Population normative data for three cognitive screening tools for older adults in sub-Saharan Africa / Dados normativos populacionais para três instrumentos de triagem cognitiva para idosos na áfrica subsaariana

ABSTRACT In sub-Saharan Africa (SSA),cognitive screening is complicated by both cultural and educational factors, and the existing normative values may not be applicable. The Identification of Dementia in Elderly Africans (IDEA) cognitive screen is a low-literacy measure with good diagnostic accuracy for dementia. Objective: The aim of this study is to report normative values for IDEA and other simple measures [i.e., categorical verbal fluency, the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) 10-word list] in representative community-dwelling older adults in SSA. Methods: Individuals aged ≥60 years resident in 12 representative villages in Kilimanjaro, Tanzania and individuals aged ≥65 years resident within three communities in Akinyele Local Government Area, Oyo State, Nigeria underwent cognitive screening. The normative data were generated by the categories of age, sex, and education. Results: A total of 3,011 people in Tanzania (i.e., 57.3% females and 26.4% uneducated) and 1,117 in Nigeria (i.e., 60.3% females and 64.5% uneducated) were screened. Individuals with higher age, lower education, and female gender obtained lower scores. The 50th decile values for IDEA were 13 (60-64 years) vs. 8/9 (above 85 years), 10-11 uneducated vs. 13 primary educated, and 11/12 in females vs. 13 in males. The normative values for 10-word list delayed recall and categorical verbal fluency varied with education [i.e., delayed recall mean 2.8 [standard deviation (SD) 1.7] uneducated vs. 4.2 (SD 1.2) secondary educated; verbal fluency mean 9.2 (SD 4.8) uneducated vs. 12.2 (SD 4.3) secondary educated], substantially lower than published high-income country values. Conclusions: The cut-off values for commonly used cognitive screening items should be adjusted to suit local normative values, particularly where there are lower levels of education.

RESUMO Na África Subsaariana (ASS), a triagem cognitiva é complicada por fatores culturais e educacionais, além dos valores normativos existentes poderem não ser aplicáveis. O rastreio cognitivo Identification of Dementia in Elderly Africans (IDEA) é uma medida para níveis baixos de alfabetização com boa acurácia diagnóstica para demência. Objetivo: Relatar os valores normativos para a IDEA e outras medidas simples (fluência verbal categórica, a lista de 10 palavras do Consortium to Establish a Registry for Alzheimer's Disease (CERAD) em idosos residentes na comunidade, representativos da ASS. Métodos: Indivíduos com idade ≥60 residentes em 12 comunidades representativas em Kilimanjaro, Tanzânia e indivíduos com idade ≥65 anos residentes em três comunidades na área governamental de Akinyele, Estado de Oyo, Nigéria, foram submetidos à triagem cognitiva. Os dados normativos foram gerados por faixas etárias, sexo e escolaridade. Resultados: Um total de 3.011 pessoas na Tanzânia (57,3% mulheres, 26,4% sem educação) e 1.117 na Nigéria (60,3% mulheres, 64,5% sem educação) foram examinadas. Os indivíduos com idade mais alta, menor escolaridade e mulheres obtiveram escores mais baixos. Os valores do percentil 50 para a IDEA foram 13 (60-64 anos) vs. 8/9 (85+ anos), 10-11 para analfabetos vs. 13 com educação primária e 11/12 em mulheres vs. 13 em homens. Os valores normativos para a evocação tardia da lista de 10 palavras e a fluência verbal categórica variaram com a educação (evocação tardia 2,8 (SD 1,7) para os sem educação, vs. 4,2 (SD 1,2) para com educação secundária; fluência verbal 9,2 (DP 4,8) para os sem educação vs. 12,2 (SD 4.3) para os com ensino médio, substancialmente inferior aos valores publicados em países de alta renda. Conclusões: Os valores de corte para testes de triagem cognitiva comumente usados devem ser ajustados para se adequar aos valores normativos locais, particularmente em níveis baixos de educação.

Perceptional gaps among women, husbands and family members about intentions for birthplace: a cross-sectional study / Lacunas de percepção entre as mulheres, maridos e membros da família sobre intenções para local de parto: um estudo transversal / Brechas de percepción entre mujeres, maridos y familiares acerca de las intenciones de lugar del parto: un estudio transversal

ABSTRACT Objective: women are more likely to give birth at a health facility when their families agree with the birthplace. However, in rural areas of Tanzania, women are often marginalized from decision-making. This study predicted birthplace intention and identified factors to reduce perceptional gaps among pregnant women, husbands and family members. Method: explanatory cross-sectional survey was conducted in three villages in North Eastern Tanzania. Participants were 138 pregnant women and their families who answered the Birth Intention Questionnaire (BIQ), measuring knowledge, attitude, perceived behavioral control, subjective norms and intention for birthplace. Descriptive analysis, ANOVA, Chi-square, and multiple linear regression was used to analyze the data. Results: the regression model showed that knowledge, perceived behavioral control, and subjective norms predicted intention for birthplace (R2 = .28). While 81% of pregnant women thought their husbands were decision-makers for their birth, only 38% of husbands and 37% of family members agreed. Pregnant women had significantly lower scores on the item “I will prepare for childbirth with my family” compared with husbands (p < .01) and other family members (p < .001). Conclusion: providing evidence-based birth preparation and reducing the identified perceptual gaps may enhance women’s intention to deliver at health facilities.

RESUME Objetivo: as mulheres são mais propensas a dar à luz em um centro de saúde quando suas famílias estão de acordo com o local de nascimento. No entanto, nas áreas rurais da Tanzânia, as mulheres são muitas vezes marginalizadas do processo de decisão. Este estudo fez previsoes de intenção para o local do parto e fatores para reduzir as lacunas de percepção entre as mulheres grávidas, seus maridos e familiares identificados. Método: estudo transversal explicativo realizado em três aldeias no nordeste da Tanzânia. Os participantes foram 138 mulheres grávidas e suas famílias que responderam ao Questionário de Intenção sobre Parto (BIQ), medindo o conhecimento, atitude, percepcão de controle comportamental, normas subjetivas e intenção para lugar de parto. Análise descritivas, ANOVA, Qui-quadrado e regressão linear múltipla foram utilizados para analisar os dados. Resultados: o modelo de regressão mostrou que o conhecimento, percepcão de controle comportamental e normas subjetivas previram intenção de lugar de parto (R2 = 0,28). Enquanto 81% das mulheres grávidas pensavam que seus maridos eram os decisores para seu parto, apenas 38% dos maridos e 37% dos membros da família concordaram. As mulheres grávidas tiveram escores significativamente mais baixos sobre o item “Vou me preparar para o parto com a minha família”, em comparação com os maridos (p < 0,01) e outros membros da família (p < 0,001). Conclusão: Proporcionar preparação para o parto baseada em evidencias e a redução das lacunas de percepção identificadas podem melhorar a intenção das mulheres para dar à luz em unidades de saúde.

RESUMEN Objetivo: las mujeres son más propensas a dar a luz en un centro de salud cuando sus familias están de acuerdo con el lugar de parto. Sin embargo, en las zonas rurales de Tanzania, las mujeres son a menudo marginadas de la toma de decisiones. Este estudio predijo la intención del lugar de parto y los factores identificados para reducir la brecha de percepción entre las mujeres embarazadas, esposos y miembros de la familia. Método: encuesta transversal explicativa llevada a cabo en tres aldeas en el noreste de Tanzania. Los participantes fueron 138 mujeres embarazadas y sus familias, que respondieron al Cuestionario sobre Intención del Parto (BIQ), que mide el conocimiento, la actitud, percepción de control del comportamiento, las normas subjetivas y la intención de lugar de parto. Se utilizaron análisis descriptivo, ANOVA, Chi-cuadrado y regresión lineal múltiple para analizar los datos. Resultados: el modelo de regresión mostró que el conocimiento, la percepción de control del comportamiento, y las normas subjetivas predijeron la intencion del lugar de parto (R2 = 0,28). Mientras que el 81% de las mujeres embarazadas pensaba que sus maridos estaban encargados de tomar decisiones para el nacimiento, sólo el 38% de los esposos y el 37% de los miembros de la familia estuvieron de acuerdo. Las mujeres embarazadas tenían puntuaciones significativamente más bajas en el tema “Me prepararé para el parto con mi familia”, en comparación con los maridos (p < 0,01) y otros miembros de la familia (p < 0,001). Conclusión: proporcionar la preparación al parto basada en la evidencia y reducir las brechas de percepción identificadas pueden mejorar intención de las mujeres a dar a luz en centros de salud.

Empleo del clavo intramedular de Küntscher en pacientes con fracturas diafisarias de tibia / Use of Küntscher intramedullary nail in patients with tibial diaphyseal fractures

Se realizó un estudio descriptivo, longitudinal y retrospectivo de 123 pacientes con fractura diafisaria de tibia, quienes fueron intervenidos mediante la técnica quirúrgica de fijación con clavo intramedular de Küntscher sin fresado del canal, desde agosto del 2012 hasta diciembre del 2013, en el Hospital Especial de Tumbi, de Kibaha, Tanzania, con vistas a evaluar los resultados de dicho procedimiento. En la serie predominaron el sexo masculino (74,0 %), el grupo etario de 26-35 años (37,4 %), los accidentes de tránsito como causa principal de las lesiones (74,0 %) y la reducción de la fractura de forma abierta (90,2 %); asimismo, 29,4 % de los pacientes presentó complicaciones y 80,5 % mostró buenos resultados en la evaluación final. Finalmente, se pudo concluir que el uso del clavo intramedular de Küntscher sin fresado del canal, es una técnica quirúrgica viable para solucionar las fracturas diafisarias de tibia.

A descriptive, longitudinal and retrospective study of 123 patients with tibial diaphyseal fracture who were surgically treated by means of the surgical technique of fixation with Küntscher intramedullary nail without reaming of channels was carried out from August, 2012 to December, 2013, in Tumbi Special Hospital, Kibaha, Tanzania, with the aim of evaluating the results of this procedure. The male sex (74.0%), the age group 26-35 years (37.4%), the traffic accidents as main cause of the lesions (74.0%) and the reduction of the fracture in an open way (90.2%) prevailed in the series; also, 29.4% of the patients presented complications and 80.5% showed good results in the final evaluation. Finally, it could be concluded that the use of Küntscher intramedullary nail without reaming channels, is a viable surgical technique to solve the tibial diaphyseal fractures.

Snakes and snakebite envenoming in Northern Tanzania: a neglected tropical health problem

Background 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.Methods 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.Results 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 (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.Conclusion 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 association between educational level and dementia in rural Tanzania / Associação entre nível educacional e demência na zona rural da Tanzânia

The majority of people with dementia worldwide live in developing countries. Studies from the developed world have reported an association between lower educational attainment and dementia, but there are few data from the developing world where literacy and educational levels are frequently much lower. In this study we assessed the association between education and dementia prevalence in a rural Tanzanian setting. METHODS: In phase I, 1198 individuals aged 70 and over were assessed using the Community Screening Instrument for Dementia (CSI-D). In phase Ii a stratified sample of those seen in phase I were fully assessed and a clinical diagnosis based on DSM-IV criteria was made where appropriate. Information regarding literacy, highest attained educational level and occupation were also collected. RESULTS: The median subject cognitive score on the CSI-D was 25.7 (IQR 22.7 to 28.0) for females and 27.7 (IQR 25.7 to 29.4) for males. This difference was significant (U=117770.0, z= -9.880, p<0.001). In both males and females a lower CSI-D subject cognitive score was significantly associated with having had no formal education (U=34866.5, z= -6.688, p<0.001, for females; U=20757.0, z= -6.278, p<0.001, for males). After adjusting for the effect of age, having no formal education was significantly associated with greater odds of having 'probable dementia' by CSI-D, as was illiteracy. Amongst those interviewed in phase II, there was no significant difference in literacy or education between those with diagnosed DSM-IV dementia and those without. CONCLUSION: In this rural Tanzanian population, we found a significant association between low levels of education and dementia by CSI-D. This relationship was not significant in cases meeting DSM-IV criteria for dementia.

A maioria das pessoas com demência no mundo vivem em países em desenvolvimento. Estudos realizados em países desenvolvidos têm relatado uma associação entre baixa escolaridade e demência, onde os níveis de alfabetização e educação são frequentemente muito mais baixos. Neste estudo avaliou-se a associação entre a educação e a prevalência de demência em um cenário rural da Tanzânia. MÉTODOS: Na fase I, 1.198 indivíduos com 70 anos ou mais foram avaliados utilizando o Instrumento de Rastreamento Comunitário para Demência (CSI-D). Na Fase II uma amostra estratificada dos pacientes avaliados na fase I foram totalmente avaliados e um diagnóstico clínico baseado em critérios do DSM-IV foi feito quando necessário. RESULTADOS: A mediana do escore cognitivo no CSI-D foi de 25,7 (IQR 22,7-28,0) para o sexo feminino e 27,7 (IQR 25,7-29,4) para o sexo masculino. Esta diferença foi significativa (U=117770,0, z= -9,880, p <0,001). Em ambos os sexos, masculino e feminino a pontuação cognitiva menor no CSI-D foi significativamente associada com ausência de educação formal (U=34866,5, z= -6,688, p <0,001, para as mulheres; U=20757,0, z= -6,278, p<0.001, para o sexo masculino). Após o ajuste para o efeito da idade, ausência de educação formal foi significativamente associada com maiores chances de ter provável demência pelo CSI-D, como foi para o analfabetismo. Entre os entrevistados na fase II, não houve diferença significativa na alfabetização ou de educação entre aqueles com ou sem diagnóstico de demência do DSM-IV. CONCLUSÃO: Nesta população da Tanzânia rural, encontramos uma significativa associação entre baixos níveis de educação e demência pelo CSI-D. Esta relação não foi significativa em casos que preencheram os critérios do DSM-IV para demência.

Apertura de la primera Escuela de Medicina en la isla Zanzíbar, Tanzania / The opening of the first school of Medicine in the Island of Zanzíbar, Tanzania

La colaboración médica internacional es un principio insoslayable del Sistema Nacional de Salud cubano. Con el objetivo de describir la creación de la primera Escuela de Medicina en la isla de Zanzíbar, durante el curso premédico y el primer año académico de la carrera de Medicina, se realizó el presente trabajo. Se aborda la participación de profesores cubanos que iniciaron la colaboración internacionalista en la esfera de la Educación Médica Superior en este archipiélago africano. Fueron tenidas en cuenta las dificultades de infraestructura y los logros alcanzados en el desarrollo de los procesos sustantivos universitarios que cimentaron las bases de este centro universitario. Además, se resaltó el apoyo recibido por el Gobierno Revolucionario de Zanzíbar, y el impacto que produjo en la población del lugar la creación de esta Escuela de Medicina, lo que permitió estrechar aún más los lazos de amistad entre ambos pueblos, y sentar las bases para extender el programa de formación de médicos a la isla de Pemba y la apertura de una Escuela de Medicina similar en la región continental de la República Unida de Tanzania

The international collaboration is an unavoidable principle of the Cuban National Health System. We carried out this work with the objective of describing the foundation of the first School of Medicine in the Island of Zanzibar ,during the pre-medical and first academic year. We deal with the participation of Cuban professors who began the international collaboration in the sphere of High Medical Education in this African archipelago. We took into account the infrastructural difficulties and the goals achieved in the development of the main university processes founding the basis of this university centre. Besides that we highlighted the help given by the Revolutionary Government of Zanzibar, and the impact the foundation of this school of medicine had on the local population, leading to the straightening of the friendly ties among our people, and settling down the basis to extend the program of medical preparation to the island of Pemba and to found a similar School of Medicine in the continental part of the United Republic of Tanzania

On two pterosaur humeri from the Tendaguru beds (Upper Jurassic, Tanzania)

Jurassic African pterosaur remains are exceptionally rare and only known from the Tendaguru deposits, Upper Jurassic, Tanzania. Here we describe two right humeri of Tendaguru pterosaurs from the Humboldt University of Berlin: specimens MB.R. 2828 (cast MN 6661-V) and MB.R. 2833 (cast MN 6666-V). MB.R. 2828 consists of a three-dimensionally preserved proximal portion. The combination of the morphological features of the deltopectoral crest not observed in other pterosaurs suggests that this specimen belongs to a new dsungaripteroid taxon. MB.R. 2833 is nearly complete, and because of a long and round proximally placed deltopectoral crest it could be referred to the Archaeopterodactyloidea. It is the smallest pterosaur from Africa and one of the smallest flying reptiles ever recorded. These specimens confirm the importance of the Tendaguru deposits for the Jurassic pterosaur record. This potential, however, has to be fully explored with more field work.

Fragmentos de pterossauros africanos do Jurássico são excepcionalmente raros e conhecidos apenas dos depósitos de Tendaguru, Jurássico Superior, Tanzânia. Este estudo descreve dois úmeros direitos de pterossauros de Tendaguru depositados na Universidade Humboldt de Berlim: espécimes MB.R. 2828 (réplica MN 6661-V) e MB.R. 2833 (réplicaMN 6666-V). MB.R. 2828 consiste em uma porção proximal com preservação tridimensional. Características morfológicas combinadas da crista deltopeitoral não observadas em outros pterossauros sugerem que este espécime pertença a um novo táxon dsungaripteróide. B.R. 2833 é quase completo e, por causa da sua crista deltopeitoral extensa e arredondada, posicionada proximalmente, pode ser associado a Archaeopterodactyloidea. De qualquer forma, este é o menor pterossauro da África e um dos menores já registrados. Estes espécimes corroboram a importância dos depósitos de Tendaguru para registros de pterossauros jurássicos. Este potencial, no entanto, deve ser mais amplamente explorado com um maior número de trabalhos de campo.

Barriers to the adoption of the ART approach as perceived by dental practitioners in governmental dental clinics, in Tanzania

OBJECTIVES: This study aimed to determine the magnitude of the barriers to the practice of Atraumatic Restorative Treatment (ART) as perceived by dental practitioners working in pilot dental clinics, and determine the influence of these barriers on the practice of ART. MATERIAL AND METHODS: A validated and tested questionnaire on barriers that may hinder the practice of ART was administered to 20 practitioners working in 13 pilot clinics. Factor analysis was performed to generate barrier factors. These were patient load, management support, cost sharing, ART skills and operator opinion. The pilot clinics kept records of teeth extracted; teeth restored by conventional approach and teeth restored by ART approach. These treatment records were used to compute the percentage of ART restorations to total teeth treated, percentage of ART restorations to total teeth restored and percentage of total restorations to total teeth treated. The mean barrier scores were generated and compared to independent variables, using the t-test. The influence of barriers to ART-related dependent variables was determined using Pearson correlation coefficients. RESULTS: Mean barrier values were low, indicating low influence on ART practice. Female practitioners had higher scores on patient load than male practitioners (p = 0.003). Assistant Dental Officers had higher scores on cost sharing than Dental Therapists (p = 0.024). Practitioners working in urban clinics had higher mean scores on patient load than those who worked in rural clinics (p = 0.0008). All barrier factors were negatively correlated with ART practice indices but all had insignificant association with ART practice indices. CONCLUSION: The barriers studied were of low magnitude, with no significant impact on practice of ART in dental clinics in the pilot area.

Dental practitioners' attitudes, subjective norms and intentions to practice atraumatic restorative treatment (ART) in Tanzania

The aim of this study was to describe the attitude and subjective norm of dental practitioners towards practicing the atraumatic restorative treatment (ART) in Tanzania. A pre-tested questionnaire on attitudes and subjective norms to practice ART was mailed to all 147 dental practitioners working in the regional and district government clinics. The independent variables were: gender, working experience, qualification and ever heard of ART. The dependent variables were: attitude, subjective norm and intention to practice ART. Chi-square tests and multiple regression analysis were used to test for effects between independent and dependent variables. Significance level was set at 5 percent. A total of 138 practitioners returned completed questionnaires. More experienced dental practitioners encountered moderate social pressure than less experienced dental practitioners, who met strong social pressure (p=0.045). A total of 73.2 percent of dental practitioners felt that ART was worth introducing in Tanzania, 92.8 percent recommended ART training for all dental practitioners and 97.8 percent recommended inclusion of ART in dental curricula. Positive attitude, strong subjective norm and high intention to practice ART were recorded in 76.3 percent, 28.1 percent and 90.6 percent of the practitioners, respectively. Only subjective norm had a statistically significant influence on the intention to practice ART (p<0.0001). The results indicated that dental practitioners were willing to have ART introduced in Tanzania and had positive attitudes towards practicing this technique. Nevertheless, their intention to perform ART was strongly influenced by social pressures. Therefore, in order to have a successful introduction of ART in Tanzania, people who matter in the daily practice of dental practitioners need to accept and appraise the ART approach positively.

Influencia de la parasitemia sobre los valores de hemoglobina y anemia en niños con malaria por Plasmodium falciparum no complicada: experiencia en un Hospital de Tanzania / Influence of parasitemia on anemia and hemoglobin values in children with uncomplicated Plasmodium falciparum malaria: experience of a Hospital from Tanzania

Objetivos: Analizar la importancia de la parasitemia, su relación con los valores de hemoglobina y anemia en niños internados con malaria por Plasmodium falciparum no complicada, y su potencial uso como variable en la predicción de la hemoglobina y la anemia. Materiales y Métodos: Se realizó un estudio clínico epidemiológico en el Hospital de Nzega, provincia de Tabora, Tanzania entre el 2001-2005, haciendo el diagnóstico con gota gruesa y extendido para investigar la presencia de hemoparásitos. Resultados: En el período de estudio fueron evaluados 165 pacientes con una edad media de 4,1 años (61,2% <5 años). La malaria se confirmó en 87,3% de ellos (100% por P. falciparum). La densidad parasitaria media fue de nueve parásitos por cada 200 glóbulos blancos (IC95% 6,69–11,24) y su Hb 8,4 (±1,6g/dL) (82,42% con anemia). La edad y la parasitemia fueron predictores significativos de la anemia (F=13,622; p<0,001), teniendo mayor importancia la parasitemia (p=0,001) que la edad (p=0,014). Conclusión: El nivel de parasitemia de P. falciparum se asocia significativamente con menores niveles de hemoglobina en niños.

Objectives: In this work parasitemia importance, relation with hemoglobin values and anemia in hospitalized children with uncomplicated falciparum malaria, and its potential use as prediction variable for anemia and hemoglobin values are analyzed. Materials and methods: A clinical study of malaria at Nzega Hospital, Tabora province, Tanzania between 2001-2005, performing thick and thin smears to evaluate hemoparasites was made. Results: In the study period 165 patients were evaluated, mean age of 4,1 y-old (61,2% <5 y-old). Malaria was confirmed in 87,3% (100% due to P. falciparum). Mean parasitemia was 9 parasites/200 white blood cells (95%CI 6,69-11,.24) and Hb 8,4 (±1,6 g/dL) (82,42% with anemia). Age and parasitemia were significant predictors of anemia (F=13,622; p<0,001), being most important the parasitemia (p=0,001) than age (p=0,014). Conclusion: Parasitemia level of P.falciparum it is significantly associate with smaller levels of hemoglobin in children.

Control of urinary schistosomiasis on Zanzibar (Unguja Island): a pilot evaluation of the educational impact of the Juma na Kichocho health booklet within primary schools

To improve health education within primary schools, the health education booklet Juma na kichocho was evaluated during a study within 5 schools using key-informant questionnaires that recorded children's knowledge and attitude (KA) towards schistosomiasis before and after daily structured-use of booklets. A total of 229 schoolchildren (114 boys : 115 girls) of between 11 and 15 years of age were interviewed and re-assessed after a working school week. Existing and putative booklet-induced changes in KA scores for schistosomiasis were compared directly against equivalent KA scores for malaria. In total 47.4 percent of children were already aware that schistosomiasis was a water-borne disease while only 10.5 percent knew of its exact aetiology; after booklet intervention these levels increased to 54.6 and 15.7 percent, respectively. The majority of children still failed, however, to realise that re-infection could take place soon after treatment. While a positive increase was observed for children's total KA questionnaire scores for both malaria and schistosomiasis after booklet intervention, these were not statistically significant. In the context of control, further educational efforts are needed to promote and guide behavioural change, especially in relation to reduction of environmental water contact.

Micronutrient dietary supplements--a new fourth approach

Currently the three main widely used strategies to control micronutrient deficiencies are food diversification, fortification, and consumption of medicinal supplements. In Tanzania a fourth strategy has been evaluated in school children, and is to be studied in pregnant and lactating women. The dietary supplement comes in the form of a powder used to prepare a fruit flavored drink. Children consumed for six months 25 grams per school day attended, the powder being added to 200 ml of water. The dietary supplement provides between 40 and 100 percent of the RDA of 10 micronutrients, which includes iron, vitamin A and iodine. Unlike medicinal supplements it provides the multiple vitamins and minerals in physiologic, not megadoses. In a well conducted randomized double blind placebo controlled trial, a dietary supplement in the form of a fortified powder fruit drink produced statistically significant differences not only in vitamin A and iron status, but also in the growth of young school age children.

Un ejercicio en biodiversidad: algunos microhongos tropicales de la litera foliar, Tanzania, Africa / An exercise in biodiversity: some tropical microfungi of foliar litter, Tanzania, Africa

En un viaje por algunas regiones de Tanzania (Marzo de 1999), desde las llanuras costeras a las zonas altas de Iringa, se recolectaron 14 muestras de diverso material de la litera foliar y otros sustratos vegetales senescentes, con la dinalidad de analizar a nivel de género y especie (cuando fuere ppsible) y bajo condiciones de cámara húmeda, la presencia de microhongos tropicales. En todas las muestras se detectaron 419 taxa, de los cuales 368 pudieron clasificarse y repartirse en 81 géneros y 142 especies. En 51, no fue posible llegar a una identificación por falta de información, a pesar que un buen porcentaje de ellos representaron taxa similares. De los clasificados, 47 correspondieron a hyphomycetes (58,02 porciento), 18 a coelomycetes (22,22 porciento), 13 a ascomycetes (16,04 porciento) y 3 a zygomycetes (3,70 porciento). Doce fueron los taxa dominantes con el 24,34 porciento de la presencia total en las muestras y 18 los frecuentes en el 22,19 porciento, los restantes fueron esporádicos. Los géneros más representativos en presencia y variedad de especies fueron: phoma, fusarium, bipolaris, curvularia, myrothecium, penicillium, alternaria y aspergillus. Se concluye que nuestros resultados considerados preliminares debido a lo complejo de nuestra labor, permitieron un interesante ejercicio en biodiversidad fúngica, con aportes informativos y formativos necesarios en la rutina del micológico

Allelic diversity at the Merozoite surface protein-1 (MSP-1) locus in natural Plasmodium falciparum populations: a brief overview

The merozoite surface protein-1 (MSP-1) locus of Plasmodium falciparum codes for a major asexual blood-stage antigen currently proposed as a major malaria vaccine candidate. The protein, however, shows extensive polymorphism, which may compromise its use in sub-unit vaccines. Here we compare the patterns of allelic diversity at the MSP-1 locus in wild isolates from three epidemiologically distinct malaria-endemic areas: the hypoendemic southwestern Brazilian Amazon (n=54), the mesoendemic southern Vietnam (n=238) and the holoendemic northern Tanzania (n=79). Fragments of the variable blocks 2, 4a, 4b and 6 or 10 of this single-copy gene were amplified by the polymerase chain reaction, and 24 MSP-1 gene types were defined as unique combinations of allelic types in each variable block. Ten different MSP-1 types were identified in Brazil, 23 in Vietnam and 13 in Tanzania. The proportion of genetically mixed infections (isolates with carrying more one MSP-1 version) ranged from 39 per cent in Brazil to 44 per cent in Vietnam and 60 per cent in Tanzania. The vast majority (90 per cent) of the typed parasite populations from Brazil and Tanzania belonged to the same seven most frequent MSP-1 gene types. In contrast, these seven types corresponded to only 61 per cent of the typed parasite populations from Vietnam. Non-random associations were found between allelic types in blocks 4a and 6 among Vietnamese isolates, the same pattern being observed in independent studies performed in 1994, 1995 and 1996. These results suggest that MSP-1 is under selective pressure in the local parasite population. Nevertheless, the finding that similar MSP-1 type frequencies were found in 1994 and 1996 argues against the prominence of short-term frequency-dependent immune selection of MSP-1 polymorphisms. Non-random associations between MSP-1 allelic types, however, were not detected among isolates from Brazil and Tanzania. A preliminary analysis of the distribution od MSP-1 gene types per host among isolates from Tanzania, but not among those from Brazil and Vietnam, shows significant deviation from that expected under the null hypothesis of independent distribution of parasites carrying different gene types in the human hosts. Some epidemiological consequences of these findings are discussed.

The stabilizing effects of the acquired immunity on the schistosomiasis transmission modeling - the sensitivity analysis

A mathematical model is proposed to analyze the effects of acquired immunity on the transmission of schistosomiasis in the human host. From this model the prevalence curve dependent on four parameters can be obtained. These parameters were estimuted fitting the data by the maximum likehood method. The model showed a good retrieving capacity of real data from two endemic areas of schistosomiasis: Touros, Brazil (Schistosoma mansoni) and Misungwi, Tanzania (S. haematobium). Also, the average worm burden per person and the dispersion of parasite per person in the community can be obtained from the model. In this paper, the stabilizing effects of the acquired immunity assumption in the model are assessed in terms of the epidemiological variables as follows. Regarded to the prevalence curve, we calculate the confidence interval, and related to the average worm burden and the worm dispersion in the community, the sensitivity analysis (the range of the variation) of both variables with respect to their parameters is performed.

Evaluation of chemical and physical-morphological factors as potencial determinants of Biomphalaria pfeifferi (Krauss, 1848) distribution

This study was carried out in five sites along a small perennial river system in south-central Tanzania, which had been identified as the focus for transmission of intestinal schistosomiasis in the area. Malacological surveys preceding the study showed a focal distribution of Biomphalaria pfeifferi, intermediate host snail of Schistosoma mansoni, the snail being present in three sites but absent from the other two sites. The objective of this study was to evaluate to what extent chemical and/or physical-morphological factors determine the distribution of B. pfeifferi between these five sites. It was found that none of the chemical constituents in the waters examined were outside the tolerance range of B. pfeifferi snails. Moreover, the composition of water from B. pfeifferi-free sites was not different from that in those sites where snails occurred. Furthermore, none of the physical-morphological constituents seemed likely to be determinant for the absence of B. pfeifferi. In view of these findings, and those of previous studies, it is concluded that the focal distribuition of B. pfeifferi cannot be associated with a single environmental factor and is rather the result of more complex interactions of habitat factors.

Evaluation of a gp41 synthetic peptide for detection of antibodies anti-HIV1

Un péptido sintético derivado de una región conservada de la glicoproteína de transmembrana gp41 compuesto por 12 aminoácidos fue evaluado abtígeno de fase sólida en un enzimoinmunoensayo. Se analizaron 3 diferentes paneles de suero de Suecia, la Argentina y Tanzania. Se encontró una especificidad del 97.7% y 97.2% para los sueros suecos y argentinos respectivamente, siendo la sensibilidad del 100% para ambos paneles. Para el panel africano la especificidad fue del 90.5% y la sensibilidad del 96.0%. Los resultados indican que este péptido es altamente reactivo con sueros positivos para HIVl y puede ser útil en ensayos de inmunodiagnóstico

La planificación del sector salud: la experiencia de Tanzania / The planning in the health sector: the experience of Tanzania

"El problema de la salud -mejor podría decirse: el de la enfermedad- ocupa un lugar central en los países subdesarrollados con un pasado de expoliación colonial y un presente de grave atraso económico. La experiencia de Tanzania, un país prácticamente reconstruido desde la cima del Estado-nación, es descriptiva de esta condición, e instructiva en más de un aspecto." "Bajo los lineamientos del régimen socialista, la administración de Tanzania ha procurado una acción amplia y equitativa, así como reconocer y utilizar la capacidad de autogestión de las comunidades. Ante las presiones de una necesidad extrema, la posición social del médico se ha reformulado de un modo realista y la práctica profesional se ha ido despojando del interés mercantil. El modelo del 'médico descalzo' chino se ha implantado en Tanzania, donde la disgregación y aislamiento de los núcleos poblacionales hacen difícil una atención sistemática. La ayuda internacional y las iniciativas de instituciones religiosas, privadas y cívicas han sido acogidas sabiamente en un momento del proyecto nacional en que la salubridad está ligada a la autodeterminación y la soberanía." "A través de campañas educativas se ha ganado terreno en la carrera prevención-curación de enfermedades. El cambio de hábitos y la participación activa de la gente para crear por sí mismos condiciones sanitarias harán posible en lo futuro programas de salud, en vez de los planes de combate a la enfermedad delineados hasta ahora." "Compartir entre el gobierno y los ciudadanos las responsabilidades del desarrollo es una decisión viable en lo político y que aporta resultados estimulantes en lo económico." (ED). Los capítulos del libro son los siguientes: Introducción. I) Antecedentes de la planificación sanitaria en Tanzania. II) El plan de salud. III) Financiamiento de los servicios de salud. IV) El personal de los servicios de salud. V) Instalaciones del servicio de salud. VI) Servicios móviles y de aldea. VII) Los servicios preventivos. VIII) Servicios de atención materna e infantil. IX) Servicios farmacéuticos y otros servicios auxiliares de salud. X) Los servicios no gubernamentales. XI) La ayuda exterior