Clustering of under-five mortality in Rufiji Health and Demographic Surveillance System in rural Tanzania

BACKGROUND\ud \ud Less than 5 years remain before the 2015 mark when countries will be evaluated on their achievements for the Millennium Development Goals (MDGs). The MDG 4 and 6 call for a reduction of child mortality by two-thirds and combating malaria, HIV/AIDS, TB, and other diseases, respectively. To accelerate the achievement of these goals, focused allocation of resources and high deployment of cost-effective interventions is paramount. The knowledge of spatial and temporal distribution of diseases is important for health authorities to prioritize and allocate resources.\ud \ud METHODS\ud \ud To identify possible significant clusters, we used SatTScan software, and analyzed 2,745 cases of under-five with 134,099 person-years for the period between 1999and 2008. Mortality rates for every year were calculated, likewise a spatial scan statistic was used to test for clusters of total under-five mortalities in both space and time.\ud \ud RESULTS\ud \ud A number of significant clusters from space, time, and space-time analysis were identified in several locations for a period of 10 years in the Rufiji Demographic Surveillance Site (RDSS). These locations show that villages within the clusters have an elevated risk of under-five deaths. The spatial analysis identified three significant clusters. The first cluster had only one village, Kibiti A (p < 0.05, the second cluster involved five villages (Mtawanya, Pagae, Kibiti A, Machepe, and Kibiti B; p < 0.05), the third cluster involved one village, Jaribu Mpakani (p < 0.05). A space-time cluster of 10 villages for the period between 1999 and 2002 with a radius of 14.73 km was discovered with the highest risk (RR 1.6, p < 0.001). The mortality rates were very high for the years 1999-2002 according to the analysis. The death rates were 33.5, 26.4, 24.1, and 24.9, respectively. Total childhood mortality rates calculated for the period of 10 years were 21.0 per 1,000 person-years.\ud \ud CONCLUSION\ud \ud During the 10 years of analysis, mortality seemed to decrease in RDSS. The mortality decline should be taken with caution because the Demographic Surveillance System is not statistically representative of the whole population; therefore, inference should not be made to the general population of Tanzania. The pattern observed could be attributed to demographic and weather characteristics of RDSS. This should provide new insights for further studies and interventions toward reducing under-five mortality

A brief history of selected malaria vaccine and medical interventions pursued by the Swiss Tropical and Public Health Institute and partners, 1943-2021

In order to be successful in global health today, all the long-established European tropical research institutes had to undergo a transition which can be described as "hunter-gatherer" and descriptive approaches during colonial and postcolonial times to a deeper understanding of infection biology and finally to public health interventions from which populations at large can benefit. During the 1980s and 1990s, the Swiss Tropical Institute (today: Swiss Tropical and Public Health Institute, Swiss TPH) based in Basel too has changed its focus from individual medicine to a public health context. This article does not present new scientific data but takes a historical perspective. Its aim is to highlight the above-mentioned transformation by focusing on selected malaria research-cum-action interventions during the crucial period of the 1990s, which were tailored to the social-ecological settings where the disease was endemic. In order for this transformation to be successful, we intend to emphasise the importance of (i) having a fundamental understanding of local transmission; (ii) building and nurturing relationships with partner institutions; and (iii) developing a coherent research portfolio as key elements for researching and applying evidence in malaria control and elimination as part of national malaria control programmes

The use of morbidity questionnaires to identify communities with high prevalences of schistosome or geohelminth infections in Tanzania

Parasitic infections were investigated in Morogoro Rural District, Tanzania, between October 1992 and June 1993. A total of 4589 schoolchildren (aged 7-17 years) from 30 primary schools was screened for infection with Ascaris lumbricoides, Trichuris trichiura, hookworms (3456 children only), Schistosoma mansoni and S. haematobium. The children were also asked about their recent experiences of the following: diarrhoea, abdominal pain, blood in stool, perception of suffering from schistosomiasis, and worm infection and examined for spleen and liver enlargement. Among schools, there were correlations between the prevalence of S. mansoni infection and bloody stools, spleen enlargement and liver enlargement, and between S. haematobium infection and the presence of blood in urine. To exclude ecological explanations for the correlations, logistic regression was used to estimate the adjusted odds ratio (OR) for each infection and each sign or symptom. No sign or symptom was significantly associated with any geohelminth infection. Reported blood in stool was significantly associated with S. mansoni infection (OR = 1·62, P = 0·045). Reported blood in urine was significantly associated with S. haematobium infection (OR = 7·71, P < 0·001), as was reported blood in stool (OR = 11·52, P < 0·001), indicating that presence of blood in either form of excreta was related to the local term for schistosomiasis. These results support the possibility of using reported blood in stool as a means of rapid assessment for identifying communities with a high prevalence of S. mansoni infectio

Predictors of Antibiotics Co-prescription with Antimalarials for Patients Presenting with Fever in Rural Tanzania.

Successful implementation of malaria treatment policy depends on the prescription practices for patients with malaria. This paper describes prescription patterns and assesses factors associated with co-prescription of antibiotics and artemether-lumefantrine (AL) for patients presenting with fever in rural Tanzania. From June 2009 to September 2011, a cohort event monitoring program was conducted among all patients treated at 8 selected health facilities in Ifakara and Rufiji Health and Demographic Surveillance System (HDSS).It included all patients presenting with fever and prescribed with AL. Logistic regression was used to model the predictors on the outcome variable which is co-prescription of AL and antibiotics on a single clinical visit. A cohort of 11,648 was recruited and followed up with 92% presenting with fever. Presumptive treatment was used in 56% of patients treated with AL. On average 2.4 (1 -- 7) drugs was prescribed per encounter, indicating co-prescription of AL with other drugs. Children under five had higher odds of AL and antibiotics co-prescription (OR = 0.63, 95% CI: 0.46 -- 0.85) than those aged more than five years. Patients testing negative had higher odds (OR = 2.22, 95%CI: 1.65 -- 2.97) of AL and antibiotics co-prescription. Patients receiving treatment from dispensaries had higher odds (OR = 1.45, 95% CI: 0.84 -- 2.30) of AL and antibiotics co-prescription than those from served in health centres even though the deference was not statistically significant. Regardless the fact that Malaria is declining but due to lack of laboratories and mRDT in most health facilities in the rural areas, clinicians are still treating malaria presumptively. This leads them to prescribe more drugs to treat all possibilities

Isolation and Characterization of Micro-organisms with Industrial Importance From Sisal Bole Rots

Investigation of microorganisms naturally acclimatized to Agave hybrid H 11648 (sisal bole rot) was conducted, with the aim of isolating and characterizing Aspergillus niger strains for industrial use. Microorganism were identified morphologically and then confirmation made by polymerase chain reaction (PCR). Results showed the existence of four major groups, listed in order of abundances as follows; Aspergilli (36.0±0.8) %, Penicillin (28.0±0.1) %, Yeast (15.0±1.6) %and Fusarium (10.0±0.12) %. The main groups of Aspergilli strains were A. nidulans, A. tamari and A. niger in ratios (3:2:2), respectively. Several endo-spore forming non-enteric gram (-) rods and coccid bacteria identified by API20 NE identification systemincluded,Brevundimonas diminuta sp, Shewanella putrefaciens sp, Brevundimonas vesicularis sp and Pasteurella sp. Results showed that sisal bole rot stems hosts a high bio-diversity of microorganism species other than A. niger. Exploitation of the individual strains is recommended. This could eventually produce strains forprecursors of industrially and therapeutically metabolites

9. Effect of insecticide-treated bed nets on haemoglobin values, prevalence and multiplicity of infection with Plasmodium falciparum in a randomized controlled trial in Tanzania

A randomized controlled trial of insecticide-treated bed nets (ITNs) was conducted in an area of high malaria transmission in Tanzania in order to assess the effects of ITNs on infection and anaemia. One hundred and twenty-two children, aged 5 to 24 months, were randomly allocated to 2 groups, one of which received ITNs. Outcome measures were assessed in 6 consecutive months with monthly cross-sectional surveys. These measures were haemoglobin values, Plasmodium falciparum prevalence and density, and multiplicity of infection determined by polymerase chain reaction-restriction fragment length polymorphism analysis (PCR-RFLP) of the msp2 locus. There was a significant increase in mean heamoglobin values and a significant decrease of 16·4% in microscopically determined P. falciparum prevalence in children in the ITN group six months after the start of the trial. Both effects were more pronounced in younger children. However, no significant difference was observed in parasite density or multiplicity of infection among infected children. Comparison with PCR results indicated that microscopically subpatent parasitaemia was more frequently found in children in the ITN group. This, together with the observed similar multiplicity in the 2 groups, suggests that infections are maintained despite ITN use, owing to the chronicity of infections. This study shows that ITNs reduce the risk of anaemia in highly exposed young children. The virtually unchanged multiplicity of infection indicates that the potentially protective concomitant immunity is not compromise

Mobile-based and open-source case detection and infectious disease outbreak management systems: a review [version 1; peer review: awaiting peer review]

In this paper we perform a rapid review of existing mobile-based, open-source systems for infectious disease outbreak data collection and management. Our inclusion criteria were designed to match the PANDORA-ID-NET consortium’s goals for capacity building in sub-Saharan Africa, and to reflect the lessons learned from the 2014–16 West African Ebola outbreak. We found eight candidate systems that satisfy some or most of these criteria, but only one (SORMAS) fulfils all of them. In addition, we outline a number of desirable features that are not currently present in most outbreak management systems