SHORT COMMUNICATION: Urban malaria in Dodoma and Iringa, Tanzania

Cross sectional malaria parasitaemia and entomological surveys were carried out in urban Iringa and Dodoma in Tanzania. A total of 395 and 392 schoolchildren (age range= 6-15 years) were screened for malaria parasites in Iringa and Dodoma, respectively. Plasmodium falciparum was the predominant malaria parasite (Iringa= 100%, Dodoma= 97.8%). Malaria parasitaemia was observed in 14.9% and 12% of the schoolchildren in Iringa and Dodoma, respectively. The geometric mean parasite density for P. falciparum was higher (632 parasites/μl) in Iringa than in Dodoma (74.1 parasites/μl). The average spleen rates were 0.5% and 2% in Iringa and Dodoma, respectively. A slightly higher haemoglobin level was observed among schoolchildren in Dodoma (10.2g/dl) than in Iringa (9.5g/dl). Only a few Anopheles gambiae sensu lato were collected indoors in the two areas. On the average 47.3% and 80% of the children in Iringa and Dodoma, respectively were sleeping under mosquito nets. Although malaria endemicity in the two municipalities is low, unplanned rapid urbanisation is likely to change malaria epidemiology in Tanzania. Continuous malaria and mosquito density surveillance should therefore, form an in integral part of the malaria control strategies in urban areas. Communities should be continuously sensitised to use insecticide-treated mosquito nets and strengthen community-based environmental management to minimise malaria breeding sites. Keywords: urban, malaria, schoolchildren, Tanzania Tanzania Health Research Bulletin Vol. 8 (2) 2006: pp. 115-11

Treatment of neonatal infections: a multi-country analysis of health system bottlenecks and potential solutions.

BACKGROUND: Around one-third of the world's 2.8 million neonatal deaths are caused by infections. Most of these deaths are preventable, but occur due to delays in care-seeking, and access to effective antibiotic treatment with supportive care. Understanding variation in health system bottlenecks to scale-up of case management of neonatal infections and identifying solutions is essential to reduce mortality, and also morbidity. METHODS: A standardised bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the development of the Every Newborn Action Plan. Country workshops involved technical experts to complete a survey tool, to grade health system "bottlenecks" hindering scale up of maternal-newborn intervention packages. Quantitative and qualitative methods were used to analyse the data, combined with literature review, to present priority bottlenecks and synthesise actions to improve case management of newborn infections. RESULTS: For neonatal infections, the health system building blocks most frequently graded as major or significant bottlenecks, irrespective of mortality context and geographical region, were health workforce (11 out of 12 countries), and community ownership and partnership (11 out of 12 countries). Lack of data to inform decision making, and limited funding to increase access to quality neonatal care were also major challenges. CONCLUSIONS: Rapid recognition of possible serious bacterial infection and access to care is essential. Inpatient hospital care remains the first line of treatment for neonatal infections. In situations where referral is not possible, the use of simplified antibiotic regimens for outpatient management for non-critically ill young infants has recently been reported in large clinical trials; WHO is developing a guideline to treat this group of young infants. Improving quality of care through more investment in the health workforce at all levels of care is critical, in addition to ensuring development and dissemination of national guidelines. Improved information systems are needed to track coverage and adequately manage drug supply logistics for improved health outcomes. It is important to increase community ownership and partnership, for example through involvement of community groups

Scaling up quality care for mothers and newborns around the time of birth: an overview of methods and analyses of intervention-specific bottlenecks and solutions.

BACKGROUND: The Every Newborn Action Plan (ENAP) and Ending Preventable Maternal Mortality targets cannot be achieved without high quality, equitable coverage of interventions at and around the time of birth. This paper provides an overview of the methodology and findings of a nine paper series of in-depth analyses which focus on the specific challenges to scaling up high-impact interventions and improving quality of care for mothers and newborns around the time of birth, including babies born small and sick. METHODS: The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the ENAP process. Country workshops engaged technical experts to complete a tool designed to synthesise "bottlenecks" hindering the scale up of maternal-newborn intervention packages across seven health system building blocks. We used quantitative and qualitative methods and literature review to analyse the data and present priority actions relevant to different health system building blocks for skilled birth attendance, emergency obstetric care, antenatal corticosteroids (ACS), basic newborn care, kangaroo mother care (KMC), treatment of neonatal infections and inpatient care of small and sick newborns. RESULTS: The 12 countries included in our analysis account for the majority of global maternal (48%) and newborn (58%) deaths and stillbirths (57%). Our findings confirm previously published results that the interventions with the most perceived bottlenecks are facility-based where rapid emergency care is needed, notably inpatient care of small and sick newborns, ACS, treatment of neonatal infections and KMC. Health systems building blocks with the highest rated bottlenecks varied for different interventions. Attention needs to be paid to the context specific bottlenecks for each intervention to scale up quality care. Crosscutting findings on health information gaps inform two final papers on a roadmap for improvement of coverage data for newborns and indicate the need for leadership for effective audit systems. CONCLUSIONS: Achieving the Sustainable Development Goal targets for ending preventable mortality and provision of universal health coverage will require large-scale approaches to improving quality of care. These analyses inform the development of systematic, targeted approaches to strengthening of health systems, with a focus on overcoming specific bottlenecks for the highest impact interventions

Using retrospective epidemiological data to determine malaria epidemic prone areas and development of an epidemic early warning sysltem in Mpwapwa Districe, Central Tanzania

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Urban malaria in Dodoma and Iringa, Tanzania

Cross sectional malaria parasitaemia and entomological surveys were carried out in urban Iringa and Dodoma in Tanzania. A total of 395 and 392 schoolchildren (age range= 6-15 years) were screened for malaria parasites in Iringa and Dodoma, respectively. Plasmodium falciparum   was the predominant malaria parasite (Iringa= 100%, Dodoma= 97.8%). Malaria parasitaemia was observed in 14.9% and 12% of the schoolchildren in Iringa and Dodoma, respectively. The geometric mean parasite density for P. falciparum was higher (632 parasites/μl) in Iringa than in Dodoma (74.1 parasites/μl). The average spleen rates were 0.5% and 2% in Iringa and Dodoma, respectively. A slightly higher haemoglobin level was observed among schoolchildren in Dodoma (10.2g/dl) than in Iringa (9.5g/dl). Only a few Anopheles gambiae   sensu lato were collected indoors in the two areas. On the average 47.3% and 80% of the children in Iringa and Dodoma, respectively were sleeping under mosquito nets. Although malaria endemicity in the two municipalities is low, unplanned rapid urbanisation is likely to change malaria epidemiology in Tanzania. Continuous malaria and mosquito density surveillance should therefore, form an in integral part of the malaria control strategies in urban areas. Communities should be continuously sensitised to use insecticide-treated mosquito nets and strengthen community-based environmental management to minimise malaria breeding sites