Community knowledge, attitude and practices regarding zoonotic viral haemorrhagic fevers in five geo-ecological zones in Tanzania.

BACKGROUND: Viral haemorrhagic fevers (VHF) cause significant economic and public health impact in Sub-Saharan Africa. Community knowledge, awareness and practices regarding such outbreaks play a pivotal role in their management and prevention. This study was carried out to assess community knowledge, attitude and practices regarding VHF in five geo-ecological zones in Tanzania. METHODS: A cross-sectional study was conducted in Buhigwe, Kalambo, Kyela, Kinondoni, Kilindi, Mvomero, Kondoa and Ukerewe districts representing five geo-ecological zones in Tanzania. Study participants were selected by multistage cluster sampling design. A semi-structured questionnaire was used to collect socio-demographic and information related to knowledge, attitude and practices regarding VHFs. Descriptive statistics and logistic regression were used for the analysis. RESULTS: A total of 2,965 individuals were involved in the study. Their mean age was 35 (SD ± 18.9) years. Females accounted for 58.2% while males 41.8%. Most of the respondents (70.6%; n = 2093) had never heard of VHF, and those who heard, over three quarters (79%) mentioned the radio as their primary source of information. Slightly over a quarter (29.4%) of the respondents were knowledgeable, 25% had a positive attitude, and 17.9% had unfavourable practice habits. The level of knowledge varied between occupation and education levels (P < 0.005). Most participants were likely to interact with a VHF survivor or take care of a person suffering from VHF (75%) or visit areas with known VHF (73%). There were increased odds of having poor practice among participants aged 36-45 years (AOR: 3.566, 95% CI: 1.593-7.821) and those living in Western, North-Eastern and Lake Victoria zones (AOR: 2.529, 95% CI: 1.071-6.657; AOR: 2.639, 95% CI: 1.130-7.580 AOR: 2.248, 95% CI: 1.073-3.844, respectively). CONCLUSION: Overall, the knowledge on VHF among communities is low, while a large proportion of individuals in the community are involved in activities that expose them to the disease pathogens in Tanzania. These findings highlight the need for strengthening health educational and promotion efforts on VHF targeting specific populations.

Socioecological systems analysis of potential factors for cholera outbreaks and assessment of health system's readiness to detect and respond in Ilemela and Nkasi districts, Tanzania.

BACKGROUND: Cholera outbreaks are a recurrent issue in Tanzania, with Ilemela and Nkasi districts being particulary affected. The objective of this study was to conduct a socio-ecological system (SES) analysis of cholera outbreaks in these districts, identifying potential factors and assessing the preparedness for cholera prevention and control. METHODS: A cross-sectional study was carried out in Ilemela and Nkasi districts of Mwanza and Rukwa regions, respectively in Tanzania between September and October 2021. A SES framework analysis was applied to identify potential factors associated with cholera outbreaks and assess the readiness of the districts to cholera prevention and control. RESULTS: Ilemela is characterised by urban and peri-urban ecosystems while Nkasi is mainly rural. Cholera was reported to disproportionately affect people living along the shores of Lake Victoria in Ilemela and Lake Tanganyika in Nkasi, particularly fishermen and women involved infish trading. The main potential factors identified for cholera outbreaks included defecation in the shallow ends and along the edges of lakes, open defecation, bathing/swimming in contaminated waters and improper waste disposal. The preparedness of both districts for cholera prevention and response was found to be inadequate due to limited laboratory capacity, insufficient human resources, and budget constraints. CONCLUSION: People of Ilemela and Nkasi districts remain at significant risk of recurrent cholera outbreaks and the capacity of the districts to detect the disease is limited. Urgent preventive measures, such as conducting considerable community awareness campaigns on personal hygiene and environmental sanitation are needed to alleviate the disease burden and reduce future cholera outbreaks.

Synergism between nonane and emanations from soil as cues in oviposition-site selection of natural populations of Anopheles gambiae and Culex quinquefasciatus.

BACKGROUND: Olfactory cues have been shown to have an important role in guiding gravid mosquito females to selected sites for egg laying. The objective of this study was to determine the influence of emanations from soil from a breeding site and the putative oviposition pheromone nonane on oviposition-site selection of natural populations of Anopheles gambiae sensu lato (s.l.) and Culex quinquefasciatus. METHODS: This field-based study was conducted in Mvomero District in East-central Tanzania. In a dual-choice experimental set up, clay bowls were dug into the ground and filled with one of the following treatments: (i) distilled water + autoclaved soil (control), (ii) distilled water + soil from a natural mosquito breeding site, (iii) distilled water + nonane and (iv) distilled water + nonane + soil from a natural breeding site. Soil was dried and autoclaved or dried only before use. After five days of incubation, larvae were collected daily for 10 days. The median number of larvae per bowl per day was used as outcome measure. RESULTS: Autoclaved soil had a significant attractive effect on oviposition behaviour of Cx. quinquefasciatus (median values ± s.e: 8.0 ± 1.1; P < 0.005) but no effect on An. gambiae (median value ± s.e: 0.0 ± 0.2; P = 0.18). Nonane and emanations from untreated soil significantly and positively influenced the selection of oviposition sites by both An. gambiae s.l. (median values ± s.e.: 12.0 ± 2.0 and 4.5 ± 1.5, respectively; P < 0.0001) and Cx. quinquefasciatus (median values ± s.e.: 19.0 ± 1.3 and 17.0 ± 2.0, respectively; P < 0.0001). A mixture of nonane and untreated soil caused a synergistic effect on oviposition behaviour in An. gambiae s.l. (median value ± s.e.: 23.5 ± 2.5; P < 0.0001) compared to either nonane (median values ± s.e.: 12.0 ± 2.0; P < 0.0001) or untreated soil alone (median value ± s.e.: 4.5 ± 1.5; P < 0.0001). A synergistic effect of nonane mixed with untreated soil was also found in Cx. quinquefasciatus (median value ± s.e.: 41.0 ± 2.1; P < 0.0001) compared to either nonane (median value ± s.e. 19.0 ± 1.3; P < 0.0001) or untreated soil alone (median value ± s.e.: 17.0 ± 2.0; P < 0.0001). The oviposition activity index for An. gambiae was 0.56 (P < 0.001) and for Cx. quinquefasciatus 0.59 (P < 0.0001). CONCLUSIONS: The larval pheromone nonane and emanations from breeding-site soil both induced oviposition in wild An. gambiae s.l. and Cx. quinquefasciatus, with a synergistic effect when both stimuli were present simultaneously. This is the first study in which nonane is shown to cause oviposition under natural conditions, suggesting that this compound can potentially be exploited for the management of mosquito vectors.

Assessment of the core and support functions of the integrated disease surveillance and response system in Zanzibar, Tanzania.

BACKGROUND: Disease surveillance is a cornerstone of outbreak detection and control. Evaluation of a disease surveillance system is important to ensure its performance over time. The aim of this study was to assess the performance of the core and support functions of the Zanzibar integrated disease surveillance and response (IDSR) system to determine its capacity for early detection of and response to infectious disease outbreaks. METHODS: This cross-sectional descriptive study involved 10 districts of Zanzibar and 45 public and private health facilities. A mixed-methods approach was used to collect data. This included document review, observations and interviews with surveillance personnel using a modified World Health Organization generic questionnaire for assessing national disease surveillance systems. RESULTS: The performance of the IDSR system in Zanzibar was suboptimal particularly with respect to early detection of epidemics. Weak laboratory capacity at all levels greatly hampered detection and confirmation of cases and outbreaks. None of the health facilities or laboratories could confirm all priority infectious diseases outlined in the Zanzibar IDSR guidelines. Data reporting was weakest at facility level, while data analysis was inadequate at all levels (facility, district and national). The performance of epidemic preparedness and response was generally unsatisfactory despite availability of rapid response teams and budget lines for epidemics in each district. The support functions (supervision, training, laboratory, communication and coordination, human resources, logistic support) were inadequate particularly at the facility level. CONCLUSIONS: The IDSR system in Zanzibar is weak and inadequate for early detection and response to infectious disease epidemics. The performance of both core and support functions are hampered by several factors including inadequate human and material resources as well as lack of motivation for IDSR implementation within the healthcare delivery system. In the face of emerging epidemics, strengthening of the IDSR system, including allocation of adequate resources, should be a priority in order to safeguard human health and economic stability across the archipelago of Zanzibar.

Emerging epidemics: is the Zanzibar healthcare system ready to detect and respond to mosquito-borne viral diseases?

BACKGROUND: Effective control of emerging mosquito-borne viral diseases such as dengue, chikungunya, and Zika requires, amongst other things, a functional healthcare system, ready and capable of timely detection and prompt response to incipient epidemics. We assessed the readiness of Zanzibar health facilities and districts for early detection and management of mosquito-borne viral disease outbreaks. METHODS: A cross-sectional study involving all 10 District Health Management Teams and 45 randomly selected public and private health facilities in Zanzibar was conducted using a mixed-methods approach including observations, document review, and structured interviews with health facility in-charges and District Health Management Team members. RESULTS: The readiness of the Zanzibar healthcare system for timely detection, management, and control of dengue and other mosquito-borne viral disease outbreaks was critically low. The majority of health facilities and districts lacked the necessary requirements including standard guidelines, trained staff, real-time data capture, analysis and reporting systems, as well as laboratory diagnostic capacity. In addition, health education programmes for creating public awareness and Aedes mosquito surveillance and control activities were non-existent. CONCLUSIONS: The Zanzibar healthcare system has limited readiness for management, and control of mosquito-borne viral diseases. In light of impending epidemics, the critical shortage of skilled human resource, lack of guidelines, lack of effective disease and vector surveillance and control measures as well as lack of laboratory capacity at all levels of health facilities require urgent attention across the Zanzibar archipelago.

Data utilisation and factors influencing the performance of the health management information system in Tanzania.

BACKGROUND: Health Management Information System (HMIS) is a set of data regularly collected at health care facilities to meet the needs of statistics on health services. This study aimed to determine the utilisation of HMIS data and factors influencing the health system's performance at the district and primary health care facility levels in Tanzania. METHODS: This cross-sectional study was carried out in 11 districts and involved 115 health care facilities in Tanzania. Data were collected using a semi-structured questionnaire administered to health workers at facility and district levels and documented using an observational checklist. Thematic content analysis approach was used to synthesise and triangulate the responses and observations to extract essential information. RESULTS: A total of 93 healthcare facility workers and 13 district officials were interviewed. About two-thirds (60%) of the facility respondents reported using the HMIS data, while only five out of 13 district respondents (38.5%) reported analysing HMIS data routinely. The HMIS data were mainly used for comparing performance in terms of services coverage (53%), monitoring of disease trends over time (50%), and providing evidence for community health education and promotion programmes (55%). The majority (41.4%) of the facility's personnel had not received any training on data management related to HMIS during the past 12 months prior to the survey. Less than half (42%) of the health facilities had received supervisory visits from the district office 3 months before this assessment. Nine district respondents (69.2%) reported systematically receiving feedback on the quality of their reports monthly and quarterly from higher authorities. Patient load was described to affect staff performance on data collection and management frequently. CONCLUSION: Inadequate analysis and poor data utilisation practices were common in most districts and health facilities in Tanzania. Inadequate human and financial resources, lack of incentives and supervision, and lack of standard operating procedures on data management were the significant challenges affecting the HMIS performance in Tanzania.

A zooprophylaxis strategy using L-lactic acid (Abate) to divert host-seeking malaria vectors from human host to treated non-host animals.

BACKGROUND: Zooprophylaxis is a technique in which blood-seeking vectors are diverted to non-host animals in order to lower blood-feeding rates on human hosts. The success of this technique depends on the host preference of the vector being targeted. The objective of this study was to evaluate the effect of L-lactic acid (Abate) to divert malaria mosquito, Anopheles gambiae from feeding on human host. METHODS: A 14-month-old female goat was treated with Abate, a formulation incorporating L-lactic acid into a slow-release matrix. This formulation was applied on the fur of the goat's back and neck. The treated animal was then presented to Anopheles gambiae sensu stricto (s.s.) as a prospective host in a semi-field environment ('mosquito sphere') together with either an untreated animal or a human. The number of mosquitoes caught to each host choice offered were compared. RESULTS: Goat treated with the L-lactic acid formulation successfully attracted An. gambiae at higher rates (70.2%) than the untreated ones (29.8%). Furthermore, An. gambiae s.s. were attracted to a treated goat at an equivalent degree (47.3%) as to their preferred human host (52.7%), even when the preferred host was present in the same environment. CONCLUSIONS: The findings indicate that human host-seeking mosquitoes can be diverted into feeding on non-preferred hosts despite the close proximity of their favoured host, hence reducing chances for the transmission of blood-borne parasites.

Is Anopheles gambiae attraction to floral and human skin-based odours and their combination modulated by previous blood meal experience?

BACKGROUND: Mosquitoes use odours to find energy resources, blood hosts and oviposition sites. While these odour sources are normally spatio-temporally segregated in a mosquito's life history, here this study explored to what extent a combination of flower- and human-mimicking synthetic volatiles would attract the malaria vector Anopheles gambiae sensu stricto (s.s.) METHODS: In the laboratory and in large (80 m2) outdoor cages in Tanzania, nulliparous and parous A. gambiae s.s. were offered choices between a blend of human skin volatiles (Skin Lure), a blend of floral volatiles (Vectrax), or a combination thereof. The blends consisted of odours that induce distinct, non-overlapping activation patterns in the olfactory circuitry, in sensory neurons expressing olfactory receptors (ORs) and ionotropic receptors (IRs), respectively. Catches were compared between treatments. RESULTS: In the laboratory nulliparous and parous mosquitoes preferred skin odours and combinations thereof over floral odours. However, in semi-field settings nulliparous were significantly more caught with floral odours, whereas no differences were observed for parous females. Combining floral and human volatiles did not augment attractiveness. CONCLUSIONS: Nulliparous and parous A. gambiae s.s. are attracted to combinations of odours derived from spatio-temporally segregated resources in mosquito life-history (floral and human volatiles). This is favourable as mosquito populations are comprised of individuals whose nutritional and developmental state steer them to diverging odours sources, baits that attract irrespective of mosquito status could enhance overall effectiveness and use in monitoring and control. However, combinations of floral and skin odours did not augment attraction in semi-field settings, in spite of the fact that these blends activate distinct sets of sensory neurons. Instead, mosquito preference appeared to be modulated by blood meal experience from floral to a more generic attraction to odour blends. Results are discussed both from an odour coding, as well as from an application perspective.

Chemical Mediation of Oviposition by Anopheles Mosquitoes: a Push-Pull System Driven by Volatiles Associated with Larval Stages.

The oviposition behavior of mosquitoes is mediated by chemical cues. In the malaria mosquito Anopheles gambiae, conspecific larvae produce infochemicals that affect this behavior. Emanations from first instar larvae proved strongly attractive to gravid females, while those from fourth instars caused oviposition deterrence, suggesting that larval developmental stage affected the oviposition choice of the female mosquito.We examined the nature of these chemicals by headspace collection of emanations of water in which larvae of different stages were developing. Four chemicals with putative effects on oviposition behavior were identified: dimethyldisulfide (DMDS) and dimethyltrisulfide (DMTS) were identified in emanations from water containing fourth instars; nonane and 2,4-pentanedione (2,4-PD) were identified in emanations from water containing both first and fourth instars. Dual-choice oviposition studies with these compounds were done in the laboratory and in semi-field experiments in Tanzania.In the laboratory, DMDS and DMTS were associated with oviposition-deterrent effects, while results with nonane and 2,4-PD were inconclusive. In further studies DMDS and DMTS evoked egg retention, while with nonane and 2,4-PD 88% and 100% of female mosquitoes, respectively, laid eggs. In dual-choice semi-field trials DMDS and DMTS caused oviposition deterrence, while nonane and 2,4-PD evoked attraction, inducing females to lay more eggs in bowls containing these compounds compared to the controls. We conclude that oviposition of An. gambiae is mediated by these four infochemicals associated with conspecific larvae, eliciting either attraction or deterrence. High levels of egg retention occurred when females were exposed to chemicals associated with fourth instar larvae.

Data quality of the routine health management information system at the primary healthcare facility and district levels in Tanzania.

BACKGROUND: Effective planning for disease prevention and control requires accurate, adequately-analysed, interpreted and communicated data. In recent years, efforts have been put in strengthening health management information systems (HMIS) in Sub-Saharan Africa to improve data accessibility to decision-makers. This study assessed the quality of routine HMIS data at primary healthcare facility (HF) and district levels in Tanzania. METHODS: This cross-sectional study involved reviews of documents, information systems and databases, and collection of primary data from facility-level registers, tally sheets and monthly summary reports. Thirty-four indicators from Outpatient, Inpatient, Antenatal care, Family Planning, Post-natal care, Labour and Delivery, and Provider-Initiated Testing and Counselling service areas were assessed. Indicator records were tracked and compared across the process of data collection, compilation and submission to the district office. Copies of monthly report forms submitted by facilities to the district were also reviewed. The availability and utilization of HMIS tools were assessed, while completeness and data accuracy levels were quantified for each phase of the reporting system. RESULTS: A total of 115 HFs (including hospitals, health centres, dispensaries) in 11 districts were involved. Registers (availability rate = 91.1%; interquartile range (IQR) 66.7-100%) and report forms (86.9%; IQR 62.2-100%) were the most utilized tools. There was a limited use of tally-sheets (77.8%; IQR 35.6-100%). Tools availability at the dispensary was 91.1%, health centre 82.2% and hospital 77.8%, and was low in urban districts. The availability rate at the district level was 65% (IQR 48-75%). Wrongly filled or empty cells in registers and poor adherence to the coding procedures were observed. Reports were highly over-represented in comparison to registers' records, with large differences observed at the HF phase of the reporting system. The OPD and IPD areas indicated the highest levels of mismatch between data source and district office. Indicators with large number of clients, multiple variables, disease categorization, or those linked with dispensing medicine performed poorly. CONCLUSION: There are high variations in the tool utilisation and data accuracy at facility and district levels. The routine HMIS is weak and data at district level inaccurately reflects what is available at the source. These results highlight the need to design tailored and inter-service strategies for improving data quality.

Trends, patterns and causes of respiratory disease mortality among inpatients in Tanzania, 2006-2015.

OBJECTIVE: To determine the causes, patterns and trends of respiratory diseases-related deaths in hospitals of Tanzania 2006-2015. METHODS: Retrospective study involving 39 hospitals. Medical records of patients who died in hospital were retrieved, reviewed and analysed. Sources of data were hospital admission registers, death registers and International Classification of Diseases report forms. Information on demographic characteristics, date of death, the immediate underlying cause of death and co-morbid conditions was collected. RESULTS: Of the 247 976 deaths reported during the 10-year period, respiratory diseases accounted for 12.92% (n = 32 042). The majority of the respiratory mortality was reported among males (55.9%). Overall median age at death was 31 years with an interquartile range (IQR) of 1-47. Median age at death was significantly higher among males (35 years) than females (28 years) (P < 0.0001). Most deaths (37.8%) occurred in eastern Tanzania. About one-third (31.3%) of all respiratory mortality was reported among under-five children, being among girls than boys (34.3% vs. 28.9%, χ2  = 10.3, P < 0.0001). Adolescent and young adult females (15-29 years) had higher age-standardised mortality rates per 100 000 due respiratory diseases than males. Pneumonia (n = 16 639; 51.9%) and pulmonary tuberculosis (n = 9687; 30.2%) accounted for the majority of deaths due to respiratory diseases. Significantly more females (n = 7665; 54.5%) than males died from pneumonia (n = 8878; 49.8%; χ2  = 8.5, P < 0.0001). By contrast, significantly more males (n = 6024; 34%) than females (n = 3596; 26%; χ2  = 15.5, P < 0.0001) died of tuberculosis. The proportion of death due to tuberculosis declined from 32.8% in 2006-2010 to 7.9% in 2011-2015. However, there was a significant increase in the proportion of death due to pneumonia from 49.6% in 2006-2010 to 53.4% in 2011-2015. Co-morbid conditions contributed to 9.1% (2871/31 628) of all deaths due to respiratory diseases. The most common co-morbid condition was HIV which accounted for 1735 (60.4%) deaths and was more common among males (60.8%; n = 957) than among females (59.7%; n = 764). CONCLUSIONS: Respiratory diseases account for a substantial proportion of all causes of hospital death in Tanzania. Pneumonia and tuberculosis contribute to more than three quarters of all deaths due to respiratory diseases. Since most major respiratory illnesses are avoidable, it is important to strengthen the capacity of the health delivery system in managing cases of respiratory diseases.

Spatio-temporal prevalence of malaria and anaemia in relation to agro-ecosystems in Mvomero district, Tanzania.

BACKGROUND: Agro-ecological systems have been associated with increased malaria intensity. This study determined association between different agro-ecological systems, prevalence of malaria parasitaemia and anaemia in Mvomero district, Tanzania. METHODS: The study was carried out in three agro-ecosystems namely, savannah, rice-irrigation, and sugarcane. Malaria and anaemia prevalence were measured in four seasons of a year. Villages were categorized according to environmental characteristics, proportion of water-shaded areas and agro-ecosystems. Mixed-effects logistic regression analysis was used to determine factors associated with malaria infection. RESULTS: A total of 7888 individuals were involved with the overall malaria prevalence of 34.4%. Plasmodium falciparum was the dominant (99.52%) malaria species. Malaria prevalence was highest (42.9%) in children of 10-15 years of age, and significantly low during dry and hot season. Of the infected individuals, 78.1% were from rice-irrigation, 18.7% savannah and 3.2% sugarcane ecosystem. Individuals living in villages with high levels of water-shaded areas had highest malaria risk. Over three-quarters (78.9%) of the individuals slept under a mosquito net, with the highest (88.5%) coverage among individuals in sugarcane ecosystem. On average 47.1% of the children were anaemic. Anaemia was more prevalent (60.5%) among individuals in the savannah than in the rice-irrigation (48.2%) or sugarcane communities (23%). Analysis indicated that ecosystems and levels of water-shaded area were highly correlated, and altered levels of malaria infection. Gender, age, mosquito net-use, and season were other significant determinants of P. falciparum infection. Males had higher odds than females (OR = 1.16, 95% CI 1.05, 1.29). The risk for children 6-9 years and older children (10-15 years) was over 50% and 24%, respectively, higher compared to young ones (0-5 years). Use of mosquito net reduced malaria risk by 26%. The risk of infection was higher during dry and cool season (OR = 1.92, 95 %CI 1.66, 2.23) compared to other seasons. Living in villages with high level of water-shaded areas increased the chances of getting malaria up to 15 times than living in drier areas. Similarly, infection odds increased when living in savannah and rice-irrigation ecosystems than in the sugarcane ecosystem. CONCLUSIONS: Findings show significant variations in malaria prevalence between communities living in different agro-ecosystems within the same district. Local malaria control strategies should consider these variations and liaise with agricultural experts while designing interventions to maximize effectiveness.

Malaria mosquito control in rice paddy farms using biolarvicide mixed with fertilizer in Tanzania: semi-field experiments.

BACKGROUND: The wide distribution of malaria mosquito breeding sites within tropical environments limits the mosquito larval source management efforts to control malaria. Rice farming contributes substantially in supporting malaria mosquito productivity in tropical countries. To overcome this challenge, this study was carried out to determine the effect of applying a mixture of biolarvicide and fertilizer on mosquito larvae density in rice farms under semi-field conditions in Tanzania. METHODS: A semi-field experiment was designed to determine the timing of application of a biolarvicide, Bacillus thuringiensis israelensis (Bti) and fertilizer (di-ammonium phosphate-DAP or urea) and assess their effect on mosquito larvae density and rice grain outputs. The experiment had five blocks (4 treatment arms and one control arm) and each had four replicates. Treatment arms had different intervals of days between treatments for mixtures of fertilizer and biolarvicides. The dosages used were 10 g of Bti/16 M2 and 160 g of DAP/Urea/16 m2. RESULTS: In overall, the intervention blocks (with biolarvicide) had lowest mean mosquito larvae abundance compared to control block (F = 22.42, P < 0.001). Similarly, the control arm maintained highest density of Anopheles gambiae sensu lato larvae compared to interventions blocks (F = 21.6, P < 0.001). The best determined timing for application of Bti was in 7 and in 10 days (F = 3.753, P < 0.001). There was neither significant different in mean rice grain harvest per ten panicle (F = 1.453, P = 0.27) nor mean difference in rice grain harvest (F = 1.479, P = 0.26) per intervention arms. CONCLUSION: The findings of this study have shown that application of a mixture of Bti and fertilizer have impact on both mosquito larvae density and maintaining yield rice harvest. Thus, application of a combination of biolarvicide and fertilizer can be an alternative approach in malaria mosquito intervention among rice farming communities of rural Tanzania.

Rice farmers' perceptions and acceptability in the use of a combination of biolarvicide (Bacillus thuringiensis var. israeliensis) and fertilizers application for malaria control and increase rice productivity in a rural district of central Tanzania.

BACKGROUND: The use of larval source management as a supplementary intervention for malaria control has not been widely used in rural Africa due to perceived high costs and complex logistics. To reduce the cost of larviciding in rice farming communities, concurrent application of biolarvicides and fertilizer in rice fields was introduced to control malaria vectors larvae and improve rice grain yields. The present study determined rice farmers' perceptions and acceptability in the use of a combination of biolarvicide and fertilizers in farming practices. METHODS: This was a qualitative study conducted among rice farmers at Kilangali village, south-central Tanzania. Semi-structured interviews and three focus group discussions (FGDs) were conducted with men and women who participated in the biolarvicide and fertilizer application project. The interviews and discussion focused on knowledge, attitudes and perceptions of participants on the use of the innovation in their farming practices and their willingness to pay for the innovation. RESULTS: A total of 40 (mean age = 38.8 ± 10.12 years) rice farmers were involved in the study. Overall, all farmers agreed that it was possible to apply the two products concurrently with minimal challenges. The trust on the safety of biolarvicides on both human and paddy health was high. Respondents reported no challenge in preparation and applying the product in their rice fields. Over half (56.6%) of the participants reported an average decrease in mosquito density in their households and a quarter (26.6%) of them reported a decrease in mosquito population in their farms. Similarly, 93.3% of the participants reported that the intervention had reduced malaria risk in their households. In general, all participants expressed willingness to contribute to a biolarvicide and fertilizer programme and to use the approach in their farming practices. CONCLUSION: Community-based concurrent application of biolarvicides and fertilizer in rice fields was feasible and led to a perceived reduction in mosquito density. Willingness to pay for the larviciding/fertilizer approach was expressed by participants and they accepted to use the approach in their future farming practices. However, the impact of this approach on malaria transmission and rice grain harvest need to be evaluated in a large-scale programme.

The impact on malaria of biannual treatment with azithromycin in children age less than 5 years: a prospective study.

BACKGROUND: The MORDOR study, a cluster randomized clinical trial, showed that single-dose azithromycin (20 mg/kg) administered biannually for 2 years to preschool children reduced mortality; a study was conducted to determine its effect on clinical symptomatic episodes of malaria as a potential mechanism for mortality benefit. METHODS: A randomized control trial (RCT) was conducted, whereby 30 randomly selected communities in Kilosa District, Tanzania were randomized to receive 6-monthly treatment of children ages 1-59 months with single-dose azithromycin (20 mg/kg) vs. placebo. A prospective cohort study was nested within the RCT: children, aged 1 to 35 months at baseline, were randomly selected in each community and evaluated at 6-monthly intervals for 2 years. At each visit, the children were assessed for recent or ongoing fever and anti-malarial treatment; a rapid diagnostic test (RDT) for malaria was performed. The two major outcomes of interest were prevalence of RDT positivity and clinical malaria. The latter was defined as RDT-positivity with fever at time of evaluation and/or reported fever in the 3 days prior to evaluation. Methods that account for correlations at community level and within individuals over time were used to evaluate associations. RESULTS: At baseline, the prevalence rates in the children in the azithromycin and placebo arms were 17.6% vs. 15.5% for RDT positivity (p = 0.76) and 6.1% vs. 4.3% (p = 0.56) for clinical malaria. There was a decline in both RDT-positivity and clinical malaria over time in both arms. The difference by treatment assignment was not significant for clinical malaria; it was significant for RDT-positivity with greater odds of decline in the placebo arm (p = 0.01). CONCLUSIONS: Lack of evidence for a significant difference in the prevalence of clinical malaria in children at any visit following treatment suggests that the effect of single-dose azithromycin on malaria is at best transient and limited in scope. Chance overrepresentation of non-seasonal transmission in the communities in the azithromycin arm may account for higher rates of RDT-positivity and less decline over time. Trial registration Clinicaltrials.gov NCT02047981.

Hospital mortality statistics in Tanzania: availability, accessibility, and quality 2006-2015.

BACKGROUND: Accurate and reliable hospital information on the pattern and causes of death is important to monitor and evaluate the effectiveness of health policies and programs. The objective of this study was to assess the availability, accessibility, and quality of hospital mortality data in Tanzania. METHODS: This cross-sectional study involved selected hospitals of Tanzania and was carried out from July to October 2016. Review of hospital death registers and forms was carried out to cover a period of 10 years (2006-2015). Interviews with hospital staff were conducted to seek information as regards to tools used to record mortality data, staff involved in recording and availability of data storage and archiving facilities. RESULTS: A total of 247,976 death records were reviewed. The death register was the most (92.3%) common source of mortality data. Other sources included the International Classification of Diseases (ICD) report forms, Inpatient registers, and hospital administrative reports. Death registers were available throughout the 10-year period while ICD-10 forms were available for the period of 2013-2015. In the years between 2006 and 2010 and 2011-2015, the use of death register increased from 82 to 94.9%. Three years after the introduction of ICD-10 procedure, the forms were available and used in 28% (11/39) hospitals. The level of acceptable data increased from 69% in 2006 to 97% in 2015. Inconsistency in the language used, use of non-standard nomenclature for causes of death, use of abbreviations, poorly and unreadable handwriting, and missing variables were common data quality challenges. About 6.3% (n = 15,719) of the records had no patient age, 3.5% (n = 8790) had no cause of death and ~ 1% had no sex indicated. The frequency of missing sex variable was most common among under-5 children. Data storage and archiving in most hospitals was generally poor. Registers and forms were stored in several different locations, making accessibility difficult. CONCLUSION: Overall, this study demonstrates gaps in hospital mortality data availability, accessibility, and quality, and highlights the need for capacity strengthening in data management and periodic record reviews. Policy guidelines on the data management including archiving are necessary to improve data.

Performance of health laboratories in provision of HIV diagnostic and supportive services in selected districts of Tanzania.

BACKGROUND: Roll-out and implementation of antiretroviral therapy (ART) necessitated many countries in Sub-Saharan Africa to strengthen their national health laboratory systems (NHLSs) to provide high quality HIV diagnostic and supportive services. This study was conducted to assess the performance of health laboratories in provision of HIV diagnostic and supportive services in eight districts (from four regions of Iringa, Mtwara, Tabora and Tanga), after nine years of implementation of HIV/AIDS care and treatment plan in Tanzania. METHODS: In this cross-sectional study, checklists and observations were utilized to collect information from health facilities (HFs) with care and treatment centres (CTCs) for HIV/AIDS patients; on availability of laboratories, CTCs, laboratory personnel, equipment and reagents. A checklist was also used to collect information on implementation of quality assurance (QA) systems at all levels of the NHLS in the study areas. RESULTS: The four regions had 354 HFs (13 hospitals, 41 Health Centres (HCs) and 300 dispensaries); whereby all hospitals had laboratories and 11 had CTCs while 97.5 and 61.0% of HCs had both laboratories and CTCs, respectively. Of the dispensaries, 36.0 and 15.0% had laboratories and CTCs (mainly in urban areas). Thirty nine HFs (12 hospitals, 21 HCs and six dispensaries) were assessed and 56.4% were located in urban areas. The assessed HFs had 199 laboratory staff of different cadres (laboratory assistants = 35.7%; technicians =32.7%; attendants = 22.6%; and others = 9.1%); with >61% of the staff and 72.3% of the technicians working in urban areas. All laboratories were using rapid diagnostic tests for HIV testing. Over 74% of the laboratories were performing internal quality control and 51.4% were participating in external QA programmes. Regional and district laboratories had all key equipment and harmonization was maintained for Fluorescence-Activated Cell Sorting (FACS) machines. Most of the biochemical (58.0%) and haematological analysers (74.1%) were available in urban areas. Although >81% of the equipment were functional with no mechanical faulty, 62.6% had not been serviced in the past three years. CONCLUSION: Diagnostic and supportive services for HIV were available in most of the HCs and hospitals while few dispensaries were providing the services. Due to limitations such as shortage of staff, serving of equipment and participation in QA programmes, the NHLS should be strengthened to ensure adequate human resource, implementation of QA and sustainable preventive maintenance services of equipment.

Clinical, Virologic, and Epidemiologic Characteristics of Dengue Outbreak, Dar es Salaam, Tanzania, 2014.

We investigated a dengue outbreak in Dar es Salaam, Tanzania, in 2014, that was caused by dengue virus (DENV) serotype 2. DENV infection was present in 101 (20.9%) of 483 patients. Patient age and location of residence were associated with infection. Seven (4.0%) of 176 patients were co-infected with malaria and DENV.

Midterm review of national health plans: an example from the United Republic of Tanzania.

In the health sector, planning and resource allocation at country level are mainly guided by national plans. For each such plan, a midterm review of progress is important for policy-makers since the review can inform the second half of the plan's implementation and provide a situation analysis on which the subsequent plan can be based. The review should include a comprehensive analysis using recent data - from surveys, facility and administrative databases - and global health estimates. Any midterm analysis of progress is best conducted by a team comprising representatives of government agencies, independent national institutions and global health organizations. Here we present an example of such a review, done in 2013 in the United Republic of Tanzania. Compared to similar countries, the results of this midterm review showed good progress in all health indicators except skilled birth attendance.

Dans le secteur de la santé, la planification et l'allocation des ressources au niveau national sont principalement guidées par les plans des pays. Pour chacun de ces plans, un examen à mi-parcours des progrès réalisés est important pour les responsables politiques, puisque cet examen peut donner des informations pour la deuxième moitié de la mise en œuvre du plan et fournir une analyse de la situation à partir de laquelle la suite du plan peut se baser. L'examen devrait inclure une analyse complète utilisant les données récentes (obtenues à partir des bases de données des enquêtes, des établissements et de l'administration) et les estimations sanitaires mondiales. Toute analyse à mi-parcours des progrès réalisés doit être menée de préférence par une équipe comprenant des représentants des agences gouvernementales, des institutions nationales indépendantes et des organisations sanitaires mondiales. Nous présentons ici un exemple d'un tel examen, réalisé en 2012 dans la République-Unie de Tanzanie. Par rapport à d'autres pays similaires, les résultats de cet examen à mi-parcours montrent une progression satisfaisante de tous les indicateurs de santé, à l'exception de l'accouchement assisté par un soignant qualifié.

En el sector de la salud, la planificación y la asignación de recursos a nivel nacional se guían principalmente por planes nacionales. Para los planificadores de políticas es importante contar una revisión intermedia de los progresos de cada plan, ya que puede proporcionar información sobre la segunda mitad de la implementación del plan y un análisis de la situación en la que basar planes posteriores. La revisión debe incluir un análisis exhaustivo con datos recientes - a partir de encuestas y bases de datos administrativas y de los centros - y estimaciones mundiales de salud. La mejor manera de realizar cualquier análisis intermedio de los progresos es a través de un equipo integrado por representantes de organismos gubernamentales, instituciones nacionales independientes y organizaciones mundiales de salud. Aquí presentamos un ejemplo de ese tipo de revisiones, realizada en 2012 en Tanzania. En comparación con países similares, los resultados de este examen intermedio mostraron un progreso correcto en todos los indicadores de salud, excepto en la prestación de atención especializada en el parto.

Malaria, anaemia and nutritional status among schoolchildren in relation to ecosystems, livelihoods and health systems in Kilosa District in central Tanzania.

BACKGROUND: Malaria prevalence and transmission intensity in Tanzania is heterogeneous with spatial and temporal variations between geographical areas and ecological systems. The objective of this study was to determine the prevalence of malaria, anaemia and nutritional status in relation to livelihoods, ecosystem and health systems in Kilosa District in central Tanzania. METHODS: This study was conducted in four villages, two characterised by rice irrigation ecosystem and the other two by dry savannah ecosystem and pastoral livelihoods. In each ecosystem, one of the villages had a healthcare facility. Schoolchildren were screened for malaria infection using malaria rapid diagnostic test (mRDT) and microscopy and they were assessed for their anaemia and nutritional statuses. RESULTS: A total of 1,019 school children (age = 4-16 years) were screened for malaria infection. The overall prevalence of Plasmodium falciparum infection was 10.6% and 4.5% by mRDT and microscopy, respectively. Children from pastoral villages had lower (2.9%) prevalence of malaria than their counterparts (18.2%) in the rice irrigation villages. A significantly high risk of malaria was observed among children in rice irrigation than in the pastoral ecosystem (OR: 0.13; 95%CI 0.07, 0.23). Children living in areas with health care facilities had a low odd of malaria infection by 45% (OR: 0.55; 95% CI = 0.35, 0.86). Overall, the prevalence of anaemia in the district was 43.4% (n = 775); and 58.3% of those with severe anaemia were among children from the pastoral villages. Anaemia was significantly higher among children not using mosquito nets (p = 0.049); and among those with malaria infection (p <0.001). The majority (96%) of the children had Body Mass Index less than 18.5 kg/m(2) which indicate high proportion of underweight. CONCLUSION: There are significant variations in the risk of acquiring malaria infection between different ecosystems and livelihoods. These findings suggest that malaria control programmes must take into account ecosystems and livelihoods of the targeted population through an integrated management of malaria and nutrition approach.