Challenges of implementing an Integrated Disease Surveillance and Response strategy using the current Health Management Information System in Tanzania

Tanzania adopted an Integrated Disease Surveillance and Response (IDSR) strategy in 1998 in order to strengthen its infectious disease surveillance system. During that time, the country had 5 separate surveillance systems to monitor infectious disease trends and disease control programmes. The systems included the Health Management Information System (HMIS); Infectious Disease Week Ending; Tuberculosis/Leprosy; Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome; and Acute Flaccid Paralysis/Poliomyelitis). An assessment of the surveillance systems in the country has shown inadequacy in the use of standard case definitions and laboratory confirmation of cases, supervision and feedback as well as data collection tools. Moreover, in some of the existing vertical disease surveillance programmes, the epidemiological data generated were neither fully analyzed nor utilized at district level, but rather were forwarded to higher levels, which hardly provided any feedback to the lower levels. For these and other reasons, the Ministry of Health adopted the IDSR strategy that will focus on selected priority diseases. Although a significant progress has been made as far as the IDSR strategy is concerned, its implementation is facing several challenges. This is due to the fact that the current surveillance system has to utilize the existing HMIS system in collecting and compiling epidemiological data from health facility and district levels. This paper intends to discuss in detail challenges, which the Ministry of Health and district councils have to take into consideration during the implementation of IDSR strategy. Recommendations are also made for possible adoption to enable smooth running of the IDSR strategy at the national, district and facility levels. Tanzania Health Research Bulletin Vol.6(2) 2004: 57-6

Participatory involvement of farming communities and public sectors in determining malaria control strategies in Mvomero District, Tanzania

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Analysis of Cost Impact of HIV/AIDS on Health Service Provision in Nine Regions, Tanzania: Methodological Challenges and Lessons for Policy

Background: Tanzania is one of African countries that have since 1983 been facing the human immuno-deficiency virus-acquired immune-deficiency syndrome (HIV-AIDS) pandemic, thereby, drawing attention to the general public, the governmental and non-governmental organizations and government’s partner development agencies. Due to few socio-economic studies done so far to evaluate the impact this pandemic, a study was designed and undertaken in 2001 to analyse how this disease had impacted on health service provision in Tanzania from a cost perspective.Methods: The study involved a review of health service management information documents at selected health facilities in nine regions within mainland Tanzania, interviews with health service workers (HWs) at selected health facilities and health managers at district and regional levels as well as focus group discussions with people living with HIV/AIDS (PLWA).Findings: We noted that on average, HIV/AIDS caused 72% of all the deaths recorded at the study hospitals. The health management information system (HMIS) missed some data in relation to HIV/AIDS services, including the costs of such services which limited the investigators’ ability to determine the actual costs impact. Using their experience, health managers and HWs reported substantial amounts of funds, labour time, supplies and other resources to have been spent on HIV/AIDS preventive and curative services. The frontline HWs reported to face a problem of identifying the PLWA among those who presented multiple illness conditions at HF levels which means sometimes the services given to such people could not be separated for easy costing from services delivered to other categories of the patients. Such respondents and their superiors (i.e. Health managers) testified that PLWA were being screened and receiving treatment. HWs were concerned with spending much time on counselling PLWA, attending home-based care, sick-leaves and funeral ceremonies either after their relatives or co-staff have died of AIDS, lowering time for delivering services to other patients. HWs together with their superiors at district and regional levels reported increasing shortages of essential supplies, office-working space and other facilities at HF levels, although actual costs of such items were not documented.Conclusion: The cost impact of HIV/AIDS to the health sector is undoubtedly high even though it is not easy to establish the cost of each service delivered to PLWA in Tanzania. As adopted in the present study, designers of methods for analysing impacts of diseases like this should consider a mixture of both quantitative and qualitative techniques. Meanwhile concerted measures are needed to improve health service record keeping so as enhancing data usability for research and rational management decision-making purposes

Changing association between schooling levels and HIV-1 infection over 11 years in a rural population cohort in south-west Uganda.

BACKGROUND: Previous studies have found that in Africa, a greater risk of HIV infection is often found in groups with higher educational attainment. However, some serial cross-sectional studies have found greater reductions in HIV prevalence among more educated groups, especially in cohorts of young adults. More recent studies have found some instances where higher schooling levels are associated with lower HIV prevalence. METHODS: We describe changes in the association between schooling levels, HIV prevalence and condom use in a rural population-based cohort between 1989/1990 and 1999/2000, in Masaka District, Uganda. RESULTS: In 1989-1990, higher educational attainment was associated with higher risk of HIV-1 infection, especially among males, but once odds ratios are adjusted for age, no significant relation between schooling and HIV infection remains. In 1999-2000, there is, for females aged 18-29 years, a significant relationship between higher educational attainment and lower HIV prevalence, even after adjustment for age, gender, marital status and wealth (P for trend 0.01). Tests for interaction, significant for males and both genders combined, show that more schooling has been shifting towards an association with less HIV infection between 1989-1990 and 1999-2000, especially for young individuals. Condom use increased during the study period and this increase has been concentrated among more educated individuals. CONCLUSIONS: These findings suggest that over a decade more educated young adults, especially females, have become more likely to respond to HIV/AIDS information and prevention campaigns by effectively reducing their sexual risk behaviour

Magnitude of HIV infection among older people in Mufindi and Babati districts of the Tanzania mainland

Vitus Nyigo,1 Andrew Kilale,2 Stella Kilima,1 Elizabeth H Shayo,1 Kesheni P Senkoro,1 Jonathan Mshana,1 Adiel K Mushi,1 Lucas Matemba,1 Julius Massaga11National Institute for Medical Research, 2Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es Salaam, Tanzania Introduction: According to the 2011–2012 HIV and Malaria Indicator Survey, the prevalence of HIV infection in Tanzania is 5.1%, with limited information on its magnitude among older people, as the community believes that the elderly are not at risk. Consequently, little attention is given to the fight against HIV and AIDS in this group. The present study investigated the magnitude of HIV and AIDS infection among older people in rural and urban areas of the Tanzania mainland. Subjects and methods: The study was conducted in Mufindi and Babati districts of Iringa and Manyara regions, respectively, through multistage sampling procedures. Dried blood spot cards were used to collect blood samples for HIV testing among consenting participants. HIV testing was done and retested using different enzyme-linked immunosorbent assay kits. Results: A total of 720 individuals, 340 (47.2%) males and 380 (52.8%) females, were randomly selected, of whom 714 (99.2%) consented to HIV testing while six (0.8%) refused to donate blood. The age ranged from 50 to 98 years, with a mean age of 64.2 years. Overall, a total of 56 (7.8%) participants were HIV-positive. Females had a higher prevalence (8.3%) than males (7.4%), with Mufindi district recording the higher rate (11.3%) compared to the 3.7% of Babati district. The prevalence was higher in the rural population (9.4%) compared to 6.4% of their urban counterparts. Conclusion: Although HIV/AIDS is considered a disease of individuals aged 15–49 years, the overall prevalence among the older people aged 50 years and above for Mufindi and Babati districts was higher than the national prevalence in the general population. These findings point to the need to consider strengthening interventions targeting older populations against HIV/AIDS in these districts while establishing evidence countrywide to inform policy decisions. Keywords: HIV/AIDS, prevalence, elderly, Iringa, Manyara, HIV in the elderly, older populatio