Comparative detection of trypanosomal DNA by loop-mediated isothermal amplification and PCR from flinders technology associates cards spotted with patient blood.

We analyzed DNA eluted from FTA (Flinders Technology Associates) cards spotted with blood from human African trypanosomiasis (HAT) patients admitted at Lwala Hospital in eastern Uganda and Kaliua Health Centre in northwestern Tanzania. The aims were to evaluate loop-mediated isothermal amplification (LAMP) for detection of trypanosomal DNA in clinical samples and to characterize the infecting trypanosomes to the subspecies level. LAMP targeting the Trypanozoon conserved random inserted mobile element (RIME-LAMP) and that for the serum resistance-associated (SRA) gene (SRA-LAMP) were performed. For comparison, PCRs for the SRA gene specific for Trypanosoma brucei rhodesiense (SRA-PCR) and that to amplify the Trypanosoma brucei gambiense-specific surface glycoprotein (TgSGP-PCR) were done. Out of 128 samples analyzed, SRA-PCR was positive in 101 samples (78.9% sensitivity; 95% confidence interval [CI], 71.1 to 85.1%), SRA-LAMP was positive in 120 (93.8%; 95% CI, 88.2 to 96.8%), while RIME-LAMP revealed signals in 122 (95.3%; 95% CI, 90.2 to 97.8%). RIME-LAMP and SRA-LAMP were each significantly more sensitive than SRA-PCR (P values of 0.000 and 0.001, respectively; Fisher's exact test). There was poor agreement between RIME-LAMP and SRA-LAMP and the SRA-PCR, yielding kappa values of 0.31 and 0.40, respectively. Agreement between SRA-LAMP and RIME-LAMP was almost perfect (kappa value, 0.85; 95% CI, 0.64 to 1). All the 128 field samples were negative by TgSGP-PCR. Blood spots from three T. b. gambiense HAT cases from northwestern Uganda were positive by TgSGP-PCR and RIME-LAMP. PCR took five times longer to execute than LAMP. LAMP may be useful to monitor emerging HAT foci or to test travelers returning from countries where HAT is endemic. It should be evaluated in a case-control study to determine its utility as a HAT diagnostic.

Integrating reproductive and child health and HIV services in Tanzania: Implication to policy, systems and services.

In Tanzania, reproductive health and HIV services are coordinated by the Ministry of Health and Social Welfare in two separate units namely Reproductive and Child Health Section and the National AIDS Control Programme. The importance of integrating the two services that are vertically run is expected to improve access to and uptake of key essential services and extend coverage to underserved and vulnerable populations and thus minimizing missed opportunities. Experts around the world recognize the central role of Sexual and Reproductive Health (SRH) services in preventing HIV infection. Evidence suggests that improving access to contraception for women to prevent pregnancy is an important and cost-effective way to prevent HIV-positive births. Integrating SRH and HlV services therefore verifies its importance for improving maternal and child health as well as leading to prevention of HIV infection. The primary objective of this review was to gain an understanding of the current linkages between SRH and HIV within Tanzania's policies, programmes, systems and services. Policy documents, guidelines, national laws, and published reports on SRH and HIV were reviewed. The majority of the reviewed documents mentioned fundamentals of integration between SRH and HIV. Majority of policies and guidelines both in family planning (FP) and HIV documents mandate bi-directional linkages. This review suggests that there are linkages between the two services and can be operationalised together. However, policies and guidelines only specify services to be integrated without due consideration of resources and structural orientation for linked services.

Quality of malaria microscopy in 12 district hospital laboratories in Tanzania.

BACKGROUND: The WHO recommendation for parasitological diagnosis of malaria wherever possible is challenged by evidence of poor-quality microscopy in African hospitals but the reasons are not clear. METHODS: All 12 of the busier district hospital laboratories from three regions of Tanzania were assessed for quality of the working environment and slide readers read 10 reference slides under exam conditions. Slides that had been routinely read were removed for expert reading. RESULTS: Of 44 slide readers in the study, 39 (88.6%) correctly read >90% of the reference slides. Of 206 slides that had been routinely read, 33 (16%) were judged to be unreadable, 104 (51%) were readable with difficulty, and 69 (34%) were easily readable. Compared to expert reading of the same slide, the sensitivity of routine slide results of easily readable slides was 85.7% (95% confidence interval: 77.4-94.0), falling to 44.4% (95% confidence interval: 34.5-54.4) for slides that were 'readable with difficulty'. CONCLUSIONS: The commonest cause of inaccurate results was the quality of the slide itself, correction of which is likely to be achievable within existing resources. A minority of slide readers were unable to read slides even under ideal conditions, suggesting the need for a 'slide reading licence' scheme.

Safety and efficacy of the 10-day melarsoprol schedule for the treatment of second stage Rhodesiense sleeping sickness.

OBJECTIVE: Assessment of the safety and efficacy of a 10-day melarsoprol schedule in second stage T.b. rhodesiense patients and the effect of suramin-pretreatment on the incidence of encephalopathic syndrome (ES) during melarsoprol therapy. DESIGN: Sequential conduct of a proof-of-concept trial (n = 60) and a utilization study (n = 78) using historic controls as comparator. SETTING: Two trial centres in the T.b. rhodesiense endemic regions of Tanzania and Uganda. PARTICIPANTS: Consenting patients with confirmed second stage disease and a minimum age of 6 years were eligible for participation. Unconscious and pregnant patients were excluded. MAIN OUTCOME MEASURES: The primary outcome measures were safety and efficacy at end of treatment. The secondary outcome measure was efficacy during follow-up after 3, 6 and 12 months. RESULTS: The incidence of ES in the trial population was 11.2% (CI 5-17%) and 13% (CI 9-17%) in the historic data. The respective case fatality rates were 8.4% (CI 3-13.8%) and 9.3% (CI 6-12.6%). All patients discharged alive were free of parasites at end of treatment. Twelve months after discharge, 96% of patients were clinically cured. The mean hospitalization time was reduced from 29 to 13 days (p<0.0001) per patient. CONCLUSIONS: The 10-day melarsoprol schedule does not expose patients to a higher risk of ES or death than does treatment according to national schedules in current use. The efficacy of the 10-day melarsoprol schedule was highly satisfactory. No benefit could be attributed to the suramin pre-treatment. TRIAL REGISTRATION: Current Controlled Trials ISRCTN40537886.

Quantifying the burden of rhodesiense sleeping sickness in Urambo District, Tanzania.

BACKGROUND: Human African trypanosomiasis is a severely neglected vector-borne disease that is always fatal if untreated. In Tanzania it is highly focalised and of major socio-economic and public health importance in affected communities. OBJECTIVES: This study aimed to estimate the public health burden of rhodesiense HAT in terms of DALYs and financial costs in a highly disease endemic area of Tanzania using hospital records. MATERIALS AND METHODS: Data was obtained from 143 patients admitted in 2004 for treatment for HAT at Kaliua Health Centre, Urambo District. The direct medical and other indirect costs incurred by individual patients and by the health services were calculated. DALYs were estimated using methods recommended by the Global Burden of Disease Project as well as those used in previous rhodesiense HAT estimates assuming HAT under reporting of 45%, a figure specific for Tanzania. RESULTS: The DALY estimate for HAT in Urambo District with and without age-weighting were 215.7 (95% CI: 155.3-287.5) and 281.6 (95% CI: 209.1-362.6) respectively. When 45% under-reporting was included, the results were 622.5 (95% CI: 155.3-1098.9) and 978.9 (95% CI: 201.1-1870.8) respectively. The costs of treating 143 patients in terms of admission costs, diagnosis, hospitalization and sleeping sickness drugs were estimated at US$ 15,514, of which patients themselves paid US$ 3,673 and the health services US$ 11,841. The burden in terms of indirect non-medical costs for the 143 patients was estimated at US$ 9,781. CONCLUSIONS: This study shows that HAT imposes a considerable burden on affected rural communities in Tanzania and stresses the urgent need for location- and disease-specific burden estimates tailored to particular rural settings in countries like Tanzania where a considerable number of infectious diseases are prevalent and, due to their focal nature, are often concentrated in certain locations where they impose an especially high burden.