The use of nominal group technique in identifying community health priorities in Moshi rural district, northern Tanzania.

This article highlights issues pertaining to identification of community health priorities in a resource poor setting. Community involvement is discussed by drawing experience of involving lay people in identifying priorities in health care through the use of Nominal Group Technique. The identified health problems are compared using four selected village communities of Moshi district in Kilimanjaro region, Tanzania. We conducted this study to trace the experience and knowledge of lay people as a supplement to using 'health experts' in priority setting using malaria as a tracer condition. The patients/caregivers, women's group representatives, youth leaders, religious leaders and community leaders/elders constituted the principal subjects. Emphasis was on providing qualitative data, which are of vital consideration in multi-disciplinary oriented studies, and not on quantitative information from larger samples. We found a high level of agreement across groups, that malaria remains the leading health problem in Moshi rural district in Tanzania both in the highland and lowland areas. Our findings also indicate that 'non-medical' issues including lack of water, hunger and poverty heralded priority in the list implying that priorities should not only be focused on diseases, but should also include health services and social cultural issues. Indeed, methods which are easily understood and applied thus able to give results close to those provided by the burden of disease approaches should be adopted. It is the provision of ownership of the derived health priorities to partners including the community that enhances research utilization of the end results. In addition to disease-based methods, the Nominal Group Technique is being proposed as an important research tool for involving the non-experts in priority setting in Tanzania.

Trial of pyrethroid impregnated bednets in an area of Tanzania holoendemic for malaria. Part 1. Operational methods and acceptability.

In five Tanzanian villages, nets impregnated with permethrin or lambdacyhalothrin were given out. The people received them enthusiastically and brought their nets for re-impregnation at six monthly intervals. Bioassays showed that the insecticidal power of permethrin impregnated nets remained adequate for six months unless the nets were washed. Nets with 30 mg lambdacyhalothrin/m2 retained high insecticidal power despite washing, but this dose caused temporary cold-like symptoms in those sleeping under freshly treated dry nets. Methods by which durable bednets might be made affordable by Tanzanian villagers are discussed.

Community satisfaction with primary health care services: an evaluation undertaken in the Morogoro region of Tanzania.

Satisfaction is an important element of the quality of health care, often determining patient willingness to comply with treatment and influencing the effectiveness of care. However, few specific assessments of patient satisfaction in developing countries have been undertaken. This paper presents findings from such a study, carried out in Tanzania and primarily undertaken through the use of qualitative interviewing techniques. The study illustrates the perceived problems of the care available, such as structural and inter-personal skill failings, both of which were seen to influence drug availability and maternal services--key weaknesses of the available care. Health centres were perceived to be little better than dispensaries. Although church health care was generally perceived to be better than government care, there was considerable variation in community judgements and clear signs of poor quality church care. The use of villagers' own words and experiences brought into sharp focus the problems they experience in relation to health care and allow planning lessons are identified.

Clinical and parasitological aspects of itching caused by onchocerciasis in Morogoro, Tanzania.

A clinical and parasitological assessment of onchodermatitis was conducted in a rural area of Morogoro district, Tanzania. The study population consisted of 1,005 individuals aged > or = 5 years: 749 from a hyper-endemic community and 256 from a hypo-endemic. The prevalence of troublesome itching was 67.0% in the hyper-endemic community but only 5% (13/256) in the hypo-endemic. The corresponding prevalences of nodules among the adult male subjects were 77.7% (171/220) and 2.3% (2/86). The most common onchocercal skin lesion in the hyper-endemic community was chronic papular onchodermatitis (CPOD) manifested by itching, which was often very severe. There was a strong association between skin itching and endemicity (r = 0.75; P < 0.001). The prevalence of CPOD in the hyper-endemic community was significantly higher in males than females (P< 0.001). CPOD was only observed in subjects aged > or = 7 years. Many of the subjects were checked for microfilaridermia, by skin-snipping. The prevalence of microfilaridermia [58.2% (393/675) v. 6.2% (3/48)] and its geometric mean intensity (8.9 v. 1.0 microfilariae/mg skin snip) were both higher in the hyper-endemic community than the hypo-endemic. Itching appears to be related to reactive onchodermatitis.