Effect of awareness training to frontline health workers and the use of e-based technology on reporting of brucellosis cases in selected pastoral communities, Tanzania: a quasi-experimental study.

INTRODUCTION: Brucellosis is a serious community health problem and endemic disease in Tanzania in both humans and animals. Frontline health workers (FHWs) play a vital role in reporting and hence prevent and control brucellosis in rural settings. This study aims to evaluate the effect of awareness training to frontline health workers and use of electronic technology (e- technology) on reporting of brucellosis cases. METHODS: A quasi-experimental design was implemented in two pastoral communities in eastern part of Tanzania with one as control and another as treatment involving 64 FHWs who were purposively selected from May 2020 to December 2020. A total of 32 FHWs from treatment pastoral community were purposively selected for awareness training, rapid diagnosis using Rose Bengal test (RBT) and use of electronic technology (AfyaData app) for brucellosis reporting while nothing was done in control community. Before and after training information about their knowledge, attitude and practices were collected from all participants using a structured questionnaires uploaded in the mobile phone powered by AfyaData application. Blood samples were collected from 141 febrile patients attending the selected facilities in treatment community. Serum obtained from collected blood were analyzed using RBT and Competitive Enzyme Linked Immunosorbent Assay (c-ELISA) for brucellosis screening and confirmatory, respectively. Results from this analysis were reported back to the health facility using AfyaData app. Chi-square was used to analyze categorical variables and t-test and/Anova test was used to assess the effectiveness of the intervention. RESULTS: Results revealed that before the training majority of the participants were ignorant about brucellosis, although they had good attitude towards brucellosis prevention. Participant's awareness, practice and attitude increased significantly (p = 0.003, p = 0.001, p = 0.032) respectively, after the intervention. Total of 17(12.1%) patients were positive on RBT and four (2.8%) were confirmed by c-ELISA. AfyaData app was proven to provide quick reports regarding brucellosis in the study area. CONCLUSION: The training program was effective in increasing the level of knowledge and practice about brucellosis. Electronic based technology (AfyaData app) improved the reporting of brucellosis cases. There is a need for the use of electronic based technology to improve timely management of brucellosis in pastoral communities. Also, continuous training on FHWs regarding the disease is needed to improved their awareness and practices.

Quantitative risk assessment for human Taenia solium taeniasis/cysticercosis exposure through consumption of pork in Mpwapwa District of Dodoma Region, Tanzania.

Background and Aim: Pig farming is a livelihood activity undertaken by many rural communities in Tanzania. However, pigs in rural communities become infected with Taenia solium, a zoonotic parasite leading to porcine cysticercosis (PCC). Thus, routine meat inspection is fundamental in ensuring that the meat consumed is PCC-free. However, routine meat inspection is constrained by low sensitivity as a diagnostic test. Regardless of its low sensitivity, at the local level, no substitute tool would potentially lead to meat being risk-free for human infection. This study aimed at quantifying the risk of humans getting exposed to T. solium taeniasis through the consumption of pork approved safe for human consumption by employing a quantitative risk assessment (QRA) model. Materials and Methods: A cross-sectional study employing a quantitative risk assessment technique was conducted to quantify the risk of human infection in Mpwapwa District through exposure to T. solium infection through consumption of officially inspected pork. The input parameters in this study were simulated in @risk software to obtain the risk of exposure and the risk factors for exposure to T. solium taeniasis. Results: The risk of one getting exposed to T. solium taeniasis/cysticercosis (TSTC) through consumption of pork approved for human consumption was found to be 0.018 (95% confidence interval [CI] = 0.00-0.0250). Likewise, the probability that a cyst is localized in a pork portion was found to be the most influencing input risk factor of getting exposed to TSTC. Furthermore, the probability of developing T. solium taeniasis was estimated to be 0.73605 (95% CI = 0-0.950) when infected undercooked pork portion is consumed and 0.99652 (95% CI = 0.98161-0.99908) from consuming raw pork portion. Likewise, about 47 (95% CI = 42-52) people who consumed undercooked pork and 26 (95% CI = 22-30) who consumed raw pork would get infected in Mpwapwa District per year. Conclusion: The results from this study are anticipated to create public awareness of the problem and promote the use of one-health approach in the control and prevention of the consumption of infected pork.

Knowledge, attitudes and practices related to Taenia solium cysticercosis and taeniasis in Tanzania.

BACKGROUND: Taenia solium cysticercosis/taeniasis (TSCT) is reported to be endemic in pig producing areas around the world, causing significant disease burden and economic losses. METHODS: This cross-sectional study aimed at assessing Knowledge, Attitudes and Practices (KAP) regarding TSCT in four districts, namely Mbulu, Mpwapwa, Mbinga, and Rungwe in Tanzania. Data on KAP were collected through questionnaire-based interviews and household infrastructure observations. RESULTS: Knowledge about porcine cysticercosis was good, particularly among pig keepers across the districts. Many participants had heard about the pork tapeworm (T. solium taeniasis), and the knowledge about signs/symptoms and treatment was fair, but the means of transmission and prevention measures were often unknown. Whilst most participants were familiar with epilepsy, no one knew anything about human cysticercosis and the link between cysticercosis and epileptic seizures. A similar trend is reflected through the attitudes toward the low risk perception of cysticercosis infection. Not surprisingly, the risk perception of the infection with the pork tapeworm was low too. Many participants reported not washing their hands before eating or after using the toilet which highlights potential risks for the development of human cysticercosis. Albeit nearly every participant reported using the toilet always, household observations revealed that toilets were either lacking or had no complete walls. Generally, household observations revealed a discrepancy between questionnaire answers on the one hand and the availability of toilet and handwashing facilities and the confinement of pigs on the other hand. CONCLUSION: This study demonstrates knowledge gaps and adverse practices which may hinder and/or slow down the control/elimination of T. solium in endemic countries. The study results are also useful for appropriate designing of TSCT health interventions that need to be planned carefully, taking into account the local context and designing TSCT in partnership with the local communities from the beginning to the end applying a One Health approach to allow the possible sustained and best impacts.

Knowledge, attitude and practices of frontline health workers in relation to detection of brucellosis in rural settings of Tanzania: a cross-sectional study.

BACKGROUND: Brucellosis an important zoonotic disease worldwide, which frequently presents as an undifferentiated febrile illness with otherwise varied and non-specific clinical manifestations. Despite its importance, there are few reports on its awareness among frontline health workers. This study aimed at assessing the baseline knowledge, attitude and practice (KAP) related to detection and management of brucellosis among frontline health workers (FHWs) namely; healthcare workers (HWs) and community health workers (CHWs). METHODS: A cross-sectional study was conducted from December 2019 to January 2020 in Kilosa and Chalinze districts of Tanzania. Data on demographic characteristics, knowledge, attitude and practices regarding brucellosis were collected from the study participants using a structured questionnaire. Interviews were conducted with 32 HWs and 32 CHWs who were systematically selected in study districts. Chi square/fisher Exact was used to assess the association between sociodemographic variables and those related to knowledge, attitude and practices. RESULTS: Overall, a total of 30 (93.8%) HWs and nine (28.1%) CHWs from the study districts heard about brucellosis, with (34.4%) of HWs having knowledge about the causative organism. Overall, knowledge showed almost half (46.9%) HWs and (28.1%) CHWs were aware of the symptoms, clinical signs, diagnosis and control regarding brucellosis. Knowledge difference was statistically significant with HWs' age (p = 0.016). Almost half (46.9%) HWs and less than quarter (12.5%) CHWs had good practices regarding brucellosis control. Almost three quarters (71.9%) of HWs and (21.9%) CHWs had positive attitude regarding brucellosis control; overall attitude was statistically significant with CHWs age (p = 0.028) and education level (p = 0.024). Lack of awareness and unavailability of diagnostic tools were the main challenges faced by FHWs in the two districts. CONCLUSION: The majority of participants were not aware of human brucellosis. Moreover, their overall knowledge was inadequate and the common practices were diagnostic tools, and adequate knowledge to manage brucellosis cases. These findings highlight the need to strengthen frontline health workers knowledge, practices and diagnostic capacities related to brucellosis.

Performance of Ag-ELISA in the diagnosis of Taenia solium cysticercosis in naturally infected pigs in Tanzania.

BACKGROUND: Taenia solium is a zoonotic parasite responsible for neurocysticercosis-a major cause of late-onset acquired epilepsy in humans. Lack of affordable, specific and sensitive diagnostic tools hampers control of the parasite. This study assessed the performance of an antigen detection enzyme-linked immunosorbent assay (Ag-ELISA) in the diagnosis of viable T. solium cysticercosis in naturally infected slaughter-age pigs in an endemic area in Tanzania. METHODS: A total of 350 pigs were bled before they were slaughtered and their carcases examined. Serum was analyzed for circulating antigens by using a monoclonal antibody-based B158/B60 Ag-ELISA. Each carcase was examined for the presence of Taenia hydatigena cysticerci and half carcase musculature together with the whole brain, head muscles, tongue, heart and diaphragm were sliced with fine cuts (< 0.5 cm) to reveal and enumerate T. solium cysticerci. Half carcase dissection can detect at least 84% of infected pigs. Prevalence and their 95% confidence intervals (CI) were calculated in Stata 12. Sensitivity, specificity, predictive values and likelihood ratios were determined. RESULTS: Twenty-nine pigs (8.3%, 95% CI: 5.6-11.7%) had viable T. solium cysticerci while 11 pigs had T. hydatigena cysticerci (3.1%, 95% CI: 1.6-5.5%). No co-infection was observed. Sixty-eight pigs (19.4%, 95% CI: 15.4-20%) tested positive on Ag-ELISA; of these, 24 had T. solium cysticerci and 7 had T. hydatigena cysticerci. Sensitivity and specificity were determined to be 82.7% and 86.3%, respectively. Positive and negative predictive values were 35.2% and 98.2%, respectively. Likelihood ratios for positive and negative Ag-ELISA test results were 6.0 and 0.2, respectively. There was a significant positive correlation between the titre of circulating antigens and intensity of T. solium cysticerci (r(348) = 0.63, P < 0.001). CONCLUSIONS: The Ag-ELISA test characteristics reported in this study indicate that the test is more reliable in ruling out T. solium cysticercosis in pigs, than in confirming it. Hence, a negative result will almost certainly indicate that a pig has no infection, but a positive result should always be interpreted with caution. Estimates of T. solium prevalence based on Ag-ELISA results should, therefore, be adjusted for test performance characteristics and occurrence of T. hydatigena.

TSOL18 vaccine and oxfendazole for control of Taenia solium cysticercosis in pigs: A field trial in endemic areas of Tanzania.

A field trial was conducted in Tanzania to determine the effectiveness of TSOL18 vaccine used concurrently with oxfendazole (OFZ), and of OFZ alone, on T. solium cysticercosis determined by organ and half carcase dissection of slaughter age pigs. This study followed a quasi-experimental group design. Suitable trial sites were randomly allocated to either treatment group T1 (OFZ treatment alone [30mg/kg, Paranthic 10%]) or T2 (TSOL18 [1ml, Cysvax] plus OFZ). Three 4-monthly treatments were administered to eligible pigs. A random selection of pigs were necropsied at baseline and at endline, 2-3.5 months after the final treatment. Additionally, untreated pigs from T1 and T2 areas were necropsied at endline to provide contemporaneous comparisons with T1 and T2 pigs. Baseline prevalence of viable T. solium cysticerci for T1 was 25.5% (Exact 95% CI: 13.9, 40.3; n = 12/47), and for T2 was 12.0% (CI: 6.4, 20.0; n = 12/100). At endline, prevalence was 2.8% for T1 (CI: 0.1, 14.5, n = 1/36) and 0% for T2 (CI: 0, 4.7, n = 0/77). Among untreated pigs, three had viable cysticerci, one from T1 area (12.5%, CI: 0.3, 52.7; n = 1/8) and two from T2 area (5.7%, CI: 0.7, 19.2, n = 2/35). Fisher's exact test showed significant changes in prevalence from baseline to endline in both groups (T1: p = 0.005, T2: p = 0.001). Firth's penalized Maximum Likelihood method suggested the changes were not significant relative to their controls (T1: p = 0.245, T2: p = 0.076). These findings showed a significant reduction in the prevalence of viable cysticerci from baseline to endline after both interventions. However, the changes could not be definitively attributed to the interventions due, in part, to small numbers of control pigs. Concurrent administration of the TSOL18 and OFZ cleared infection among assessed pigs whereas infection remained after treatment with OFZ only. Further studies including larger sample sizes would be required for more definitive conclusions. A One Health approach is recommended for rapid and sustainable impact.

Endemicity of Taenia solium cysticercosis in pigs from Mbeya Rural and Mbozi districts, Tanzania.

BACKGROUND: Taenia solium taeniasis/cysticercosis is a disease of substantial economic and public health importance particularly in low-income countries. The disease was reported to be endemic in Mbeya Rural and Mbozi districts, in the southern highlands of Tanzania, the major pig production area in the country. In 2008, using B158/B60 antigen detection enzyme-linked immunosorbent assay (Ag-ELISA), porcine cysticercosis prevalence of up to 32% was reported in the districts. A number of interventions have been implemented in selected villages including an integrated approach consisting of improving pig confinement and selective treatment of pigs with oxfendazole. Mass drug administration with praziquantel targeting schistosomiasis, with an expected effect on T. solium, was also provided to school-age children in the area. This study aimed at providing an update on prevalence and intensities of porcine cysticercosis; and assessing farmers' knowledge, attitudes and practices which could be associated to disease transmission in the area. The study involved a questionnaire survey conducted using face-to-face household interviews with 890 consenting farmers; and carcass dissections performed on 282 pigs randomly selected from the surveyed households. RESULTS: Twenty-six pigs (9.2%) were infected with T. solium; of which two-thirds (65.4%) had light to moderate infection intensities (1-1000 cysticerci), and one-third (34.6%) had heavy intensities (> 1000 cysticerci). Questionnaire results showed that only 5.7% of the respondents perceived T. solium cysticercosis to be an important disease in pigs. About 18.5% of the respondents were aware of T. solium taeniasis, but 32% of them were unaware of how the infection is acquired. Half of the respondents had seen cysticerci in pork, of whom 61% were not aware that consumption of infected pork could cause taeniasis. Latrines were observed to often (90%) lack doors with 45% considered accessible to pigs. CONCLUSIONS: This study provided an evidence that the disease was still endemic in the area. Poor knowledge of farmers, attitudes, and risky practices responsible for disease perpetuation were also revealed. A One Health approach targeting the whole area incorporating improvement of farmer knowledge regarding disease transmission needs to be trialed as a feasible approach to control.

An epidemiological survey of porcine cysticercosis in Nyasa District, Ruvuma Region, Tanzania.

Porcine cysticercosis (PC) caused by Taenia solium larvae is continuing being important zoonotic disease in many developing countries. It poses a serious public health risk and leads to economic losses to pig production industry. This study was carried out to determine the prevalence and risk factors associated with PC transmission in Nyasa District. To establish the prevalence of PC, a cross-sectional survey was conducted involving 698 pigs by tongue examination, 330 pigs by Ag-ELISA test and 22 pigs by meat inspection. A questionnaire survey was administered to a member of selected households to gather information on pig management and other potential factors that could explain the prevalence of PC in the area. Results showed that 44 pigs were positive by tongue examination (6.3%, 95% C.I. 4.5-8.1%), 110 tested positive for Ag-ELISA (33.3%, 95% C.I. 28.22-38.38%) and meat inspection detected four infected pigs (18.2%, 95% C.I. 2.08-34.32%). Risk factors associated with PC transmission in Nyasa District were free ranging of pigs (p = 0001), sex of pig (p = 0.011), source of pork (p = 0.0001) and outdoor defecation (0.0001). The present findings indicate that PC is endemic in Nyasa District and that free-ranging of pigs in conjunction with limited use of latrines contributes significantly to PC transmission. Therefore, mandatory pig confinement, together with use of latrine/toilets should be considered in controlling PC in Nyasa District.

Hair cortisol and dehydroepiandrosterone concentrations in naturally Taenia solium infected pigs in Tanzania.

The aim of this study was to measure hair cortisol and dehydroepiandrosterone (DHEA) concentrations in naturally Taenia solium infected and non-infected control pigs and assess the effect of an environmental change on the aforementioned parameters. Three hair patches were obtained from 13 T. solium infected and 15 non-infected controls sows, respectively corresponding to 3 time points (prior to, at and approximately two weeks after arrival at the research facility). Cortisol and DHEA were extracted using methanol and analysed by radio immune assay. Mean hair cortisol concentrations were significantly lower (p<0.001) in T. solium infected (4.7±3.0pg/mg) compared to control pigs (9.0±3.7pg/mg) prior to arrival at the research facility, however no significant difference was observed between the two groups at arrival and after approximately two weeks. Similar patterns were also observed for DHEA concentrations (infected pigs 253.9±82.3pg/mg, control pigs 387.7±116.4pg/mg) (p<0.001). Results showed that lean animals had significantly higher cortisol concentrations in both groups, infected and controls pigs, while DHEA was not significantly different between lean and normal animals. Results of this study have shown that an environmental change could have an effect on pigs' hormonal levels suggesting an undergoing adaptation process. After the pigs were kept under the same conditions, fed and watered ad libitum, no significant differences were observed between the groups, but a drop in DHEA concentrations was observed in all the pigs. Weight however had an effect on cortisol levels as lean animals had significantly higher cortisol concentrations in both groups, compared to normal pigs.

Severe seizures in pigs naturally infected with Taenia solium in Tanzania.

Neurocysticercosis (NCC) caused by Taenia solium is a serious neurological disease. In humans neurological symptoms have been thoroughly studied and documented, however, there is limited information on clinical signs in pigs infected with T. solium cysticerci. Among the scientific community, it is in fact believed that pigs with NCC rarely show neurological signs. The aim of this study was to describe clinical manifestations associated with NCC in pigs and correlate the manifestations to the number and distribution of cysticerci in brains of naturally infected pigs in Tanzania. Sixteen infected and 15 non-infected control pigs were observed for 14 days during daylight hours, and subsequently videotaped for another 14 consecutive days using close circuit television cameras. All occurrences of abnormal behaviour (trembling, twitching, mouth and ear paralysis, ataxia, dribbling, salivating, eye blinking, walking in circles) were recorded. At the end of the recording period, pigs were slaughtered and their brains dissected, cysticerci counted and locations noted. During the recording period, two infected pigs were observed having seizures. Some of the observed autonomic signs during a seizure were chewing motions with foamy salivation and ear stiffening. Motor signs included tonic muscle contractions followed by a sudden diminution in all muscle function leading to collapse of the animal. Stereotypic walking in circles was observed on several occasions. At dissection, both pigs had a high number of brain cysticerci (241 and 247 cysticerci). The two pigs with seizures were also older (36 months) compared to the others (18.3 months, ± 8.2 standard deviation). Results of this study have shown that pigs with NCC can develop clinical signs and suffer from seizures like humans with symptomatic NCC. Results of this study could potentially open up a new experimental pathway to explore the aetiology of neurological symptoms in humans with NCC associated epilepsy.

Sanitary practices and occurrence of zoonotic conditions in cattle at slaughter in Morogoro Municipality, Tanzania: implications for public health.

As meat consumption is increasing worldwide to cover for protein demands, also raise concerns and challenges regarding meat hygiene and safety. The current one year follow up study aimed at investigating on sanitary practices and occurrence of zoonotic conditions, during post-mortem examination, in cattle at slaughter in Morogoro Municipality abattoir. Sanitary practices were assessed through direct observation where as routine post-mortem inspection procedures were employed to detect zoonotic conditions in cattle at slaughter. During the study period a total of 30,713 cattle were slaughtered and inspected at the abattoir. Results revealed poor hygienic practices at the level of abattoir surrounding, the slaughter operation area, personnel as well as meat vans. Whole carcasses, lungs, livers, hearts and heads were condemned due to zoonotic conditions at rates of 0.026%, 1.96%, 1.61%, 0.02% and 0.21% respectively. Bovine tuberculosis, Cysticercus bovis cysts, fasciolosis and hydatidosis were the responsible zoonotic conditions for the condemnations. Bovine tuberculosis was a leading zoonotic cause of condemnations accounting for 95.7% of lungs and 100% of all head and carcass condemnations. Cysticercus bovis cysts were ranking the second in serving as causes of condemnations closely followed by fasciolosis and lastly hydatidosis. Occurrence of disease conditions with zoonotic implication in cattle at slaughter, meant for human consumption, may pose significant economic and public health risks to especially disaster-prone marginalized communities. Thus, there is a need to introduce appropriate control measures of livestock diseases to minimize the rate of infection; and eventually reduce economic losses and safeguard public health.

Sanitary Practices and Occurrence of Zoonotic Conditions in Cattle at Slaughter in Morogoro Municipality; Tanzania: Implications for Public Health

Abstract:As meat consumption is increasing worldwide to cover for protein demands; also raise concerns and challenges regarding meat hygiene and safety. The current one year follow up study aimed at investigating on sanitary practices and occurrence of zoonotic conditions; during postmortem examination; in cattle at slaughter in Morogoro Municipality abattoir. Sanitary practices were assessed through direct observation where as routine post-mortem inspection procedures were employed to detect zoonotic conditions in cattle at slaughter. During the study period a total of 30;713 cattle were slaughtered and inspected at the abattoir. Results revealed poor hygienic practices at the level of abattoir surrounding; the slaughter operation area; personnel as well as meat vans. Whole carcasses; lungs; livers; hearts and heads were condemned due to zoonotic conditions at rates of 0.026; 1.96; 1.61; 0.02 and 0.21 respectively. Bovine tuberculosis; Cysticercus bovis check for this species in other resources cysts; fasciolosis and hydatidosis were the responsible zoonotic conditions for the condemnations. Bovine tuberculosis was a leading zoonotic cause of condemnations accounting for 95.7 of lungs and 100 of all head and carcass condemnations. Cysticercus bovis cysts were ranking the second in serving as causes of condemnations closely followed by fasciolosis and lastly hydatidosis. Occurrence of disease conditions with zoonotic implication in cattle at slaughter; meant for human consumption; may pose significant economic and public health risks to especially disaster-prone marginalized communities. Thus; there is a need to introduce appropriate control measures of livestock diseases to minimize the rate of infection; and eventually reduce economic losses and safeguard public health

Prevalence of extra-intestinal porcine helminth infections and assessment of sanitary conditions of pig slaughter slabs in Dar es Salaam city, Tanzania.

A study was carried out to establish the prevalence of extra-intestinal porcine helminth infections and to assess the pig slaughter slab sanitary conditions in Dar es Salaam city, Tanzania. A total of 24 privately owned pig slaughter slabs were assessed. All slaughter slabs were sub-standard; wrongly located, poorly designed and constructed and lacked most basic requirements for a slaughter house. Because of inadequate slaughtering, disposal and cleaning facilities, the slaughter slabs were under unhygienic condition with questionable safety, soundness and wholesomeness of the pork produced. Routine meat inspection procedures were used to detect extra-intestinal porcine helminth infections. Of the 731 examined pigs; 8.1%, 5.9% and 0.4% were infected with ascariosis, porcine cysticercosis and hydatidosis, respectively. It was noted that almost all slaughter pigs in Dar es Salaam originated from different regions. Based on the region of origin, the status of porcine cysticercosis was 8.2% for Dodoma (n = 98), 8.2% for Manyara (n = 260) and 6.9% for Mbeya (n = 116). This study disclosed the unhygienic sanitary condition prevailing in Dar es Salaam pig slaughter slabs and recommends that strategies should be devised to improve the situation. Porcine ascariosis and cysticercosis were widely prevalent and caused economic losses due to condemnations. Because of their zoonotic nature, the observed extra-intestinal porcine helminth infections in pig pose a public health risk among consumers. Thus, there is a need to introduce appropriate control measures of parasitic infections in pigs.