Adherence to national malaria treatment guidelines in private drug outlets: a cross-sectional survey in the malaria-endemic Kisumu County, Kenya.

BACKGROUND: Malaria prevalence in Kenya is 6%, with a three-fold higher prevalence in western Kenya. Adherence to malaria treatment guidelines improves care for suspected malaria cases and can reduce unnecessary anti-malarial use. Data on adherence to guidelines in retail drug outlets (DOs) is limited, yet approximately 50% of people with fever access treatment first in these outlets. This study assessed adherence to the national malaria treatment guidelines among DOs in a high transmission area of Western Kenya. METHODS: In a cross-sectional survey of DOs in Kisumu Central and Seme sub-counties in 2021, DO staff were interviewed using structured questionnaires to assess outlet characteristics (location, testing services), staff demographics (age, sex, training), and health system context (supervision, inspection). Mystery shoppers (research assistants disguised as clients) observed malaria management practices and recorded observations on a standardized tool. Adherence was defined as dispensing artemether-lumefantrine (AL) to patients with a confirmed positive test, accompanied by appropriate medication counseling. Logistic regression was used to test for association between adherence to guidelines and DO-related factors. RESULTS: None of the 70 DOs assessed had a copy of the guidelines, and 60 (85.7%) were in an urban setting. Staff adhered to the guidelines in 14 (20%) outlets. The odds of adherence were higher among staff who had a bachelor's degree {odds ratio (OR) 6.0, 95% confidence interval (95% CI) 1.66-21.74}, those trained on malaria rapid diagnostic test (RDT) {OR 4.4, 95% CI 1.29-15.04}, and those who asked about patient's symptoms {OR 3.6, 95% CI 1.08-12.25}. DOs that had higher odds of adherence included those with functional thermometers {OR 5.3, 95% CI 1.46-19.14}, those recently inspected (within three months) by Pharmacy and Poisons Board (PPB) {OR 9.4, 95% CI 2.55-34.67}, and those with all basic infrastructure {OR 3.9, 95% CI 1.01-15.00}. On logistic regression analysis, recent PPB inspection {adjusted OR (AOR) 4.6, 95% CI 1.03-20.77} and malaria RDT-trained staff (aOR 4.5, 95% CI 1.02-19.84) were independently associated with adherence. CONCLUSION: Most outlets didn't adhere to malaria guidelines. Regular interaction with regulatory bodies could improve adherence. Ministry of Health should enhance private sector engagement and train DOs on RDT use.

Prevalence, recent infection and predictors of HIV infection in fishing community along the shore of Lake Victoria in Tanzania.

BACKGROUND: Fishing communities are a subpopulation burdened by human immunodeficiency virus (HIV), mainly due to their mobility and cash income access. Strategies to mitigate the spread of HIV in fishing communities have varying outcomes. We conducted a study to determine the prevalence of HIV, recent infection and associated factors among fishing communities at Lake Victoria in Tanzania. METHODS: We conducted a cross-sectional study in the first quarter of 2019. The participants' information was collected using a structured questionnaire. Blood samples were screened for HIV infection; the positive samples were tested for avidity and viral load to determine the recent infection. Logistic regression analysis was used to determine the factors associated with HIV infection. RESULTS: A total of 1048 individuals were included with a mean age of 34 years (SD ± 11.5). The overall prevalence of HIV was 9.1%, while 7.4% had a recent infection. Lack of formal education, being separated/divorced/widowed, transactional sex, history of sexually transmitted infections, not tested for HIV in the last 12 months had 1.7 to three times more odds of contracting HIV. CONCLUSION: A proportion of HIV recent infection among the fisherfolks was relatively high, signifying the continuous spread, which is predisposed by some demographic and behavioural characteristics.

Factors associated with Salmonella infection in patients with gastrointestinal complaints seeking health care at Regional Hospital in Southern Highland of Tanzania.

BACKGROUND: Salmonellosis remains an important public health problem globally. The disease is among the leading causes of morbidity and mortality in developing countries that experience poor hygiene and lack of access to clean and safe water. There was an increase in reported cases of Salmonellosis in Njombe Region, Southern Highland of Tanzania between 2015 and 2016 based on clinical diagnosis. Nevertheless, little is known about the factors contributing to the transmission of this disease in the region. This study was conducted to determine the prevalence, antimicrobial susceptibility, and factors associated with Salmonella infection among patients who report gastrointestinal complaints. METHODS: A cross-sectional study was conducted from December 2017 to February 2018 among patients with gastrointestinal complaints at Kibena Regional Hospital. Stool samples were submitted for isolation of Salmonella spp. Identification was based on conventional biochemical tests and serotyping to differentiate typhoid and non-typhoid Salmonella (NTS). Antimicrobial susceptibility was performed using the Kirby-Bauer disc diffusion method. Multivariable logistic regression analysis was performed to examine the factors independently associated with Salmonella infection. RESULTS: The prevalence of Salmonella infection among participants with gastrointestinal complaints was 16.5% (95% CI: 12.7-21.1) of them, 83.7, 95% CI: 70.9-91.5 were NTS while 16.3, 95% CI: 8.5-29.0 were Typhoid Salmonella species. All isolates were sensitive to ceftriaxone and ciprofloxacin, whereas 27.8 and 100% were resistant to co-trimoxazole and ampicillin respectively. The odd of Salmonella infection was fourfold higher among participants with formal employment (AOR 3.8, 95% CI, 1.53-9.40). Use of water from wells/rivers (AOR 2.2, 95% CI, 1.07-4.45), drinking untreated water (AOR 2.6, 95% CI, 1.21-5.48) and often eating at a restaurant (AOR 3.4, 95% CI, 1.28-8.93) had increased odds of Salmonella infection. Likewise, having abdominal pain (AOR 8.5, 95% CI, 1.81-39.78) and diarrhea (AOR 2.3, 95% CI, 1.12-4.68) were independent symptoms that predict Salmonella infection. CONCLUSION: There is a high prevalence of Salmonella infection among people who report gastrointestinal complaints and it is clinically predicated by diarhoea and abdominal pain. Employed participants and those eating at restaurant and drinking unsafe water had higher risk of infection. Salmonella spp. causing gastroenteritis has developed resistance to commonly used antibiotics.

Identification and antimicrobial resistance patterns of bacterial enteropathogens from children aged 0-59 months at the University Teaching Hospital, Lusaka, Zambia: a prospective cross sectional study.

BACKGROUND: Bacterial diarrhoeal disease is among the most common causes of mortality and morbidity in children 0-59 months at the University Teaching Hospital in Lusaka, Zambia. However, most cases are treated empirically without the knowledge of aetiological agents or antimicrobial susceptibility patterns. The aim of this study was, therefore, to identify bacterial causes of diarrhoea and determine their antimicrobial susceptibility patterns in stool specimens obtained from the children at the hospital. METHODS: This hospital-based cross-sectional study involved children aged 0-59 months presenting with diarrhoea at paediatrics wards at the University Teaching Hospital in Lusaka, Zambia, from January to May 2016. Stool samples were cultured on standard media for enteropathogenic bacteria, and identified further by biochemical tests. Multiplex polymerase chain reaction was used for characterization of diarrhoeagenic Escherichia coli strains. Antimicrobial susceptibility testing was performed on antibiotics that are commonly prescribed at the hospital using the Kirby-Bauer disc diffusion method, which was performed using the Clinical Laboratory Standards International guidelines. RESULTS: Of the 271 stool samples analysed Vibrio cholerae 01 subtype and Ogawa serotype was the most commonly detected pathogen (40.8%), followed by Salmonella species (25.5%), diarrhoeagenic Escherichia coli (18%), Shigella species (14.4%) and Campylobacter species (3.5%). The majority of the bacterial pathogens were resistant to two or more drugs tested, with ampicillin and co-trimoxazole being the most ineffective drugs. All diarrhoeagenic Escherichia coli isolates were extended spectrum ß-lactamase producers. CONCLUSION: Five different groups of bacterial pathogens were isolated from the stool specimens, and the majority of these organisms were multidrug resistant. These data calls for urgent revision of the current empiric treatment of diarrhoea in children using ampicillin and co-trimoxazole, and emphasizes the need for continuous antimicrobial surveillance as well as the implementation of prevention programmes for childhood diarrhoea.

National surveillance data on the epidemiology of cholera in Kenya, 1997-2010.

BACKGROUND: Kenya has experienced multiple cholera outbreaks since 1971. Cholera remains an issue of major public health importance and one of the 35 priority diseases under Kenya's updated Integrated Disease Surveillance and Response strategy. METHODS: We reviewed the cholera surveillance data reported to the World Health Organization and the Kenya Ministry of Public Health and Sanitation from 1997 through 2010 to determine trends in cholera disease for the 14-year period. RESULTS: A total of 68 522 clinically suspected cases of cholera and 2641 deaths were reported (overall case-fatality rate [CFR], 3.9%), affecting all regions of the country. Kenya's largest outbreak occurred during 1997-1999, resulting in 26 901 cases and 1362 deaths (CFR, 5.1%). Following a decline in disease occurrence, the country experienced a resurgence of epidemic cholera during 2007-2009 (16 616 cases and 454 deaths; CFR, 2.7%), which declined rapidly to 0 cases. Cases were reported through July 2010, with no cases reported during the second half of the year. About 42% of cases occurred in children aged <15 years. Vibrio cholerae O1, serotype Inaba, was the predominant strain recorded from 2007 through 2010, although serotype Ogawa was also isolated. Recurrent outbreaks have most frequently affected Nairobi, Nyanza, and Coast provinces, as well as remote arid and semiarid regions and refugee camps. DISCUSSION: Kenya has experienced substantial amounts of reported cases of cholera during the past 14 years. Recent decreases in cholera case counts may reflect cholera control measures put in place by the National Ministry of Health; confirmation of this theory will require ongoing surveillance.

A national cholera epidemic with high case fatality rates--Kenya 2009.

BACKGROUND: Cholera remains endemic in sub-Saharan Africa. We characterized the 2009 cholera outbreaks in Kenya and evaluated the response. METHODS: We analyzed surveillance data and estimated case fatality rates (CFRs). Households in 2 districts, East Pokot (224 cases; CFR = 11.7%) and Turkana South (1493 cases; CFR = 1.0%), were surveyed. We randomly selected 15 villages and 8 households per village in each district. Healthcare workers at 27 health facilities (HFs) were surveyed in both districts. RESULTS: In 2009, cholera outbreaks caused a reported 11 425 cases and 264 deaths in Kenya. Data were available from 44 districts for 6893 (60%) cases. District CFRs ranged from 0% to 14.3%. Surveyed household respondents (n = 240) were aware of cholera (97.5%) and oral rehydration solution (ORS) (87.9%). Cholera deaths were reported more frequently from East Pokot (n = 120) than Turkana South (n = 120) households (20.7% vs. 12.3%). The average travel time to a HF was 31 hours in East Pokot compared with 2 hours in Turkana South. Fewer respondents in East Pokot (9.8%) than in Turkana South (33.9%) stated that ORS was available in their village. ORS or intravenous fluid shortages occurred in 20 (76.9%) surveyed HFs. CONCLUSIONS: High CFRs in Kenya are related to healthcare access disparities, including availability of rehydration supplies.

New Vibrio cholerae sequences from Eastern and Southern Africa alter our understanding of regional cholera transmission.

Despite ongoing containment and vaccination efforts, cholera remains prevalent in many countries in sub-Saharan Africa. Part of the difficulty in containing cholera comes from our lack of understanding of how it circulates throughout the region. To better characterize regional transmission, we generated and analyzed 118 Vibrio cholerae genomes collected between 2007-2019 from five different countries in Southern and Eastern Africa. We showed that V. cholerae sequencing can be successful from a variety of sample types and filled in spatial and temporal gaps in our understanding of circulating lineages, including providing some of the first sequences from the 2018-2019 outbreaks in Uganda, Kenya, Tanzania, Zambia, and Malawi. Our results present a complex picture of cholera transmission in the region, with multiple lineages found to be co-circulating within several countries. We also find evidence that previously identified sporadic cases may be from larger, undersampled outbreaks, highlighting the need for careful examination of sampling biases and underscoring the need for continued and expanded cholera surveillance across the African continent.

The quality of malaria case management in different transmission settings in Tanzania mainland, 2017-2018.

Tanzania is undergoing an epidemiological transition for malaria transmission with some areas of the country having <10% (hypoendemic) and other areas 10% - 50% malaria prevalence (mesoendemic). It is not known whether there is a difference in the quality of malaria case management based on endemicity in Tanzania mainland. We examined the influence of endemicity on the quality of malaria case management at health facilities. We conducted a cross-sectional analysis of 1713 health facilities in Tanzania mainland, using data collected by the National Malaria Control Program through an assessment tool to evaluate quality of malaria case management. The data was gathered from September 2017 to December 2018. Using standard quality factors, mean scores from facilities in the different endemicity regions were compared by a Student's t-test. Simple and multiple linear regression analyses were performed to determine the association between facility performance (score) and endemicity (mesoendemic vs. hypoendemic). Facilities in mesoendemic regions scored higher than those in hypoendemic regions on the overall quality of services [difference in mean scores ([Formula: see text]) = 2.52; (95% Confidence Interval (CI) 1.12, 3.91)], site readiness [[Formula: see text] = 2.97; (95% CI 1.30, 4.61)], availability of malaria reference materials [[Formula: see text] = 4.91; (95% CI 2.05, 7.76)], availability of Health Management Information System tools [[Formula: see text] = 5.86; (95% CI 3.80, 7.92)] and patient satisfaction [[Formula: see text] = 6.61; (95% CI 3.75, 9.48)]. Predictors associated with lower facility scores included; being located in a hypoendemic region [ß: -2.49; (95% CI -3.83, -1.15)] and urban area [ß: -3.84; (95% CI -5.60, -2.08)]. These findings highlight the differences in quality of malaria case management based on endemicity, but there is still a need to target improvement efforts in underperforming facilities, regardless of endemicity.

Diagnostic accuracy of the Panbio COVID-19 antigen rapid test device for SARS-CoV-2 detection in Kenya, 2021: A field evaluation.

BACKGROUND: Accurate and timely diagnosis is essential in limiting the spread of SARS-CoV-2 infection. The reference standard, rRT-PCR, requires specialized laboratories, costly reagents, and a long turnaround time. Antigen RDTs provide a feasible alternative to rRT-PCR since they are quick, relatively inexpensive, and do not require a laboratory. The WHO requires that Ag RDTs have a sensitivity ≥80% and specificity ≥97%. METHODS: This evaluation was conducted at 11 health facilities in Kenya between March and July 2021. We enrolled persons of any age with respiratory symptoms and asymptomatic contacts of confirmed COVID-19 cases. We collected demographic and clinical information and two nasopharyngeal specimens from each participant for Ag RDT testing and rRT-PCR. We calculated the diagnostic performance of the Panbio™ Ag RDT against the US Centers for Disease Control and Prevention's (CDC) rRT-PCR test. RESULTS: We evaluated the Ag RDT in 2,245 individuals where 551 (24.5%, 95% CI: 22.8-26.3%) tested positive by rRT-PCR. Overall sensitivity of the Ag RDT was 46.6% (95% CI: 42.4-50.9%), specificity 98.5% (95% CI: 97.8-99.0%), PPV 90.8% (95% CI: 86.8-93.9%) and NPV 85.0% (95% CI: 83.4-86.6%). Among symptomatic individuals, sensitivity was 60.6% (95% CI: 54.3-66.7%) and specificity was 98.1% (95% CI: 96.7-99.0%). Among asymptomatic individuals, sensitivity was 34.7% (95% CI 29.3-40.4%) and specificity was 98.7% (95% CI: 97.8-99.3%). In persons with onset of symptoms <5 days (594/876, 67.8%), sensitivity was 67.1% (95% CI: 59.2-74.3%), and 53.3% (95% CI: 40.0-66.3%) among those with onset of symptoms >7 days (157/876, 17.9%). The highest sensitivity was 87.0% (95% CI: 80.9-91.8%) in symptomatic individuals with cycle threshold (Ct) values ≤30. CONCLUSION: The overall sensitivity and NPV of the Panbio™ Ag RDT were much lower than expected. The specificity of the Ag RDT was high and satisfactory; therefore, a positive result may not require confirmation by rRT-PCR. The kit may be useful as a rapid screening tool only for symptomatic patients in high-risk settings with limited access to rRT-PCR. A negative result should be interpreted based on clinical and epidemiological information and may require retesting by rRT-PCR.

Measles containing vaccine coverage and factors associated with its uptake among children aged 24-59 months in Cherangany Sub County, Trans Nzoia County, Kenya.

INTRODUCTION: Measles is a vaccine-preventable disease whose elimination depends on the measles-containing vaccine (MCV) coverage of ≥95% in the population. In 2020, Kenya reported 597 cases, an increase of 158 cases from those reported in 2019. This study aimed to estimate the measles vaccine coverage and factors associated with its uptake in Cherangany Sub County. METHODS: We conducted a cross-sectional study using cluster sampling in the Cherangany Sub County of Trans Nzoia County in May 2021. We enrolled eligible children aged between 24-59 months and interviewed their caregivers using a structured questionnaire. We conducted descriptive, bivariate, and multivariate analyses. We used Prevalence Odds Ratio (POR) at bivariate and adjusted POR (aPOR) at multivariate with their corresponding 95% confidence interval as the measure of association. We regarded the variables with a p-value of less <0.05 at the multivariate level as independently associated with immunization status. RESULTS: We recruited 536 eligible children. The median age of the participants was 39 months (Interquartile Range 31-50). The coverage was 96.6% (518/536) for MCV dose one (MCV 1), and 56.2% (301/536) MCV dose two (MCV 2). At the bivariate level, family monthly income (POR 2.32, 95% CI 1.14-4.72), child vaccination status for other scheduled vaccines (POR 0.21, 95% CI 0.07-0.66), caregiver's level of education (POR = 1.82, 95% CI 1.29-2.57), knowledge of the vaccine-preventable diseases (POR = 0.55, 95% CI 0.38-0.80), and knowledge of the number of MCV scheduled doses (POR = 0.13, 95% CI 0.09-0.02) were significantly associated with MCV uptake. The Caregiver's knowledge on the number of MCV scheduled doses (POR = 5.73, 95% CI 3.48-9.45) and children whose birth order was ≤5th born (POR = 0.5, 95% CI 0.22-0.95) were significantly associated with MCV uptake at the multivariate analysis. CONCLUSION: The MCV 2 coverage was lower than the WHO recommended ≥ 95%. Lack of knowledge of the number of MCV scheduled doses and the child's birth order in the family are factors associated with not being fully vaccinated against measles. RECOMMENDATION: There is a need to strengthen the defaulter tracing system to follow up the children who default after receiving MCV 1, focusing interventions on the identified factors.

An Assessment of Household Knowledge and Practices during a Cholera Epidemic- Dar es Salaam, Tanzania, 2016.

From August 15, 2015 to March 5, 2016, Tanzania reported 16,521 cholera cases and 251 deaths, with 4,596 cases and 44 deaths in its largest city, Dar es Salaam. To evaluate outbreak response efforts, we conducted a household survey with drinking water testing in the five most affected wards in Dar es Salaam. We interviewed 641 households 6 months after the beginning of the outbreak. Although most respondents knew that cholera causes diarrhea (90%) and would seek care if suspecting cholera (95%), only 45% were aware of the current outbreak in the area and only 5% would use oral rehydration salts (ORS) if ill. Of 200 (31%) respondents reporting no regular water treatment, 46% believed treatment was unnecessary and 18% believed treatment was too expensive. Fecal contamination was found in 45% of water samples and was associated with water availability (P = 0.047). Only 11% of samples had detectable free chlorine residual, which was associated with water availability (P = 0.025), reported current water treatment (P = 0.006), and observed free chlorine product in the household (P = 0.015). The provision of accessible, adequately chlorinated water supply, and implementation of social mobilization campaigns advocating household water treatment and use of ORS should be prioritized to address gaps in cholera prevention and treatment activities.

Evaluation of a New Field Epidemiology Training Program Intermediate Course to Strengthen Public Health Workforce Capacity in Tanzania.

OBJECTIVES: Sub-Saharan Africa faces a shortage of skilled epidemiologists to prevent, detect, and respond to health threats. Tanzania has implemented one of the first Centers for Disease Control and Prevention Field Epidemiology Training Program (FETP) Intermediate courses in Africa. This course aims to strengthen health workforce capacity in surveillance system assessment, outbreak investigation, and evaluation, prioritizing HIV control. We conducted an outcome evaluation of this new course. METHODS: We used a pre/post evaluation design using data from 4 cohorts of trainees who took the FETP Intermediate course from 2017 to 2020. We conducted knowledge assessments before and after each cohort and combined those results. Outcomes included knowledge and self-rated competency and trends in integrated disease surveillance and response (IDSR) data. We collected data through tests, field assignments, exit interviews, and data audits. We compared the mean change in pre-/posttest scores using linear regression and 95% CIs. We used content analysis to summarize exit interviews. RESULTS: Fifty-three FETP trainees from 10 regions enrolled in the FETP Intermediate course, and 52 (99.0%) completed the course. We found substantial increases in mean knowledge (44.0 to 68.0 points) and self-rated competency (4.14 to 4.43) scores before and after the course. Trainees evaluated 52 surveillance systems and 52 district HIV care programs, and 39 (75.0%) trainees participated in outbreak investigations. From before to after cohort 1, timeliness and completeness of IDSR reports increased from 4.2% to 52.1% and from 27.4% to 76.5%, respectively. Course strengths were quality of instruction, individualized mentoring, and practical skills gained. Challenges were mentor availability, limited time for data analysis practice, and balancing work and field assignments. CONCLUSIONS: The Tanzania FETP Intermediate course substantially improved trainee knowledge and helped to improve local data quality and reporting. This course is a promising model to strengthen subnational capacity to prevent, detect, and respond to public health threats in Africa.

Risk factors associated with under nutrition among children aged 6-59 months in Ngorongoro, Arusha region, Tanzania: a case-control study, 2017.

INTRODUCTION: childhood undernutrition is one of the leading causes of morbidity and mortality in children below five years of age especially in developing countries like Tanzania, particularly in rural area. Inappropriate child caring and feeding practices have been strongly associated with it. Many actions have been taken to reduce prevalence of undernutrition in children in Ngorongoro district, however, the problem persist. This study identified risk factors associated with undernutrition in children under-five years of age in Ngorongoro district, Arusha region. METHODS: a health facility-based unmatched case-control study was conducted with 400 (100 cases and 300 controls) children aged 6-59 months. Cases included children with undernutrition according to the WHO anthropometric indicators. Controls were children within the normal range of these indicators. Both cases and controls, were obtained from children attending the Reproductive and Child Health (RCH) for assessment of growth and development or admitted in pediatric ward. A questionnaire was used to collect demographic characteristics, child health and caring practices and environmental factors. Height, weight and Mid Upper Arm Circumference (MUAC) were measured using standard approaches. We employed logistic regression analysis to identify significant risk factors for undernutrition. RESULTS: undernutrition was associated with young age of mothers/caregivers (adjusted Odds Ratio (aOR)=38.8, 95% CI: 15.38-59.03.); early age of initiation complementary foods (aOR=13.6, 95%CI: 3.15-59.06); a child having diarrhoea in past one month (aOR=4.0; 95%CI: 1.76-12.85); large family size (aOR=6.1, 95% CI: 2.16-16.90); low frequency of feeding (aOR=3.9, 95%CI: 1.59-9.58); low birth weight (aOR:=7.3, 95%: CI: 1.15-46.70); and source of drinking water; well (aOR=16.3, 95%: CI: 1.81-147.05) and surface water (aOR=16.18, 95%CI: 1.85-141.71). CONCLUSION: household and individual characteristics of the children and mother/caregiver are important predictors of undernutrition in this community. Tailored interventions, instead of blanket approaches, should be designed to mitigate and eliminate childhood undernutrition in Ngorongoro.

Factors associated with non-uptake of measles-rubella vaccine second dose among children under five years in Mtwara district council, Tanzania, 2017.

INTRODUCTION: in 2014, Tanzania introduced the combined measles-rubella vaccine in the routine immunization schedule. Two doses of measles-rubella vaccine (MR1 and MR2) are recommended at 9 and 18 months, respectively. In 2015, MR2 coverage among eligible 18-month-old children in Tanzania was only 57%, lower than the WHO-recommended coverage (95%). During the same period Mtwara District Council (MDC) reported a coverage of 52% which is lower than the nation average. We determined factors associated with non-uptake of MR2 among children in MDC Tanzania. METHODS: we conducted a community-based cross-sectional survey using cluster sampling during January - April 2017 in MDC. Caretakers of children born during January 2014 - January 2015 and residing in MDC for the past three years were recruited. We interviewed participants and reviewed vaccination cards. Logistic regression modeling was employed to identify independent factors associated with uptake of MR2. RESULTS: of 1,000 children assessed, 558 (55.8%) were unvaccinated with MR2. Factors independently associated with non-uptake of MR2 included the caretaker being unaware of the ages for MR1 and MR2 administration [aOR=3.50; 95%CI 1.98-6.21; p<0.001], having MR2 vaccination services offered at the local vaccination station fewer than three days per week [aOR=1.50; 95%CI 1.42-5.59; p<0.001], not having the vaccine available during vaccination days [aOR=3.38; 95%CI 1.08-10.61; p<0.01], unwillingness of health workers to open multi-dose vaccine vials for a single child [aOR=3.80; 95% CI 2.12-6.79; p<0.001], and long waiting times for vaccination services [aOR=1.80; 95% CI 1.08-3.00; p<0.01]. CONCLUSION: more than half the children under five years in MDC were not vaccinated with MR2. Lack of caretaker knowledge about appropriate vaccination age, unavailability of vaccine, having insufficient numbers of children waiting to warrant multidose vial use, and long clinic waiting times were associated with MR2 non-uptake. The community should receive education about MR vaccine; we recommend thorough screening of children?s vaccination status at each clinic visit and provision of vaccine whenever possible. Vaccine distribution should be improved in MDC.

Awareness and factors associated with reported intake of folic acid-fortified flour among women of reproductive age in Ifakara, Morogoro region, Tanzania: a cross-sectional study.

BACKGROUND: Folic acid fortification of staple foods has been in place in many countries for over two decades. Studies have shown that folic acid fortification can significantly reduce incidence of neural tube defects. Tanzania adopted a mandatory fortification policy for commercially-produced wheat and maize flour in 2011. We determined factors influencing intake of folic acid-fortified flour among women of reproductive age (WRA). METHODS: We conducted a cross-sectional study among WRA during March-April 2017 in Ifakara Town Council, Morogoro region. Multistage cluster sampling was used to select study participants. We used a questionnaire to capture information on demographics, awareness of folic acid, awareness of existence of folic acid fortified flour in community and intake of folic acid fortified flour. Intake was defined as reported consumption of folic acid fortified flour products at least once within 7 days before interview. Univariate, bivariate, and multivariable logistic analyses were done to evaluate factors associated with intake of folic acid fortified flour. RESULTS: The median age of the 698 participating WRA was 30 years (range: 18-49). Awareness of folic acid and folic acid fortified flour was 6.9% (95% CI: 5.2-9.0%) and 7.5% (95% CI: 5.7-9.6%), respectively. Consumption of folic acid fortified flour was 63.3% (95% CI: 59.7-66.8%). Independent factors associated with intake included being employed (aOR = 1.91; 95% CI: 1.19-3.06), having no children (nulliparity) (aOR = 2.59; 95% CI: 1.36-4.95) or having 1-4 children (aOR = 1.98; 95% CI: 1.17-3.33) (vs. 5 or more children), and folic acid awareness (aOR = 2.53; 95% CI: 1.30-4.92). CONCLUSION: Folic acid fortified flour was used by most respondents in our study despite low awareness of existence of folic acid fortified flour in the community. Being employed, having fewer than five children, and folic acid awareness were independent factors associated with intake. We recommend scaling up of mandatory flour fortification program and doing further studies on blood folate level among women of reproductive age in Ifakara to assess fortification program effectiveness.

Field Epidemiology and Laboratory Training Program, Where Is the L-Track?

Background: Modifications of the Field Epidemiology Training Program (FETP) curricula to include a laboratory track (L-Track), to become Field Epidemiology and Laboratory Training Program (FELTP), began in 2004 in Kenya. The L-Track offered candidates training on laboratory competencies in management, policy, quality systems, and diagnostic methods as well as epidemiology, disease surveillance and outbreak response. Since then several FELTPs have discontinued the L-Track and instead offer all candidates, epidemiologists and laboratorians, a single FETP curriculum. Reasons for these changes are reported here. Methods: A questionnaire was sent to directors of 13 FELTP programs collecting information on the status of the programs, reasons for any changes, basic entry qualifications, source institutions and where residents were post enrollment or after graduation. Data from previous CDC internal assessments on FELTP L-Track was also reviewed. Results: Out of the 13 FELTPs included, directors from 10 FELTPs sent back information on their specific programs. The FELTPs in Kenya, Mozambique, Cameroon and Kazakhstan and Mali have discontinued a separate L-Track while those in Ghana, Georgia, Nigeria, Rwanda, and Tanzania continue to offer the separate L-Track. Reasons for discontinuation included lack of standardized curriculum, unclear strategies of the separate L-Track, and funding constraints. Two countries Kenya and Tanzania reported on the career progression of their graduates. Results show 84% (Kenya) and 51% (Tanzania) of candidates in the FELTP, L-Track were recruited from national/regional medical health laboratories. However post-graduation, 56% (Kenya) and 43% (Tanzania) were working as epidemiologists, program managers, program coordinators, or regulatory/inspection boards. Professional upward mobility was high; 87% (Kenya) and 73% (Tanzania) residents, reported promotions either in the same or in new institutions. Conclusions: The FELTP L-Track residents continue to offer critical contributions to public health workforce development with high upward mobility. While this may be a reflection of professional versatility and demand of the FELTP graduates, the move from core laboratory services underscores the challenges in filling and retaining qualified staff within the laboratory systems. Results suggest different strategies are needed to strengthen laboratory management and leadership programs with a clear focus on laboratory systems and laboratory networks to meet current and future clinical and public health laboratory workforce demands.

Use of TaqMan Array Cards to Screen Outbreak Specimens for Causes of Febrile Illness in Tanzania.

We describe the deployment of a custom-designed molecular diagnostic TaqMan Array Card (TAC) to screen for 31 bacterial, protozoal, and viral etiologies in blood from outbreaks of acute febrile illness in Tanzania during 2015-2017. On outbreaks notified to the Tanzanian Ministry of Health, epidemiologists were dispatched and specimens were collected, transported to a central national laboratory, and tested by TAC within 2 days. This algorithm streamlined investigation, diagnosed a typhoid outbreak, and excluded dozens of other etiologies. This method is usable in-country and may be incorporated into algorithms for diagnosing outbreaks.

Investigating a paralytic shellfish poisoning in Gando Village, Wete District, Tanzania, July 2015.

The investigation of foodborne outbreaks requires a multi-disciplinary set of skills. Frequently, foodborne-related outbreaks are poorly investigated due to lack of all required skills on the part of the investigators. This case study, based on a shellfish poisoning outbreak investigation conducted in Wete, Zanzibar in July 2015 by the Tanzania Field Epidemiology Training Program (TFETP), seeks to reinforce principles and skills in foodborne outbreak investigation. It is primarily intended for training public health practitioners in a classroom setting. Facilitating this case study should take approximately 3 hours.

Methicillin-resistant staphylococcus aureus (MRSA) colonization among Intensive Care Unit (ICU) patients and health care workers at Muhimbili national hospital, Dar Es Salaam, Tanzania, 2012.

INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) has been recognized as important nosocomial pathogens worldwide. S aureus may induce clinically manifested diseases, or the host may remain completely asymptomatic. METHODS: A cross-sectional hospital-based study was conducted from October 2012 to March 2013 in two ICUs at MNH. Admitted patients and health care workers were enrolled in the study. Interviewer administered questionnaires; patient history forms, observation charts and case report forms were used to collect data. Swabs (nostrils, axillary or wounds) were collected. MRSA were screened and confirmed using cefoxitin, oxacillin discs and oxacillin screen agar. Antibiotic susceptibility was performed using Kirby-Bauer disk diffusion method. The risk factors for MRSA were determined using the logistic regression analysis and a p - value of <0.05 was considered as statistically significant. RESULTS: Of the 169 patients and 47 health workers who were recruited, the mean age was 43.4 years ± SD 15.3 and 37.7 years ± (SD) 11.44 respectively. Among the patients male contributed 108 (63.9%) while in health worker majority 39(83%) were females. The prevalence of MRSA colonization among patients and health care workers was 11.83% and 2.1% respectively. All (21) MRSA isolates were highly resistant to penicillin and erythromycin, and 17 (85.7%) were highly sensitive to vancomycin. Being male (AOR 6.74, 95% CI 1.31-34.76), history of sickness in past year (AOR 4.89, 95% CI 1.82- 13.12), being sick for more 3 times (AOR 8.91, 95% CI 2.32-34.20), being diabetic (AOR 4.87, 95% CI 1.55-15.36) and illicit drug use (AOR 10.18, 95%CI 1.36-76.52) were found to be independently associated with MRSA colonization. CONCLUSION: A study identified a high prevalence of MRSA colonization among patients admitted in the ICU. MRSA isolates were highly resistant to penicillin and erythromycin. History of illegal drug use was highly associated with MRSA colonization.

Post exposure prophylaxis following occupational exposure to HIV: a survey of health care workers in Mbeya, Tanzania, 2009-2010.

INTRODUCTION: Approximately, 1,000 HIV infections are transmitted annually to health care workers (HCWs) worldwide from occupational exposures. Tanzania HCWs experience one to nine needle stick injuries (NSIs) per year, yet the use of post-exposure prophylaxis (PEP) is largely undocumented. We assessed factors influencing use of PEP among HCWs following occupational exposure to HIV. METHODS: A cross-sectional study was conducted in Mbeya Referral Hospital, Mbozi and Mbarali District Hospitals from December 2009 to January 2010 with a sample size of 360 HCWs. Participants were randomly selected from a list of eligible HCWs in Mbeya hospital and all eligible HCWs were enrolled in the two District Hospitals. Information regarding risk of exposure to body fluids and NSIs were collected using a questionnaire. Logistic regression was done to identify predictors for PEP use using Epi Info 3.5.1 at 95% confidence interval. RESULTS: Of 291 HCWs who participated in the study, 35.1% (102/291) were exposed to NSIs and body fluids, with NSIs accounting for 62.9% (64/102). Exposure was highest among medical attendants 38.8% (33/85). Out of exposed HCWs, (22.5% (23/102) used HIV PEP with females more likely to use PEP than males. Reporting of exposures (OR=21.1, CI: 3.85-115.62) and having PEP knowledge (OR =6.5, CI: 1.78-23.99) were significantly associated with using PEP. CONCLUSION: Despite the observed rate of occupational exposure to HCWs in Tanzania, use of PEP is still low. Effective prevention from HIV infection at work places is required through proper training of HCWs on PEP with emphasis on timely reporting of exposures.