rwanda

Background: Toxoplasma gondii infection in pregnancy, if left untreated, is associated with spontaneous abortions, low birth weight babies, congenital deformities and intrauterine deaths. The infection is also associated with human immune deficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). In Rwanda, the burden and risk factors of T. gondii infection among pregnant women and among HIV infected pregnant women is largely unknown. This cross-sectional study aimed at determining the seroprevalence of T. gondii infections and their risk factors among pregnant women in Kigali, Rwanda.Methods: Pregnant women aged 18 years and above who were attending antenatal care at four clinics in Kigali City, between April and August 2014 were screened for IgG and IgM antibodies against T. gondii using ELISA technique. Information on their HIV status and CD4+ cell count was obtained from their medical records. Participants were also interviewed on selected behaviours that predispose individuals to T. gondii infection.Results: A total of 384 pregnant women were involved in the study. The overall T. gondii seroprevalence was 12.2%. Of the 384 pregnant women studied, 37 (9.6%) were positive for anti-T. gondii-specific IgG antibodies, indicating past infection and 15 (3.9%) had positive IgM results indicating recent infection. Drinking untreated water and eating undercooked meat were identified as important risk factors for T. gondii infection respectively at 22.4% and 22.3% [OR=3.95, CI:2.09-7.49; p<0.001 and OR=3.27, 95% CI: 1.75-6.09; p<0.001].Conclusion: Although the seroprevalence of T. gondii antibodies is relatively low, institution of interventional measures is desirable

Characterization of malaria vectors in Huye District, Southern Rwanda

Background: Effective control of malaria requires knowledge of vector species, their feeding and resting behaviour as well as breeding habitats. The objective of this study was to determine malaria vector species abundance and identify their larval habitats in Huye district, southern Rwanda.Methods: Adult mosquitoes were collected indoors using light trap and pyrethrum spray catch techniques, and outdoors using light traps. Female Anopheles mosquitoes were identified to species level by morphological characteristics. Enzyme-linked Immunosorbent Assay (ELISA) was used to screen for Plasmodium falciparum circumsporozoite protein and host blood meal sources. Anopheles larvae were sampled using dippers and raised into adult mosquitoes which were identified morphologically.Results: Anopheles gambiae sensu lato comprised of 70% of the 567 Anopheles collected. Other Anopheles species identified were An. funestus 4%, An. squamosus 16.5%, An. maculipalpis 6.5%, An. ziemanni 1.7%, An. pharoensis 1.2 % and An. coustani 0.1%. The majority, 63.5% of the collected mosquitoes were from indoors collections. The overall human blood index was 0.509. The P. falciparum circumsporozoite protein was found in 11 mosquitos including 8 Anopheles gambiae s.l. and 3 secondary vectors out of the 567 tested. The overall sporozoite rate was 1.9%. A total of 661 Anopheline larvae from 22 larval habitats were collected. They comprised of An. gambiae s.l. (89%) and An. ziemanni (11%). The absolute breeding index was 86.4%. The most common larval habitats were in full sunlight with still water like rice paddies and pools of stagnant water.Conclusion: These findings show that Anopheles gambiae s.l. is the dominant malaria vector in the area with other vectors playing a secondary role in malaria transmission. Malaria interventions need to be strengthened to reduce even further the malaria transmission in the area.

Integrated research partnerships for malaria control through an ecohealth approach in East Africa : Kenya, Rwanda, Tanzania and Uganda projects; final report

The study focuses on linkages between malaria and livelihoods, malaria and ecosystems, and malaria and health systems. Malaria was found to be relatively low in savannah areas compared to rice irrigation agroecology. The report provides detailed breakdowns of project outputs, outcomes and impacts. The four agro-ecosystems in study countries (Rusinga Island (Kenya), Nyagatare District (Rwanda), Kilosa District (Tanzania) and Kamuli District in Uganda) were rice irrigation, savannah, and maize and mixed farming. The findings indicate that the main livelihoods of people in East Africa are driven by water availability and resource management availability (crop farming, livestock farming and fishing)

Willingness to Pay for 'Olyset' Bednets Among Formal Employees and Rural Peasants in Korogwe and Muheza Districts, Northeastern Tanzania

Owing to their impact on reducing mosquito nuisance, morbidity and mortality due to malaria, insecticide treated bednets are promoted to be used at household level and in schools, military camps, health facility wards, and guest houses. Nevertheless, the large-scale use of such materials is constrained by demand and supply factors. The contemporary debate is that people might be willing to pay for bednets but their short supply could constrain their actual use. Also it is concerned that supplying bednets in the market is one thing but whether people are prepared to purchase them is another thing since the actual uptake of bednets is determined by personal or household's disposable income, and their prices, their shapes and sizes as well as people's attitudes. This paper reports on a study of willingness to pay (WTP) for Olyset bednets among formal employees and villagers predominantly engaged in subsistence farming in Korogwe and Muheza districts in Tanzania. Generally, the study found that, fixing a price of Tshs. 3,500 or more per one bednet to be paid at once is practically undesirable to many peasants even if the majority of them might have had stated their WTP that price. On the other hand, allowing prepayments or payments by instalments has the advantage of promoting sales and utilization of bednets among formal and informal employees. The study recommends demand creation mechanisms like social marketing towards changing public perceptions and attitudes for better utilization of bednets