Effectiveness of Point of Entry Health Screening Measures among Travelers in the Detection and Containment of the International Spread of COVID-19: A Review of the Evidence.

COVID-19 remains a communicable disease with the capacity to cause substantial damage to health and health systems. Enhanced health screening at points of entry (POEs) is a public health measure implemented to support early detection, prevention and response to communicable diseases, such as COVID-19. The purpose of this study was to review the available evidence on the effectiveness of POE health screening in the detection and containment of the COVID-19 pandemic. This study was registered under PROSPERO and followed PRISMA guidelines in which the literature between 2019 and 2022 was retrieved from Scopus, PubMed, Web of Science, Global Health, CINAHL, Embase, Google Scholar and international organizations. A total of 33,744 articles were screened for eligibility, from which 43 met the inclusion criteria. The modeling studies predicted POE screening able to detect COVID-19 in a range of 8.8% to 99.6%, while observational studies indicated a detection rate of 2% to 77.9%, including variants of concern depending on the screening method employed. The literature also indicated these measures can delay onset of the epidemic by 7 to 32 days. Based on our review findings, if POE screening measures are implemented in combination with other public health interventions such as rapid tests, they may help detect and reduce the spread of COVID-19.

Correlating food and nutritional patterns with cancers in the pediatric oncology population at two specialized hospitals in Tanzania.

BACKGROUND: This study of nutritional patterns in relation to cancers among pediatric oncology population in Tanzania was motivated by the lack of up-to-date information about the nutritional practices, the controversy around the importance of nutritional support and the lack of consistent nutritional criteria among pediatric oncology populations. METHODS: A survey study in two cancer referral hospitals of children diagnosed with any cancers, aged between 1 and 17 years inclusive and being eligible for enteral feeding included 131 children. Their demographic, nutritional, feeding and cancer profiles were analyzed descriptively through mapping and other approaches as well as inferentially using multinomial regression models to understand different aspects of nutrition for children suffering from cancers. RESULTS: The majority (15% or higher) of pediatric oncology population originated from the lake zone. Between 7 and 12% of pediatric oncology population originated from the Western zone. The top-three cancers with their percentages in the brackets were: Wilms Tumor (32%), Acute Lymphoblastic Leukemia (26%) and Retinoblastoma (13%). About 69% of the pediatric oncology population ate foods that are rich in energy but poor in protein such as rice (21.5%), porridge (19.3%), banana (11.7%) and potatoes (10.2%). On the other hand, only 17.5% ate foods that are generally protein-rich such as meat (8.0%), fish (5.3%) and chicken (4.2%); and 12.7% ate milk (4.2%), beans (3.4%), vegetables (2.7%), eggs (1.9%) and fruits (1.5%). Cancers impacted food intake in about 60% of all children with cancers and affected appetite in 18.3% of them. Cancers caused vomiting in 16% and diarrhea in 6.1% of children. The majority of children with cancers (61.8%) took at least one meal while 34.4% took just snacks (p < 0.001). CONCLUSIONS: The majority of pediatric oncology population had erratic nutritional patterns and took foods high in energy and poor in proteins. There is a two-way interaction between cancers and nutrition in which cancers affect general nutritional intake which could affect the cancer treatment outcomes in return. Therefore, it is important to consider these interactions while managing pediatric oncology populations in this and similar settings.

Prevalence and risk factors of brain atrophy and associated confusion state among adults from three hospitals in northern Tanzania.

Introduction: brain atrophy is the reduction of brain volume often accompanied with cognitive changes. Despite the availability of computerized-tomography (CT) scanners in Tanzania, little is known about the magnitude of brain atrophy, its associated confusion state and the risk factors in adults. This study aimed to fill those knowledge gaps. Methods: a retrospective cross-sectional hospital-based survey was conducted in northern Tanzania using a sample size of 384 CT images of adults who underwent brain CT scans in three referral hospitals. CT images were evaluated using a diagonal brain fraction (DBF) method to determine the presence of brain atrophy. Data for other covariates were also collected. Results: we report a prevalence of 60.67% for brain atrophy and 35% for the associated confusion state. Association between confusion state and brain atrophy was statistically significant (χ2 = 21.954, p<0.001). Brain atrophy was prognosticated by: age (adjusted OR: 1.11; 95% CI [1.05, 1.20], p<0.001), smoking (adjusted OR: 6.97; 95% CI [2.12, 26.19], p<0.001), alcohol-consumption (adjusted OR: 11.87; 95% CI [3.44, 40.81], p<0.001), hypertension (adjusted OR: 61.21; 95 CI [15.20, 349.43], p<0.001), type-2 diabetes mellitus (adjusted OR: 15.67; 95% CI [5.32, 52.77], p<0.001) and white matter demyelination (adjusted OR: 13.45; 95% CI [4.66, 44.25], p<0.001). Conclusion: there is high prevalence of brain atrophy and associated confusion state among hospitalized adults in northern Tanzania. Reported prognostic factors for brain atrophy such as age, smoking, alcohol consumption, hypertension, type-2 diabetes mellitus and white matter demyelination could help focus interventions in this area.

The neuroimaging magnitude of pediatric brain atrophy in northern Tanzania.

INTRODUCTION: The loss of parenchymal brain volume per normative age comparison is a distinctive feature of brain atrophy. While the condition is the most prevalent to elderly, it has also been observed in pediatric ages. Various causes such as trauma, infection, and malnutrition have been reported to trigger the loss of brain tissues volume. Despite this literature based knowledge of risk factors, the magnitude of brain atrophy in pediatric age group is scantly addressed in most developing countries including Tanzania. The current study aims to understand the magnitude of brain atrophy in children residing in Northern Zone, Tanzania. METHODS: A cross-sectional hospital survey was performed in which 455 children who were presented with various brain pathologies from the year 2013 to 2019 and whose brains examined by Computerized tomography (CT)-Scanners were recruited in the study. The brain statuses were examined using three linear radiological methods including the measure of sulcal-width, Evans index, and lateral ventricular body width. RESULTS: Results showed a significant number of atrophied brains among children in Northern Tanzania and that the condition was observed to have a 1:1 male to female ratio. The prevalence of pediatric brain atrophy was found to be 16.04%. CONCLUSION: The cortical subtype of brain atrophy presented as the most prevalent type of brain volume loss. The findings of this study suggest existence of considerable trends of brain atrophy in children which need special attention and mitigation plans.

One Health in Practice: Using Integrated Bite Case Management to Increase Detection of Rabid Animals in Tanzania.

Rabies is a neglected zoonotic disease that causes an estimated 59,000 human deaths worldwide annually, mostly in Africa and Asia. A target of zero human deaths from dog-mediated rabies has been set for 2030, and large-scale control programs are now advocated. However, in most low-income endemic countries surveillance to guide rabies control is weak and few cases of rabies are recorded. There is an urgent need to enhance surveillance to improve timely case detection and inform rabies control and prevention, by operationalizing a "One Health" approach. Here we present data from a study piloting Integrated Bite Case Management (IBCM) to support intersectoral collaboration between health and veterinary workers in Tanzania. We trained government staff to implement IBCM, comprising risk assessments of bite patients by health workers, investigations by livestock field officers to diagnose rabid animals, and use of a mobile phone application to support integration. IBCM was introduced across 20 districts in four regions of Tanzania and results reported after 1 year of implementation. Numbers of bite patient presentations to health facilities varied across regions, but following the introduction of IBCM reporting of bite patients at high-risk for rabies more than doubled in all regions. Over 800 high-risk investigations were carried out, with 49% assessed as probable dog rabies cases on the basis of clinical signs, animal outcome, and rapid diagnostic testing. The status of a further 20% of biting animals could not be determined but rabies could not be ruled out. Livestock field officers reported that use of rapid diagnostic tests (RDTs) were useful for confirming rabies occurrence. Overall, our study provides further evidence that IBCM is a practical approach that can improve rabies detection in endemic countries, and be used to monitor the impact of mass dog vaccinations, including potential to verify rabies freedom. However, the main challenges to implementation are limited training of health workers in rabies, perceived burden of real-time recording and limited resources for livestock field officers to undertake investigations. Nonetheless, IBCM dramatically improved case detection and communication between sectors and we recommend further implementation research to establish best practice and applicability to other settings.

Toward Elimination of Dog-Mediated Human Rabies: Experiences from Implementing a Large-scale Demonstration Project in Southern Tanzania.

A Rabies Elimination Demonstration Project was implemented in Tanzania from 2010 through to 2015, bringing together government ministries from the health and veterinary sectors, the World Health Organization, and national and international research institutions. Detailed data on mass dog vaccination campaigns, bite exposures, use of post-exposure prophylaxis (PEP), and human rabies deaths were collected throughout the project duration and project areas. Despite no previous experience in dog vaccination within the project areas, district veterinary officers were able to implement district-wide vaccination campaigns that, for most part, progressively increased the numbers of dogs vaccinated with each phase of the project. Bite exposures declined, particularly in the southernmost districts with the smallest dog populations, and health workers successfully transitioned from primarily intramuscular administration of PEP to intradermal administration, resulting in major cost savings. However, even with improved PEP provision, vaccine shortages still occurred in some districts. In laboratory diagnosis, there were several logistical challenges in sample handling and submission but compared to the situation before the project started, there was a moderate increase in the number of laboratory samples submitted and tested for rabies in the project areas with a decrease in the proportion of rabies-positive samples over time. The project had a major impact on public health policy and practice with the formation of a One Health Coordination Unit at the Prime Minister's Office and development of the Tanzania National Rabies Control Strategy, which lays a roadmap for elimination of rabies in Tanzania by 2030 by following the Stepwise Approach towards Rabies Elimination (SARE). Overall, the project generated many important lessons relevant to rabies prevention and control in particular and disease surveillance in general. Lessons include the need for (1) a specific unit in the government for managing disease surveillance; (2) application of innovative data collection and management approaches such as the use of mobile phones; (3) close cooperation and effective communication among all key sectors and stakeholders; and (4) flexible and adaptive programs that can incorporate new information to improve their delivery, and overcome challenges of logistics and procurement.

Viruses that cross borders: factors responsible for global dissemination of viral infections.

OBJECTIVE: Pandemic viral infections as emerging infectious diseases are of a great global concern. However, for some viruses, particular strains are endemic to specific areas and can be genetically distinguished from strains in other regions. In contrast, for some other viruses, genetically similar strains can spread and circulate all over the world. This study addresses global dissemination of various viral infections. METHODS: We classified 34 viruses as per their ability to cross borders by review. We also described factors responsible for and the dynamics of global dissemination. We examined biological characteristics of viruses, manners or routes of transmission, host responses and epidemiological factors. RESULTS: Factors required for viruses to cross borders include 'non-blood infection', 'short incubation period', 'short infectious period', 'frequent re-infection', 'small basic reproductive number (R(0))' and 'high annual incidence'. CONCLUSION: Knowing the factors responsible for global dissemination of pathogens is useful for controlling and/or containing both classic and emerging infectious diseases.