HIV/AIDS/STI Surveillance Report:Report Number 21

Since the first cases of Acquired Immunodeficiency Syndrome (AIDS) in Tanzania were reported in 1983, the epidemic has evolved from being a rare and new disease to a common household problem, which has affected most Tanzania families. The mainland Tanzania faces a generalized human immunodeficiency virus (HIV) and AIDS epidemic, with an estimated 6.5% of the mainland population infected with HIV (7.7% of adult women and 6.3% of adult men). Overall, 1.4 million Tanzanians (1,300,000 adults and 110,000 children) are living with HIV infection, in a total population of 41 million. The social, economic, and environmental impact of the pandemic is sorely felt as an estimated 140,000 Tanzanians have perished, leaving behind as estimated 2.5 million orphans and vulnerable children, representing approximately 10-12% of all Tanzanian children. As elsewhere in sub-Saharan African, the underlying factors of poverty, migration, marginalization, lack of information and skills, disempowerment, and poor access to services raise the risk of HIV and have an impact on the course and spread of the pandemic. Close to 85% of HIV transmission in Tanzania occurs through heterosexual contact, less than 6% through mother-to-child transmission, and less than 1% through blood transfusion. There continues to be a significant difference in the prevalence among urban (10.9%) and rural (5.3%) areas of the country. The National AIDS Control Programme (NACP) of Tanzania was founded in 1987 to champion the health sector response to the HIV epidemic. The primary objectives of the program were to reduce spread of HIV infection, screen blood supplies, enhance clinical services for HIV/AIDS patients and improve STI treatment, prevention of mother-to-child transmission (PMTCT), advocate behavioral change and conduct epidemiologic surveillance and other research. The program phases started with a two-year phase called Short Term Plan\ud (1985-1986). Subsequent phases were termed Medium Term Plans lasting for five-year periods. Through these program phases successful national responses have been identified, the most effective ones being those touching on the major determinants of the epidemic and addressing priority areas that make people vulnerable to HIV infection. These include the following; Since early eighties great efforts have been made to reduce spread of HIV infection through screening of donor blood, advocating behavioral change, condom promotion and improvement of STI treatment. In addition a number of epidemiologic surveillance have been conducted to monitor the trend of HIV infection among different subpopulations e.g. blood donors and pregnant women attending antenatal clinics. In 2004, the National Blood Transfusions Services (NBTS), which is a centralized system of coordinated blood transfusion services, was established. The NBTS is responsible for collection, processing, storage and distribution of safe blood and blood products to health facilities. At the moment NBTS coordinates eight zonal blood transfusion centers, namely Lake Zone-(LZBTC) in Mwanza region, Western-(WZBTC) in Tabora, Northern (NZBTC) in Kilimanjaro region, Eastern (EZBTC) in Dar es Salaam, Southern highlands (SHZBTC) in Mbeya, Southern (SZBTC) in Mtwara and Zanzibar and a military zone –Tanzania People’s Defence Force (TPDF). Since the establishment of NBTS, donated blood in the eight zones is systematically screened for HIV, hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis. The National HIV Care and Treatment Plan (NCTP) was launched in October 2004, with the main focus of a rapid scaling up of HIV care and treatment services, aimed at having more than 400,000 patients on care and treatment by the end of 2008 and, at the same time, follow up disease progression in 1.2 million HIV+ persons who are not eligible for ntiretroviral therapy (ART). Prevention of Mother to Child Transmission of HIV (PMTCT) services were established in 2002 , providing a package of services that include: counseling and testing for pregnant women; short-course preventive ARV regimens to prevent mother-to-child transmission; counseling and support for safe\ud infant feeding practices; family planning counseling or referral; and referral for long-term ART for the\ud child. This report which covers the NACP activities through December 2008 has been arranged in five chapters and is intended for various stakeholders, primarily those working within the health sector.\u

Feed, food and fuel: Competition and potential impacts on small-scale crop-livestock-energy farming systems

CGIAR System-wide Livestock Programm

Durability associated efficacy of long-lasting insecticidal nets after five years of household use

<p>Abstract</p> <p>Background</p> <p>Long-lasting insecticidal nets (LLINs) have been strongly advocated for use to prevent malaria in sub-Saharan Africa and have significantly reduced human-vector contact. PermaNet^®2.0 is among the five LLINs brands which have been given full approval by the WHO Pesticide Evaluation Scheme (WHOPES). The LLINs are expected to protect the malaria endemic communities, but a number of factors within the community can affect their durability and efficacy. This study evaluated the durability, efficacy and retention of PermaNet^®2.0 after five years of use in a Tanzanian community.</p> <p>Method</p> <p>Two to three day- old non blood-fed female mosquitoes from an insectary susceptible colony (<it>An. gambiae </it>s.s, this colony was established at TPRI from Kisumu, Kenya in 1992) and wild mosquito populations (<it>An. arabiensis </it>and <it>Culex quinquefasciatus</it>) were used in cone bioassay tests to assess the efficacy of mosquito nets.</p> <p>Findings</p> <p>The knockdown effect was recorded after three minutes of exposure, and mortality was recorded after 24 hours post-exposure. Mortality of <it>An. gambiae </it>s.s from insectary colony was 100% while <it>An. arabiensis </it>and <it>Cx.quinquefasciatus </it>wild populations had reduced mortality. Insecticide content of the new (the bed net of the same brand but never used before) and used PermaNet^®2.0 was determined using High Performance Liquid Chromatography (HPLC).</p> <p>Conclusion</p> <p>The results of this study suggest that, in order to achieve maximum protection against malaria, public health education focusing on bed net use and maintenance should be incorporated into the mass distribution of nets in communities.</p

Climate-smart agriculture global research agenda: Scientific basis for action

Background: Climate-smart agriculture (CSA) addresses the challenge of meeting the growing demand for food, fibre and fuel, despite the changing climate and fewer opportunities for agricultural expansion on additional lands. CSA focuses on contributing to economic development, poverty reduction and food security; maintaining and enhancing the productivity and resilience of natural and agricultural ecosystem functions, thus building natural capital; and reducing trade-offs involved in meeting these goals. Current gaps in knowledge, work within CSA, and agendas for interdisciplinary research and science-based actions identified at the 2013 Global Science Conference on Climate-Smart Agriculture (Davis, CA, USA) are described here within three themes: (1) farm and food systems, (2) landscape and regional issues and (3) institutional and policy aspects. The first two themes comprise crop physiology and genetics, mitigation and adaptation for livestock and agriculture, barriers to adoption of CSA practices, climate risk management and energy and biofuels (theme 1); and modelling adaptation and uncertainty, achieving multifunctionality, food and fishery systems, forest biodiversity and ecosystem services, rural migration from climate change and metrics (theme 2). Theme 3 comprises designing research that bridges disciplines, integrating stakeholder input to directly link science, action and governance. Outcomes: In addition to interdisciplinary research among these themes, imperatives include developing (1) models that include adaptation and transformation at either the farm or landscape level; (2) capacity approaches to examine multifunctional solutions for agronomic, ecological and socioeconomic challenges; (3) scenarios that are validated by direct evidence and metrics to support behaviours that foster resilience and natural capital; (4) reductions in the risk that can present formidable barriers for farmers during adoption of new technology and practices; and (5) an understanding of how climate affects the rural labour force, land tenure and cultural integrity, and thus the stability of food production. Effective work in CSA will involve stakeholders, address governance issues, examine uncertainties, incorporate social benefits with technological change, and establish climate finance within a green development framework. Here, the socioecological approach is intended to reduce development controversies associated with CSA and to identify technologies, policies and approaches leading to sustainable food production and consumption patterns in a changing climate

Smart investments in sustainable food production: revisiting mixed crop-livestock systems

Farmers in mixed crop-livestock systems produce about half of the world’s food. In small holdings around the world, livestock are reared mostly on grass, browse, and nonfood biomass from maize, millet, rice, and sorghum crops and in their turn supply manure and traction for future crops. Animals act as insurance against hard times and supply farmers with a source of regular income from sales of milk, eggs, and other products. Thus, faced with population growth and climate change, small-holder farmers should be the first target for policies to intensify production by carefully managed inputs of fertilizer, water, and feed to minimize waste and environmental impact, supported by improved access to markets, new varieties, and technologies

Post Eclosion Age Predicts the Prevalence of Midgut Trypanosome Infections in Glossina

The teneral phenomenon, as observed in Glossina sp., refers to the increased susceptibility of the fly to trypanosome infection when the first bloodmeal taken is trypanosome-infected. In recent years, the term teneral has gradually become synonymous with unfed, and thus fails to consider the age of the newly emerged fly at the time the first bloodmeal is taken. Furthermore, conflicting evidence exists of the effect of the age of the teneral fly post eclosion when it is given the infected first bloodmeal in determining the infection prevalence. This study demonstrates that it is not the feeding history of the fly but rather the age (hours after eclosion of the fly from the puparium) of the fly when it takes the first (infective) bloodmeal that determines the level of fly susceptibility to trypanosome infection. We examine this phenomenon in male and female flies from two distinct tsetse clades (Glossina morsitans morsitans and Glossina palpalis palpalis) infected with two salivarian trypanosome species, Trypanosoma (Trypanozoon) brucei brucei and Trypanosoma (Nannomonas) congolense using Fisher's exact test to examine differences in infection rates. Teneral tsetse aged less than 24 hours post-eclosion (h.p.e.) are twice as susceptible to trypanosome infection as flies aged 48 h.p.e. This trend is conserved across sex, vector clade and parasite species. The life cycle stage of the parasite fed to the fly (mammalian versus insect form trypanosomes) does not alter this age-related bias in infection. Reducing the numbers of parasites fed to 48 h.p.e., but not to 24 h.p.e. flies, increases teneral refractoriness. The importance of this phenomenon in disease biology in the field as well as the necessity of employing flies of consistent age in laboratory-based infection studies is discussed

Genome sequence of the tsetse fly (Glossina morsitans):Vector of African trypanosomiasis

Tsetse flies are the sole vectors of human African trypanosomiasis throughout sub-Saharan Africa. Both sexes of adult tsetse feed exclusively on blood and contribute to disease transmission. Notable differences between tsetse and other disease vectors include obligate microbial symbioses, viviparous reproduction, and lactation. Here, we describe the sequence and annotation of the 366-megabase Glossina morsitans morsitans genome. Analysis of the genome and the 12,308 predicted protein-encoding genes led to multiple discoveries, including chromosomal integrations of bacterial (Wolbachia) genome sequences, a family of lactation-specific proteins, reduced complement of host pathogen recognition proteins, and reduced olfaction/chemosensory associated genes. These genome data provide a foundation for research into trypanosomiasis prevention and yield important insights with broad implications for multiple aspects of tsetse biology.IS

Is aging raw cattle urine efficient for sampling <it>Anopheles arabiensis </it>Patton?

Abstract Background To ensure sustainable routine surveillance of mosquito vectors, simple, effective and ethically acceptable tools are required. As a part of that, we evaluated the efficiency of resting boxes baited with fresh and aging cattle urine for indoor and outdoor sampling of An. arabiensis in the lower Moshi rice irrigation schemes. Methods A cattle urine treatment and re-treatment schedule was used, including a box with a piece of cloth re-treated with urine daily, and once after 3 and 7 day. Resting box with piece of black cloth not treated with urine was used as a control. Each treatment was made in pair for indoor and outdoor sampling. A 4 by 4 Latin square design was used to achieve equal rotation of each of the four treatments across the experimental houses. Sampling was done over a period of 6 months, once per week. Results A total of 7871 mosquitoes were collected throughout the study period. 49.8% of the mosquitoes were collected from resting box treated with urine daily; 21.6% and 20.0% were from boxes treated 3 and 7 days respectively. Only 8.6% were from untreated resting box (control). The proportion collected indoors was ~2 folds greater than the outdoor. Of all mosquitoes, 12.3% were unfed, 4.1% full fed, 34.2% semi-gravid and 49.4% gravid. Conclusion Fresh and decaying cattle urine odour baited resting boxes offer an alternative tool for sampling particularly semi-gravid and gravid An. arabiensis. Evaluation in low density seasons of An. arabiensis in different ecological settings remains necessary. This sampling method may be standardized for replacing human landing catch.</p

Social economic factors and malaria transmission in Lower Moshi, Northern Tanzania

Abstract Background For many years social economic status has been used as an indicator to characterize malaria treatment seeking behaviors of communities and their adherence to malaria control programs. The present study was therefore conducted to assess the influence of household social economic status, knowledge, attitude and practice on treatment seeking behaviors, distance to health facilities and vector control measures in the Lower Moshi area, northern Tanzania. Methods A cross-sectional household survey was carried out, a quantitative method was used to collect information from the households, and the household socio-economic status was estimated by employing a household asset-based approach. The structured questionnaire also collected information on malaria knowledge, attitudes and treatment seeking behaviors. Results A total of 197 (68.8% were female) household heads were interviewed. Distance to the health centers influenced malaria treatment seeking behaviors especially for children (P = 0.001) and the number of visits to the health facilities made by the household members (P = 0.001). The head of the households' level of education had an influence on bed-net retreatment (P P Conclusion Distance to the health centre influenced malaria treatment seeking behaviors, and the number of visits made by the household members. In addition, the education level of the household heads played a role in understanding and in the selection of malaria interventions for the households. Increasing the number of health facilities close to rural areas will improve malaria treatment seeking behavior, case management and hence reduce malaria-associated morbidities, especially in high risk groups.</p