The illusion of community ownership: community-based water management in Uchira, Kilimanjaro region

Water resource managementSocial participationWater users’ associationsWater policyWater shortagePricingWater costsWater supplyLabor

The illusion of community ownership: community-based water management in Uchira, Kilimanjaro region

Water resource managementWater governanceSocial participationWater users’ associationsWater policyWater shortagePricingWater costsWater supplyLabor

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

Background: 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.   Methods: 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".   Results: 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.   Recommendations: 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

The magnitude and factors associated with delays in management of smear positive tuberculosis in Dar es Salaam, Tanzania

To assess the magnitude and factors responsible for delay in TB management. A cross sectional hospital based survey in Dar es Salaam region, May 2006. We interviewed 639 TB patients. A total of 78.4% of patients had good knowledge on TB transmission. Only 35.9% had good knowledge on the symptoms. Patient delay was observed in 35.1% of the patients, with significantly (X2 = 5.49, d.f. = 1, P = 0.019) high proportion in females (41.0%) than in males (31.5%). Diagnosis delay was observed in 52.9% of the patients, with significantly (X2 = 10.1, d.f. = 1, P = 0.001) high proportion in females (62.1%) than in males (47.0%). Treatment delay was observed in 34.4% of patients with no significant differences among males and females. Several risk factors were significantly associated with patient's delays in females but not in males. The factors included not recognizing the following as TB symptoms: night sweat (OR = 1.92, 95% CI 1.20, 3.05), chest pain (OR = 1.62, 95% CI 1.1, 2.37), weight loss (OR = 1.55, 95% CI 1.03, 2.32), and coughing blood (OR = 1.47, 95% CI 1.01, 2.16). Other factors included: living more than 5 Km from a health facility (OR = 2.24, 95% CI 1.41, 3.55), no primary education (OR = 1.74, 95% CI 1.01, 3.05) and no employment (OR = 1.77, 95% CI 1.20, 2.60). In multiple logistic regression, five factors were more significant in females (OR = 2.22, 95% CI 1.14, 4.31) than in males (OR = 0.70, 95% CI 0.44, 1.11). These factors included not knowing that night sweat and chest pain are TB symptoms, a belief that TB is always associated with HIV infection, no employment and living far from a health facility. There were significant delays in the management of TB patients which were contributed by both patients and health facilities. However, delays in most of patients were due to delay of diagnosis and treatment in health facilities. The delays at all levels were more common in females than males. This indicates the need for education targeting health seeking behaviour and improvement in health system

Cryptococcus: from environmental saprophyte to global pathogen.

Cryptococcosis is a globally distributed invasive fungal infection that is caused by species within the genus Cryptococcus which presents substantial therapeutic challenges. Although natural human-to-human transmission has never been observed, recent work has identified multiple virulence mechanisms that enable cryptococci to infect, disseminate within and ultimately kill their human host. In this Review, we describe these recent discoveries that illustrate the intricacy of host-pathogen interactions and reveal new details about the host immune responses that either help to protect against disease or increase host susceptibility. In addition, we discuss how this improved understanding of both the host and the pathogen informs potential new avenues for therapeutic development

Descriptive analysis and lessons learned from the disaster medical response to an urban building collapse

An effective disaster medical response plan is imperative for any established emergency medicine program. Here we describe the response to an urban building collapse in Dar es Salaam, Tanzania, including a description of the event, type and severity of casualties, and lessons learned. Methods: We interviewed members of the medical response team and reviewed the treatment records and the results of the investigation. Results: Several local hospitals sent personnel to assist at the site. The Muhimbili National Hospital Emergency Department (ED) sent staff to establish triage and provide stabilizing medical care, while another team remained in the ED and prepared to treat survivors. Of fifty nine casualties, 37 were dead at the scene. The most common injuries among the survivors were musculoskeletal and soft tissue trauma, including fractures, lacerations, and degloving injuries. All were stabilized on-site prior to transport to the hospital. The search and rescue efforts were hampered by a lack of resources. Heavy machinery, sufficient to clear the rubble and facilitate rescue efforts, was not immediately available. Private engineering companies later provided this equipment. Protective gear, such as hard hats, gloves, and boots were not available, thus some responders were injured while clearing the rubble and three were bitten by police dogs. Family members gathered at the scene to await news of survivors and some developed respiratory distress due to the dusty environment while others syncopized. The investigation revealed that the building was licensed for 10 floors, but construction continued illegally to 16 floors. Structural factors contributing to the collapse included poorly mixed concrete and substandard steel bars. Conclusions: This event highlights the importance of a well-developed disaster response plan, including coordination of medical and rescue workers. Additional policy and advocacy issues identified include the need for building safety code enforcement and available rescue supplies, equipment, and machinery

Capacity of healthcare facilities in the implementation of Direct Observed Treatment strategy for tuberculosis in Arumeru and Karatu districts, Tanzania

Abstract: Directly Observed Treatment Short course strategy (DOTS) has proved to have potential improvement in tuber-culosis (TB) control in Tanzania. The objective of this cross sectional study was to assess the capacity of health facilities in implementing DOTS, in Arumeru and Karatu districts, Tanzania. Information sought included the capacity to offer TB service and availability of qualifi ed staff and equipment for TB diagnosis. Information on availability and utilization of TB registers and treatment outcome for the year 2004 were also collected. A total of 111 health facilities were surveyed, 86 (77.5%) in Arumeru and 25 (22.5%) in Karatu. Only 23.4 % (26/111) facilities were offering TB treatment services in the two districts. Majority 17/26 (65.38%) of them were government owned. Thirty eight (44.7%) facilities were offer-ing TB laboratory services. All facilities with TB services (TB laboratory investigation and treatment) had TB registers. Seventy two (85.0%) of health facilities which do not provide any TB services had qualifi ed clinical offi cers and at least a microscopy. Of the 339 cases notifi ed in Arumeru in 2004, 187 (60.7%) had treatment outcome available, 124 (66.3%) were cured and 55 (29.4%) completed treatment. In Karatu 638 cases were notifi ed in 2004, 305 (47.8%) had treatment outcome available, 68 (22.3%) cured and 165 (54.1%) completed treatment. In conclusion, the overall capacity for imple-menting DOTS among the facilities surveyed is found only in about 20 % and 30 % for clinical and laboratory components of DOTS, respectively. The capacity to provide TB diagnosis and treatment in Karatu district was relatively lower tha