Prevalence and Predictors of HIV Infection among Under FiveYear Children Born to HIV Positive Mothers in Muheza District, North-Eastern Tanzania

Background: Human Immunodeficiency Virus (HIV) pandemic has become a serious public health concern worldwide. The prevalence of paediatric HIV infection is largely unknown in many countries in Sub-Saharan Africa (SSA). We aimed to determine the prevalence and predictors of HIV infection among under-5 years children in Muheza District, Tanzania.Methods: A facility-based study among mothers/guardians with their under-5 years children exposed to HIV infection was conducted from June 2015 to June 2016. Information on HIV status, socio-demographic and other family characteristics was collected using a structured questionnaire. Data analysis was performed using STATA version 13.0.Results: A total of 576 HIV-exposed under-5 years children were recruited together with their respective mothers/guardians. The HIV prevalence among under-5 years children was 10.6% (95% CI: 8.1-13.1%). The burden of HIV infection was observed among older children aged 25 to 59 months (AOR= 8.0, 95% CI 2.5-26.0) than in the younger children. There was a four-fold (AOR=3.9, 95% CI 1.7-9.1) risk of HIV infection among children born to mothers of unknown HIV status at conception than among children born to mothers with known HIV status. The odds of HIV infection were higher among children who were delivered from home (AOR=2.6, 95% CI 1.0-6.5), received mixed feeding (AOR=2.4, 95% CI 1.2-4.9), and those living far from a health facility (AOR=3.0, 95% CI 1.4-6.5).Conclusion: The prevalence of HIV among under-5 years children in Muheza is higher among older children. The high prevalence is associated with being born to mothers with unknown HIV status at conception, received mixed feeding, home delivery, and living far from the health facility. Campaigns that provide health educational massages addressing risk factors of HIV need to be emphasised in order to promote the control and prevention of HIV among children

Evaluation of the KEMRI Hep-cell II test kit for detection of hepatitis B surface antigens in Tanzania

Hepatitis B surface antigen (HBsAg) is one of the most important serological markers used to diagnose acute and chronic hepatitis B infection. The objective of the current evaluation was to assess the operational characteristics of the Kenya Medical Research Institute (KEMRI) Hep-cell II against an ELISA Exsym HBsAg in the detection of hepatitis B surface antigens. To evaluate the Hep-cell II test, blood samples were collected from blood donors and processed for detection of HBsAg using Hep-cell II based on the test principle and procedure outlined by the manufacturer. ELISA Axsym HBsAg test was used as golden standard. Of the 400 samples tested, 287 (71.8%) were positive by Hep-cell test and 295 (73.8%) were positive by the ELISA Axsym. Hep-cell test had a sensitivity of 98.6% and specificity of 95.96%. Similar values of sensitivity and specificity of the Hep-cell test were obtained even when Bayesian Analysis Model was applied. The positive and negative predictive values of Hep-cell test were 98.61% and 95.96%, respectively. The positive and negative diagnostic likelihood ratios of Hep-cell test were 24.4% and 0.0145, respectively. In conclusion, the Hep-cell test is useful for detecting hepatitis B virus and the high likelihood ratio observed suggests that it may be useful in blood screening. However, it may be necessary to evaluate for cost-effectiveness and robustness in field conditions before the test is recommended for use

Accessibility of services for early infant diagnosis of Human Immunodeficiency Virus in sub-Saharan Africa: a systematic review

Background: Early Infant Diagnosis (EID) of Human Immunodeficiency Virus (HIV) is one of the major interventions for HIV and AIDS in sub-Saharan Africa. However, the coverage is still lower than the recommended levels. The objective of this review was to systematically assess factors associated with accessibility of EID services in sub-Saharan Africa.Methods: Scientific engines were searched from library catalogues and public databases. The review included free full text articles in English published from 1996 to 2015 and fitting to the objectives of the study.Results: A total of 1,039,715 results appeared on the databases after initial searching. Of these, 48 eligible articles were identified and reviewed. From 2004 to 2014, the proportion of HIV exposed infants who received a virological test within the first 2 months of life in sub-Saharan Africa varied from 3 to 58%, far below the 80% recommended level by the World Health Organization. EID services were not available in more than 30% of health facilities in most sub-Saharan African countries. Factors associated with accessibility of EID services included parents with low formal education level, maternal unemployment, geographical relocation, religious beliefs, lack of paternal support, insufficient awareness of HIV control and prevention services, poor compliance to prevention of mother to child transmission services, lack of general knowledge of HIV transmission, stigma and discrimination, inadequate human resource for health, weak infrastructure, inadequate supplies of laboratory materials and late feedback of HIV test results.Conclusion: Availability and accessibility of EID services in sub-Saharan Africa is still low despite the investment made during the past decade. Both individual and institutional factors affect the availability and accessibility of the services. It is important that these factors are urgently addressed to improve EID services

Primary health care staff's perceptions of childhood tuberculosis: a qualitative study from Tanzania

<p>Abstract</p> <p>Background</p> <p>Diagnosing tuberculosis in children remains a great challenge in developing countries. Health staff working in the front line of the health service delivery system has a major responsibility for timely identification and referral of suspected cases of childhood tuberculosis. This study explored primary health care staff's perception, challenges and needs pertaining to the identification of children with tuberculosis in Muheza district in Tanzania.</p> <p>Methods</p> <p>We conducted a qualitative study that included 13 semi-structured interviews and 3 focus group discussions with a total of 29 health staff purposively sampled from primary health care facilities. Analysis was performed in accordance with the principles of a phenomenological analysis.</p> <p>Results</p> <p>Primary health care staff perceived childhood tuberculosis to be uncommon in the society and tuberculosis was rarely considered as a likely differential diagnosis. Long duration and severe signs of disease together with known exposure to tuberculosis were decisive for the staff to suspect tuberculosis in children and refer them to hospital. None of the staff felt equipped to identify cases of childhood tuberculosis and they experienced lack of knowledge, applicable tools and guidelines as the main challenges. They expressed the need for more training, supervision and referral feedback to improving case identification.</p> <p>Conclusions</p> <p>Inadequate awareness of the burden of childhood tuberculosis, limited knowledge of the wide spectrum of clinical presentation and lack of clinical decision support strategies is detrimental to the health staff's central responsibility of suspecting and referring children with tuberculosis especially in the early disease stages. Activities to improve case identification should focus on skills required by primary health care staff to fulfil their responsibility and reflect primary health care level capacities and challenges.</p

The changing landscape of public health in sub-Saharan Africa: Control and prevention of communicable diseases needs rethinking

In sub-Saharan Africa, communicable diseases (CDs) are the leading public health problems and major causes of morbidity and mortality. CDs result in significant individual suffering, disrupting daily life, threatening livelihoods and causing one-third of the years lost to illness or death worldwide. This paper aims to analyse the current strategies in the control and prevention of CDs in sub-Saharan Africa and proposes an ecohealth approach in relation to current changing epidemiological profiles. Whilst in recent years the burden of HIV and AIDS, tuberculosis and malaria have helped to mobilise large amounts of funding and expertise to help address them, many CDs, particularly those affecting the poor, have been neglected. People living in rural areas are also likely to be politically marginalised and living in degraded environments. They often lack assets, knowledge and opportunities to gain access to health care or protect themselves from infections. New diseases are also emerging at unprecedented rates and require attention. Many CDs are rooted in environmental and livelihood conditions and mediated by social and individual determinants. It is now increasingly recognised that a much broader, coordinated and multi-sectoral ecohealth approach is required to address CDs in sub-Saharan Africa. An ecohealth approach has been shown to be more robust in public health interventions than the traditional medical approach. The approach helps to generate an understanding of ecosystem factors that influence the emergence and spread of both old and new diseases, considers temporal and spatial dimensions of disease infection and allows systems thinking. In conclusion, establishing intersectoral and multisectoral linkages is important to facilitate joint efforts to address CDs at the national, district and community levels

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.

Availability of HIV/AIDS community intervention programmes and quality of services in and around selected mining sites in Tanzania

Background: Mining is one of the major sectors of the country’s economy as it employs and attracts a large number of people from different areas. As a result, mining sites are at great risk of HIV transmission. While a few unsynchronized mine-specific population-based studies provide evidence of a growing HIV problem in this sector, virtually few evidence exists on availability and quality of interventions targeting HIV and AIDS in this population. The study was conducted to assess the availability and quality of HIV/AIDS intervention programmes in and around mining sites in Tanzania.Methods: This cross sectional study was conducted from November 2012 to April 2013. Both quantitative and qualitative methods were used to collect data. Study areas involved both mining sites and its surrounding communities in Kahama, Nzega and Geita Districts. It involved household members from villages in and around the mining sites, mining community relations officers, community health facility workers, district HIV/AIDS focal persons and village leaders.Results: A total of 463 individuals were recruited into the study for household interviews. In-depth interviews with Key Informants involved 15 respondents. HIV/AIDS intervention programmes in the study area were available despite that knowledge of their existence was limited to a segment of the community.  Their availability was only known to about 25% of the study respondents in Geita and Kahama study sites.  The programmes carried out intervention activities which included HIV/AIDS education campaigns, promoting uptake of voluntary counselling and testing services, promoting and supporting condom use, safer sex, and male circumcision. HIV/AIDS services such as screening, distribution of condoms and ARVs for infected people were available and were offered free of charge. Conclusion: Our findings show that HIV/AIDS intervention programmes were available despite that they were unequally distributed. Although their availability has contributed to the decrease of HIV prevalence in the community, knowledge of their availability was limited to some people in the community

Use of a molecular bacterial load assay to distinguish between active TB and post-TB lung disease

Authors acknowledge financial support from the EDCTP2 programme supported by the European Union project (grant #: TMA2016SF-1463-REMODELTZ) and DELTAS Africa Initiative (Afrique One-ASPIRE /DEL-15-008). The Afrique One-ASPIRE is funded by a consortium of donors including the African Academy of Sciences, Alliance for Accelerating Excellence in Science in Africa, the New Partnership for Africa's Development Planning and Coordinating Agency, the Wellcome Trust (107753/A/15/Z), and the UK Government. PMM, SKH and SGM were also supported by NIH U01AI115594.Publisher PDFPeer reviewe

Post-Ebola Awakening: Urgent Call for Investing in Maintaining Effective Preparedness Capacities at the National and Regional Levels in Sub-Saharan Africa

Background:&nbsp;The 2014 Ebola outbreak reminded us of the importance of preparedness for addressing health security threats. Learning from this experience, we aim to (1) enhance the understanding of preparedness by policy and decision makers, (2) discuss opportunities for Africa to invest in the prevention of health security threats, (3) highlight the value of investing in preventing health security threats, and (4) propose innovations to enhance investments for the prevention or containment of health security threats at the source. &nbsp; Methods:&nbsp;We used observations of governments’ attitudes towards investing in preparedness for health security prevention or containment at the source. We conducted a literature review through PubMed, the World Wide Web, and Mendeley using the keywords: "health emergency financing", "investing in health threats prevention", and "stopping outbreaks at the source". &nbsp; Results:&nbsp;Countries in sub-Saharan Africa invest inadequately towards building and maintaining critical capacities for preventing, detecting, and containing outbreaks at the source. Global health security emergency funding schemes target responses to outbreaks but neglect their prevention. Governments are not absorbing and maintaining adequately capacity built through GHS, World Bank, and development aid projects – a lost opportunity for building and retaining outbreak prevention capacity. &nbsp; Recommendations:&nbsp;Governments should (1) allocate adequate national budgets for health honouring the Abuja and related commitments; (2) own and maintain capacities developed through International Development Aids, OH networks, research consortia and projects; (3) establish a regional health security threats prevention fund. The global community and scientists should (1) consider broadening existing health emergency funds to finance the prevention and containment outbreaks at the source and (2) Strengthen economic analyses and case studies as incentives for governments’ budget allocations to prevent health security threats

Smear microscopy and culture conversion rates among smear positive pulmonary tuberculosis patients by HIV status in Dar es Salaam, Tanzania

Tanzania ranks 15th among the world's 22 countries with the largest tuberculosis burden and tuberculosis has continued to be among the major public health problems in the country. Limited data, especially in patients co infected with HIV, are available to predict the duration of time required for a smear positive pulmonary tuberculosis patient to achieve sputum conversion after starting effective treatment. In this study we assessed the sputum smear and culture conversion rates among HIV positive and HIV negative smear positive pulmonary tuberculosis patients in Dar es Salaam The study was a prospective cohort study which lasted for nine months, from April to December 2008 A total of 502 smear positive pulmonary tuberculosis patients were recruited. HIV test results were obtained for 498 patients, of which 33.7% were HIV positive. After two weeks of treatment the conversion rate by standard sputum microscopy was higher in HIV positive(72.8%) than HIV negative(63.3%) patients by univariate analysis(P = 0.046), but not in multivariate analysis. Also after two weeks of treatment the conversion rate by fluorescence microscopy was higher in HIV positive (72.8%) than in HIV negative(63.2%) patients by univariate analysis (P = 0.043) but not in the multivariate analysis. The conversion rates by both methods during the rest of the treatment period (8, 12, and 20 weeks) were not significantly different between HIV positive and HIV negative patients.With regards to culture, the conversion rate during the whole period of the treatment (2, 8, 12 and 20 weeks) were not significantly different between HIV positive and HIV negative patients.\ud Conversion rates of standard smear microscopy, fluorescence microscopy and culture did not differ between HIV positive and HIV negative pulmonary tuberculosis patients