Global maps of travel time to healthcare facilities.

Access to healthcare is a requirement for human well-being that is constrained, in part, by the allocation of healthcare resources relative to the geographically dispersed human population1-3. Quantifying access to care globally is challenging due to the absence of a comprehensive database of healthcare facilities. We harness major data collection efforts underway by OpenStreetMap, Google Maps and academic researchers to compile the most complete collection of facility locations to date. Leveraging the geographically variable strengths of our facility datasets, we use an established methodology4 to characterize travel time to healthcare facilities in unprecedented detail. We produce maps of travel time with and without access to motorized transport, thus characterizing travel time to healthcare for populations distributed across the wealth spectrum. We find that just 8.9% of the global population (646 million people) cannot reach healthcare within one hour if they have access to motorized transport, and that 43.3% (3.16 billion people) cannot reach a healthcare facility by foot within one hour. Our maps highlight an additional vulnerability faced by poorer individuals in remote areas and can help to estimate whether individuals will seek healthcare when it is needed, as well as providing an evidence base for efficiently distributing limited healthcare and transportation resources to underserved populations both now and in the future.

Assessing seasonal variations and age patterns in mortality during the first year of life in Tanzania.

Lack of birth and death registries in most of developing countries, particularly those in sub-Saharan Africa led to the establishment of Demographic Surveillance Systems (DSS) sites which monitor large population cohorts within defined geographical areas. DSS collects longitudinal data on migration, births, deaths and their causes via verbal autopsies. DSS data provide an opportunity to monitor many health indicators including mortality trends. Mortality rates in Sub-Sahara Africa show seasonal patterns due to high infant and child malaria-related mortality which is influenced by seasonal features present in environmental and climatic factors. However, it is unclear whether seasonal patterns differ by age in the first few months of life. This study provides an overview of approaches to assess, capture and detect seasonality peaks and patterns in mortality using the infant mortality data from the Rufiji DSS, Tanzania. Seasonality was best captured using Bayesian negative binomial models with time and cycle dependent seasonal parameters and autoregressive temporal error terms. Seasonal patterns are similar among different age groups during infancy and timing of their mortality peaks do not differ. Seasonality in mortality rates with two peaks per year is pronounced which corresponds to rainy seasons. Understanding of these trends is important for public health preparedness.

Mosquito larval productivity in rice-fields infested with Azolla in Mvomero District, Tanzania.

Azolla (Salviniales: Azollaceae) is known to reduce oviposition and adult emergence of a number of mosquito species. Several species of Azolla are reportedly indigenous to Tanzania. However, the potential of Azolla as a biocontrol agent against malaria mosquitoes has not been evaluated in the country. This cross-sectional study was carried out to assess mosquito larval productivity in irrigated rice-fields infested with Azolla in Mvomero District, Tanzania. A systematic larval sampling covering all open water bodies along designed transect was carried in rice-fields. Larval density was estimated by dipping water bodies with or without Azolla. The degree of Azolla coverage was categorized as 0%, <50%, 50%, and >80%. Larvae densities were categorised as low (<50/m2), medium (50-500/m2) and high (> or = 500/m2) productivity. A total of 120 water bodies were surveyed and 105 (87.5%) had Azolla microphyla and A. pinnata at varying degrees of coverage. Of the total 105 water bodies with Azolla, 80 (76.2%) had a green Azolla mat, and 25 (23.8%) a brown Azolla mat. Eighty-eight (73.3%) of the sites were infested with anophelines and 109 (90.8%) with culicine larvae. Seventy percent of all water bodies contained anophelines and culicines in sympatric breeding, while 20.8% and 3.3% had only culicines and anophelines, respectively. The majority (82%) of mosquito breeding sites were found in area with Azolla substrate. Mosquito larva productivity was low in sites with highest (>80%) Azolla coverage. Seventy-two (81.8%) of the anopheline and 90 (82.6%) culicine breeding sites were infested with Azolla. Water bodies infested with green Azolla were more productive than those covered by brown coloured Azolla substrates for both culicines (13%) and anophelines (8%). Of the 1537 field collected larvae that hatched to adult stage, 646 (42.03%) were Anopheles gambiae s.l., 42 (2.73%) were An. funestus and 769 (50.03%) were Culex quinquefasciatus. These findings suggest that the mosquito productivity is low when the Azolla coverage is high (>80%). The promotion of Azolla in mosquito control should take into consideration the degree of Azolla coverage.

Monitoring and evaluation of integrated disease surveillance and response in selected districts in Tanzania.

Integrated Disease Surveillance and Response (IDSR) is a strategy developed by the World Health Organization Regional Office for Africa in 1998. The Ministry of Health, Tanzania has adopted this strategy for strengthening communicable diseases surveillance in the country. In order to improve the effectiveness of the implementation of IDSR monitoring and evaluating the performance of the surveillance system, identifying areas that require strengthening and taking action is important. This paper presents the findings of baseline data collection for the period October-December 2003 in 12 districts representing eight regions of Tanzania. The districts involved were Mbulu, Babati, Dodoma Rural, Mpwapwa, Igunga, Tabora Urban, Mwanza Urban, Muleba, Nkasi, Sumbawanga Rural, Tunduru and Masasi. Results are grouped into three key areas: surveillance reporting, use of surveillance data and management of the IDSR system. In general, reporting systems are weak, both in terms of receiving all reports from all facilities in a timely manner, and in managing those reports at the district level. Routine analysis of surveillance data is not being done at facility or district levels, and districts do not monitor the performance of their surveillance system. There was also good communication and coordination with other sectors in terms of sharing information and resources. It is important that districts' capacity on IDSR is strengthened to enable them monitor and evaluate their own performance using established indicators.

Knowledge and health information communication in Tanzania

Objective: To explore and identify gaps in knowledge and information communication at all levels of health delivery system in Tanzania. Methods: In-depth interviews and twelve Focus Group Discussions were conducted to capture information on the community knowledge on different health problems and the health information communication process. Interviews and discussions were also held with primary schoolchildren; traditional healers; health facility workers and district health management team members. Documentary review and inventory of the available health education materials at community; health facility and district levels; was made. Results: Major community health and health-related problems included diseases (61.6); lack of potable water (36.5); frequent famine (26.9) and lack of health facility services (25.3). Malaria; HIV/AIDS and diarrhoeal diseases were the leading causes of morbidity and mortality. Most of the health communication packages covered communicable diseases and their prevention. Health care facility was the main (91.6) source of health information for most communities. Public meetings; radio and print materials were the most frequently used channels of health information communication. Major constraints in adopting health education messages included poverty; inappropriate health education; ignorance and local beliefs.Conclusion: This study has identified gaps in health knowledge and information communication in Tanzania. There is lack of adequate knowledge and information exchange capacities among the health providers and the ability to share that information with the targeted community. Moreover; although the information gets to the community; most of them are not able to utilize it properly because they lack the necessary background knowledge

Monitoring and evaluation of Integrated Disease Surveillance and Response in selected districts in Tanzania

Integrated Disease Surveillance and Response (IDSR) is a strategy developed by the World Health Organization. Regional Office for Africa in 1998. The Ministry of Health; Tanzania has adopted this strategy for strengthening communicable diseases surveillance in the country. In order to improve the effectiveness of the implementation of IDSRmonitoring and evaluating the performance of the surveillance system; identifying areas that require strengthening and taking action is important. This paper presents the findings of baseline data collection for the period October - December 2003 in 12 districts representing eight regions of Tanzania. The districts involved were Mbulu; Babati; odoma Rural; Mpwapwa; Igunga; Tabora Urban; Mwanza Urban; Muleba; Nkasi; Sumbawanga Rural; Tunduru and Masasi. Results are grouped into three key areas: surveillance reporting; use of surveillance data and management of the IDSR system. In general; reporting systems are weak; both in terms of receiving all reports from all acilities in a timely manner; and in managing those reports at the district level. Routine analysis of surveillance data is not being done at facility or district levels; and districts do not monitor the performance of their surveillance system. There was also good communication and coordination with other sectors in terms of sharing information and resources. It is important that districts' capacity on IDSR is strengthened to enable them monitor and evaluate their own performance using established indicators

The relationship between malaria parasitaemia and availability of healthcare facility in Mpwapwa district, central Tanzania.

A study was carried out in six villages located at different altitudes in Mpwapwa district of central Tanzania to determine malaria parasitaemia and transmission levels in villages with or without health care facilities. A total of 1119 schoolchildren (age = 5.9-12.3 years) were examined for malaria parasitaemia. Plasmodiumfalciparum was the predominant malaria species accounting for 92.8% of all species. The average malaria prevalence rate among schoolchildren was 25.8% (range 1.5-53.8%). The geometric mean parasite densities for P.falciparum was 361 (N = 286). Higher malaria prevalence was observed in villages at lower (< 1000 m) than at intermediate (1000-1500m) or higher (> 1500m) altitudes. Schoolchildren in areas with health care facilities were less at risk of acquiring malaria by 33.4% as compared with those living in areas without health facilities. Mean packed cell volume in schoolchildren was 38.5% (range = 35.2-41.0%). Splenomegaly was observed in 18.1% (0-40.2%) of the schoolchildren examined and it was higher among those in villages without health care facilities. Anopheles gambiae sensu lato was the only malaria vector found in the district and was found in all villages and at all altitudes. Sporozoite rate in An. gambiae s.l. ranged from 0-10.5%, with the lowland villages recording the highest rates. This study indicates that altitude and geographical accessibility to healthcare service are important determinants of malaria infection among rural communities in Tanzania.

Participatory involvement of farming communities and public sectors in determining malaria control strategies in Mvomero District, Tanzania.

Addressing the malaria-agriculture linkages requires a broad inter-disciplinary and integrated approach that involves farming communities and key public sectors. In this paper, we report results of participatory involvement of farming communities in determining malaria control strategies in Mvomero District, Tanzania. A seminar involving local government leaders, health and agricultural officials comprising of a total of 27 participants was held. Public meetings in villages of Komtonga, Mbogo, Mkindo, Dihombo and Luhindo followed this. Findings from a research on the impact of agricultural practices on malaria burden in the district were shared with local communities, public sector officials and other key stakeholders as a basis for a participatory discussion. The community and key stakeholders had an opportunity to critically examine the linkages between agricultural practices and malaria in their villages and to identify problems and propose practical solutions. Several factors were identified as bottlenecks in the implementation of malaria control in the area. Lack of community participation and decision making in malaria interventions was expressed as among the major constraints. This denied the community the opportunities of determining their health priorities and accessing knowledge needed to effectively implement malaria interventions. In conclusion, this paper emphasizes the importance of participatory approach that involves community and other key stakeholders in malaria control using an ecosystem approach. An interdisciplinary and integrated approach is needed to involve farmers and more than one sector in malaria control effort.

Community knowledge and information communication gaps on HIV/AIDS in Iringa Municipality; Tanzania

This study was carried out to determine community knowledge and information communication gaps on HIV/AIDS in Iringa Municipality; Tanzania. In-depth interviews and focus group discussions were used to collect data from both the community and health workers. Results showed that eighty-one percent of the respondents were knowledgeable of at least one mode of HIV/AIDS transmission. Sexual intercourse; sharing of sharp instruments; blood transfusion and mother to child transmission were known to be the most common ways on how HIV is transmitted. The community knowledge on the symptoms of AIDS was poor. The main sources of information on HIV/AIDS were health facilities; radio; televisions; religious leaders and relatives. The information covered in most of the health education programmes included prevention; treatment and care for AIDS patients. The understanding of HIV/AIDS messages was found to vary significantly between respondents with different levels of education and marital status. It was higher among those with at least a primary school education than in those without education. Singles and individuals with primary or post-primary education sought more new information than those who had no education at all. Among the respondents; 59.7reported to have difficulties in adopting and utilising HIV/AIDS educational messages. Singles had a better understanding of information provided than married respondents. However; the former had more difficulties in adopting and utilising health education information. Poor utilisation of the HIV/AIDS messages was attributed to culture; poverty; and illiteracy. The majority of the respondents; 370 (92.8) reported to often carry out discussions with their family members (including children) on HIV/AIDS. It is concluded that health education should identify community needs and address economic and socio-cultural barriers to facilitate education utilisation and behaviouralchanges required in HIV/AIDS prevention and control in Tanzania