Monitoring of HIV-1 infection prevalence and trends in the general population using pregnant women as a sentinel population: 9 years experience from the Kagera region of Tanzania.

In the Kagera region of Tanzania, a population-based study was initiated in 1987 followed by the establishment of antenatal-clinic-based sentinel surveillance system in the town of Bukoba in 1990. Repeat studies in both populations in Bukoba in 1993 and 1996 made it possible to study the dynamics of HIV infection prevalence and incidence in the area. This study aims at comparing the findings from this sentinel surveillance system with those of cross-sectional studies in the general population to assess its validity in estimating HIV prevalence and their trends in the general population. A multistage cluster sampling technique was used in the population-based studies whereas the antenatal-clinic-based population was obtained by consecutively recruiting antenatal care attenders coming for the first time during a given pregnancy. Antibodies against HIV infection were tested using two independent enzyme-linked immunosorbent assay (ELISA) antibody detection tests. Unlinked anonymous testing strategy was adopted for the sentinel population. Age-adjusted prevalence among antenatal care attenders decreased from 22.4% (95% confidence interval [CI], 20.6-25.2) in 1990 to 16.1% (95% CI, 15.9-18.8) in 1993 and further to 13.7% (95% CI, 11.8-14.3) in 1996. These results closely resemble those of the general population of adult women in the clinic's catchment area (the town of Bukoba) where the age-adjusted prevalence of 29.1% (95% CI, 24.4-34.6) in 1987 showed a decrease in the studies in 1993 18.7% (95% CI, 15.1-23.0) and in 1996 14.9% (95% CI, 12.0-17.1). The study indicates that general population trend estimates can be generated using sentinel surveillance data based on pregnant women visiting an antenatal clinic for the first time during a given pregnancy. The benefits of using this group outweigh its limitations that are brought about by possible selection bias. Continued surveillance of the epidemic based on antenatal care patients as a sentinel population is therefore recommended.

Prevalence of HIV infection among hospital patients in north west Tanzania.

In order to estimate hospital HIV prevalence, the economic impact of AIDS on health care and to assess the implications of HIV testing on clinical suspicion of AIDS this hospital based study was done at the government regional hospital of Kagera, Tanzania. Consecutive admissions were recruited into the study, and those consenting had a blood specimen taken, one portion of which was used to aid clinical diagnosis, while the other was tested anonymously for HIV antibodies using two ELISA systems. A short questionnaire was used to specify demographic characteristics, hospital ward of admission and diagnosis of each study subject. The overall age adjusted HIV-1 prevalence was 32.8% (N = 1422) and there was no significant difference in the age adjusted sex specific prevalence. The highest prevalence (53.3%) was found in the 25-34 years age group as well as in the gynaecological and medical wards (41.2% and 40.4%, respectively). The diagnostic category of clinical AIDS had a sensitivity of 11.3% and a specificity of 99.3%, indicating that only 11.3% of the HIV seropositives would have been HIV tested on clinical suspicion of AIDS. Similarly, the HIV-1 antibody sensitivity and specificity for tuberculosis were 5.9% and 97.9%, respectively. Patients who were HIV-1 infected were more likely to have a history of previous hospital admissions, RR = 1.34 (95% CI = 1.16-1.56), and were at an increased risk of developing tuberculosis, RR = 2.02 (95% CI = 1.50-2.70). The diagnostic categories with the highest HIV-1 infection prevalence were clinical AIDS (88.5%), herpes zoster and other HIV-1 skin manifestations combined (85.7%) and pulmonary tuberculosis (58.3%). In conclusion, the prevalence of HIV-1 infection was high among hospitalized patients in Bukoba hospital indicating that the major cause of illness leading to admission to the hospital may have been underlying HIV-1 infection. The findings also indicate that in a high HIV-1 prevalence area, testing for HIV infection on the basis of clinical suspicion of AIDS alone is not sufficient to provide rational care to the majority of HIV infected patients.

PIP: A study was conducted to assess the prevalence of HIV infection among patients at Bukoba regional government hospital in the Kagera region of Tanzania, the economic impact of AIDS upon health care, and the implications of HIV testing upon clinical suspicion of AIDS. 1471 consecutive admissions were recruited into the study, of whom 1422 completed questionnaires and had their blood sera tested for HIV antibodies. The overall age-adjusted HIV-1 prevalence among the hospitalized patients was 32.8%, with no statistically significant difference in the age-adjusted, sex-specific HIV-1 prevalence rate. The highest HIV-1 prevalence of 53.3% was found among people aged 25-34 years, as well as in the gynecological and medical wards (41.2% and 40.4%, respectively). HIV-1-infected patients were more likely to have a history of previous hospital admissions, and were at an increased risk of developing tuberculosis (TB). The diagnostic categories with the highest HIV-1 infection prevalence were clinical AIDS (88.5%), herpes zoster and other HIV-1 skin manifestations combined (85.7%), and pulmonary TB (58.3%). The prevalence of HIV-1 infection was high among these patients, indicating that the major cause of illness leading to admission to the hospital may have been underlying HIV-1 infection. However, since the diagnostic category of clinical AIDS was only 11.3% sensitive, only 11.3% of the HIV-seropositive cases would have been HIV tested on the clinical suspicion of AIDS. These findings indicate that in a high HIV-1 prevalence area, testing for HIV infection on the basis of clinical suspicion of AIDS alone is insufficient to provide rational care to the majority of HIV-infected patients.

Acceptability of voluntary HIV testing with counselling in a rural village in Kagera, Tanzania.

A pilot study on acceptability of voluntary HIV testing with counselling was performed in a rural village in Kagera, Tanzania as a potential intervention against HIV transmission. Village residents were prepared by their leaders and subsequently invited to health education group meetings to volunteer for the test. Consenting individuals were interviewed to determine awareness and acceptance of the offer followed by pre-test counselling and taking of a blood sample for subsequent HIV testing. Two months later, the results of the test were returned with post-test counselling coupled with a short interview of a random sample of adults in the village. Of the 245 adults responding to the call, 137 (55.9%) subsequently volunteered. The main reason for volunteering was to know the HIV status (96%). Among those who were aware of the offer, the main reason for not volunteering was that they felt unlikely to catch AIDS, implying that they had a false perception of being at low risk. In this study a significant proportion were willing to volunteer for the HIV test and to receive the results, indicating a moderate level of acceptability. The results also indicate the need for developing innovative ways of enhancing acceptability of voluntary HIV testing with counselling. However, the relationship between knowledge of HIV status and behavioural change is complex and therefore several potential mechanisms may exist by which HIV testing in combination with counselling can influence behaviour. For this reason, people should be given the choice of knowing their HIV status since it may constitute a potential mechanism for influencing behaviour towards reduction of HIV transmission.

PIP: The acceptability of voluntary HIV testing with counseling was investigated in a pilot study conducted in a rural village in Kagera, Tanzania, in 1993. Village residents were informed about the study by their leaders and invited to attend health education group meetings to learn more about the study. 245 (54%) of the 450 adults in the village attended the group meetings. 137 attendees (55.9%) volunteered to participate and received both pretest counseling and HIV testing at that time. 2 months later, researchers returned to the village to give test results and conduct post-test counseling. 13 volunteers (9.8%) were HIV-positive. After post-test counseling, half the infected volunteers and 37.5% of HIV-negatives indicated they would adapt safer sex practices, including reducing their number of sexual partners. Interviews conducted at the second visit with 195 village residents revealed half of the volunteers compared with only one-third of nonparticipants had a relative with AIDS. 96% of those who volunteered did so to learn their HIV status. Seven men and 22 women did not want their spouse to know their HIV test result. Among those who were aware of the study but did not volunteer, the main reasons for nonparticipation were the perception of low personal HIV risk and feeling healthy and strong. These findings indicate a moderate level of acceptability of voluntary HIV screening. The extent to which such testing can reduce HIV transmission remains to be addressed in well-controlled studies.

Prevalence of intestinal parasites in adult patients with enteropathic AIDS in north-eastern Tanzania.

A six month study was conducted in north-eastern Tanzania to determine the prevalence of pathogenic intestinal parasites among adult patients with enteropathic AIDS. A total of 352 patients were recruited of whom 158 (45%) had chronic diarrhoea. Of the 352 patients, 123 (35%) had intestinal parasites. Of the 123, 77 (62.6%) patients had chronic diarrhoea. The types of parasites detected were Cryptosporidium, Isospora belli, Strongyloides stercoralis, Schistosoma mansoni, Trichuris, trichiura, Ascaris lumbricoides, hookworm and Entamoeba histolytica. The prevalence of intestinal parasites was significantly higher in patients with chronic diarrhoea than in those without (P < 0.05). Cryptosporidium and Isospora belli were only detected in patients with chronic diarrhoea and were thus the most likely cause of the diarrhoea. This study has established that coccidian parasites are the most important gut opportunistic infections in Tanzanian patients with enteropathic AIDS. The fact that a high proportion of patients with chronic diarrhoea (51.3%) had no identifiable parasitic agents, suggests that other infectious agents or alternative mechanisms other than infections are responsible for the diarrhoea.

PIP: A 6-month study was conducted in northeastern Tanzania to assess the prevalence of pathogenic intestinal parasites among adult patients with enteropathic AIDS. Of the 352 patients recruited, 158 had chronic diarrhea and 123 had intestinal parasites. 77 of the 123 patients with intestinal parasites had chronic diarrhea. Cryptosporidium, Isospora belli, Strongyloides stercoralis, Schistosoma mansoni, Trichuris trichiura, Ascaris lumbricoides, hookworm, and Entamoeba histolytica were detected. The prevalence of intestinal parasites was significantly higher in patients with chronic diarrhea than in those without. Cryptosporidium and Isospora belli were only detected in patients with chronic diarrhea and were therefore the most likely cause of the diarrhea. Coccidian parasites have thus been identified as the most important gut opportunistic infections in Tanzanian patients with enteropathic AIDS. However, that 51.3% of patients with chronic diarrhea had no identifiable parasitic agents suggests that other infectious agents or alternative mechanisms are responsible for the condition.

Sentinel surveillance and cross sectional survey on HIV infection prevalence: a comparative study.

Despite widespread use of sentinel surveillance systems in monitoring the magnitude of HIV-1 infection in populations, little is known of how the trends they produce compare with those of the larger populations which they support to represent. The objective of this study, therefore, was to assess how useful sentinel surveillance data on HIV-1 infection might be in estimating the magnitude of HIV-1 infection in the general population. To achieve this, results from a population based study on HIV-1 infection in Bukoba town were compared with those from antenatal mothers and blood donors, all from the same town. The studies were done during the period of 1987-90. The overall HIV-1 prevalence was highest in the general population sample at 24.2% (95% CI 20.6-27.8) followed by that in antenatal mothers at 22.4% (95% CI 20.6-25.2) and lowest in blood donors at 11.9% (95% CI 9.1-15.3). Seroprevalence among antenatal clinic attenders was significantly lower than that of females from the general population sample (p = 0.016). Prevalence among female blood donors did not differ significantly from that of females from the general population sample (p = 0.06). Blood donor males had a lower HIV-1 seroprevalence when compared to that from the general population males (p = 0.038). The age group 25-34 years had the highest prevalence of HIV-1 infection in all the three populations indicating that this group is at the highest risk of HIV infection and that the three populations show a similar trend of age specific prevalence. From these findings, it is noted that female blood donors as a sentinel population represents more closely estimates of HIV-1 seroprevalence of females in the general population than antenatal clinic attenders or male blood donors. Further studies are proposed in different settings in order to come up with guidelines on the methodology of using sentinel surveillance populations in monitoring HIV-1 infection.

PIP: Researchers compared the results of a sentinel surveillance study on HIV-1 infection in 1292 pregnant women 15-47 years old attending prenatal care and in 454 blood donors (mean age = 28.7 years) in Bukoba, Tanzania, in 1990 with those from a cross sectional population-based study on HIV-1 infection among 553 people 15-54 years old also conducted in Bukoba during August 1987 to April 1988 to determine which sentinel populations most closely represented the HIV-1 infection rate of the general population. The HIV-1 prevalence rate was 24.4% for the population-based sample, 22.4% for the pregnant women, and 11.6% for the blood donors. The general population females had the highest HIV-1 prevalence rate, while the male blood donors had the lowest rate (29.4% vs. 10.5%). Pregnant women had a significantly lower rate than general population females (22.4% vs. 29.4%; p = 0.016). The 25-34 year old age group had the highest prevalence of HIV-1 infection in all three populations, suggesting that this group faces the highest risk of HIV infection and that the three populations have a similar trend of age-specific prevalence. There were no significant differences between the HIV-1 prevalence rates among general population females and those among female blood donors, suggesting that female blood donors more closely represent the HIV-1 seroprevalence rate of general population females than pregnant women attending prenatal care or male blood donors. There is a need for additional studies in different settings in order to establish guidelines on the methodology of using sentinel surveillance studies in monitoring HIV-1 infection.

Self-medication with antimalarial drugs in Dar es Salaam, Tanzania.

A hospital-based cross-sectional study was conducted in Dar es Salaam, Tanzania, using a questionnaire to assess the extent of self-medication with antimalarial drugs and malaria treatment-seeking behaviour among patients attending out-patient treatment at Mnazi mmoja dispensary. It was found that 15.3% of respondents admitted to having ever used malaria chemoprophylaxis while 8.0% reported to be current users of chemoprophylaxis. Among the current users of malaria chemoprophylaxis, some reported having used quinine and Fansidar. While 71.7% reported having treated themselves with home-kept antimalarial drugs for a suspected malaria fever, 14.7% consulted traditional healers. The data suggest the need for increasing public awareness on malaria and appropriate use of antimalarial drugs.

Prevalence and incidence of syphilis and its association with HIV-1 infection in a population-based study in the Kagera region of Tanzania.

Population-based prevalence and incidence studies on HIV-1 infection were started in the Kagera region of Tanzania in 1987. The prevalence and incidence of infection with Treponema pallidum was studied to enable development of better strategies for STD control. Serological diagnosis of a past or treated infection with Troponema pallidum was made by seropositivity only to TPHA testing while active syphilis was diagnosed by seropositivity to both VDRL and TPHA tests. Seroconversion was measured in 1989 by finding TPHA serologically positive individuals during the follow-up period among the initially seronegative study population of 1987. The overall prevalence of active syphilis in the total sample of adults in the region was found to be 5.9% while that of past syphilis was 13.5%. The association between the prevalence of HIV-1 infection and syphilis of both types was found to be highly significant. However, the association between one pre-existing infection and seroconversion in the other was present but not statistically significant. The overall incidence of syphilis based on seroconversion in a cohort of adults in the region was found to be 11.6 per 1000 person-years at risk. In view of these findings, syphilis is a significant health problem in the region with a high level of transmission and efforts should be made to control it. Intervention studies should use these base-line data and monitor changes in syphilis incidence which may indicate changes in sexual behaviour. Such indicators could also be useful for evaluating the impact of interventions directed at reducing the transmission of HIV, syphilis and other STDs in the region.

PIP: Population-based prevalence and incidence studies on HIV-1 infection were started in the Kagera region of Tanzania in 1987. In 1989, a follow-up population-based serosurvey was conducted in the same population with the aim of determining the incidence of HIV-1 infection in the region. In 1987 multi-stage cluster sampling technique was employed to visit all the households selected and to choose at random 1 adult between 15 and 54 years old and 1 child under 15 years old. Syphilis serological examination was done on 2307 adults; 135 had active infection (both VDRL and TPHA positive), 1837 were negative, and 24 had false positive serology (VDRL positive and TPHA negative). The overall prevalence of active syphilis in the regional study sample was 5.9%, while that of past syphilis infection was 13.5%. The prevalence of past infection with syphilis in the rural areas (12.1%) was statistically significantly different from that in the urban area (17.8%, p 0.001). The prevalence of both types of infection increased with age in both rural and urban areas (p 0.001), except for active infection in the urban area (p 0.05). Analysis determining the association between HIV-1 infection and treponemal disease of both types found that there was a highly significant association between the 2 infections after controlling for the number of sexual partners in 3 categories of 0-1, 2-4, and 5 or more sexual partners an individual had had during the 8 years before 1987 (Mantel Haenszel weighted odds ratio 2.38). Between 1987 and 1989 the mean risk period for syphilis seroconversion of the 1133 individuals tested, was 1.82 years with a range between 1.20 and 2.49 years. The overall incidence was 11.6 per 1000 person-years at risk. The highest incidence was in the urban zone (15.4 per 1000 person-years at risk) and the lowest in the Karagwe rural zone (6.5 per 1000 person-years at risk). There was but a weak association between 1 pre-existing infection and seroconversion in the other as indicated by the risk ratios, which were more than unity.

Incidence of HIV-1 infection among adults in the Kagera region of Tanzania.

The results of a population-based follow-up study are presented. The baseline study which started in August 1987, was carried out to determine the prevalence of human immunodeficiency virus (HIV-1) infection in the Kagera region of Tanzania. A multistage cluster sampling technique was adopted in the selection of the study population. In the follow-up survey which started in June 1988, members of the same study population were revisited and studied in order to determine the incidence of HIV-1 infection among those who were HIV seronegative in the initial survey. HIV serology was conducted by using enzyme-linked immunosorbent assay and all positive sera were confirmed by the Western blot technique. A total population of 1316 adults aged 15-54 years was studied, constituting an average follow-up response rate of 69% in the rural areas and of 59% in the urban area. The overall incidence of HIV-1 infection among the adult population sample was 13.7 per 1000 person-years at risk with the highest incidence in the urban zone (47.5 per 1000 person-years at risk) and the lowest incidence in one of the three rural zones (4.9 per 1000 person-years at risk). The age-specific annual incidence was highest in the age group 25-34 years for males and in the age group 15-24 for females. From these results it was estimated that the number of newly infected adults in the region each year is about 8200 with a range between 5400 and 11,000 corresponding to the 95% confidence limits on the overall incidence.(ABSTRACT TRUNCATED AT 250 WORDS)

The epidemiology of HIV-1 infection in urban areas, roadside settlements and rural villages in Mwanza Region, Tanzania.

OBJECTIVE: To determine the prevalence of HIV-1 infection and to identify the most important risk factors for infection. DESIGN: A cross-sectional population survey carried out in 1990 and 1991 in Mwanza Region, Tanzania. METHODS: Adults aged 15-54 years were selected from the region (population, 2 million) by stratified random cluster sampling: 2434 from 20 rural villages, 1157 from 20 roadside settlements and 1554 from 20 urban wards. Risk factor information was obtained from interviews. All sera were tested for HIV-1 antibodies using enzyme-linked immunosorbent assay (ELISA); sera non-negative on ELISA were also tested by Western blot. RESULTS: The response rate was 81%. HIV-1 infection was 1.5 times more common in women than in men; 2.5% of the adult population in rural villages, 7.3% in roadside settlements and 11.8% in town were infected. HIV-1 infection occurred mostly in women aged 15-34 years and men aged 25-44 years. It was associated with being separated or widowed, multiple sex partners, presence of syphilis antibodies, history of genital discharge or genital ulcer, travel to Mwanza town, and receiving injections during the previous 12 months, but not with male circumcision. CONCLUSION: This study confirms that HIV-1 infection in this region in East Africa is more common in women than in men. The results are consistent with the spread of HIV-1 infection along the main roads. There is no evidence that lack of circumcision is a risk factor in this population.

PIP: Between August 1990 and February 1991, health workers took blood samples from, and trained interviewers spoke to, 5145 15-to-54-year-old adults living in either an urban area (1554), in a rural village (2434), or in a roadside settlement (1157) in the Mwanza Region of Tanzania to determine the prevalence of HIV-1 infection and its most significant risk factors. The prevalence rate of HIV-1 infection was highest in urban areas, lower in roadside settlements, and lowest in rural areas (11.8%, 7.3%, and 2.5%, respectively), suggesting that HIV-1 had spread along main roads. Yet, there were as many people infected with HIV-1 in rural areas of the Mwanza Region as there were in Mwanza town. Women were 1.2 (rural) to 1.7 (urban) times more likely to be infected with HIV-1 than were men, indicating greater efficiency of HIV-1 transmission from men to women than from women to men. HIV-1 infection peaked in the 15-to-34-year-old group in women and in the 25-to-44-year-old group in men. Separated, divorced, or widowed men and women were at increased risk of being HIV-1 infected, even when controlled for numerous factors (odds ratio (OR) = 3.4 and 1.6, respectively). This may have been an indication of multiple partners, since the question concerning multiple partners was vague. Other important risk factors for women and men were syphilis antibodies (OR = 1.7 and 1.85), history of genital discharge or chancroid (OR = 2, 1.6 and 2.7, 1.6), travel to Mwanza town (OR = 2.1 and 1.7), and receiving injections during the previous 12 months (OR = 1.5 and 1.9). There was no link between male circumcision and HIV-1 infection. In fact, there seemed to be a moderate protective effect (OR = 0.8). This effect may be even more likely since urban men, who were at greatest risk of HIV-1 infection (8.7% vs. 5.4% [roadside] and 2.4% [rural]), had the highest rate of circumcision (61% vs. 29% and 17%, respectively).

An overview of the epidemiology of HIV-1 infection in Kagera region; Tanzania

This series of studies in the Kagera Region have shown that the prevalence of HIV-1 infection in the regions differs considerably from one area to another with a high urban prevalence

An overview of the epidemiology of HIV-1 infection in Kagera region; Tanzania

This series of studies in the Kagera Region have shown that the prevalence of HIV-1 infection in the region differs considerably from one area to another with a high urban prevalence

HIV and infant feeding practices: epidemiological implications for sub-Saharan African countries.

In industrialized countries HIV-1-seropositive mothers who are nursing infants are advised to use artificial feeds, whilst HIV-infected women in the developing world are recommended to breast-feed. Current evidence is insufficient even to estimate the attributable risk associated with breast-feeding. There is a possibility that the policy promoted in industrialized societies will eventually become established in urban and peri-urban areas of sub-Saharan Africa. This may be defensible for some elite urban mothers providing safe artificial feeding. However, calculations of the consequence of any population-level change to bottle-feeding indicate that it would result in more deaths from infectious causes, substantially adding to the child deaths directly attributable to HIV-1 infection. These data demonstrate that there is a clear need for policy-makers and health care workers to undertake further promotion of breast-feeding despite the AIDS epidemic.

PIP: The 3 retrospective studies conducted to date have involved a total of 12 children exposed to human immunodeficiency virus (HIV) via breastfeeding have yielded findings of 8 cases in which breastfeeding did appear to have led to HIV transmission and 4 cases where the children did not become infected. These findings, as well as the detection of HIV-1 in the breast milk of 3 women, have led to a policy in most developed countries that HIV-positive mothers are advised to use artificial milk. Of concern, however, is the possibility that this policy may become adopted in sub-Saharan African countries where child mortality from infectious diseases associated with bottle-feeding greatly exceed the risks of HIV transmission through breastfeeding. Compared to exclusively breastfed infants, artificial feeding in sub- Saharan countries is associated with a 1.8-2.6 times greater risk of post perinatal mortality. To examine the impact of changes in infant feeding practices in this regions, a model sub-Saharan country with an infant mortality rate of 90/1000 live births (ignoring the effects of HIV) was constructed and a 10% rate of maternal HIV infection, a 30% vertical transmission rate of HIV, and a 20 % HIV-associated infant mortality rate were assumed. To allow for competing causes of death, the number of infants dying from HIV infection was reduced by 10%. Calculations suggest that a reduction from 90% to 75% in the prevalence of breastfeeding would result in an increase in infant wastage of 1780 at best and 3580 at worst. The maximum (assuming a transmission rate of 100%) saving in infant wastage if breastfeeding were entirely eliminated would be only 630. Although more research is needed on the true level of risk from breastfeeding by HIV-infected mothers, it i s recommended that breastfeeding should be continued in developing countries where artificial feeding does not present a safe alternative, irrespective of the prevalence of HIV-1.

An investigation of a cholera epidemic in Butiama village of the Mara Region, Tanzania.

An outbreak of cholera between 19 March and 10 April 1986 in Butiama village of the Mara Region, Tanzania, was investigated in a case-control study, to try to find out the source of infection and its mode of transmission. Sixty-seven patients, including 11 deaths occurring before 29 March, were used to describe the epidemic, but 26 of the first patients were interviewed using a questionnaire, and each was compared with age and sex-matched healthy next-door neighbours. They were questioned about likely risk factors. Though the first two patients were recorded from 2 of the 4 zones of the village, from the second day onwards they came concurrently from all the 4 zones. Also, the number of patients from each zone did not vary significantly. The number of patients reached its peak on 22 March. Females were five times more infected than males, but the case fatality rate was similar. Vibrio cholerae was not isolated from water and fish-scale samples, but a history of handling and eating fish, and attendance at social gatherings were significantly associated with the transmission of cholera. The origin of the outbreak appeared to be either multifocal or a common source with concurrent multiple exists.

Mothers' definition of diarrhoea in a suburban community in Tanzania.

A study was conducted in Temeke District, a suburban area of Dar-es-Salaam, Tanzania, to assess the usefulness of a definition coined by mothers in the identification and subsequent management of diarrhoeal diseases. The mothers were asked about stool frequency and consistency of diarrhoeal episodes of their children aged under 5 and at what stage they would initiate remedial action. From their responses, seven categories of stool frequency per 12-hour period were established. Among the 630 mothers studied, it was observed that a majority of mothers (92%) would take remedial action for diarrhoea when the stool frequency was 3 or more per 12-hour period. It was, therefore, concluded that the mothers' definition for diarrhoea, being simpler, less confusing and less varied than the other definitions used commonly, could be adopted in surveys and epidemiological studies.

PIP: A study was conducted in Temeke District, a suburban area of Dar-es-Salaam, Tanzania, to assess the usefulness of a definition coined by mothers in the identification and subsequent management of diarrheal diseases. The mothers were asked about stool frequency and consistency of diarrheal episodes of their children aged under 5 and at what stage they would initiate remedial action. From their responses, 7 categories of stool frequency per 12-hour period were established. Among the 630 mothers studied, it was observed that a majority of mothers (92%) would take remedial action for diarrhea when the stool frequency was 3 or more per 12-hour period. It was, therefore, concluded that the mother's definition for diarrhea, being simpler, less confusing and less varied than the other definitions used commonly, could be adopted in surveys and epidemiological studies. (Author's).