Infection prevention and control of highly infectious pathogens in resource-limited countries: an experience from Marburg viral disease outbreak in Kagera Region - Tanzania.

Marburg viral disease (MVD) is a highly infectious disease with a case fatality rate of up to 90%, particularly impacting resource-limited countries where implementing Infection Prevention and Control (IPC) measures is challenging. This paper shares the experience of how Tanzania has improved its capacity to prevent and control highly infectious diseases, and how this capacity was utilized during the outbreak of the MVD disease that occurred for the first time in the country in 2023.In 2016 and the subsequent years, Tanzania conducted self and external assessments that revealed limited IPC capacity in responding to highly infectious diseases. To address these gaps, initiatives were undertaken, including the enhancement of IPC readiness through the development and dissemination of guidelines, assessments of healthcare facilities, supportive supervision and mentorship, procurement of supplies, and the renovation or construction of environments to bolster IPC implementation.The official confirmation and declaration of MVD on March 21, 2023, came after five patients had already died of the disease. MVD primarily spreads through contact and presents with severe symptoms, which make patient care and prevention challenging, especially in resource-limited settings. However, with the use of a trained workforce; IPC rapid needs assessment was conducted, identifying specific gaps. Based on the results; mentorship programs were carried out, specific policies and guidelines were developed, security measures were enhanced, all burial activities in the area were supervised, and both patients and staff were monitored across all facilities. By the end of the outbreak response on June 1, 2023, a total of 212 contacts had been identified, with the addition of only three deaths. Invasive procedures like dialysis and Manual Vacuum Aspiration prevented some deaths in infected patients, procedures previously discouraged.In summary, this experience underscores the critical importance of strict adherence to IPC practices in controlling highly infectious diseases. Recommendations for low-income countries include motivating healthcare providers and improving working conditions to enhance commitment in challenging environments. This report offers valuable insights and practical interventions for preparing for and addressing highly infectious disease outbreaks through implementation of IPC measures.

Epidemiological description of Marburg virus disease outbreak in Kagera region, Northwestern Tanzania.

INTRODUCTION: In March 2023, a Marburg Virus Disease (MVD) outbreak was declared in Kagera region, Northwestern Tanzania. This was the first MVD outbreak in the country. We describe the epidemiological characteristics of MVD cases and contacts. METHODS: The Ministry of Health activated an outbreak response team. Outbreak investigation methods were applied to cases identified through MVD standard case definitions and confirmed through reverse-transcriptase polymerase chain reaction (RT PCR). All identified case contacts were added into the contact listing form and followed up in-person daily for any signs or symptoms for 21 days. Data collected from various forms was managed and analyzed using Excel and QGIS software for mapping. RESULTS: A total of nine MVD cases were reported with eight laboratory-confirmed and one probable. Two of the reported cases were frontline healthcare workers and seven were family related members. Cases were children and adults between 1-59 years of age with a median age of 34 years. Six were males. Six cases died equivalent to a case fatality rate (CFR) of 66.7%. A total of 212 individuals were identified as contacts and two (2) became cases. The outbreak was localized in two geo-administrative wards (Maruku and Kanyangereko) of Bukoba District Council. CONCLUSION: Transmission during this outbreak occurred among family members and healthcare workers who provided care to the cases. The delay in detection aggravated the spread and possibly the consequent fatality but once confirmed the swift response stemmed further transmission containing the disease at the epicenter wards. The outbreak lasted for 72 days but as the origin is still unknown, further research is required to explore the source of this outbreak.

Reducing therapeutic injection overuse through patients-prescribers interaction group discussions in Kinondoni District, Dar es Salaam, Tanzania.

Inappropriately prescription of injections has been reported in developing and developed countries. Previous studies in Tanzania showed that over 70% of patients attending out- patient clinics at private dispensaries received at least one injection per consultation, a value higher than WHO recommended target of 10%. This is of concern considering the likelihood of adverse effects of possible use of unsafe syringes to transmit HIV, hepatitis B and C, poliomyelitis and added economic impact on the patient and the healthcare system. This study aimed to investigate the impact of Interaction Group Discussion on behavioural change on injection prescribing practices in ten selected public dispensaries in Kinondoni District, Dar es Salaam, Tanzania. Patient records of injection prescriptions were obtained covering the period three months prior to the study from 5 randomly selected control and 5 randomly selected intervention facilities. At each health facility IGDs were conducted for one month on mothers and prescribers followed by a survey 3 months after IGD to determine the impact of IGDs. Chi-square statistical calculations were made to compare data on the percent of prescriptions with an injection prescribed and in those conforming to national standard treatment guidelines (STG) between baseline and 3 months follow up. Results showed no significant difference between the percentage of prescriptions with an injection prescribed at baseline and 3 months follow-up in public dispensaries (P>0.05, X2 test). Prescribed injections that complied with STG was low at baseline and did not significantly improve 3 months after (P>0.05, X2 test). Comprehensive studies and sensitization of compliance to STG by prescribers are recommended.