Distribution of primary health care facilities in Mtwara District, Tanzania: availability and accessibility of services

Background: Access to health care services is a significant factor to health seeking practices that contributes to a healthy population. Improving health care accessibility is an important health priority in low-income countries. The objective of this study was to determine distribution of health care facilities and identify the high priority areas, which require more services in Mtwara, southern Tanzania.Methods: This study was carried in Mtwara Rural district of southern Tanzania and involved health care facilities. A hand held global positioning system was used to geo-reference the coordinates of all facilities. A questionnaire with both closed and open-ended questions was used to gather information from patients who attended the respective facilities. Interviews with district health officials and facility in-charges were conducted.Results:  There were 38 health in the district. Most of them were located within southern part of the district. The majority of facilities (97%) were government owned. On average each facility was serving 2,400 population. Malaria management, reproductive and child health services, family planning and integrated management of childhood illnesses were offered by all health facilities in the district. Prevention of mother to child transmission of HIV was offered by 34 (89.5%) facilities. Tuberculosis services were offered by only 3 facilities while voluntary counselling and testing of HIV and anti-retroviral treatment services were available in 15 and 10 health facilities, respectively. Only 4 facilities had laboratory and inpatients services. The majority of the staff included Medical Attendants (39%), Nurse Midwives (34%), and Clinical Officers (20%). Assistant Medical Officers and Nursing Officers each accounted for 2% of the total staff. There were no Medical Officers, laboratory technicians or pharmaceutical technicians in the district.  A total of 408 health facility clients (≥18yrs) were interviewed. Factors influencing the choice of a health facility were the availability of special services, medicine and qualified human resources.Conclusion: The majority of facilities in Mtwara are government and there is disparity in the distribution of the facilities. Availability of medicines and qualified human resources were the major factors on the preference for accessing health care services

Production of Paper Pulp Using Sisal Fiber Waste from Sisal Spinning Processes

Disposal of large volumes of textile waste is an escalating problem for textile industries. Sisal spinning industry is the one of the textile industries releasing large volumes of textile waste in the landfills. The rising costs, and reduction of available space together with increasing stringent environmental measures are making burying and land filling of textile waste, a declining option. This study therefore explores recycling options where the potential of using sisal fiber waste produced during sisal spinning processes as raw materials for the production of paper pulp was investigated. Sampling was done at 21stCentury Holdings Limited allocated at Chang’ombe industrial street Dar es Salaam mainly dealer of sisal yarns production. Materials were prepared and cut into small pieces of about ½ inches to reduce the fiber into unit lengths so as to achieve pulping required performance. Pulping process was achieved through Soda pulping techniques with two different effective alkali charges (EA-20% and EA-24%) for 240 minutes under maximum temperature 140 C, and liquor to fiber ratio 4:1by using Mathis Labomat dyeing Machine. The kappa number obtained was (25.5, 34.5) for material treated under EA 24% and EA 20% respectively, Percentage pulp yield were (47.1, 54.4) for EA 24% and EA20% pulp respectively. Freeness (630CFS, 555CSF) after refining at 4500rpm. Finally, the resulting pulp was used for hand sheet making and the sheets were tested for their mechanical properties; Grammage (61.1, 61.1) g/m2, Tensile index (9.9, 22.3) Nm/g, Tear index (13.3, 17.4) Nm2/g, burst index (1.7, 3.7 and 1.6) k.pa.m2/g and Elongation at break (2.02, 2.22) % for EA24% pulp, EA20% pulp respectively. The findings shows that sisal fiber wastes have a promising potential for paper pulp production compared to other non-wood raw material

The development of reading tests for use in a regularly spelled language.

Data are presented on the development of tests of reading skill in rural Tanzanian primary school pupils. Instruction in these schools is in Kiswahili, a regularly spelt language. Using a translation of a standard reading test, children could read aloud all words once they had learnt sound-letter correspondences, regardless of comprehension. In addition, children can appear to pass traditional comprehension tasks by decoding only some of the words. Three graded tests were developed which allow testing of children who either have only some letter knowledge, can read single words, or are proficient readers. The tests require children to both decode and understand the reading material in order to achieve high scores. The tests correlated well with scores on other educational achievement tests, and showed age and school grade differences. It is suggested that these tests are useful measures of reading development in a regularly spelt language. Adaptation to English and validation against standardised instruments is planned

Baseline Trachoma Surveys in Kaskazini A and Micheweni Districts of Zanzibar: Results of Two Population-Based Prevalence Surveys Conducted with the Global Trachoma Mapping Project.

PURPOSE: Based on health care records and trachoma rapid assessments, trachoma was suspected to be endemic in Kaskazini A and Micheweni districts of Zanzibar. This study aimed to investigate the prevalence of trachomatous inflammation-follicular (TF), and trachomatous trichiasis (TT) in each of those districts. METHODS: The survey was undertaken in Kaskazini A and Micheweni districts on Unguja and Pemba Islands, respectively. A multi-stage cluster random sampling design was applied, whereby 25 census enumeration areas (clusters) and 30 households per cluster were included. Consenting eligible participants (children aged 1-9 years and people aged 15 years and older) were examined for trachoma using the World Health Organization simplified grading system. RESULTS: A total of 1673 households were surveyed and 6407 participants (98.0% of those enumerated) were examined for trachoma. Examinees included a total of 2825 children aged 1-9 years and 3582 people aged 15 years and older. TF prevalence in 1-9-year-olds was 2.7% (95% confidence interval, CI, 2.7-4.1%) in Kazkazini A and 11.4% (95% CI 6.6-16.5%) in Micheweni. Among people aged 15 years and older, TT prevalence was 0.01% (95% CI 0.00-0.04%) in Kazkazini A and 0.21% (95% CI 0.08-0.39%) in Micheweni. CONCLUSION: Trachoma is a public health problem in Micheweni district, where implementation of all four components of the SAFE strategy (surgery, antibiotics, facial cleanliness, and environmental improvement), including mass drug administration with azithromycin, is required. These findings will facilitate planning for trachoma elimination

Malignant lymphomas (ML) and HIV infection in Tanzania

\ud HIV infection is reported to be associated with some malignant lymphomas (ML) so called AIDS-related lymphomas (ARL), with an aggressive behavior and poor prognosis. The ML frequency, pathogenicity, clinical patterns and possible association with AIDS in Tanzania, are not well documented impeding the development of preventive and therapeutic strategies. Sections of 176 archival formalin-fixed paraffin-embedded biopsies of ML patients at Muhimbili National Hospital (MNH)/Muhimbili University of Health and Allied Sciences (MUHAS), Tanzania from 1996-2001 were stained for hematoxylin and eosin and selected (70) cases for expression of pan-leucocytic (CD45), B-cell (CD20), T-cell (CD3), Hodgkin/RS cell (CD30), histiocyte (CD68) and proliferation (Ki-67) antigen markers. Corresponding clinical records were also evaluated. Available sera from 38 ML patients were screened (ELISA) for HIV antibodies. The proportion of ML out of all diagnosed tumors at MNH during the 6 year period was 4.2% (176/4200) comprising 77.84% non-Hodgkin (NHL) including 19.32% Burkitt's (BL) and 22.16% Hodgkin's disease (HD). The ML tumors frequency increased from 0.42% (1997) to 0.70% (2001) and 23.7% of tested sera from these patients were HIV positive. The mean age for all ML was 30, age-range 3-91 and peak age was 1-20 years. The male:female ratio was 1.8:1. Supra-diaphragmatic presentation was commonest and histological sub-types were mostly aggressive B-cell lymphomas however, no clear cases of primary effusion lymphoma (PEL) and primary central nervous system lymphoma (PCNSL) were diagnosed. Malignant lymphomas apparently, increased significantly among diagnosed tumors at MNH between 1996 and 2001, predominantly among the young, HIV infected and AIDS patients. The frequent aggressive clinical and histological presentation as well as the dominant B-immunophenotype and the HIV serology indicate a pathogenic association with AIDS. Therefore, routine HIV screening of all malignant lymphoma patients at MNH is necessary to enable comprehensive ARL diagnosis and formulation of preventive and therapeutic protocols.\u

Maternal oral health status and preterm low birth weight at Muhimbili National Hospital, Tanzania: a case-control study

The study examined the relationship between oral health status (periodontal disease and carious pulpal exposure (CPE)) and preterm low-birth-weight (PTLBW) infant deliveries among Tanzanian-African mothers at Muhimbili National Hospital (MNH), Tanzania. A retrospective case-control study was conducted, involving 373 postpartum mothers aged 14-44 years (PTLBW--150 cases) and at term normal-birth-weight (TNBW)--223 controls), using structured questionnaire and full-mouth examination for periodontal and dentition status. The mean number of sites with gingival bleeding was higher in PTLBW than in TNBW (P = 0.026). No significant differences were observed for sites with plaque, calculus, teeth with decay, missing, filling (DMFT) between PTLBW and TNBW. Controlling for known risk factors in all post-partum (n = 373), and primiparaous (n = 206) mothers, no significant differences were found regarding periodontal disease diagnosis threshold (PDT) (four sites or more that had probing periodontal pocket depth 4+mm and gingival bleeding > or = 30% sites), and CPE between cases and controls. Significant risk factors for PTLBW among primi- and multiparous mothers together were age < or = 19 years (adjusted Odds Ratio (aOR) = 2.09, 95% Confidence interval (95% CI): 1.18-3.67, P = 0.011), hypertension (aOR = 2.44, (95% CI): 1.20-4.93, P = 0.013) and being un-married (aOR = 1.59, (95% CI): 1.00-2.53, P = 0.049). For primiparous mothers significant risk factors for PTLBW were age < or = 19 years (aOR = 2.07, 95% CI: 1.13 - 3.81, P = 0.019), and being un-married (aOR = 2.58, 95% CI: 1.42-4.67, P = 0.002). These clinical findings show no evidence for periodontal disease or carious pulpal exposure being significant risk factors in PTLBW infant delivery among Tanzanian-Africans mothers at MNH, except for young age, hypertension, and being unmarried. Further research incorporating periodontal pathogens is recommended

Heavy schistosomiasis associated with poor short-term memory and slower reaction times in Tanzanian schoolchildren.

Cross-sectional studies of the relationship between helminth infection and cognitive function can be informative in ways that treatment studies cannot. However, interpretation of results of many previous studies has been complicated by the failure to control for many potentially confounding variables. We gave Tanzanian schoolchildren aged 9-14 a battery of 11 cognitive and three educational tests and assessed their level of helminth infection. We also took measurements of an extensive range of potentially confounding or mediating factors such as socioeconomic and educational factors, anthropometric and other biomedical measures. A total of 272 children were moderately or heavily infected with Schistosoma haematobium, hookworm or both helminth species and 117 were uninfected with either species. Multiple regression analyses, controlling for all confounding and mediating variables, revealed that children with a heavy S. haematobium infection had significantly lower scores than uninfected children on two tests of verbal short-term memory and two reaction time tasks. In one of these tests the effect was greatest for children with poor nutritional status. There was no association between infection and educational achievement, nor between moderate infection with either species of helminth and performance on the cognitive tests. We conclude that children with heavy worm burdens and poor nutritional status are most likely to suffer cognitive impairment, and the domains of verbal short- term memory and speed of information processing are those most likely to be affecte

A cross-sectional study on African Swine fever (ASF) in domestic pigs in Northern Tanzania

UNE ETUDE TRANSVERSALE SUR LA PESTE PORCINE AFRICAINE (PPA) CHEZ LES PORCS DOMESTIQUES DANS LE NORD DE LA TANZANIE Résumé Une enquête sérologique transversale a été menée entre le 5 et le 17 octobre 2003 sur les porcs domestiques dans sept districts géographiques et administratifs du nord de la Tanzanie. Une technique d'échantillonnage aléatoire à deux étapes a été adoptée : les premières unités étant des fermes et les deuxièmes des porcs à l'intérieur des fermes. Le Titrage indirect avec immunoadsorbant lié à une enzyme (Technique ELISA) a été utilisé pour évaluer le titre d'anticorps contre le virus de la peste porcine africaine (PPA). Quatorze (14,9%) des 94 fermes, qui ont fait l'objet d'enquête, avaient des porcs ayant des anticorps contre le virus de la PPA. La séroprévalence globale aux anticorps PPA chez les porcs était de 7% parmi les 313 porcs. Le taux de séropositivité des fermes variait entre 0 et 80% et la prévalence entre les districts était de 0 – 17,4%. L'analyse des facteurs de risque pour la séropositivité a été effectuée à l'aide d'un modèle de régression logistique : l'état de séroconversion (positif ou négatif) étant la variable dépendante; la ferme et le porc, les variables indépendantes. Après l'ajustement de l'effet conjugué des âges et des modes d'élevage, les porcs des régions proches du poste de frontière et les porcs mâles avaient une séropositivité plus forte (Ratio de probabilité [RP] = 10,1 ; P = 0,013 pour les porcs des régions proches du poste de frontière et [RP] = 4,2 ; P = 0,018 pour les mâles respectivement). Mots-clés : Peste porcine africaine, porcs domestiques, séroprévalence, facteurs de risque, Tanzanie. Summary A cross-sectional serological survey was conducted between 5-17 October 2003 on domestic pigs in seven geographical and administrative districts in Northern Tanzania. A two-stage random sampling technique was adopted with primary sampling units being farms and secondary units being pigs within farms. The indirect enzyme-linked immunosorbent assay (ELISA) technique was used to estimate antibody titre to African Swine fever (ASF) virus. Fourteen (14.9%) of the 94 farms surveyed had pigs with antibodies against ASF virus. The overall seroprevalence to ASF antibodies in pigs was found to be 7 % among 313 pigs. The level of seropositive farms ranged from 0 - 80% and prevalence between districts ranged from 0 - 17.4%. Analysis of risk factors for seropositivity was undertaken using a logistic regression model with sero-conversion status (positive or negative) as dependent variable and farm and pig level variables as independent variables. After adjusting for the confounding effect of ages and management practices, pigs located in the areas close to border post and male pigs were associated with higher seropositivity (Odd ratio [OR] =10.1, P = 0.013 for border post and [OR] = 4.2, P = 0.018 for males, respectively). Key words :African swine fever, domestic pigs, sero-prevalence, risk factors, Tanzania. Bull Anim. Hlth. Prod. Afr. (2004) 53, 43-4

Smallholder vegetable farmers in northern Tanzania: pesticides use practices, perceptions, cost and health effects. Crop Protection 26

Abstract Smallholder farmers in Northern Tanzania grow vegetables that include tomatoes, cabbages and onions and use many types of pesticides to control pests and diseases that attack these crops. Based on the use of questionnaires and interviews that were conducted in Arumeru, Monduli, Karatu and Moshi rural districts, this study investigates farmers&apos; practices, perceptions and related cost and health effects on vegetable pest management using pesticides. The types of pesticides used by the farmers in the study areas were insecticides (59%), fungicides (29%) and herbicides (10%) with the remaining 2% being rodenticides. Pesticides were bought from pesticides shops (60%), general shops (30%) and cooperative shops (10%). The pesticides were supplied in containers ranging from 0.5 to 5 l or in packets ranging from 0.5 to 25 kg. Vendors often dispensed smaller quantities of pesticides in unlabelled containers. About a third of the farmers applied pesticides in mixtures. Up to 90% of this third had a maximum of 3 pesticides in a mixture. In all cases, there were no specific instructions either from the labels or extension workers regarding these tank mixtures. More than 50% of the respondents applied pesticides up to 5 times or more per cropping season depending on the crop. Insecticides and fungicides were routinely applied by 77% and 7%, respectively. Fifty-three percent of the farmers reported that the trend of pesticide use was increasing, while 33% was constant and 14% was decreasing. Sixty-eight percent of farmers reported having felt sick after routine application of pesticides. Pesticide-related health symptoms that were associated with pesticides use included skin problems and neurological system disturbances (dizziness, headache). Thirty-nine percent of farmers reported spending between 20 and 130,200 Tanzanian shillings (0.018-116 US dollars) in a year on health due to pesticides. These results will contribute to the reformation of pesticide policies for safe and effective use of pesticides by smallholder farmers in Tanzania.