Recurrence of konzo in southern Tanzania: rehabilitation and prevention using the wetting method.

There have been four konzo outbreaks in Tanzania from 1985 to 2002/2003 with a total of 363 cases of konzo. Every outbreak of konzo resulted from large cyanogen intakes from bitter cassava during drought, which caused food shortages and led to people using short-cut methods of cassava processing. Rehabilitation of the 214 konzo subjects from the two most recent outbreaks of konzo in southern Tanzania was carried out by screening konzo subjects and included provision of crutches and wheel chairs. The wetting method was taught to 216 women activists from the konzo-prone villages, in the first large scale community based intervention to reduce cyanogen intake. Using cassava cyanide kits, the average total cyanide content was reduced by the wetting method about 4-fold, in agreement with previous studies. This model to help prevent konzo requires the widespread education of women activists to use the wetting method.

Risk factors for anaemia in schoolchildren in Tanga Region, Tanzania.

Anaemia is one of the major public health problems affecting more than half of school children along the coast in Tanzania. Due to the multiplicity of its causes it sometimes becomes difficult to find appropriate intervention measures. In order to assist schools in implementing appropriate public health measures for anaemia in Tanga Region of Tanzania risk factors were investigated in school children. A total of 845 schoolchildren age 7-14 years were randomly selected in a cross-sectional survey conducted in 20 randomly selected schools for inclusion in the investigations. Socio-economic, environmental and biological data were collected, as well as academic information, health care and feeding practices. Diagnosis of anaemia was based on haemoglobin concentration below 115 g/L determined by HemoCue meter. Serum Retinol was determined by High performance liquid chromatography and serum ferritin by an Enzyme linked immunosorbent assay. Urine from each child was tested for blood using a haematest reagent strip and those testing positive were examined microscopically by filtration method for Schistosoma haematobium ova. A faecal sample collected from them was also examined microscopically for ova and larvae of intestinal worms. To analyse variables associated with anaemia a stepwise multiple regression model was used. The prevalence of anaemia was 79.6%. Micronutrient deficiencies were highly prevalent. Iron deficiency (SF <20 microg/dl) was affecting 33%, vitamin A deficiency (SR < 20 microg/dL) 31.9% and 25% of the children had mild iodine deficiency (UIE < 20 microg/L). Intestinal helminths were also highly prevalent; 68% of children had hookworm and 54% had urinary schistosomiasis. Inadequate diet was a feature in >50% of children. About 10% of households had no latrines and multiple infection rank score was high especially in older age children. The risk of having anaemia was two times higher in children with iron deficiency (RR=2.1) and 49% higher in those with vitamin A deficiency. These deficiencies correlated significantly with the anaemia (P<0.05). Vitamin A deficiency and infections with hookworm and schistosomiasis were the most significant factors predicting for anaemia (r=0.318 and r2=0.101). We therefore conclude that high prevalence of infections and nutritional deficiencies are important risk factors for anaemia in this community. The high attributable fractions for hookworm, schistosomiasis, iron deficiency and vitamin A confirms that these are significant risk factors to be considered when designing public health measures for anaemia prevention in this community.

Effect of micronutrient fortified beverage on nutritional anaemia during pregnancy.

OBJECTIVE: To evaluate the efficacy of a multiple micronutrient fortified beverage containing eleven nutrients at physiological levels in prevention of anaemia and improving iron and vitamin A status during pregnancy. DESIGN: A randomised double blind placebo controlled study. SETTING: Mpwapwa and Kongwa Districts in Dodoma Region of Tanzania. SUBJECTS: Five hundred and seventy nine pregnant women were screened for entry into the study and 439 women who met the study criteria were enrolled. INTERVENTIONS: Study participants received either a fortified (F) or non-fortified (NF) orange flavoured drinks identical in appearance, provided in two self administered servings per day for an eight week period. MAIN OUTCOME MEASURES: Comparison of haemoglobin (Hb), serum ferritin (SF) and serum retinol (SR) at baseline and follow up. RESULTS: After eight weeks of supplementation, the F group (n=129) had a significantly higher Hb increase of 0.86 g/dL compared to 0.45 g/dL in the NF group (n=130) p<0.0001. Gestational age at entry into the study, moderated the effect on Hb of the fortified drink. Women at earlier gestational age upon entry, had a higher rise in Hb than women of late gestational age (0.8 g/dL versus 0.04 g/dL rise respectively, p=0.038, n=188). The risk of being anaemic at the end of the study for those in the F group was reduced by 51% (RR=0.49, CI=0.28 to 0.85). Iron stores (by serum ferritin levels) increased by 3 microg/L in the F group (p=0.012) and a decrease of 2 microg/L in the NF group (p=0.115). The follow up ferritin concentration depended on initial ferritin level. Regardless of treatment group, serum retinol concentrations were significantly higher in mothers who had delivered. Mothers who had adequate levels at entry benefited more from the supplement than those with low levels (0.26 micromol/L versus no significant difference). CONCLUSIONS: The multiple micronutrient-fortified beverage given for eight weeks to pregnant women improved their haemoglobin, serum ferritin and retinol status. The risk for anaemia was also significantly reduced. The important predictors of Hb increase at follow up were the fortified beverage, baseline Hb, serum retinol, baseline ferritin and gestational age at entry into study. Anthropological research showed that the beverage was highly acceptable and well liked.