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

Using Community-Owned Resource Persons to Provide Early Diagnosis and Treatment and Estimate Malaria Burden at Community Level in North-Eastern Tanzania.

Although early diagnosis and prompt treatment is an important strategy for control of malaria, using fever to initiate presumptive treatment with expensive artemisinin combination therapy is a major challenge; particularly in areas with declining burden of malaria. This study was conducted using community-owned resource persons (CORPs) to provide early diagnosis and treatment of malaria, and collect data for estimation of malaria burden in four villages of Korogwe district, north-eastern Tanzania.In 2006, individuals with history of fever within 24 hours or fever (axillary temperature ≥37.5°C) at presentation were presumptively treated using sulphadoxine/pyrimethamine. Between 2007 and 2010, individuals aged five years and above, with positive rapid diagnostic tests (RDTs) were treated with artemether/lumefantrine (AL) while under-fives were treated irrespective of RDT results. Reduction in anti-malarial consumption was determined by comparing the number of cases that would have been presumptively treated and those that were actually treated based on RDTs results. Trends of malaria incidence and slide positivity rates were compared between lowlands and highlands. Of 15,729 cases attended, slide positivity rate was 20.4% and declined by >72.0% from 2008, reaching <10.0% from 2009 onwards; and the slide positivity rates were similar in lowlands and highlands from 2009 onwards. Cases with fever at presentation declined slightly, but remained at >40.0% in under-fives and >20.0% among individuals aged five years and above. With use of RDTs, cases treated with AL decreased from <58.0% in 2007 to <11.0% in 2010 and the numbers of adult courses saved were 3,284 and 1,591 in lowlands and highlands respectively. Malaria incidence declined consistently from 2008 onwards; and the highest incidence of malaria shifted from children aged <10 years to individuals aged 10-19 years from 2009. With basic training, supervision and RDTs, CORPs successfully provided early diagnosis and treatment and reduced consumption of anti-malarials. Progressively declining malaria incidence and slide positivity rates suggest that all fever cases should be tested with RDTs before treatment. Data collected by CORPs was used to plan phase 1b MSP3 malaria vaccine trial and will be used for monitoring and evaluation of different health interventions. The current situation indicates that there is a remarkable changing pattern of malaria and these areas might be moving from control to pre-elimination levels

Pattern and spatial distribution of plague in Lushoto, north-eastern Tanzania

A review of plague records from 1986 to 2002 and household interviews were carried out in the plague endemic villages to establish a pattern and spatial distribution of the disease in Lushoto district, Tanzania. Spatial data of households and village centres were collected and mapped using a hand held Global Positioning System and Geographical Information System. During the 16-year period, there were 6249 cases of plague of which 5302 (84.8%) were bubonic, 391 (6.3%) septicaemic, and 438 (7.0%) pneumonic forms. A total of 118 (1.9%) cases were not categorized. Females and individuals aged 7-18 years old were the most affected groups accounting for 54.4% (95% CI: 52.4–56.0) and 47.0% (95% CI: 45–49) of all reported cases, respectively. Most cases were found in villages at high altitudes (1700-1900m); and there was a decline in case fatality rate (CFR) in areas that experienced frequent outbreaks. Overall, there was a reduction in mean reporting time (from symptoms onset to admission) to an average of 1.35 days (95% CI: 1.30–1.40) over the years, although this remained high among adult patients (>18 years). Despite the decrease in the number of cases and CFR over the years, our findings indicate that Lushoto district experiences human plague epidemic every year; with areas at high altitudes being more prone to outbreaks. The continued presence of plague in this focus warrants further studies. Nonetheless, our findings provide a platform for development of an epidemic preparedness plan to contain future outbreaks.. Keywords: plague, epidemics, pattern, spatial distribution, Tanzania Tanzania Health Research Bulletin Vol. 9 (1) 2007: pp. 12-1

Supply chain management of laboratory supportive services and its potential implications on the quality of HIV diagnostic services in Tanzania

Background: Reliable supply of laboratory supportive services contributes significantly to the quality of HIV diagnostic services. This study assessed the status of supply chain management of laboratory supportive services and its potential implications on the quality of HIV diagnostic services in selected districts of Tanzania.Methods: The study was conducted in 39 health facilities (HFs) from eight districts in four regions of Tanzania, namely Iringa, Mtwara, Tabora and Tanga. Facilities with care and treatment centres for HIV/AIDS patients were purposively selected for the study. The study utilized a quantitative method of data collection. A questionnaire was administered to heads of laboratories to obtain information on laboratory supply chain management.Results:  A total of 39 health facilities (HF) were included in the study. This included 23 public and 16 private facilities. In 82% of the HFs, ordering of supplies was performed by the laboratory departments. The information commonly used to forecast requirements of the laboratories included the number of tests done (74.4%; n=29), current stock levels (69.2%; n=27), average monthly consumption (64.1%, n=25) and minimum and maximum stock levels (10.2%, n=4). Emergency orders were significantly common in public than private facilities (73.9% vs. 56.3%, p=0.004).  Delivery of ordered supplies took 1 to 180 days with a significantly longer period for public than private facilities (32.5 vs. 13.1 days, p=0.044). Most of the public HFs ordered supplies from diverse sources compared to private facilities (68.2% vs. 31.8%).Conclusion: There was a weak inventory management system and delays in delivery of supplies in the majority of HFs, which are likely to impede quality of HIV care and treatment. Strengthening capacity for data management and ensure constant supply will potentially improve the quality of HIV diagnostic services

Lost to follow up and clinical outcomes of HIV adult patients on antiretroviral therapy in care and treatment centres in Tanga City, north-eastern Tanzania

Scaling up of Antiretroviral (ARV) drugs is crucial and should be a perpetual venture in developing countries in-order to increase the survival period of HIV/AIDS individuals. In Tanzania, information on the rate of patients considered as lost to follow up during treatment with ARVs is scarce. The objective of this study was to determine the rate of lost to follow up and treatment outcome among patients attending two care and treatment clinics (CTCs) in Tanga City in north-eastern Tanzania. A descriptive observational study was carried out on cohorts from Tanga AIDS Working Group and Bombo Regional Hospital. The total number of patients identified as “lost to follow up” were 89 of which 14 (15.7%) died. Among those who died, 3 (21.4%) died between the second week and 3 months after ARV initiation. Of those still alive (84.3%; 75/89), 25% (19/75) were still on ARVs, whereas 47 (62.7%) self transferred to other CTCs. Proper patient documentation with actual residence address is a crucial aspect for adherence. Similarly, frequent prompt tracing of patient should be part of any drug interventional programme linking   facility and communities

Malaria and nutritional status in children living in the East Usambara Mountains, north-eastern Tanzania

A cross-sectional survey was conducted in Kwelumbizi and Shambangeda villages, in the East Usambara Mountains, in north-east Tanzania, to determine the prevalence of malaria parasitaemia and nutritional status in children ≤ 11 years old. In addition, knowledge and practice on malaria among the households were determined using questionnaires and focus group discussions. The results showed that prevalence of malaria (48.5 -51.0%) and parasite density levels was similar in both villages. A significantly higher malaria prevalence was observed in children ≥ 5 years old than in the &lt; 5 years old (P=0.01). This correlated with the higher spleen rate in the same age group (P=0.022). However, higher anaemia prevalence (both severe and moderate), lower haemoglobin levels were found in children &lt; 5 years old. There was no variation in most of the clinical history/symptoms among children with malaria in the two villages. However, coughing (P=0.014) was frequently observed among children in Shambangeda. The use of mosquito nets was more common among the residents of Shambangeda than Kwelumbizi (P=0.001). Children ≥ 5 years old were significantly malnourished in all levels of measurement. Wasting was more frequently observed among females in the &lt; 5year old while stunting and underweight were more observed among males in all age groups. Malaria, anaemia and malnutrition are prevalent in the East Usambara Mountains. Efforts to address these conditions are urgently needed

Health sector reform:situation analysis of 37 districts for the first phase of health sector reform

\ud This study was a collaborative undertaking between the National Institute for Medical Research and the Ministry of Health. The main aim was to obtain baseline information for 37 districts to be involved in the First Phase of Health Sector Reforms. The information is to be used to inform and guide the process, as well as providing a basis for evaluation of the impact of Health Sector Reform in the future. The data was collected by DHMT in each of the 37 districts. During the process two meetings were conducted. The first meeting discussed the catalogue and the methods of data collection. The second meeting rook the fom1 of feedback in which the results were discussed with DHMT. The meetings involved NIMR supervisors. In each of the study district, three catalogues were filled out. A copy was given to DMO’s office for local use, another copy was given to the RMO's office in the region involved. The research team retained the third copy.\u

Skin Cancers Among Albinos at a University Teaching Hospital in Northwestern Tanzania: A Retrospective Review of 64 Cases.

Skin cancers are a major risk associated with albinism and are thought to be a major cause of death in African albinos. The challenges associated with the care of these patients are numerous and need to be addressed. The aim of this study was to outline the pattern and treatment outcome of skin cancers among albinos treated at our centre and to highlight challenges associated with the care of these patients and proffer solutions for improved outcome. This was a retrospective study of all albinos with a histopathological diagnosis of skin cancer seen at Bugando Medical Centre from March 2001 to February 2010. Data collected were analyzed using descriptive statistics. A total of 64 patients were studied. The male to female ratio was 1.5:1. The median age of patients was 30 years. The median duration of illness at presentation was 24 months. The commonest reason for late presentation was financial problem. Head and the neck was the most frequent site afflicted in 46(71.8%) patients. Squamous cell carcinoma was the most common histopathological type in 75% of cases. Surgical operation was the commonest modality of treatment in 60 (93.8%) patients. Radiotherapy was given in 24(37.5%) patients. Twenty-seven (42.2%) of the patients did not complete their treatment due to lack of funds. Local recurrence following surgical treatment was recorded in 6 (30.0%) patients. Only thirty-seven (61.7%) patients were available for follow-up at 6-12 months and the remaining patients were lost to follow-up. Skin cancers are the most common cancers among albinos in our environment. Albinism and exposure to ultraviolet light appears to be the most important risk factor in the development of these cancers. Late presentation and failure to complete treatment due to financial difficulties and lack of radiotherapy services at our centre are major challenges in the care of these patients. Early institution of preventive measures, early presentation and treatment, and follow-up should be encouraged in this population for better outcome

Epidemiology of Malaria in an Area Prepared for Clinical Trials in Korogwe, North-eastern Tanzania.

Site preparation is a pre-requesite in conducting malaria vaccines trials. This study was conducted in 12 villages to determine malariometric indices and associated risk factors, during long and short rainy seasons, in an area with varying malaria transmission intensities in Korogwe district, Tanzania. Four villages had passive case detection (PCD) of fever system using village health workers. Four malariometric cross-sectional surveys were conducted between November 2005 and May 2007 among individuals aged 0-19 years, living in lowland urban, lowland rural and highland strata. A total of 10,766 blood samples were collected for malaria parasite diagnosis and anaemia estimation. Blood smears were stained with Giemsa while haemoglobin level was measured by HaemoCue. Socio-economic data were collected between Jan-Apr 2006. Adjusting for the effect of age, the risk of Plasmodium falciparum parasitaemia was significantly lower in both lowland urban, (OR = 0.26; 95%CI: 0.23-0.29, p < 0.001) and highlands, (OR = 0.21; 95%CI: 0.17-0.25, p < 0.001) compared to lowland rural. Individuals aged 6-9 years in the lowland rural and 4-19 years in both lowland urban and highlands had the highest parasite prevalence, whilst children below five years in all strata had the highest parasite density. Prevalence of splenomegaly and gametocyte were also lower in both lowland urban and highlands than in lowland rural. Anaemia (Hb <11 g/dl) prevalence was lowest in the lowland urban. Availability of PCD and higher socio-economic status (SES) were associated with reduced malaria and anaemia prevalence. Higher SES and use of bed nets in the lowland urban could be the important factors for low malaria infections in this stratum. Results obtained here were used together with those from PCD and DSS in selecting a village for Phase 1b MSP3 vaccine trial, which was conducted in the study area in year 2008

Selecting sites to prove the concept of IAR4D in the Lake Kivu Pilot Learning Site

Selecting sites is an essential step in enabling the assessment of the impact of Integrated Agricultural Research for Development (IAR4D) in the Lake Kivu Pilot Learning Site. This paper reports on the process of identifying distinct administrative territories (sites) in which to establish innovation platforms and to monitor similar communities that are experiencing alternative agricultural research for development interventions. We show how the research design for the Sub- Saharan Africa Challenge Programme (SSACP) has been modified to take into account the key conditioning factors of the LKPLS without relinquishing robustness. A key change is the explicit incorporation of accessibility to multiple markets. Candidate sites were stratified according to the national political context, followed by good and poor accessibility to markets and finally according to security considerations and agro-ecology. Randomisation was carried out at all levels, although the need for paired counterfactual sites required the diagnosis of conditioning factors at the site level. Potential sites were characterised in terms of existing or recent agricultural research initiatives, as well as local factors that would have a direct effect on the success of interventions seeking to improve productivity, ameliorate the degradation of natural resources and enhance incomes through better links to markets. Fourteen sites were selected during the initial phase, and a further ten sites were added one year afterwards due to the need for more innovation platforms to test IAR4D. The site selection was successful in pairing action and counterfactual sites in terms of the baseline socioeconomic conditions of farming households. The unavoidable proximity of action and counterfactual sites, however, allows the possibility of spill-over effects and could reduce the measurable impact of IAR4D