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1.
Malar J ; 13: 245, 2014 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-24964790

RESUMO

BACKGROUND: Community-based service delivery is vital to the effectiveness, affordability and sustainability of vector control generally, and to labour-intensive larval source management (LSM) programmes in particular. CASE DESCRIPTION: The institutional evolution of a city-level, community-based LSM programme over 14 years in urban Dar es Salaam, Tanzania, illustrates how operational research projects can contribute to public health governance and to the establishment of sustainable service delivery programmes. Implementation, management and governance of this LSM programme is framed within a nested set of spatially-defined relationships between mosquitoes, residents, government and research institutions that build upward from neighbourhood to city and national scales. DISCUSSION AND EVALUATION: The clear hierarchical structure associated with vertical, centralized management of decentralized, community-based service delivery, as well as increasingly clear differentiation of partner roles and responsibilities across several spatial scales, contributed to the evolution and subsequent growth of the programme. CONCLUSIONS: The UMCP was based on the principle of an integrated operational research project that evolved over time as the City Council gradually took more responsibility for management. The central role of Dar es Salaam's City Council in coordinating LSM implementation enabled that flexibility; the institutionalization of management and planning in local administrative structures enhanced community-mobilization and funding possibilities at national and international levels. Ultimately, the high degree of program ownership by the City Council and three municipalities, coupled with catalytic donor funding and technical support from expert overseas partners have enabled establishment of a sustainable, internally-funded programme implemented by the National Ministry of Health and Social Welfare and supported by national research and training institutes.


Assuntos
Malária/prevenção & controle , Controle de Mosquitos/métodos , Controle de Mosquitos/organização & administração , Animais , Estudos de Casos e Controles , Humanos , Malária/epidemiologia , Tanzânia , População Urbana
2.
Artigo em Inglês | MEDLINE | ID: mdl-21673195

RESUMO

OBJECTIVES: Monitoring antiretroviral treatment (ART) outcomes is essential for assessing the success of HIV care and treatment programs in resource-limited settings (RLS). METHODS: Longitudinal analyses of clinical and immunologic parameters in HIV-infected adults initiated on ART between November 2004 and June 2008 at Management and Development for Health (MDH)-Presidents Emergency Plan For AIDS Relief PEPFAR supported HIV care and treatment clinics in Tanzania. RESULTS: A total of 12 842 patients were analyzed (65.9% female, median baseline CD4 count, 106 cells/mm(3)). Significant improvements in immunologic status were observed with an increase in CD4 count to 298 (interquartile range [IQR] 199-416), 372 (256-490) and 427 (314-580) cells/mm(3), at 1, 2, and 3 years, respectively. Overall mortality was 13.1% (1682 of 12 842). Male sex, World Health Organization (WHO) stage III/IV, CD4 <200 cells/mm(3), hemoglobin (Hgb) <8.5 g/dL, and stavudine (d4T)-containing regimens were independently associated with early and overall mortality. CONCLUSIONS: Closer monitoring of males and patients with advanced HIV disease following ART initiation may improve clinical and immunologic outcomes in these individuals.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Países em Desenvolvimento , Infecções por HIV/tratamento farmacológico , Infecções por HIV/mortalidade , Falha de Tratamento , Adulto , Contagem de Linfócito CD4 , Quimioterapia Combinada , Feminino , Infecções por HIV/imunologia , Hemoglobinas/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Estavudina/uso terapêutico , Tanzânia/epidemiologia
3.
J Infect Dis ; 204(2): 282-90, 2011 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-21673040

RESUMO

BACKGROUND: Poor nutritional status is associated with immunologic impairment and adverse health outcomes among adults infected with human immunodeficiency virus (HIV). METHODS: We investigated body mass index (BMI), middle upper arm circumference (MUAC), and hemoglobin (Hgb) concentrations at initiation of antiretroviral therapy (ART) in 18,271 HIV-infected Tanzanian adults and their changes in the first 3 months of ART, in relation to the subsequent risk of death. RESULTS: Lower BMI, MUAC, and Hgb concentrations at ART initiation were strongly associated with a higher risk of death within 3 months. Among patients who survived >3 months after ART initiation, those with a decrease in weight, MUAC, or Hgb concentrations by 3 months had a higher risk of death during the first year. After 1 year, only a decrease in MUAC by 3 months after ART initiation was associated with a higher risk of death. Weight loss was associated with a higher risk of death across all levels of baseline BMI, with the highest risk observed among patients with BMI <17 kg/m(2) (relative risk, 7.9; 95% confidence interval, 4.4-14.4). CONCLUSIONS: Poor nutritional status at ART initiation and decreased nutritional status in the first 3 months of ART were strong independent predictors of mortality. The role of nutritional interventions as adjunct therapies to ART merits further investigation.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , Infecções por HIV/mortalidade , Estado Nutricional , Adulto , Composição Corporal/fisiologia , Índice de Massa Corporal , Feminino , Hemoglobinas/análise , Humanos , Masculino , Pessoa de Meia-Idade , Tanzânia
4.
Malar J ; 10: 107, 2011 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-21529365

RESUMO

BACKGROUND: Presumptive treatment of all febrile patients with anti-malarials leads to massive over-treatment. The aim was to assess the effect of implementing malaria rapid diagnostic tests (mRDTs) on prescription of anti-malarials in urban Tanzania. METHODS: The design was a prospective collection of routine statistics from ledger books and cross-sectional surveys before and after intervention in randomly selected health facilities (HF) in Dar es Salaam, Tanzania. The participants were all clinicians and their patients in the above health facilities. The intervention consisted of training and introduction of mRDTs in all three hospitals and in six HF. Three HF without mRDTs were selected as matched controls. The use of routine mRDT and treatment upon result was advised for all patients complaining of fever, including children under five years of age. The main outcome measures were: (1) anti-malarial consumption recorded from routine statistics in ledger books of all HF before and after intervention; (2) anti-malarial prescription recorded during observed consultations in cross-sectional surveys conducted in all HF before and 18 months after mRDT implementation. RESULTS: Based on routine statistics, the amount of artemether-lumefantrine blisters used post-intervention was reduced by 68% (95%CI 57-80) in intervention and 32% (9-54) in control HF. For quinine vials, the reduction was 63% (54-72) in intervention and an increase of 2.49 times (1.62-3.35) in control HF. Before-and-after cross-sectional surveys showed a similar decrease from 75% to 20% in the proportion of patients receiving anti-malarial treatment (Risk ratio 0.23, 95%CI 0.20-0.26). The cluster randomized analysis showed a considerable difference of anti-malarial prescription between intervention HF (22%) and control HF (60%) (Risk ratio 0.30, 95%CI 0.14-0.70). Adherence to test result was excellent since only 7% of negative patients received an anti-malarial. However, antibiotic prescription increased from 49% before to 72% after intervention (Risk ratio 1.47, 95%CI 1.37-1.59). CONCLUSIONS: Programmatic implementation of mRDTs in a moderately endemic area reduced drastically over-treatment with anti-malarials. Properly trained clinicians with adequate support complied with the recommendation of not treating patients with negative results. Implementation of mRDT should be integrated hand-in-hand with training on the management of other causes of fever to prevent irrational use of antibiotics.


Assuntos
Antimaláricos/administração & dosagem , Testes Diagnósticos de Rotina/métodos , Uso de Medicamentos/estatística & dados numéricos , Malária/diagnóstico , Malária/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioprevenção/métodos , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prescrições/estatística & dados numéricos , Estudos Prospectivos , Tanzânia , Adulto Jovem
5.
Malar J ; 10: 332, 2011 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-22047131

RESUMO

BACKGROUND: Laboratory capacity to confirm malaria cases in Tanzania is low and presumptive treatment of malaria is being practiced widely. In malaria endemic areas WHO now recommends systematic laboratory testing when suspecting malaria. Currently, the use of Rapid Diagnostic Tests (RDTs) is recommended for the diagnosis of malaria in lower level peripheral facilities, but not in health centres and hospitals. In this study, the following parameters were evaluated: (1) the quality of routine microscopy, and (2) the effects of RDT implementation on the positivity rate of malaria test results at three levels of the health system in Dar es Salaam, Tanzania. METHODS: During a baseline cross-sectional survey, routine blood slides were randomly picked from 12 urban public health facilities in Dar es Salaam, Tanzania. Sensitivity and specificity of routine slides were assessed against expert microscopy. In March 2007, following training of health workers, RDTs were introduced in nine public health facilities (three hospitals, three health centres and three dispensaries) in a near-to-programmatic way, while three control health facilities continued using microscopy. The monthly malaria positivity rates (PR) recorded in health statistics registers were collected before (routine microscopy) and after (routine RDTs) the intervention in all facilities. RESULTS: At baseline, 53% of blood slides were reported as positive by the routine laboratories, whereas only 2% were positive by expert microscopy. Sensitivity of routine microscopy was 71.4% and specificity was 47.3%. Positive and negative predictive values were 2.8% and 98.7%, respectively. Median parasitaemia was only three parasites per 200 white blood cells (WBC) by routine microscopy compared to 1226 parasites per 200 WBC by expert microscopy. Before RDT implementation, the mean test positivity rates using routine microscopy were 43% in hospitals, 62% in health centres and 58% in dispensaries. After RDT implementation, mean positivity rates using routine RDTs were 6%, 7% and 8%, respectively. The sensitivity and specificity of RDTs using expert microscopy as reference were 97.0% and 96.8%. The positivity rate of routine microscopy remained the same in the three control facilities: 71% before versus 72% after. Two cross-sectional health facility surveys confirmed that the parasite rate in febrile patients was low in Dar es Salaam during both the rainy season (13.6%) and the dry season (3.3%). CONCLUSIONS: The quality of routine microscopy was poor in all health facilities, regardless of their level. Over-diagnosis was massive, with many false positive results reported as very low parasitaemia (1 to 5 parasites per 200 WBC). RDTs should replace microscopy as first-line diagnostic tool for malaria in all settings, especially in hospitals where the potential for saving lives is greatest.


Assuntos
Sangue/parasitologia , Técnicas de Laboratório Clínico/métodos , Pesquisa sobre Serviços de Saúde , Malária/diagnóstico , Microscopia/métodos , Parasitologia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Feminino , Instalações de Saúde , Humanos , Lactente , Recém-Nascido , Malária/parasitologia , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Tanzânia , Adulto Jovem
6.
PLoS Med ; 6(1): e252, 2009 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-19127974

RESUMO

BACKGROUND TO THE DEBATE: Current guidelines recommend that all fever episodes in African children be treated presumptively with antimalarial drugs. But declining malarial transmission in parts of sub-Saharan Africa, declining proportions of fevers due to malaria, and the availability of rapid diagnostic tests mean it may be time for this policy to change. This debate examines whether enough evidence exists to support abandoning presumptive treatment and whether African health systems have the capacity to support a shift toward laboratory-confirmed rather than presumptive diagnosis and treatment of malaria in children under five.


Assuntos
Antimaláricos/uso terapêutico , Técnicas de Laboratório Clínico/estatística & dados numéricos , Febre/tratamento farmacológico , Malária/diagnóstico , África Subsaariana , Pré-Escolar , Febre/etiologia , Humanos , Malária/complicações , Malária/transmissão
7.
Malar J ; 7: 20, 2008 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-18218148

RESUMO

BACKGROUND: As the population of Africa rapidly urbanizes, large populations could be protected from malaria by controlling aquatic stages of mosquitoes if cost-effective and scalable implementation systems can be designed. METHODS: A recently initiated Urban Malaria Control Programme in Dar es Salaam delegates responsibility for routine mosquito control and surveillance to modestly-paid community members, known as Community-Owned Resource Persons (CORPs). New vector surveillance, larviciding and management systems were designed and evaluated in 15 city wards to allow timely collection, interpretation and reaction to entomologic monitoring data using practical procedures that rely on minimal technology. After one year of baseline data collection, operational larviciding with Bacillus thuringiensis var. israelensis commenced in March 2006 in three selected wards. RESULTS: The procedures and staff management systems described greatly improved standards of larval surveillance relative to that reported at the outset of this programme. In the first year of the programme, over 65,000 potential Anopheles habitats were surveyed by 90 CORPs on a weekly basis. Reaction times to vector surveillance at observations were one day, week and month at ward, municipal and city levels, respectively. One year of community-based larviciding reduced transmission by the primary malaria vector, Anopheles gambiae s.l., by 31% (95% C.I. = 21.6-37.6%; p = 0.04). CONCLUSION: This novel management, monitoring and evaluation system for implementing routine larviciding of malaria vectors in African cities has shown considerable potential for sustained, rapidly responsive, data-driven and affordable application. Nevertheless, the true programmatic value of larviciding in urban Africa can only be established through longer-term programmes which are stably financed and allow the operational teams and management infrastructures to mature by learning from experience.


Assuntos
Pesquisa sobre Serviços de Saúde , Malária/prevenção & controle , Controle de Mosquitos/métodos , Animais , Anopheles/microbiologia , Bacillus thuringiensis/fisiologia , Ecossistema , Eficiência Organizacional , Humanos , Larva/microbiologia , Malária/transmissão , Controle Biológico de Vetores/métodos , Tanzânia
8.
Malar J ; 6: 126, 2007 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-17880679

RESUMO

BACKGROUND: Successful malaria vector control depends on understanding behavioural interactions between mosquitoes and humans, which are highly setting-specific and may have characteristic features in urban environments. Here mosquito biting patterns in Dar es Salaam, Tanzania are examined and the protection against exposure to malaria transmission that is afforded to residents by using an insecticide-treated net (ITN) is estimated. METHODS: Mosquito biting activity over the course of the night was estimated by human landing catch in 216 houses and 1,064 residents were interviewed to determine usage of protection measures and the proportion of each hour of the night spent sleeping indoors, awake indoors, and outdoors. RESULTS: Hourly variations in biting activity by members of the Anopheles gambiae complex were consistent with classical reports but the proportion of these vectors caught outdoors in Dar es Salaam was almost double that of rural Tanzania. Overall, ITNs confer less protection against exophagic vectors in Dar es Salaam than in rural southern Tanzania (59% versus 70%). More alarmingly, a biting activity maximum that precedes 10 pm and much lower levels of ITN protection against exposure (38%) were observed for Anopheles arabiensis, a vector of modest importance locally, but which predominates transmission in large parts of Africa. CONCLUSION: In a situation of changing mosquito and human behaviour, ITNs may confer lower, but still useful, levels of personal protection which can be complemented by communal transmission suppression at high coverage. Mosquito-proofing houses appeared to be the intervention of choice amongst residents and further options for preventing outdoor transmission include larviciding and environmental management.


Assuntos
Mordeduras e Picadas de Insetos/prevenção & controle , Malária/prevenção & controle , Controle de Mosquitos/métodos , Animais , Humanos , Densidade Demográfica , Tanzânia
9.
Int J Health Geogr ; 6: 37, 2007 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-17784963

RESUMO

BACKGROUND: Half of the population of Africa will soon live in towns and cities where it can be protected from malaria by controlling aquatic stages of mosquitoes. Rigorous but affordable and scaleable methods for mapping and managing mosquito habitats are required to enable effective larval control in urban Africa. METHODS: A simple community-based mapping procedure that requires no electronic devices in the field was developed to facilitate routine larval surveillance in Dar es Salaam, Tanzania. The mapping procedure included (1) community-based development of sketch maps and (2) verification of sketch maps through technical teams using laminated aerial photographs in the field which were later digitized and analysed using Geographical Information Systems (GIS). RESULTS: Three urban wards of Dar es Salaam were comprehensively mapped, covering an area of 16.8 km2. Over thirty percent of this area were not included in preliminary community-based sketch mapping, mostly because they were areas that do not appear on local government residential lists. The use of aerial photographs and basic GIS allowed rapid identification and inclusion of these key areas, as well as more equal distribution of the workload of malaria control field staff. CONCLUSION: The procedure developed enables complete coverage of targeted areas with larval control through comprehensive spatial coverage with community-derived sketch maps. The procedure is practical, affordable, and requires minimal technical skills. This approach can be readily integrated into malaria vector control programmes, scaled up to towns and cities all over Tanzania and adapted to urban settings elsewhere in Africa.


Assuntos
Culicidae , Sistemas de Informação Geográfica , Controle de Mosquitos/métodos , Topografia Médica/métodos , Animais , Ecossistema , Monitoramento Ambiental/métodos , Monitoramento Epidemiológico , Humanos , Insetos Vetores , Larva , Malária/epidemiologia , Malária/prevenção & controle , Malária/transmissão , Tanzânia/epidemiologia , População Urbana
10.
Malar J ; 5: 9, 2006 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-16457724

RESUMO

BACKGROUND: Integrated vector management (IVM) for malaria control requires ecological skills that are very scarce and rarely applied in Africa today. Partnerships between communities and academic ecologists can address this capacity deficit, modernize the evidence base for such approaches and enable future scale up. METHODS: Community-based IVM programmes were initiated in two contrasting settings. On Rusinga Island, Western Kenya, community outreach to a marginalized rural community was achieved by University of Nairobi through a community-based organization. In Dar es Salaam, Tanzania, Ilala Municipality established an IVM programme at grassroots level, which was subsequently upgraded and expanded into a pilot scale Urban Malaria Control Programme with support from national academic institutes. RESULTS: Both programmes now access relevant expertise, funding and policy makers while the academic partners benefit from direct experience of community-based implementation and operational research opportunities. The communities now access up-to-date malaria-related knowledge and skills for translation into local action. Similarly, the academic partners have acquired better understanding of community needs and how to address them. CONCLUSION: Until sufficient evidence is provided, community-based IVM remains an operational research activity. Researchers can never directly support every community in Africa so community-based IVM strategies and tactics will need to be incorporated into undergraduate teaching programmes to generate sufficient numbers of practitioners for national scale programmes. Academic ecologists at African institutions are uniquely positioned to enable the application of practical environmental and entomological skills for malaria control by communities at grassroots level and should be supported to fulfil this neglected role.


Assuntos
Anopheles , Planejamento em Saúde Comunitária/organização & administração , Promoção da Saúde/organização & administração , Insetos Vetores , Malária/prevenção & controle , Controle de Mosquitos/métodos , África , Animais , Planejamento em Saúde Comunitária/economia , Planejamento em Saúde Comunitária/métodos , Participação da Comunidade/métodos , Humanos , Malária/transmissão , Vigilância da População , População Rural , População Urbana
11.
BMC Public Health ; 6: 154, 2006 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-16776829

RESUMO

BACKGROUND: As the population of Africa rapidly urbanizes it may be possible to protect large populations from malaria by controlling aquatic stages of mosquitoes. Here we present a baseline evaluation of the ability of community members to detect mosquito larval habitats with minimal training and supervision in the first weeks of an operational urban malaria control program. METHODS: The Urban Malaria Control Programme of Dar es Salaam recruited and provided preliminary training to teams of Community-Owned Resource Persons (CORPs) who performed weekly surveys of mosquito breeding sites. Two trained mosquito biologists accompanied each of these teams for one week and evaluated the sensitivity of this system for detecting potential Anopheles habitats. RESULTS: Overall, 42.4% of 986 habitats surveyed by an inspection team had previously been identified by CORPs. Agricultural habitats were detected less often than other habitats (30.8% detected, Odds Ratio [95%CI] = 0.46 [0.29-0.73], P = 0.001). Non-agricultural artificial habitats were less suitable than other habitats (29.3% occupancy, OR = 0.69 [0.46-1.03], P = 0.066) but still constituted 45% (169/289) of occupied habitats because of their abundance (51 % of all habitats). CONCLUSION: The levels of coverage achieved by modestly trained and supported CORPs at the start of the Dar es Salaam UMCP were insufficient to enable effective suppression of malaria transmission through larval control. Further operational research is required to develop surveillance systems that are practical, affordable, effective and acceptable so that community-based integrated vector management can be implemented in cities across Africa.


Assuntos
Meio Ambiente , Malária/prevenção & controle , Controle de Mosquitos/métodos , Vigilância da População/métodos , Características de Residência , Água/parasitologia , Animais , Anopheles/crescimento & desenvolvimento , Anopheles/parasitologia , Agentes Comunitários de Saúde , Humanos , Insetos Vetores , Larva/crescimento & desenvolvimento , Larva/parasitologia , Malária/epidemiologia , Malária/parasitologia , Tanzânia/epidemiologia , Urbanização
12.
J Int Assoc Provid AIDS Care ; 15(6): 512-521, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-25146972

RESUMO

BACKGROUND: Overweight and obesity are increasingly prevalent among HIV-infected populations. We describe their prevalence and associated risk factors among HIV-infected adults in Dar es Salaam, Tanzania. METHODS: A cross-sectional study was conducted to determine the proportion of patients who were overweight or obese at enrollment to care and treatment centres from 2004 to 2011. Multivariate relative risk regression models were fit to identify risk factors. RESULTS: A total of 53 825 patients were included in the analysis. In all, 16% of women and 8% of men were overweight, while 7% and 2% were obese, respectively. In multivariate analyses, older age, higher CD4 count, higher hemoglobin levels, female sex, and being married were associated with obesity and overweight. World Health Organization HIV disease stage, tuberculosis history, and previous antiretroviral therapy were inversely associated with obesity and overweight. CONCLUSION: Overweight and obesity were highly prevalent among HIV-infected patients. Screening for overweight and obesity and focused interventions should be integrated into HIV care.


Assuntos
Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Sobrepeso/complicações , Sobrepeso/epidemiologia , Adulto , Contagem de Linfócito CD4 , Estudos Transversais , Feminino , Infecções por HIV/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/epidemiologia , Prevalência , Fatores de Risco , Tanzânia/epidemiologia , Resultado do Tratamento
13.
Malar J ; 4: 4, 2005 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-15649333

RESUMO

INTRODUCTION: By 2030, more than 50% of the African population will live in urban areas. Controlling malaria reduces the disease burden and further improves economic development. As a complement to treated nets and prompt access to treatment, measures targeted against the larval stage of Anopheles sp. mosquitoes are a promising strategy for urban areas. However, a precise knowledge of the geographic location and potentially of ecological characteristics of breeding sites is of major importance for such interventions. METHODS: In total 151 km2 of central Dar es Salaam, the biggest city of Tanzania, were systematically searched for open mosquito breeding sites. Ecologic parameters, mosquito larvae density and geographic location were recorded for each site. Logistic regression analysis was used to determine the key ecological factors explaining the different densities of mosquito larvae. RESULTS: A total of 405 potential open breeding sites were examined. Large drains, swamps and puddles were associated with no or low Anopheles sp. larvae density. The probability of Anopheles sp. larvae to be present was reduced when water was identified as "turbid". Small breeding sites were more commonly colonized by Anopheles sp. larvae. Further, Anopheles gambiae s.l. larvae were found in highly organically polluted habitats. CONCLUSIONS: Clear ecological characteristics of the breeding requirements of Anopheles sp. larvae could not be identified in this setting. Hence, every stagnant open water body, including very polluted ones, have to be considered as potential malaria vector breeding sites.


Assuntos
Anopheles/fisiologia , Insetos Vetores/fisiologia , Malária/transmissão , Animais , Desastres , Água Doce , Humanos , Larva/fisiologia , Modelos Logísticos , Malária/prevenção & controle , Controle de Mosquitos/métodos , Densidade Demográfica , Tanzânia , Saúde da População Urbana
14.
Malar J ; 4: 40, 2005 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-16153298

RESUMO

BACKGROUND: The rapid urban malaria appraisal (RUMA) methodology aims to provide a cost-effective tool to conduct rapid assessments of the malaria situation in urban sub-Saharan Africa and to improve the understanding of urban malaria epidemiology. METHODS: This work was done in Yopougon municipality (Abidjan), Cotonou, Dar es Salaam and Ouagadougou. The study design consists of six components: 1) a literature review, 2) the collection of available health statistics, 3) a risk mapping, 4) school parasitaemia surveys, 5) health facility-based surveys and 6) a brief description of the health care system. These formed the basis of a multi-country evaluation of RUMA's feasibility, consistency and usefulness. RESULTS: A substantial amount of literature (including unpublished theses and statistics) was found at each site, providing a good overview of the malaria situation. School and health facility-based surveys provided an overview of local endemicity and the overall malaria burden in different city areas. This helped to identify important problems for in-depth assessment, especially the extent to which malaria is over-diagnosed in health facilities. Mapping health facilities and breeding sites allowed the visualization of the complex interplay between population characteristics, health services and malaria risk. However, the latter task was very time-consuming and required special expertise. RUMA is inexpensive, costing around 8,500-13,000 USD for a six to ten-week period. CONCLUSION: RUMA was successfully implemented in four urban areas with different endemicity and proved to be a cost-effective first approach to study the features of urban malaria and provide an evidence basis for planning control measures.


Assuntos
Malária/epidemiologia , Adolescente , Adulto , Envelhecimento , Benin/epidemiologia , Burkina Faso/epidemiologia , Criança , Pré-Escolar , Côte d'Ivoire/epidemiologia , Humanos , Lactente , Malária/economia , Controle de Mosquitos/métodos , Vigilância da População/métodos , Tanzânia/epidemiologia , Saúde da População Urbana , População Urbana
15.
J Hypertens ; 21(3): 509-17, 2003 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-12640244

RESUMO

BACKGROUND: Although it is well recognized that the diagnosis of hypertension should be based on blood pressure (BP) measurements taken on several occasions, notably to account for a transient elevation of BP on the first readings, the prevalence of hypertension in populations has often relied on measurements at a single visit. OBJECTIVE: To identify an efficient strategy for assessing reliably the prevalence of hypertension in the population with regards to the number of BP readings required. DESIGN: Population-based survey of BP and follow-up information. SETTING AND PARTICIPANTS: All residents aged 25-64 years in an area of Dar es Salaam (Tanzania). MAIN OUTCOME MEASURES: Three BP readings at four successive visits in all participants with high BP (n = 653) and in 662 participants without high BP, measured with an automated BP device.RESULTS BP decreased substantially from the first to third readings at each of the four visits. BP decreased substantially between the first two visits but only a little between the next visits. Consequently, the prevalence of high BP based on the third reading--or the average of the second and third readings--at the second visit was not largely different compared to estimates based on readings at the fourth visit. BP decreased similarly when the first three visits were separated by 3-day or 14-day intervals. CONCLUSIONS: Taking triplicate readings on two visits, possibly separated by just a few days, could be a minimal strategy for assessing adequately the mean BP and the prevalence of hypertension at the population level. A sound strategy is important for assessing reliably the burden of hypertension in populations.


Assuntos
Hipertensão/diagnóstico , Adulto , Pressão Sanguínea , Determinação da Pressão Arterial , Diástole , Feminino , Seguimentos , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos de Amostragem , Sístole , Tanzânia/epidemiologia
16.
Int J Epidemiol ; 31(1): 240-7, 2002 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-11914327

RESUMO

OBJECTIVE: To estimate the distribution of blood pressure (BP), body mass index (BMI), smoking habits and their associations with socioeconomic status (SES) in an urban population in early epidemiological transition. METHODS: Cross-sectional survey of the entire population aged 25-64 years in five branches of Dar es Salaam (Tanzania) through visits to all homes in the study area. Blood pressure was based on the mean of the second and third readings with an automated device. Socioeconomic status was estimated with indicators of education, occupation and wealth. RESULTS: In all 9254 people were examined. Age-adjusted prevalence (%) among men/ women aged 35-64 years was 27.1/30.2 for BP > or = 140/90 mmHg or antihypertensive medication, 13.1/17.7 for BP > or = 160/95 mmHg or antihypertensive medication, 28.0/27.4 for BMI of 25.0-29.9 kg/m(2), 6.9/17.4 for BMI > or = 30 kg/m(2), and 22.0/2.6 for smoking (> or = 1 cigarette per day). Prevalence of categories of drinking frequency and history of diabetes are also reported. After adjustment for covariates, SES was associated inversely with BP and smoking and directly with BMI. Body mass index was associated positively with BP (1.01 and 0.91 mmHg systolic BP per 1 kg/m(2) BMI in men and women, respectively) and inversely with smoking (-1.14 kg/m(2) in male smokers versus non-smokers). Hypertension treatment rates were low, particularly in people of low SES. CONCLUSIONS: High prevalence of several cardiovascular risk factors in the urban population of a low-income country stresses the need for early public health interventions and adaptation of the health care infrastructure to meet the emerging challenge of cardiovascular disease. The direct SES-BMI association may drive increasing BMI and BP while the population becomes more affluent.


Assuntos
Pressão Sanguínea , Índice de Massa Corporal , Fumar , Adulto , Consumo de Bebidas Alcoólicas , Doenças Cardiovasculares/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , Tanzânia/epidemiologia , População Urbana
17.
Ann N Y Acad Sci ; 1023: 159-63, 2004 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15253904

RESUMO

Dar es Salaam is a typical example of the rapid urbanization process in sub-Saharan Africa. Health problems in the city are tremendous and reflect the epidemiologic transition, with the emergence of chronic diseases, as well as the prevailing problems related to infectious diseases. Not surprisingly, HIV/AIDS has become a major determinant of health. Public health services have been strengthened in the past 12 years through the support of a bilateral program called the Dar es Salaam Urban Health Project (DUHP). The program was jointly funded by the Government of Tanzania and the Swiss Agency for Development and Cooperation. The focus of the program shifted from the initial rehabilitation of the health infrastructure to a strengthening of the management capacities of the public health care delivery system. The basis for the collaboration and complementarity between public and private health care providers has been created. Partly thanks to the success of the DUHP, the health system has become the spearhead and testing ground for core health sector reforms and has had a substantial influence on the introduction of a donor-supported sectorwide approach in the health sector in Tanzania. Perhaps most importantly, the foundations have been laid for a more democratic health system in which both the staff and the population are involved.


Assuntos
Saúde da População Urbana , Urbanização , Atenção à Saúde/métodos , Infecções por HIV/prevenção & controle , Humanos , Cooperação Internacional , Setor Privado , Suíça , Tanzânia , Serviços Urbanos de Saúde/economia
18.
Am J Trop Med Hyg ; 71(2 Suppl): 103-17, 2004 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-15331826

RESUMO

The rapid growth of cities in sub-Saharan Africa, much of it driven by rural-urban migration, is associated with complex transformations of these ecosystems and an intricate set of challenges for malaria control. Urban malaria transmission is substantially less intense and much more focal than in rural and peri-urban settings. However, the danger of epidemics is higher and the presence of substantial non-immune populations places people of all ages at comparable levels of risk. The limited number of breeding sites in urban centers suggests that prevention strategies based on vector control, with emphasis on environmental management, should be a central feature of urban malaria control programs. We focus on malaria in the city of Dar es Salaam, Tanzania. Following a brief review of the 100-year history of malaria control in this urban center, we describe and evaluate a control program that operated from 1988 to 1996 as a consequence of a bilateral agreement between the governments of Tanzania and Japan. We present an innovative urban malaria risk mapping methodology based on high-resolution aerial photography with ground-based validation. This strategy clarifies that remote sensing technology at a level of resolution of one meter is essential if this kind of information is to play a role in guiding the detailed specification of intervention strategies for urban malaria control. The Tanzania-Japan multiple-intervention malaria control program, adaptively implemented over time, is described and evaluated with implications for urban malaria control in sub-Saharan Africa more generally.


Assuntos
Malária/prevenção & controle , Avaliação de Resultados em Cuidados de Saúde , Serviços Preventivos de Saúde/organização & administração , Serviços Preventivos de Saúde/normas , Animais , Anopheles , Humanos , Internacionalidade , Japão , Malária/epidemiologia , Malária/etiologia , Controle de Mosquitos/métodos , Instituições Acadêmicas , Tanzânia/epidemiologia , Saúde da População Urbana
19.
AIDS ; 25(9): 1189-97, 2011 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-21505309

RESUMO

OBJECTIVE: To determine the relationship between sex and antiretroviral therapy (ART) outcomes in an urban Tanzanian setting. DESIGN: Longitudinal analysis of a cohort of HIV-infected adult men and women on ART enrolled at the Management and Development for Health (MDH)-President's Emergency Plan For AIDS Relief (PEPFAR) HIV care and treatment program in Dar es Salaam, Tanzania. METHODS: Clinical and immunologic responses to ART were compared between HIV-infected men and women enrolled from November 2004 to June 2008. Cox regression analyses were used to study sex differences with regard to mortality, immunologic failure (WHO, 2006) and loss to follow-up, after adjusting for other risk factors for the outcomes. RESULTS: Four thousand, three hundred and eighty-three (34%) men and 8459 (66%) women were analyzed. Men were significantly more immunocompromised than women at enrollment in terms of stage IV disease (27 vs. 23%, P < 0.001) and mean CD4⁺ cell count (123 vs. 136 cells/µl, P < 0.001). In multivariate analyses, men had a significantly higher risk of overall mortality [hazard ratio 1.19, 95% confidence interval (CI) 1.05-1.30, P < 0.001], immunologic nonresponse defined as CD4 cell count less than 100 cells/µl after at least 6 months of initiating ART (hazard ratio 1.74, 95% CI 1.44-2.11, P < 0.001) and loss to follow-up (hazard ratio 1.19, 95% CI 1.10-1.30, P < 0.001) than that in women. Associations did not change significantly when restricting analyses to the period of good adherence for all patients. CONCLUSION: Nonadherence to care and advanced immunodeficiency at enrollment explained only 17% of the inferior mortality in HIV-infected men in this resource-limited setting. Additional study of behavioral and biologic factors that may adversely impact treatment outcomes in men is needed to reduce these sex disparities.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Saúde da População Urbana/normas , Adolescente , Adulto , Contagem de Linfócito CD4 , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Caracteres Sexuais , Tanzânia/epidemiologia , Resultado do Tratamento , Adulto Jovem
20.
Geospat Health ; 3(2): 189-210, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19440962

RESUMO

A cross-sectional survey of agricultural areas, combined with routinely monitored mosquito larval information, was conducted in urban Dar es Salaam, Tanzania, to investigate how agricultural and geographical features may influence the presence of Anopheles larvae. Data were integrated into a geographical information systems framework, and predictors of the presence of Anopheles larvae in farming areas were assessed using multivariate logistic regression with independent random effects. It was found that more than 5% of the study area (total size 16.8 km2) was used for farming in backyard gardens and larger open spaces. The proportion of habitats containing Anopheles larvae was 1.7 times higher in agricultural areas compared to other areas (95% confidence interval = 1.56-1.92). Significant geographic predictors of the presence of Anopheles larvae in gardens included location in lowland areas, proximity to river, and relatively impermeable soils. Agriculture-related predictors comprised specific seedbed types, mid-sized gardens, irrigation by wells, as well as cultivation of sugar cane or leafy vegetables. Negative predictors included small garden size, irrigation by tap water, rainfed production and cultivation of leguminous crops or fruit trees. Although there was an increased chance of finding Anopheles larvae in agricultural sites, it was found that breeding sites originated by urban agriculture account for less than a fifth of all breeding sites of malaria vectors in Dar es Salaam. It is suggested that strategies comprising an integrated malaria control effort in malaria-endemic African cities include participatory involvement of farmers by planting shade trees near larval habitats.


Assuntos
Anopheles , Ecossistema , Jardinagem , Contagem de Ovos de Parasitas , População Urbana , Animais , Estudos Transversais , Larva , Modelos Logísticos , Tanzânia
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