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1.
Afr Health Sci ; 19(2): 1858-1865, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31656468

RESUMO

Background: A significant proportion of newborns in the developing countries are born with congenital anomalies. Objective: This study investigated congenital infections due to Rubella virus, Toxoplasma gondii, Treponema pallidum among presumed normal neonates from full term pregnant women in Mwanza, Tanzania. Methods: Sera from mothers were tested for Treponema pallidum and Toxoplasma gondii infection while newborns from mothers with acute infections were tested for T. pallidum and T. gondii, and all newborns were tested for Rubella IgM antibodies. Results: A total of 13/300 (4.3 %) mothers had T. pallidum antibodies with 3 of them having acute infection. Two (0.7 %) of the newborns from mothers with acute infection were confirmed to have congenital syphilis. Regarding toxoplasmosis, 92/300 (30.7 %) mothers were IgG seropositive and 7 had borderline positivity, with only 1/99 (1%) being IgM seropositive who delivered IgM seronegative neonate. Only 1/300 (0.3 %) newborn had rubella IgM antibodies indicating congenital rubella infection. Conclusion: Based on these results, it is estimated that in Mwanza city in every 100,000 live births about 300 and 600 newborns have congenital rubella and syphilis infections, respectively. Rubella virus and T. pallidum are likely to be among common causes of congenital infections in developing countries.


Assuntos
Complicações Infecciosas na Gravidez/epidemiologia , Vírus da Rubéola/imunologia , Rubéola (Sarampo Alemão)/congênito , Rubéola (Sarampo Alemão)/epidemiologia , Sífilis Congênita/epidemiologia , Toxoplasma/imunologia , Toxoplasmose Congênita/epidemiologia , Treponema pallidum/imunologia , Adolescente , Adulto , Anticorpos Antivirais/sangue , Estudos Transversais , Feminino , Sangue Fetal/imunologia , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Recém-Nascido , Gravidez , Complicações Infecciosas na Gravidez/imunologia , Cuidado Pré-Natal , Prevalência , Rubéola (Sarampo Alemão)/diagnóstico , Vírus da Rubéola/isolamento & purificação , Estudos Soroepidemiológicos , Sífilis/complicações , Sífilis/epidemiologia , Sífilis Congênita/diagnóstico , Tanzânia/epidemiologia , Toxoplasma/isolamento & purificação , Toxoplasmose/complicações , Toxoplasmose/epidemiologia , Toxoplasmose Congênita/diagnóstico , Treponema pallidum/isolamento & purificação , População Urbana
3.
BMC Infect Dis ; 19(1): 769, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481123

RESUMO

BACKGROUND: Health-workers in developing countries rely on clinical algorithms, such as the Integrated Management of Childhood Illnesses (IMCI), for the management of patients, including diagnosis of serious bacterial infections (SBI). The diagnostic accuracy of IMCI in detecting children with SBI is unknown. Prediction rules and guidelines for SBI from well-resourced countries at outpatient level may help to improve current guidelines; however, their diagnostic performance has not been evaluated in resource-limited countries, where clinical conditions, access to care, and diagnostic capacity differ. The aim of this study was to estimate the diagnostic accuracy of existing prediction rules and clinical guidelines in identifying children with SBI in a cohort of febrile children attending outpatient health facilities in Tanzania. METHODS: Structured literature review to identify available prediction rules and guidelines aimed at detecting SBI and retrospective, external validation on a dataset containing 1005 febrile Tanzanian children with acute infections. The reference standard, SBI, was established based on rigorous clinical and microbiological criteria. RESULTS: Four prediction rules and five guidelines, including IMCI, could be validated. All examined rules and guidelines had insufficient diagnostic accuracy for ruling-in or ruling-out SBI with positive and negative likelihood ratios ranging from 1.04-1.87 to 0.47-0.92, respectively. IMCI had a sensitivity of 36.7% (95% CI 29.4-44.6%) at a specificity of 70.3% (67.1-73.4%). Rules that use a combination of clinical and laboratory testing had better performance compared to rules and guidelines using only clinical and or laboratory elements. CONCLUSIONS: Currently applied guidelines for managing children with febrile illness have insufficient diagnostic accuracy in detecting children with SBI. Revised clinical algorithms including simple point-of-care tests with improved accuracy for detecting SBI targeting in tropical resource-poor settings are needed. They should undergo careful external validation against clinical outcome before implementation, given the inherent limitations of gold standards for SBI.


Assuntos
Infecções Bacterianas/diagnóstico , Febre/diagnóstico , Técnicas Microbiológicas/normas , Testes Imediatos/normas , Guias de Prática Clínica como Assunto , Idade de Início , Algoritmos , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Criança , Pré-Escolar , Feminino , Febre/microbiologia , Humanos , Lactente , Masculino , Técnicas Microbiológicas/métodos , Técnicas Microbiológicas/estatística & dados numéricos , Testes Imediatos/estatística & dados numéricos , Guias de Prática Clínica como Assunto/normas , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Tanzânia/epidemiologia
5.
AIDS Behav ; 23(9): 2610-2617, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31377894

RESUMO

Adherence to antiretroviral therapy (ART) during pregnancy and the postpartum period is necessary to prevent vertical HIV transmission and to secure the long-term health of an HIV-infected woman. Health behavior theory suggests that patients' attitudes towards medication can predict their medication-taking behaviour. This study sought to understand how women's attitudes towards ART changes between the pregnancy and postpartum periods, and the factors associated with these attitudes. The study enrolled 200 pregnant women living with HIV. Structured surveys were administered during pregnancy and at three and 6 months postpartum. Overall, attitudes towards ART were stable over time. More positive attitudes towards ART were associated with HIV acceptance, lower levels of depression, and lower levels of shame. Counselling interventions are needed to help HIV-infected women accept their status and reduce shameful emotions. Depression screening and treatment should be integrated into PMTCT services. This study emphasizes the importance of early attention to attitudes towards ART, in order to establish a trajectory of sustained care engagement.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Comportamentos Relacionados com a Saúde , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Adesão à Medicação/psicologia , Complicações Infecciosas na Gravidez/tratamento farmacológico , Gestantes/psicologia , Adulto , Aconselhamento , Feminino , Infecções por HIV/etnologia , Comportamentos Relacionados com a Saúde/etnologia , Humanos , Estudos Longitudinais , Adesão à Medicação/etnologia , Adesão à Medicação/estatística & dados numéricos , Período Pós-Parto/psicologia , Gravidez , Gestantes/etnologia , Tanzânia/epidemiologia , Adulto Jovem
6.
BMC Public Health ; 19(1): 1104, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412829

RESUMO

BACKGROUND: The burden of tuberculosis (TB) and diabetes mellitus (DM) is rising and substantially affecting the low-income countries, including Tanzania. Integrated management of TB and DM is becoming of importance in TB high burden countries. In this study, we sought to assess the availability and readiness of diabetes facilities to manage TB in Tanzania. METHODS: The present study was based on a secondary analysis of the 2014-2015 Tanzania Service Provision Assessment Survey data. We calculated the service availability as a percentage of diabetes facilities offering TB services: diagnosis and treatment. Regarding the readiness of diabetes facilities to provide TB management, we calculated based on the three domains: staff training and guideline, diagnostics, and medicines as identified by World Health Organization-Service Availability and Readiness Assessment (SARA) manual. A score of at least half (≥50%) of the indicators listed in each of the three domains was considered as high readiness. We used a descriptive statistics to present our findings. RESULTS: There were 619 DM facilities all over the country of which only 238 (38.4%) had TB services.72.6 and 62.6% of these DM facilities with TB services were publicly owned and located in rural settings respectively. Generally, DM facilities had low readiness to manage TB; 12·6%. More specifically, all DM facilities had low readiness in terms of trained staff and guidelines. However, in the domain of diagnostics and medications, higher levels of care (hospitals) had a comparatively higher level of readiness to manage TB. CONCLUSION: Most of the DM facilities had low availability and readiness to manage TB. The findings of our study display an urgent need to mobilize important resources to enhance the integration of TB services in DM facilities. This includes medications, management guidelines, diagnostics, and health professionals who have received refresher training on TB/DM co-management. However, presently, few DM facilities may be allowed to start managing TB as per the Strategic and Action Plan for the Prevention and Control of Non-Communicable Diseases in Tanzania 2016-2020.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Diabetes Mellitus/terapia , Instalações de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Tuberculose/terapia , Diabetes Mellitus/epidemiologia , Pesquisas sobre Serviços de Saúde , Humanos , Tanzânia/epidemiologia , Tuberculose/epidemiologia , Organização Mundial da Saúde
7.
Pan Afr Med J ; 33: 82, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31448044

RESUMO

Introduction: Surviving a traumatic cervical Spinal Cord Injury (SCI) has an immense effect on an individual's physical function and independence. It also predisposes them to financial, social, psychological and several medical complications throughout their life. In high-income countries, improved multidisciplinary care has led to better long term outcomes, however in low-income countries, the burden of the condition and its associated mortality remain high. The aim of this study was to illustrate the sociodemographic and clinical characteristics of cervical level Traumatic Spinal Cord Injuries (TSCIs) at Kilimanjaro Christian Medical Centre (KCMC) in northern Tanzania. Methods: This was a retrospective hospital-based study of 105 cervical TSCI cases admitted to KCMC from January 2012 to December 2016. Results: We included 105 patients in the study cohort, with a male preponderance of 86.7%, giving a male-to-female ratio of 6.5:1. The mean age at injury was 44.1 years. Overall, 65.7% were farmers and 69 patients were from within the Kilimanjaro region. Road Traffic Crashes (RTCs) accounted for 47.6% of the injuries, 17.9% had associated injuries, 38.1% sustained complete TSCIs and 45.7% developed secondary complications during the ward stay. The mortality rate before discharge from hospital care was 35.2%. Conclusion: The majority of patients were males from a low socioeconomic background and the most common cause of injury was RTCs. The secondary complication rates and mortality rates before discharge from hospital care are high.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Medula Cervical/lesões , Mortalidade Hospitalar , Traumatismos da Medula Espinal/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Socioeconômicos , Traumatismos da Medula Espinal/etiologia , Traumatismos da Medula Espinal/mortalidade , Tanzânia/epidemiologia , Adulto Jovem
8.
BMC Infect Dis ; 19(1): 642, 2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31324225

RESUMO

BACKGROUND: Cervicofacial necrotizing fasciitis (NF) is a rare life-threatening infection in the head and neck region that characteristically spreads along the fascial planes to involve subcutaneous tissues, fascia and fat, however, in late stages it can involve muscles and skin. The aim of this study was to determine the occurrence of cervicofacial NF among patients attending treatment at the Muhimbili National Hospital (MNH). METHODS: This was a prospective descriptive cross-sectional hospital-based study which was carried at Muhimbili National Hospital (MNH) from May 2013 to April 2014. It included 42 patients with cervicofacial NF. They were interviewed for demographic information, chief complaints, symptoms, duration and treatment received before reporting at MNH. A thorough assessment of general health condition of the patients and laboratory investigations were followed by management according to MNH protocol. Data obtained from these patients were analyzed using Statistical Package for Social Sciences SPSS 20. RESULTS: During the study period, 151 patients reported at MNH with odontogenic infections. A total of 42 (27.8%) patients satisfied our diagnostic criteria for cervicofacial NF. The age range was 15 years to 83 years (mean 43.95, SD +/- 16.16). Greater (35.7%) proportion was in the age group of 30-39 years with 31 (73.8%) males and 11 (27.2%) females making a male to female ratio of 2.8:1. Fifteen (35.7%) patients had at least one co-existing systemic condition, which included anaemia in 5 (11.9%) patients, followed by diabetes mellitus (DM) and malnutrition 4 (9.5%) patients each and HIV infection 2 (4.8%) patients. Others were combination of; HIV infection and malnutrition, HIV infection and anaemia and diabetes mellitus and anaemia each in one (2.4%) patient. There was a mortality of 42.9% comprising of 14 (33.3%) males and 4 (9.6%) females. CONCLUSIONS: Cervicofacial NF is a polymicrobial infection, requiring surgery, antibiotics and management of co-existing systemic conditions. Anaemia, diabetes mellitus and malnutrition were the main co-existing systemic conditions. The rather high mortality was mainly attributable to late reporting.


Assuntos
Fasciite Necrosante/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anemia/etiologia , Antibacterianos/uso terapêutico , Estudos Transversais , Fasciite Necrosante/tratamento farmacológico , Fasciite Necrosante/microbiologia , Fasciite Necrosante/cirurgia , Feminino , Infecções por HIV/epidemiologia , HIV-2 , Humanos , Masculino , Desnutrição/epidemiologia , Pessoa de Meia-Idade , Mortalidade , Estudos Prospectivos , Tanzânia/epidemiologia
9.
BMC Public Health ; 19(1): 972, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331303

RESUMO

BACKGROUND: Childhood lifestyle, health-risk behaviours contribute to two-thirds of non-communicable diseases (NCDs) premature mortality in adult populations. The co-occurrence of risk factors for NCDs is more harmful to health than that of individual risk factor effects when are added independently. The main objective of the present study was to explore the prevalence, sociodemographic distribution, and the co-occurrence of risk factors for NCDs among in-school adolescents. METHODS: The present study is based on the secondary analysis of the first nationwide representative sample of the 2014 Tanzania Global School-based Student Health Survey (GSHS). A total sample of 3,793 in-school adolescents was included in the present analysis. The dependent variables were as follows: an unhealthy diet, physical inactivity, tobacco use, excessive alcohol use, and suicide attempt. The analysis involved the Chi squire χ2 test, multinomial and multivariate regression models: to determine the association between the variables of interest. In all analyses, the set level of statistical significance was a p-value of less than 0.05 at 95% confidence intervals. RESULTS: The most prevalent combination of risk factors for NCDs were as follows: unhealthy diet and physical inactivity 666 (17.6%); unhealthy diet and suicide attempt 151 (4.0); unhealthy diet and tobacco use 98 (2.8); and unhealthy diet, physical inactivity, and suicide attempt 81 (2.1). In the adjusted regression model; having three 0.60 [0.40-0.91], and a sum of four and five 0.46 [0.28-0.79] risk factors than having no risk factor showed a significant declined with increasing in adolescents age. Primary in-school adolescents than secondary in-school adolescents were significantly more likely to have two 1.81 [1.42-2.32], three 2.40 [1.63-3.54]; and a sum of four and five 2.90 [1.61-5.13] combinations of risk factors. CONCLUSION: The co-occurrence of lifestyle health-risk factors for NCDs was prevalent among in-school adolescents: it was significantly higher among younger adolescents. A multi-strategy public health intervention program may be more effective than that of a single risk factor approach: therefore, suitable for resource-limited settings, such as Tanzania.


Assuntos
Doenças não Transmissíveis/epidemiologia , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Adolescente , Criança , Feminino , Política de Saúde , Inquéritos Epidemiológicos , Humanos , Estilo de Vida , Masculino , Áreas de Pobreza , Prevalência , Fatores de Risco , Instituições Acadêmicas , Tanzânia/epidemiologia
10.
Malar J ; 18(1): 228, 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31288840

RESUMO

BACKGROUND: Agro-ecological systems have been associated with increased malaria intensity. This study determined association between different agro-ecological systems, prevalence of malaria parasitaemia and anaemia in Mvomero district, Tanzania. METHODS: The study was carried out in three agro-ecosystems namely, savannah, rice-irrigation, and sugarcane. Malaria and anaemia prevalence were measured in four seasons of a year. Villages were categorized according to environmental characteristics, proportion of water-shaded areas and agro-ecosystems. Mixed-effects logistic regression analysis was used to determine factors associated with malaria infection. RESULTS: A total of 7888 individuals were involved with the overall malaria prevalence of 34.4%. Plasmodium falciparum was the dominant (99.52%) malaria species. Malaria prevalence was highest (42.9%) in children of 10-15 years of age, and significantly low during dry and hot season. Of the infected individuals, 78.1% were from rice-irrigation, 18.7% savannah and 3.2% sugarcane ecosystem. Individuals living in villages with high levels of water-shaded areas had highest malaria risk. Over three-quarters (78.9%) of the individuals slept under a mosquito net, with the highest (88.5%) coverage among individuals in sugarcane ecosystem. On average 47.1% of the children were anaemic. Anaemia was more prevalent (60.5%) among individuals in the savannah than in the rice-irrigation (48.2%) or sugarcane communities (23%). Analysis indicated that ecosystems and levels of water-shaded area were highly correlated, and altered levels of malaria infection. Gender, age, mosquito net-use, and season were other significant determinants of P. falciparum infection. Males had higher odds than females (OR = 1.16, 95% CI 1.05, 1.29). The risk for children 6-9 years and older children (10-15 years) was over 50% and 24%, respectively, higher compared to young ones (0-5 years). Use of mosquito net reduced malaria risk by 26%. The risk of infection was higher during dry and cool season (OR = 1.92, 95 %CI 1.66, 2.23) compared to other seasons. Living in villages with high level of water-shaded areas increased the chances of getting malaria up to 15 times than living in drier areas. Similarly, infection odds increased when living in savannah and rice-irrigation ecosystems than in the sugarcane ecosystem. CONCLUSIONS: Findings show significant variations in malaria prevalence between communities living in different agro-ecosystems within the same district. Local malaria control strategies should consider these variations and liaise with agricultural experts while designing interventions to maximize effectiveness.


Assuntos
Agricultura , Anemia/epidemiologia , Malária Falciparum/epidemiologia , Parasitemia/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anemia/parasitologia , Criança , Pré-Escolar , Estudos Transversais , Ecossistema , Feminino , Humanos , Lactente , Malária Falciparum/parasitologia , Masculino , Pessoa de Meia-Idade , Parasitemia/parasitologia , Plasmodium falciparum/fisiologia , Prevalência , Estações do Ano , Análise Espaço-Temporal , Tanzânia/epidemiologia , Adulto Jovem
11.
BMC Health Serv Res ; 19(1): 492, 2019 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-31311521

RESUMO

BACKGROUND: This paper reports on a rigorously designed non-masked randomized cluster trial of the childhood survival impact of deploying paid community health workers to provide doorstep preventive, promotional, and curative antenatal, newborn, child, and reproductive health care in three rural Tanzanian districts. METHODS: From August, 2011 to June 2015 ongoing demographic surveillance on 380,000 individuals permitted monitoring of neonatal, infant and under-5 mortality rates for 50 randomly selected intervention and 51 comparison villages. Over the initial 2 years of the project, logistics and supply support systems were managed by the Ifakara Health Institute. In 2013, the experiment transitioned its operational design to logistical support managed by the Ministry of Health and Social Welfare with the goal of enhancing government operational ownership and utilization of results for policy. RESULTS: The baseline under 5 mortality rate was 81.3 deaths per 1000 live births with a 95% confidence interval (CI) of 77.2-85.6 in the intervention group and 82.7/1000 (95% CI 78.5-87.1) in the comparison group yielding an adjusted hazard ratio (HR) of 0.99 (95% CI 0.88-1.11, p = 0.867). After 4 years of implementation, the under 5 mortality rate was 73.2/1000 (95% CI 69.3-77.3) in the intervention group and 77.4/1000 (95% CI 73.8-81.1) in the comparison group (adjusted HR 0.95 [95% CI 0.86-1.07], p = 0.443). The intervention had no impact on neonatal mortality in either the first 2 years (HR 1.10 [95% CI 0.89-1.36], p = .392) or last 2 years of implementation (HR 0.98 [95% CI 0.74-1.30], p = .902). Although community health worker deployment significantly reduced mortality among children aged 1-59 months during the first 2 years of implementation (HR 0.85 [95% CI 0.76-0.96], p = 0.008), mortality among post neonates was the same in both groups in years three and four (HR 1.03 [95% CI 0.85-1.24], p = 0.772). Results adjusted for stock-out effects show that diminishing impact was associated with logistics system lapses that constrained worker access to essential drugs and increased post-neonatal mortality risk in the final two project years (HR 1.42 [95% CI 1·07-1·88], p = 0·015). CONCLUSIONS: Community health worker home-visit deployment had a null effect among neonates, and 2 years of initial impact among children over 1 month of age, but a null effect when tests were based on over 1 month of age data merged for all four project years. The atrophy of under age five effects arose because workers were not continuously equipped with essential medicines in years three and four. Analyses that controlled for stock-out effects suggest that adequately supplied workers had survival effects on children aged 1 to 59 months. TRIAL REGISTRATION: Registration for trial number ISRCTN96819844 was retrospectively completed on June 21, 2012.


Assuntos
Mortalidade da Criança/tendências , Agentes Comunitários de Saúde/economia , Mortalidade Infantil/tendências , Serviços de Saúde Materno-Infantil/organização & administração , População Rural/estatística & dados numéricos , Salários e Benefícios , Adulto , Pré-Escolar , Feminino , Pesquisa sobre Serviços de Saúde , Visita Domiciliar , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Estudos Retrospectivos , Tanzânia/epidemiologia
12.
Trop Anim Health Prod ; 51(7): 1807-1815, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31228086

RESUMO

Mortality of domestic small ruminants caused by contagious caprine pleuropneumonia (CCPP) and Peste des petits ruminants (PPR) is frequently reported in Tanzania. A cross-sectional survey was conducted between June, 2016 and July, 2017 to identify risk factors for small ruminants exposure to Mycoplasma capricolum subsp. capripneumoniae (M. capripneumoniae), the causative agent of CCPP, and small ruminant morbillivirus (SRMV), the causative agent of PPR. Antibody detection was done using competitive enzyme-linked immunosorbent assays (cELISA); similarly, a semi-structured questionnaire was administered in flocks where serum samples were collected. Individual seropositivity for M. capripneumoniae was 6.5% (n = 676) and 4.2% (n = 285) in goats and sheep respectively, whereas SRMV was 28.6% in goats (n = 676) and 31.9% in sheep (n = 285). Multivariable analysis indicated that mixing of flocks was a risk factor for exposure to M. capripneumoniae (χ2 = 3.9, df = 1, p = 0.05) and SRMV (χ2 = 6.3, df = 1, p = 0.01) in goats. Age was a protective factor for SRMV seropositivity in both goats (χ2 = 7.4, df = 1, p = 0.006) and sheep (χ2 = 10.2, df = 1, p = 0.006). SRMV seropositivity in goats was also influenced by grazing in contact with wild animals (χ2 = 5.9, df = 1, p = 0.02) and taking animals to the animal markets (χ2 = 8.2, df = 1, p = 0.004). M. capripneumoniae and SRMV are influenced by several risk factors and their control needs concerted efforts between stakeholders, which may include community involvement in mandatory vaccination and animals' movement control.


Assuntos
Doenças das Cabras/epidemiologia , Mycoplasma capricolum/fisiologia , Peste dos Pequenos Ruminantes/epidemiologia , Vírus da Peste dos Pequenos Ruminantes/fisiologia , Pleuropneumonia Contagiosa/epidemiologia , Doenças dos Ovinos/epidemiologia , Animais , Cabras , Fatores de Risco , Ovinos , Tanzânia/epidemiologia
13.
PLoS Negl Trop Dis ; 13(6): e0007508, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31233497

RESUMO

BACKGROUND: The Alliance for the Global Elimination of Trachoma has set the target for eliminating trachoma as a public health problem by 2020. However, challenges remain, including socio-cultural issues. Districts in Northern Tanzania, predominantly inhabited by the Maasai ethnic group, remain endemic for trachoma. We explored socio-cultural factors that may impact the elimination of trachoma. METHODS/FINDINGS: This study was nested within a larger ethnographic study of trachoma among Maasai in Northern Tanzania. We used stratified random sampling and semi-structured interviews to examine knowledge and understanding. Interviews were conducted and recorded in Maa, by a native Maa speaking trained interviewer. Transcripts were translated into English. A framework method for a content analysis was used. There was awareness of trachoma and basic symptoms. Yet understanding of etiology and prevention was poor. Trachoma was attributed to pollen, dust, and smoke. Water was recognized as beneficial, but seen as treatment and not prevention. Traditional medicines were most often used for treating conjunctival inflammation, with the most common being a rough leaf used to scratch the inside of the eyelid until it bleeds. Knowledge of mass drug administration (MDA) was inconsistent, although many thought it helped the community, but it was perceived as only for children and the sick. Many participants reported not taking azithromycin and some had no recollection of MDA six months earlier. There was little connection between childhood infection, trichiasis and related blindness. Trichiasis was often seen as a problem of old women, and treated locally by epilation. CONCLUSION/SIGNIFICANCE: Understanding indigenous knowledge may help guide control programs, tailor them to local contexts, address local beliefs and dispel misunderstandings. There is an essential need to understand the social, cultural and political context of the target community to deliver effective programs. Despite limited knowledge, the community recognized trachoma as a public health problem. Results have implications for disease control programs in other marginalized communities.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Grupos Populacionais , Tracoma/epidemiologia , Tracoma/prevenção & controle , Adolescente , Adulto , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Tanzânia/epidemiologia , Adulto Jovem
14.
BMC Infect Dis ; 19(1): 518, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31195994

RESUMO

BACKGROUND: Heterosexual transmission is the main driver of the HIV epidemic in Tanzania. Only one estimate of the incidence rate of intra-marital HIV seroconversion in Tanzania has been reported and was derived from data collected between 1991 and 1995. Moreover, little is known about the specific risk factors for intra-marital seroconversion in Tanzania. Improved evidence around factors that increase the risk of HIV transmission to a serodiscordant spouse is needed to develop and improve evidence-based interventions. We sought to investigate the rate of intra-marital HIV seroconversion among HIV sero-discordant couples in Tanzania as well as its associated risk factors. METHODS: We identified all HIV positive individuals in the TAZAMA HIV-serosurvey cohort and followed up their serodiscordant spouse from 2006 to 2016. The rate of seroconversion was analyzed by survival analysis using non-parametric regressions with exponential distribution. RESULTS: We found 105 serodiscordant couples, 14 of which had a seroconverting spouse. The overall HIV-1 incidence rate among spouses of people with HIV-1 infection was 38.0 per 1000 person/years [22.5-64.1]. Notably, the HIV-1 incidence rate among HIV-1 seronegative male spouses was 6.7[0.9-47.5] per 1000 person/years, compared to 59.3 [34.4-102.1] per 1000 person/years among female spouses. Sex of the serodiscordant spouse was the only significant variable, even after adjusting for other variables (Hazard rate = 8.86[1.16-67.70], p = 0.036). CONCLUSIONS: Our study suggests that rates of HIV-1 seroconversion of sero-discordant partners are much higher within marriage than in the general population in Tanzania. The major risk factor for HIV-1 seroconversion is sex of the serodiscordant spouse, with female spouses being at very high risk of acquiring HIV infection. This suggests that future programs that target serodiscordant couples could be a novel and effective means of preventing HIV-1 transmission in Tanzania.


Assuntos
Anticorpos Anti-HIV/sangue , Infecções por HIV/diagnóstico , Adulto , Estudos de Coortes , Teste em Amostras de Sangue Seco , Feminino , Seguimentos , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , HIV-1/imunologia , HIV-1/isolamento & purificação , Heterossexualidade , Humanos , Incidência , Masculino , Modelos de Riscos Proporcionais , Fatores de Risco , Cônjuges , Tanzânia/epidemiologia
15.
BMC Public Health ; 19(1): 703, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174505

RESUMO

BACKGROUND: In an effort to complement the current chemotherapy based schistosomiasis control interventions in Shinyanga district, community knowledge, perceptions and water contact practices were qualitatively assessed using focus group discussions and semi structured interviews involving 271 participants in one S. haematobium prevalent community of Ikingwamanoti village, Shinyanga district, Northwestern, Tanzania. METHODS: In October, 2016 we conducted 29 parent semi structured interviews and 16 focus group discussions with a total of 168 parent informants. Adult participants were conveniently selected from three sub-villages of Butini, Miyu, and Bomani of Ikingwamanoti village, Shinyanga district. In March, 2017, a total of 103 children informants participated in 10 focus group discussions and 20 semi structured interviews, administered to children from standard four, five, six and seven attending Ikingwamanoti Primary School. Note taking and digital recorders were used to collect narrative data for thematic analysis of emergent themes. RESULTS: Among participants, 75% parents and 50% children considered urinary schistosomiasis as a low priority health problem. Of the informants, 70% children and 48.3% parents had misconceptions about the cause, modes of transmission and control of schistosomiasis demonstrating gaps in their biomedical knowledge of the disease. Assessment of treatment seeking behavior for urinary schistosomiasis revealed a combination of traditional and modern health care sectors. However, modern medicines were considered effective in the treatment of urinary schistosomiasis. Lack of alternative sources of water for domestic and recreational activities and unhygienic water use habits exposed community members to high risk of acquiring urinary schistosomiasis. CONCLUSION: Use of Schistosoma haematobium contaminated water sources for daily domestic and recreational use facilitated contraction of urinary schistosomiasis among community members in Shinyanga district. People's perceptions of urinary schistosomiasis as a less priority health problem promoted persistence of the disease. Future efforts to control urinary schistosomiasis should take into account integrated approaches combining water, sanitation and hygiene, health education, alternative sources of clean and safe water to facilitate behavior change.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Higiene , Pais/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Schistosoma haematobium , Esquistossomose Urinária/psicologia , Adolescente , Adulto , Animais , Criança , Estudos Transversais , Transmissão de Doença Infecciosa , Feminino , Grupos Focais , Humanos , Masculino , Percepção , Prevalência , Pesquisa Qualitativa , Saneamento , Esquistossomose Urinária/epidemiologia , Esquistossomose Urinária/transmissão , Tanzânia/epidemiologia , Água
16.
PLoS Negl Trop Dis ; 13(5): e0007225, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31150391

RESUMO

BACKGROUND: Leptospirosis is a bacterial zoonotic disease of worldwide importance, though relatively neglected in many African countries including sub Saharan Africa that is among areas with high burden of this disease. The disease is often mistaken for other febrile illnesses such as dengue, malaria, rickettsioses and enteric fever. Leptospirosis is an occupational disease likely to affect people working in environments prone to infestation with rodents which are the primary reservoir hosts of this disease. Some of the populations at risk include: sugarcane plantation workers, wetland farmers, fishermen and abattoir workers. In this study we investigated the prevalence of antibodies against Leptospira among sugarcane plantation and factory workers, fishing communities as well as among rodents and shrews in domestic and peridomestic environments within the study areas. METHODS: The study was conducted in Kagera region, northwestern Tanzania and it involved sugarcane plantation workers (cutters and weeders), sugar factory workers and the fishing community at Kagera Sugar Company in Missenyi district and Musira island in Lake Victoria, Kagera, respectively. Blood was collected from consenting human adults, and from rodents and shrews (insectivores) captured live using Sherman traps. Serological detection of leptospiral antibodies in blood serum was carried out by the microscopic agglutination test (MAT). RESULTS: A total of 455 participants were recruited from the sugarcane plantation (n = 401) and fishing community (n = 54) while 31 rodents and shrews were captured. The overall prevalence of antibodies against Leptospira in human was 15.8%. Sugarcane cutters had higher seroprevalence than other sugar factory workers. Prevalent antibodies against Leptospira serovars in humans were against serovars Lora (6.8%), Sokoine (5.3%), Pomona (2.4%), Hebdomadis (1.1%) and Kenya (0.2%). Detected leptospiral serovars in reservoir hosts were Sokoine (12.5%) and Grippotyphosa (4.2%). Serovar Sokoine was detected both in humans and small mammals. CONCLUSION: Leptospirosis is a public health threat affecting populations at risk, such as sugarcane plantation workers and fishing communities. Public awareness targeting risk occupational groups is much needed for mitigation of leptospirosis in the study areas and other vulnerable populations in Tanzania and elsewhere.


Assuntos
Leptospirose/microbiologia , Adolescente , Adulto , Animais , Anticorpos Antibacterianos/sangue , Reservatórios de Doenças/microbiologia , Fazendeiros/estatística & dados numéricos , Feminino , Pesqueiros , Humanos , Leptospira/classificação , Leptospira/genética , Leptospira/imunologia , Leptospira/isolamento & purificação , Leptospirose/sangue , Leptospirose/epidemiologia , Leptospirose/transmissão , Masculino , Pessoa de Meia-Idade , Prevalência , Roedores/imunologia , Roedores/microbiologia , Saccharum/crescimento & desenvolvimento , Estudos Soroepidemiológicos , Musaranhos/imunologia , Musaranhos/microbiologia , Tanzânia/epidemiologia , Adulto Jovem , Zoonoses/sangue , Zoonoses/microbiologia
17.
AIDS Behav ; 23(Suppl 2): 142-152, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31197700

RESUMO

We conducted an implementation science study of a community-based ART distribution program for HIV-positive female sex workers (FSW) whereby clients received ART services through community-based mobile and home-based platforms. We compared 6-month treatment-related outcomes in the community-based ART arm (N = 256) to the standard facility-based ART delivery arm (N = 253). Those in the intervention arm were more likely to have initiated ART (100.0% vs. 71.5%; p = 0.04), be currently taking ART at the 6-month visit (100.0% vs. 95.0%; p < 0.01), and less likely to have stopped taking ART for more than 30 days continuously (0.9% vs. 5.7%; p = 0.008) or feel high levels of internalized stigma (26.6% vs. 39.9%; p = 0.001). In the adjusted regression model, internalized stigma (adjusted OR [aOR]: 0.5; 95% CI 0.28-0.83) and receiving community-based ART (aOR: 208.6; 95% CI 12.5-3479.0) were significantly associated with ART initiation. Community-based ART distribution model can improve linkage to and adherence to ART over standard facility-based ART programs for FSWs.


Assuntos
Terapia Antirretroviral de Alta Atividade/psicologia , Serviços de Saúde Comunitária/organização & administração , Assistência à Saúde/métodos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Adesão à Medicação , Profissionais do Sexo/estatística & dados numéricos , Adolescente , Adulto , Terapia Antirretroviral de Alta Atividade/estatística & dados numéricos , Feminino , Seguimentos , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Prospectivos , Trabalho Sexual , Profissionais do Sexo/psicologia , Estigma Social , Tanzânia/epidemiologia , Resultado do Tratamento , Adulto Jovem
18.
Infect Dis Poverty ; 8(1): 35, 2019 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-31122275

RESUMO

In a study from the onchocerciasis-endemic area of Mahenge in southern Tanzania, Mmbando et al. [Inf Dis Poverty. 2018;7:64] demonstrate that in four selected villages the overall epilepsy prevalence was high, and significantly more elevated in the two villages of higher onchocerciasis endemicity compared to those of lower endemicity. This is replicating earlier findings from many other areas of tropical Africa. The authors are also providing data indicating that in the Mahenge focus, the prevalence of nodding syndrome may be related to that of onchocerciasis in the same way as epilepsy in general. The application of a clinical case definition for onchocerciasis-associated epilepsy (OAE) as used in the study of Mmbando et al. [Inf Dis Poverty. 2018;7:64] faces some difficulties; indeed, its precision in discerning cases of OAE from epilepsy due to other etiologies is not known, and it does not allow for a specific diagnosis in the individual patient. Because an operational surveillance tool for assessing the number of patients in the population could mean substantial advance for better estimating the burden of OAE, the proposed definition should be tried in different settings and its performance reviewed in the process.


Assuntos
Epilepsia/epidemiologia , Síndrome do Cabeceio , Oncocercose , Humanos , Prevalência , Tanzânia/epidemiologia
19.
BMC Infect Dis ; 19(1): 447, 2019 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-31113384

RESUMO

BACKGROUND: Helicobacter pylori (H.pylori) infection is a common medical problem in resource limited areas. The treatment outcome after triple therapy has not been well studied in developing countries and preliminary data suggests a high rate of treatment failure. This study investigated the triple therapy treatment failure rate and associated factors among dyspeptic patients receiving H. pylori first line therapy at a tertiary hospital, Tanzania. METHODS: A prospective study in the Gastroenterology unit of the Bugando Medical Centre (BMC) was conducted between October 2015 and May 2017. All dyspeptic patients with stool antigen tests positive for H.pylori were given first line therapy, and stool antigen testing was repeated within 7 days and 5 weeks after completion of the treatment. Biopsies were taken before initiation of therapy and analysed for clarithromycin and quinolone resistance mutations using polymerise chain reaction (PCR) and sequencing. Adherence and other social-demographic characteristics were documented. RESULTS: A total of 210 patients were enrolled; the median age was 35 years (interquartile range, 27-48). First line treatment failure as defined by positive stool antigen 5 weeks post treatment was observed in 65/210 (31%) of patients. Independent predictors of first line treatment failure were presence of clarithromycin resistance mutations (OR: 23.12, 95% CI (9.38-56.98), P < 0.001) and poor adherence (OR: 7.39, 95% CI (3.25-16.77), P < 0.001). The sensitivity and specificity of stool antigen testing within 7 days after completion therapy in detecting treatment failure was 100 and 93.2%, respectively. CONCLUSION: Nearly one-third of patients with clarithromycin resistance mutations and poor adherence develop first line treatment failure. Routine stool antigen testing within seven days after completion of therapy can be considered in order to initiate second line treatment early to prevent associated morbidities.


Assuntos
Antibacterianos/uso terapêutico , Infecções por Helicobacter/tratamento farmacológico , Adulto , Claritromicina/uso terapêutico , Quimioterapia Combinada , Fezes/microbiologia , Feminino , Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/microbiologia , Infecções por Helicobacter/psicologia , Helicobacter pylori/efeitos dos fármacos , Helicobacter pylori/genética , Helicobacter pylori/isolamento & purificação , Humanos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Estudos Prospectivos , Quinolonas/uso terapêutico , Tanzânia/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Falha de Tratamento , Adulto Jovem
20.
Artigo em Inglês | MEDLINE | ID: mdl-31060201

RESUMO

Rapid growth of the Zanzibari population and urbanization are expected to impact food insecurity and malnutrition in Zanzibar. This study explored the relationship between food access (FA) and sociodemographic correlates with food consumption score and food insecurity experience scale. Based on cross-sectional data of 196 randomly selected households, we first investigated the association between sociodemographic correlates and Food Consumption Score (FCS) and Food Insecurity Experience Scale using multilevel Poisson regression. Secondly, the role of FA in these associations was investigated by interaction with the respective correlates. About 65% of households had poor food consumption, and 32% were severely food-insecure. Poor FA was more prevalent in households with poor food consumption (71%). Polygamous households and larger households had a higher chance for severe food insecurity. In the interaction with FA, only larger households with poor FA showed a higher chance for severe food insecurity. In households having no vehicle, good FA increased the chance of having acceptable FCS compared to poor FA. By contrast, urban households with good FA had a twofold chance of acceptable FCS compared to rural household with poor FA. Poor FA, poor food consumption and food insecurity are challenging; hence, facilitating households' FA may improve the population's nutrition situation.


Assuntos
Ingestão de Alimentos , Abastecimento de Alimentos/estatística & dados numéricos , Estado Nutricional , Pobreza/estatística & dados numéricos , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Desnutrição/epidemiologia , Pessoa de Meia-Idade , Fatores Socioeconômicos , Tanzânia/epidemiologia
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