Snakes and Snakebite Envenoming in Northern Tanzania: A Neglected Tropical Health Problem.

Snakebites cause considerable human and livestock injuries as well as deaths worldwide, and particularly have a high impact in sub-Saharan Africa. Generating a basic platform of information on the characteristics of snakes and snakebites in various countries is relevant for designing and implementing public health interventions. This study was performed to identify types of snakes and some of the characteristics of snakebite cases in two communities, an agricultural and a pastoralist, in Arusha region, northern Tanzania. A total of 30 field visits were carried out in areas considered by local inhabitants to be potential microhabitats for snakes. Direct observation of snake types based on morphological features and a structured questionnaire were employed for data collection. A total of 25 live and 14 dead snakes were encountered. Among the dead ones, the following species were identified: two black-necked spitting cobras (Naja nigricollis); five puff adders (Bitis arietans), one common egg-eater (Dasypeltis scabra); two rufous-beaked snakes (Ramphiophis rostratus); two brown house snakes (Lamprophis fuliginosus); one Kenyan sand boa (Eryx colubrinus), and one black mamba (Dendroaspis polylepis). The frequency of snake encounters was significantly higher (χ (2) = 4.6; p = 0.03) in the pastoral than in the agricultural area; there were more snakebite cases in the former, but the differences were not statistically significant (p = 0.7). A total of 242 snakebite victims attended at the Meserani Clinic, located in the study area, between the years 2007 to 2012. Of all cases, 146 (61.6 %) and 96 (38.4 %) were male and female patients, respectively. As for age distribution, 59.1 % of snakebite victims were from the economically active age groups between 15 and 55 years. Snakebites are a threat to rural communities and public health in general. The burden of snakebites in Tanzania presents an epidemiologically similar picture to other tropical countries. Livestock keeping and agriculture are the major economic activities associated with snakebites. Community-based public education is required to create awareness on venomous snakes and predisposing factors to snakebites. These tasks demand integration of diverse stakeholders to achieve a common goal of reducing the impact of human suffering from these envenomings in Tanzania

The role of soil water monitoring tools and agricultural innovation platforms in improving food security and income of farmers in smallholder irrigation schemes in Tanzania

Smallholder irrigation is an important pathway towards better livelihoods and food security in sub-Saharan Africa. This article assesses the contribution of farmer-friendly soil and water monitoring tools, and agricultural innovation platforms, towards household income and food security in two small-scale irrigation schemes in Tanzania. Quantitative and qualitative data from farmer’s field books, household surveys and focus groups were used to assess the impacts of the two interventions. The two interventions together contributed to enhancing smallholders’ food security and household income in the two schemes, as did the agricultural innovation platform on its own

Relationships between seasonal changes in diet of multimammate rat (Mastomys natalensis) and its breeding patterns in semi-arid areas in Tanzania

The diet and breeding patterns of Mastomys natalensis in semi-arid areas of Isimani division, Iringa region, Tanzania were investigated in maize fields and fallow land. The aim was to investigate the influence of diet on breeding patterns of M. natalensis. Removal trapping was used to capture rodents and analyse diet categories while Capture-mark-release trapping was used to investigate breeding patterns of female M. natalensis. Mastomys natalensis comprised 94%of the total capture, and the remaining 6% comprised of six other species. Statistical analysis of food preferences indicated that both vegetative materials and seeds were significantly higher in the overall diet of M. natalensis compared with other food materials. Significant differences in the proportions of vegetativematerials and seeds were found between seasons (dry, wet), but not between habitats (fallow, maize). There was a clear seasonal pattern in the proportion of reproductively active females with peaks in April and troughs in October. The proportion of vegetative materialswas highest during thewet season and correlated positively with reproductive activity, suggesting that vegetative materials contain certain compounds (e.g. 6-MBOA) that trigger reproductive activity in M. natalensis. The breeding activity of M. natalensis in semi-arid areas might, thus, be reduced by limiting access to fresh vegetative food (e.g. young sprouting grass)

Transforming smallholder irrigation schemes in Africa

This publication is a guide to help farmers become more profitable and sustainable. Across Africa, smallholder irrigation schemes have performed poorly, leading to calls for their ‘revitalisation’, ‘reoperation’ or ‘rehabilitation’. The authors present knowledge generated through four years of research intervention at six irrigation schemes in Mozambique, Tanzania and Zimbabwe, and their understanding of what has worked to turn five of into successful enterprises. A summary of the best advice on good practices needed for more sustainable irrigation is presented. Each intervention can be considered alone, although a number of different complementary interventions are usually required to achieve better socioeconomic and environmental outcomes. The ideas described in the publication were developed through the project Increasing irrigation water productivity in Mozambique, Tanzania and Zimbabwe through on-farm monitoring, adaptive management and agricultural innovation platforms that was largely funded by ACAIR project FSC/2013/006

Transforming smallholder irrigation into profitable and self-sustaining systems in southern Africa

Small-scale communal irrigation schemes in Africa have not realised returns on investment. Critical to this failure is that funders, designers and managers of these schemes have not recognized them as complex socio-ecological systems with a diversity of constraints. These schemes are often under-performing and characterized by a subsistence orientation, which is compounded by poor market integration, low capacity to invest in crop production, low yields, difficulties paying for water, or lack of willingness to participate in system maintenance. The end result is unsustainable utilization of resources, failed infrastructure, inefficient use of water and land and increased conflict over access to these resources. Conventional irrigation scheme development has focused on ‘hard’ technologies to improve the functionality and efficiency of infrastructure and/or irrigation application technologies. However, hard technology improvements on their own have failed to deliver sustainable schemes and improve the livelihoods of irrigation farmers (Inocencio et al., 2007): broken and decaying infrastructure is just one element of an underperforming system. While technologies that are more efficient may help improve yield, they will not necessarily improve profitability. A great many irrigation schemes are trapped in a negative cycle of infrastructure provision, unprofitable farming, lack of investment in maintenance, infrastructure degradation leading to donors subsidizing infrastructure rehabilitation (Pittock & Stirzaker, 2014; Bjornlund et al., 2017)..

Home ranges, sex ratio and recruitment of the multimammate rat (Mastomys natalensis) in semi-arid areas in Tanzania

Investigation of home ranges, sex ratio and recruitment of the multimammate rat (Mastomys natalensis) in semi-arid areas of Tanzania was conducted in maize and fallow fields using the capture-mark-release (CMR) technique. The aim of this study was to generate useful data for the management of M. natalensis. The relative home range size of M. natalensis was significantly higher during the wet [544 m2±25 standard error (SE)] than during the dry (447 m2 ±18 SE) season, in males (521 m2 ±23 SE) than in females (450 m2 ±17 SE) and in adults (576 m2 ±34 SE) than in juveniles (459 m2 ±16 SE). However, there were no significant differences between habitats. Sex ratio was not significantly different (p=0.44) between habitats. Recruitment was significantly higher (p=0.000) in maize fields (mean=0.43) than in fallow land (mean=0.32) and differed significantly over time (p=0.0001) with the highest recruitment recorded from April to July and the lowest from October to December. Management strategies should focus on managing rodents inhabiting maize fields using methods that affect their recruitment in order to reduce the population increase of M. natalensi

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe